key: cord-021087-n4epxwn9 authors: nan title: ECR – Final Programme: Scientific and Educational Exhibits date: 2004 journal: nan DOI: 10.1007/s10406-005-0142-5 sha: doc_id: 21087 cord_uid: n4epxwn9 nan Contrast enhanced ultrasonography (CEUS) of pancreatic masses M. D'Onofrio, S. Vasori, U. Rozzanigo, S. Caffarri, N. Faccioli, C. Procacci; Verona/IT Purpose: To evaluate the role of CEUS in the study of solid and cystic masses of the pancreas. Materials and Methods: 100 masses of the pancreas, found on conventional US, were studied with CEUS, by using Sonovue (Bracco) on a Sequoia 512 (Acuson). A dynamic observation from the early contrastographic phase (during arterial enhancement), to the late contrastographic phase (after venous enhancement) was possible. All the lesions were cytologically/histologically proved. The results were compared with those obtained at Spiral CT and/or MRI. Seven distinct enhancement patterns were observed: 1) Rapid intense enhancement in the early contrastographic phases with microbubble entrapment in the late phase [14 neuroendocrine tumors, 4 metastases from hypervascular tumors, 3 poorly differentiated carcinomas]; 2) moderate enhancement in the early contrastographic phase, resulting hypoechoic in the late phase [6 poorly differentiated carcinomas, 1 acinar cell carcinoma, 18 neuroendocrine tumors]; 3) capsular enhancement in the earliest phases [1 solid and papillary epithelial neoplasm; 2 neuroendocrine tumor]; 4) no enhancement [32 ductal adenocarcinomas and 2 neuroendocrine tumor]; 5) progressive enhancement [1 solid and papillary epithelial neoplasm]; 6) "parenchymographic" enhancement [12 inflammatory masses]; 7) parietal nodules and septas enhancement [4 cystic tumors] . Results: CEUS correctly characterized 74/84 (88%) solid pancreatic tumors. In particular all (32/32) the ductal adenocarcinomas were correctly diagnosed. Small nodules and septas of pancreatic cystic tumors, not visible at conventional US, were detected at CEUS. Conclusions: CEUS can demostrate macrocirculation and microcirculation of solid pancreatic masses and can improve the characterization of cystic pancreatic lesions. Is dual-phase spiral CT adequate for the confirmation of resectability and preoperative staging of pancreatic carcinoma? S. Mylona, L. Thanos, A. Pagonas, V. Kalioras, S. Lyra, N. Batakis; Athens/GR Purpose: To present the value of dual-phase spiral CT for the confirmation of resectability and pre-operative staging of pancreatic carcinoma. Materials and Methods: In a period of 4 years 184 patients with pancreatic carcinoma underwent dual-phase spiral CT for preoperative staging. CT scans after IV administration of contrast material with an electronic injector were obtained in the arterial (scan delay = 20 sec) and in the portal venous phase (scan delay = 50 sec) under a protocol with a total volume of 150 mL, flow rate 5 mL/sec. We have correlated the CT findings with surgical-pathologo-anatomic findings. Results: Dual-phase spiral CT was positive for pancreatic carcinoma in 178 patients (96.7%). In 6 patients it was false-positive (3.3%). In 44 (78.4%) out of 55 patients it showed hepatic metastases, in 33 (64.7%) out of 51 patients it showed lymph node enlargement, in 49 (88%) out of 60 patients vascular invasion, and in 8 (66.6%) out of 12 patients peritoneal metastases. The accuracy of the method was up to 90%. Conclusion: Dual-phase spiral CT is a safe, noninvasive, and accurate method to investigate pancreatic carcinoma and should be considered as the standard preoperative method for assessing lesion resectability. Assessment of resectability of pancreatic head cancer with CT imaging G.G. Karmazanovsky, V.A. Kubyshkin, A.V. Kotchatkov; Moscow/RU Purpose: To investigate the value of preoperative CT in assessment of resectability of pancreatic head cancer. Methods and Materials: Eighty-nine patients (52 males and 37 females; mean age 60) with pancreatic head adenocarcinoma were investigated with spiral CT with bolus intravenous contrast enhancement. All of the patients were operated on. Whipple procedures were performed on 56 patients and palliative operations were performed on 33 patients. Results: Tumors of 24 patients were considered unresectable. 11 patients (Group 1) had tumors that were encircling superior mesenteric or portal veins (8 pts), superior mesenteric (2 pts) or hepatic arteries (1 pts) completely. No fat layer was identifiable between the tumors and the vessels. 13 patients (Group 2) had CT appearances of tumors that partially (less than 2/3 of the circumference and in less than 20 mm) circumscribed the vessels. Tumors of all group 1 patients were not resectable with a negative margin. Among group 2, four patients (30.8%) had unresectable tumors; six patients (46.1%) had tumors that were difficult to dissect from the vessels; 3 patients (23.1%) had no evidence of vascular involvement and in fact went through curative surgery. Conclusion: The CT findings predicted correctly surgical findings in 21 of 24 unresectable tumors (87.5%). When the tumor partially circumscribed the vessels CT was not to be relied upon in predicting whether or not the tumor was fixed against the vessels. Contrast-specific ultrasound (CS-US) imaging of the spleen: A pictorial essay of traumatic and nontraumatic disorders A. Nunziata 1 , O. Catalano 2 , M. Mattace Raso 2 , I. Matarazzo 2 , A. Siani 2 ; 1 Naples/IT, 2 Pozzuoli/IT Learning Objective: To illustrate the appearance of several splenic lesions as shown during real-time, contrast-specific, harmonic imaging. Background: Contrast-enhanced, low-mechanical index US is a new technique allowing continuous, real-time assessment of splenic abnormalities. In our institution we use the technology named contrast tuned imaging (Esaote, Italy) and we employ a second-generation, sulfur-exafluoride based, microbubble contrast agent (SonoVue-Bracco, Italy). The contrast agent, at a volume of 2.4 or 4.8 mL, in injected through a peripheral vein and a 20 G needle, using a three-way stopcock and a 5-mL normal saline flushing. Imaging Findings: A wide spectrum of splenic disorders is depicted: injury, spontaneous hematoma, abscess, capillary and cavernous hemangioma, lymphomatous infiltration, metastasis, splenomegaly, and accessory spleen. Several potential pitfalls are also shown. Conclusion: Contrast-specific US is being used with increasing frequency in the evaluation of the spleen. This is a superficial organ, with an almost homogeneous echotexture and with a dense and persistent contrast-enhancement; these characteristics make the spleen an optimal organ to be studied with contrast-specific US. Radiologists should be aware of the typical and atypical appearance of splenic disorders as shown at contrast-specific US imaging. The spleen: Normal variants and pathologies (imaging review) S. Vessal, A. Anbarasu, S.B. Rai, W. Shatwell, R. Ramachandra; Birmingham/UK Learning Objectives: To familiarise with the normal anatomy of the spleen. To further demonstrate common variations and splenic pathologies encountered in clinical practice. Background: The spleen is the largest single mass of lymphoid tissue seen in the body. We familiarise with its normal image appearance using CT, USS and MRI. The pattern of contrast enhancement of the spleen during the arterial and venous phases in CT can mimic disease by forming pseudomasses. Normal variants such as splenunculus, splenic clefts/lobulations, liver wrap-around, wandering spleen as well as congenital heterotaxic syndromes will be discussed. A spectrum of splenic pathologies are demonstrated and the list of differential diagnoses that should be considered when seeing splenomegaly, cystic lesions, solid lesions and splenic calcification. Examples of splenic trauma -laceration, subcapsular and intraparencymal haematoma will be discussed and complications such as splenosis demonstrated. Image Findings: Images of the spleen on plain radiography, CT, MRI, USS and radionuclide imaging from our institution are demonstrated along with imaging protocols. Conclusion: There are several normal variants of the spleen which should be readily recognised. Congenital abnormalities of the spleen such as polysplenia are rare, this should not be misdiagnosed as splenosis. It is useful to assess the presence and extent of splenomegaly. Further classification of parenchymal lesions into cystic or solid can be made. Solid lesions can be further subclassified into those with calcification. This poster demonstrates some splenic pathologies, a clear list of differential diagnosis is essential in interpreting any splenic lesion. Non-traumatic acute splenic lesions: Role of CT F. Garibaldi, Y. Hetmaniak, B. Gallix, J.-M. Bruel; Montpellier/FR Learning Objectives: 1-To illustrate a pictorial review of various acute splenic pathologies of non traumatic origin. 2-To learn characteristic imaging features of spontaneous spleen rupture or splenic infarction. 3-Understand the pivotal role of abdominal CT when acute splenic pathology is suspected. Background: Splenic pathology is rarely suspected in patients with acute pain of the left upper abdominal quadrant. CT imaging is a well established tool for splenic injury of traumatic origin but CT features of non traumatic acute splenic pathology are less known. The purpose of this exhibit is to review the main causes of non traumatic acute splenic lesions and to describe their specific CT patterns. B D E F A G Procedures: Material consisted of 30 patients with acute non traumatic splenic pathology who underwent multiphase contrast enhanced CT examination of the abdomen. The medical report of these patients were reviewed. Cases were categorized according to the presence of the main CT patterns we found: Spontaneous rupture, ischemic lesion, abscess or pseudo cyst or complicated tumoral involvement. Conclusion: Helical CT, in association with patients history and biology results is accurate to characterize the severity and the causes of acute non traumatic splenic injury. The new ultrasound WHO-classification for diagnosis, staging and follow-up of patients with cystic echinococcosis (CE) W.P. Hosch, G.W. Kauffmann, T. Junghanss; Heidelberg/DE Learning Objects: The new WHO-classification provides, for the first time, a standardized sonomorphological staging of echinococcal cysts. We demonstrate the clinical value of this classification with examples from our cohort of patients. Specific signs supporting the diagnosis of CE, and criteria for assessing cyst viability are presented. This allows staging of cysts relevant for treatment decisions (surgery, percutaneous drainage (PAIR), albendazole or "watch&wait") and treatment monitoring. Background: Ultrasonography plays a central role for diagnosis and follow-up of abdominal CE due to problems regarding sensitivity and specificity of clinical symptoms and serological tests. This technique allows the staging of cysts with respect to the involution process (spontaneous and treatment induced). The treatment options of CE have broadened in recent years with percutaneous drainage (PAIR), medical treatment and "watch&wait" as preferable strategies over surgery for specific cyst stages. In 2001 a standardized classification has been published by WHO allowing inter-observer comparison of treatment decisions and follow-up. Procedure Details: 55 patients with a follow-up of up to 4 years have been seen in our referral centre for CE since 1999. Apart from 3 patients with pulmonary lesions and 1 patient with a spinal manifestation, all other patients had abdominal cysts (63 hepatic, 1 spleen, 1 kidney, 1 peritoneal). We evaluated the value of the WHO-classification for diagnosis, therapeutic decision making and follow-up. Conclusion: On the basis of the WHO-classification ultrasonography is not only an excellent tool for the primary diagnosis of CE but also very valuable for clinical decision making and monitoring treatment response. The spectrum of manifestations of metastatic malignant melanoma C.S. Ng, V. Kundra, M.J. Jacobson, J. Szklaruk, D.G. Bedi; Houston, TX/US Learning Objectives: 1. To gain an appreciation of, and be alert in clinical practice to, the wide range of sites, both common and uncommon, of metastases from malignant melanoma, including the lymphatic, central nervous, and musculoskeletal systems, thorax, abdomen and pelvis. 2. To become familiar with the radiologic appearances of metastatic melanoma on CT, MR, and ultrasound. Background: Malignant melanoma is a tumor that is increasing in incidence throughout the world, with a widely varying prognosis and distinctly capricious behavior. If, and when, the tumor metastasizes it can spread in an expected manner; however, frequently both the timing and sites of dissemination can be entirely unpredictable. Imaging Findings: This exhibit will present the wide range of manifestations of metastatic melanoma throughout the body, including the lymphatic, central nervous, and musculoskeletal systems, chest, abdomen and pelvis, and soft tissues, as identified by the major cross-sectional modalities of CT, MR, and ultrasound. The hypervascular and hemorrhagic tendency of the tumor, and its typical MR signal characteristics, will be illustrated. The exhibit will demonstrate the typical sites of metastases, namely lymphatics, brain, lungs, and liver; but will also illustrate the wide spectrum of more unusual sites of dissemination, including meninges, pleura, pancreas, gallbladder, gastrointestinal tract, genitourinary tract, peritoneal cavity, skeletal muscle and bone. The illustrative examples will be correlated with the TNM staging system. Conclusions: Metastatic malignant melanoma has an extremely wide spectrum of manifestations. Practicing radiologists should be alert to these manifestations. malignancies in the AIDS affected population other neoplasms such as cervical cancer, Hodgkin's disease and others have been observed with an increased incidence, probably because of the longer survival of AIDS patients. The aim of our exhibit is to describe CT and MR features of AIDS related neoplasms. Procedure Details: We reviewed CTand MR findings of 484 AIDS patients examined between 1986-2003, amongst which 178 demonstrated pathologically confirmed neoplasms. CT's were performed by using spiral (Plus, Plus 4, Siemens, Erlangen, Germany), and multislice CT equipment (LightSpeed 16 GE Medical Systems, Milwaukee, USA); MR examinations were performed by using a 1.5 unit (Vision; Siemens Medical Systems, Erlangen, Germany) . We demonstrated 65 NHLs, 9 Hodgkin's disease, 61 KS, 6 cervical cancers, 8 leukaemias, 3 testicular, 2 larynx, 3 lung, 2 breast, 2 esophagus, 2 stomach, 3 liver, 4 kidney, and 4 adrenal carcinomas, 1 intrahepatic multinodular cholangiocarcinoma and 3 stromal tumors of the gastrointestinal tract. 45/65 NHL showed extranodal involvement to the liver (19/65), brain (13/65), lung (16/65), pleura (2 primary effusion lymphomas with lymphomatous cells in the pleural effusion and no identifiable tumor mass) and gastrointestinal tract (12/65). KS involved the gastrointestinal tract (12), lung (16), liver (6), larynx (1), muscle (1) , adrenal gland (1), spleen (2), pancreas (1) . Conclusion: CT and MR proved useful in the evaluation of the variegate pathologic findings of AIDS related neoplasms. Abdominal imaging of post transplant lymphoproliferative disorders (PTLD) K. Burney, I. Lyburn, R. Hopkins; Cheltenham/UK Learning Objectives: This exhibit will review the pathogenesis, staging and abdominal imaging findings of post-transplant lymphoproliferative disorders (PTLD) seen in cardiac, lung, renal and liver transplant organ recipients. Background: Post-transplant lymphoproliferative disorders (PTLD) are a complication of immunosuppression in solid organ transplant recipients. We reviewed the imaging of patients with a histologically proven diagnosis of PTLD treated at our sub-regional oncology unit over the past 5 years. Conclusion: PTLD is estimated to occur in between 2-5% of patients. Clinical manifestations are variable ranging from focal disease with graft dysfunction to systemic illness. PTLD may be unsuspected or more extensive than expected and imaging plays an important role in diagnosis, staging and follow-up. CT (and to a lesser extent US) is the imaging modality of choice. Does clinical examination of polytrauma guide properly CT evaluation? A. Kalai, Y.K. Maratos, T. Loeb, O. Clément, G. Frija; Paris/FR Learning Objectives: To know the new definition of polytrauma patient based on the risk factor. To know that a whole body scanner is indicated in polytrauma patient. To know the CT protocol in polytrauma. Background: The evaluation of the polytrauma patient is still most of time based on regional CT oriented with the clinical finding. Based on our experience in 100 patients this exhibit purposes a systematic evaluation with whole body scanner. Major findings and pitfalls are illustrated. Procedure Details: Whole body scanner includes: Axial head CT, cervical spine helical CT with sagittal and coronal recontructions, helical CT with contrast IV with an arterial phase on the thorax and portal phase an the abdomen and pelvis, sagittal reconstruction on the dorsolombar spine. The severity of the lesions after the clinical evaluation were compared to the ISS (Index Severity Score) after the whole-body scan. 30% of the patients had at least one missed lesion when compared to clinical assessment .The average ISS of these patients was higher and there was a surmortality. Conclusion: Whole-body scanning is highly recommended for polytrauma victims in order to enable prompt and early treatment of lesions which might have been missed at the initial clinical evaluation. Radiological exploration of the embalmed cadaver of Eva Peron C. Gotta, A. Buzzi; Buenos Aires/AR Learning Objectives: To exhibit for the first time a medical document of Eva Perón's embalmed cadaver. Background: Eva Perón was Juan Domingo Peron's wife (he was President in Argentina between 1946 Argentina between and 1955 Argentina between , and between 1973 Argentina between and 1974 . For her political and social action she is known worldwide. She died of a cervix cancer in 1952. When she died, she weighed less than 30 kg, so many people doubt that her embalmed cadaver (small and consumed) belonged to her. The cadaver was embalmed by Dr Pedro Ara, Professor of Anatomy at the School of Medicine of the University of Cordoba. He was born in Zaragoza, Spain, and he was established in Argentina in the decade of 1930. Professor Ara carried out excellent work with Eva Peron's cadaver. Contrary to the classical technique, Eva Peron's embalmed body conserves its viscera. Imaging Findings: When the régime was overthrown in 1955 Eva Peron's cadaver was deposited in the General Confederation of Work ("Confederacion General del Trabajo", CGT). The new authorities doubted of the authenticity of the cadaver. Radiological exams were made by Dr Guido Gotta (father of one of the authors), who confirmed that the body corresponded to a human being, and that there was evidence of neoplasia (abdominal nodules, bone metastasis). Conclusions: Besides its medical use, thanks to its capacity to examine the interior of bodies, since their discovery X-rays were used for other purposes. In this case, they were used to determine the authenticity of Eva Peron's embalmed cadaver. Imaging of complications of drug abuse S. Van Background: The material is culled from our databank of the emergency department of our institution. The age of the patients in our series ranged between 17and 30-years-old. Imaging Findings: Complications of drug abuse in the drug addict will be classified according to their pathogenic mechanism or by their way of administration. Pathologically, complications are usually due to their vasoconstrictive and thrombogenic effect on different organs, including the brain (stroke), heart (myocardial ischemia), the gastro-intestinal system (ischemic colitis), the nose (nasal septum perforation due to cocaine snorting). A direct toxic effect of drug metabolites is another pathogenic mechanism resulting in tissue necrosis, as typically seen in liver cell necrosis due to ecstacy. The route of administration (intravenously, orally, inhalation or smoking) may also reflect the radiological presentation. Local abscess formation, septic thrombophlebitis, septic pulmonary emboli or bloodborn infections result from intravenous access, whereas inhalation and smoking may result in pneumothorax, pneumomediastinum and epidural pneumatosis. Indirect complications, such as an increased risk for traffic accidents can be attributed to the additive effect of a cocktail of drugs and/or alcohol. Complications related to smuggling are due to accidental rupture of packed drugs in the gastrointestinal lumen. The radiologist should be aware of the possible causal relationship with drug abuse, especially when those complications are encountered in a young population. Abdominal Background: There is a broad spectrum of neurogenic tumors that involve the abdomen. In this exhibit, we will describe the variable radiologic findings of abdominal neurogenic tumors. This study included 46 patients with abdominal neurogenic tumors which were confirmed histologically by surgical resection (n = 29) or US guided biopsy (n = 17). Two radiologists reviewed radiologic findings retrospectively and correlated with pathologic results. Imaging Findings: We categorized them into 3 groups by cell of origin; nerve sheath origin (schwannoma in 7, neurofibroma in 4, plexiform neurofibromatosis in 1, malignant peripheral nerve sheath tumor in 3), paraganglionic cell origin (paraganglioma in 7, pheochromocytoma in 8), and ganglion cell origin (ganglioneuroma in 5, ganglioneurofibroma in 2, ganglioneuroblastoma in 1, neuroblastoma in 8). Conclusion: Although abdominal neurogenic tumors show a broad spectrum, some neurogenic tumors revealed characteristic radiologic findings and correlated well with pathologic findings. Familiarity with various neurogenic tumors in the abdomen is helpful in the approach of the diagnosis. Purpose: To illustrate the broad spectrum of imaging findings (CT, US, urography and barium contrast studies) of patients with proven abdominal tuberculosis. We review between January 1998 and July 2003, the typical and atypical imaging findings of 52 patients that had a final diagnosis of genitourinary (13), adrenal (3), bowel (14), peritoneal (5), and hepatosplenic (16) tuberculosis. Results: Most patients had been at increased risk because of drug abuse, alcoholism, AIDS and steroid therapy. Radiological findings included low density lymph nodes, splenomegaly, hepatomegaly, intrasplenic and intrahepatic masses, ascities, diffusely thickened and enhanced peritoneum, mottled low density masses in the omentum, pleural effusion, thickening of the bowel, adrenal enlargement, atrophy and calcification, fallopian tube fibrosis, uterine atrophy and adhesions, ureteral and bladder fibrosis, and different patterns of renal hydronephrosis and calcification. Conclusion: Patients with AIDS had more severe form of involvement than those who did not have AIDS. Sonography was the only imaging modality to demostrate septations within the tuberculous ascites, but showed the fewest morphologic details in renal tuberculosis. CT is the imaging modality that best determined the extent of intrabdominal tuberculosis. Recognition of these manifestations should help optimize the correct diagnosis and management of tuberculosis in order to obtain a favorable outcome, biopsy is mandatory in almost all cases. Predictive To develop a predictive model for the presence of esophageal varices (EV) in patients with hepatic cirrhosis (HC). This model would limit the endoscopic screening to the group of patients with high risk of bleeding from EV. Methods and Materials: 42 consecutive patients with HC were included in this prospective study (20 men, 22 women; mean age 59.7). Physical and laboratory examinations, upper gastrointestinal endoscopy and Doppler ultrasonography were recorded. Patients were divided in two groups: 1) No EV or small EV, 2) medium or large EV. The distribution of clinical, biochemical, and Doppler ultrasonographic variables were compared in each group. The U statistic of Mann-Whitney was performed for the quantitative variables, whereas the Chi-square or the Fisher's exact tests were used for the qualitative ones. Variables were also included in a multivariate stepwise logistic regression model. A ROC-analysis was performed. Results: In the stepwise logistic regression, presence of medium or large EV was independently predicted by splenomegaly, decreased platelet count, HCV infection and a decrease of the maximum portal flow velocity (MPV). The discriminating ability of the prediction rule was high, with an area under the ROC curve of 0.92 (95% CI: 0.80-0.98). Conclusion: Patients with HC should be screened by upper gastrointestinal endoscopy only if splenomegaly, low platelet count, infection by HCV and decreased MPV are present, since these parameters confidently predict the existence of medium or large EV. Premier experience of multiphasic contrast material-enhanced dynamic study on 3.0 Tesla magnetic resonance (MR) imaging T.-J. Hsieh, G.-C. Liu; Kaohsiung/TW Purpose: To evaluate the accuracy and sensitivity of a dynamic contrast material-enhanced three-dimensional (3D) volumetric breath-hold hepatic magnetic resonance (MR) imaging examination on a 3.0 Tesla machine. Methods and Materials: 3.0 Tesla MR imaging with serial multiphasic contrast material-enhanced dynamic study was performed in 69 patients with hepatocellular carcinoma (HCC). All patients had pathologic comfirmation by fine needle biopsy and followed angiographies were performed in 1.5months. Each test result was interpreted independently by two radiologists. Separate reading sessions were performed for images from the multi-phases. Sensitivity and positive predictive values were calculated for each reading session. Results: One hundred twenty-nine early-enhancing lesions were detected in the 69 patients on the 3.0 Tesla MR images. The followed angiographies showed 152 hypervascular tumor stains. All the lesions showed in the MR images were identified in the angiographies. The breath-hold dynamic examination on 3.0 Telsa showed a overall sensitivity of 84.8%. Conclusion: Multiphasic contrast material-enhanced dynamic study on 3.0 Tesla magnetic resonance (MR) imaging 3.0 Tesla MR imaging is insensitive for the diagnosis of HCCs. Role The insulinomas are rare functional pancreatic neuroendocrine tumours. The most common clinical presentations include hypoglycaemia (< 2.8 mmol/l), confusion, and loss of consciousness. Diagnosis is difficult, and performed by computed tomography, magnetic resonance or selective angiography of the pancreatic arteries by digital subtraction angiography (DSA). The aim of the study was to analyse head-to-head the diagnostic value of pancreatic DSA, computed tomography and magnetic resonance in 29 patients (25 female, 4 male; 37 ± 6 years) with insulinoma. The diagnosis was established by pathohistology after the surgical treatment in all patients. The tumours were localised in the pancreatic body in 20/29 patients (69%), in the pancreatic tail in 8/29 patients (27%) and in 1/29 patients (4%) Purpose: To estimate variants in the anatomic structure of the gallbladder, the biliary and pancreatic ducts and to develop a technique of research. Material and Methods: 780 patients underwent complex MRI using a 1.5 T unit. T2W HASTE, T1W TurboFLASH, including FS, and MRCP (single-slice TurboSE and multi-slice HASTE in different orientations) were acquired. 65 patients also examined with ERCP. Results: In 18% of patients the merger of the hepatic lobar bile ducts was extrahepatic. 21% revealed an additional right hepatic duct, more than half running into the common bile duct (CBD) low. The low fusion of the cystic duct and CBD was revealed in 19% of the patients, and its left arrangement in 23%. Anomalies in the form of the gallbladder are revealed in 35% and additional pancreatic duct in 10% of patients. In 13% patients the main pancreatic duct and CBD had a common ampoule, in more than 64% of cases they enter the duodenum parallel, in 13% cases separately. It is expedient to study the mutual relationships of ducts, parenchyma and vessels with application of T2-w HASTE. General submission about bile and pancreatic ducts and gallbladder allows receiving single-slice Tur-boSE. For better analysis of details of anatomic structure it is necessary to study of source images multi-slice HASTE in different orientations. The results of research especially are useful for planning of operative treatment. Conclusions: Complex MRI, especially reception of T2-w images and realisation of MRCP, is an excellent tool for revealing variants in anatomic structure of the gallbladder and ductal system. The clinical utility of diffusion imaging out of the central nervous system Y. Murakami 1 , K. Imoto 1 , N. Aito 1 , T. Sakamoto 1 , M. Yamasaki 2 , A. Furukawa 2 , R. Ito 2 , K. Murata 2 ; 1 Kohka/JP, 2 Shiga/JP The clinical utility of diffusion imaging out of the central nervous system is not yet clear. The purpose of this prospective study is to determine the role and the clinical usefulness of diffusion-weighted MR imaging combined with conventional MR imaging for the detection of visceral disease without of the central nervous system. Material and Methods: One hundred and thirty-four cases who were referred to our hospital for the examination of visceral disease without the central nervous system (including 114 cases with neoplasms and 20 cases with inflammatory disease, upper abdomen; 48, pelvis; 51, other organ; 35) were investigated. MR imaging (1.5 T) was performed using a diffusion-weighted single-shot spin-echo echoplanar sequence, T2-weighted fast spin-echo sequence, and T1-weighted spin-echo sequence. An experienced reviewer evaluated the diffusion-weighted MR images for the presence of a high-signal-intensity lesion and compared with other MR sequences. Imaging findings were correlated with findings from histological specimen in 20 patients and with findings from clinical follow-up examination in other patients. Results: Diffusion-weighted MR imaging depicted 62 high signal intensity lesions, including 56 cases with malignancy and five cases with inflammation, and a case of Castleman's disease. In three patients with lymphomas, high signal intensity lesions reflected the activity of the disease process. There was no high signal intensity lesion in cases with eight adnexal diseases. Conclusion: Diffusion-weighted MR imaging out of the central nervous system may possibly be useful for the extent or the activity of malignant or inflammatory disease. Evaluation of computed tomography for assessment in lipodystrophy syndrome J.A.G.S. Gallego, F.M.A.I. Ardoy, S.P.U. Padilla, F.G.R. Gutierrez; Elche/ES Purpose: Lipodystrophy syndrome (peripheral fat loss and/or visceral fat accumulation) is a main problem in HIV-patients treated with antiretroviral therapy. The diagnosis is based on physical examination and/or standardized questionaires so there is a need for quantitative diagnostic tools. The aim of this study is to evaluate computed tomography (CT) to measure fat distribution in HIV patients. Methods and Materials: 61 HIV-patients (44 men) were included. Lipodystrophy was diagnosed clinically on 31. Subcutaneous limb adipose tissue area and their percentage were measured by a single slice at mid thigh and mid arm by CT. The subcutaneous (SAT), visceral (VAT), and total (TAT) abdominal adipose tissue as 362 B D E F A G well as the VAT/TAT, SAT/TAT and VAT/SAT ratios were calculated by a single slice at umbilical level. Results: VAT/TAT and VAT/SAT ratios were significantly greater in lipodystrophic than in non-lipodystrophic patients: 0.62 vs 0.41, p < 0.01 and 2.48 vs 0.38, p < 0.01 respectively in men. 0.38 vs 0.25 p < 0.05 and 1.14 vs 0.32 p < 0.05 in female patients. SAT/TAT and mid thigh fat tissue percentage were significantly lower in lipodystrophic patients: 0.36 vs 0.57 p < 0.01 and 0.1 vs 0.2 p < 0.01 respectively in men. 0.6 vs 0.75 p < 0.05 and 0.26 vs 0.46 p < 0.05 in female patients. No significant differences were found at mid arm. A VAT/SAT ratio > 0.98 for men and > 0.35 for women had a sensitivity of 83% and 85% respectively and a specificity of 70%, to diagnose lipodystrophy syndrome. Conclusion: Computed Tomography may be a useful technique to quantify lipodystrophy in HIV-infected patients. withdrawn by authors Ultrasonographic assessment of body fat distribution in type II diabetes mellitus of insulin resistant type and its relation to anthropometric measurements N. Previous studies have shown that in subjects with type II diabetes mellitus of insulin resistant type there is a relation between cardiovascular diseases and obesity, insulin resistance and body fat distribution. In these patients body fat distribution assessed with DEXA and antrophometric measurements were correlated with ultrasonographic fat assessments. Materials and Methods: 28 subjects (14 male and 14 female with mean age of 55.5 ± 8.4) in whom type II diabetes mellitus of insulin resistant type was diagnosed with HOMA (homeostasis model assessment) were enrolled in the study. Their weights, heights, abdominal diameters, and gluteal diameters were recorded. Body mass index (BMI, kg/m²) and the ratio of abdominal diameter to gluteal diameter (A/G) were calculated. Subcutaneous (FatSC), preperitoneal (FatPP), and visceral (FatV) fat thicknesses were ultrasonographically assessed. Results: There was a significant correlation between BMI and FatSC or FatV (p < 0.01); and between total fat ratio and FatSC and FatV (p < 0.05 and p < 0.01, respectively). There was no relation between A/G and FatSC, FatPP and FatV. Conclusion: Ultrasonographically assessed subcutaneous and visceral fat thicknesses in type II diabetes mellitus patients of insulin resistant type may be used as prognostic factors of cardiovascular diseases. withdrawn by authors C-099 MRI of the upper abdomen using a new free-breathing navigator triggered T2-weighted TSE-sequence (PACE-TSE) C. Klessen, P. Asbach, R. Kirsch, B. Hamm, M. Taupitz; Berlin/DE Purpose: To evaluate image quality of a new free-breathing navigator triggered T2-TSE sequence (PACE = Prospective Acquisition Correction) for magnetic resonance imaging of the upper abdomen in comparison to a established standard breath-hold T2-weighted sequence. Materials and Methods: Prospective evaluation of 30 consecutive patients with various pathologies referred to our clinic for MRI of the upper abdomen. All patients were examined at 1.5 T (Siemens Magnetom Quantum) using the following sequences: PACE-TSE (work-in-progress sequence,320 x 224 matrix, FOV 320 mm, axial slice orientation, TR 2340 ms, TE 80 ms, Turbo Factor 21, 42 slices, 4 mm slice thickness, n = 2 excitations), breath-hold HASTE sequence (256 x 154 matrix, axial slice orientation, TR ∞, TE 63 ms, 23 slices, 7 mm slice thickness, n = 1 excitation). Three independent abdominal MRI experienced radiologists reviewed all images and evaluated motion artifacts, liver-spleen contrast, depiction of intrahepatic vessels, depiction of the pancreas and the adrenal glands and overall image quality on a 4-point scale. In addition, to directly evaluate the influence of the respiratory trigger technique, in 10 patients the T2-TSE sequence was repeated with the respiratory trigger function switched off. Results: Mean examination time of the PACE-TSE was 7.2 minutes. The depiction of anatomical details and contrast was significantly better (p < .05) using the PACE-TSE sequence compared to the standard HASTE sequence. The PACE-T2-TSE sequence has the potential to significantly im-prove recognition of anatomical details and contrast compared to standard breathhold HASTE imaging. Reactive lymph node hyperplasia: A diagnostic problem in the staging of Hodgkin's disease (HD) L. Ilic-Todoric, B. Lukac; Belgrade/YU Purpose: Therapeutic approach to HD requires determination of the disease extent to supra/infradiaphragmatic lymph nodes (LN) . A problem appears when LN are of borderline size or only slightly enlarged. Should such a finding on CT be considered as reactive hyperplasia or a pathological finding? The purpose of this report is to solve this dilemma. Methods and Materials: Infradiaphragmatic spiral CT scan was performed in 250 patients with histologically confirmed supradiaphragmatic HD. Bipedal lymphography represented the gold standard for final staging. Taking reactive hyperplasia into consideration, we estimated and statistically analysed CT's ability to differentiate benign and malignant conditions, and its value for staging. Results: Lymphography showed infradiaphragmatic disease in 48% of patients, 21% of whom had enlarged LN, while in 79% LN were of normal size or smaller. Of the total number of patients, reactive hyperplasia and lymphographically normal findings were found in 21% and 31% of patients, respectively. CT detected enlargement in 41% of patients, and in 20% of these this finding concurred with the lymphographic one. CT could neither detect affected normal/reduced LN, nor differentiate reactive from malignant hyperplasia. Postlymphographic restaging of the disease showed that 37% of patients would be understaged and 21% overstaged on the basis of CT finding only. Conclusion: Reactive hyperplasia represents a risk of up/downstaging if staging relies on CT only. Errors can be partially assigned to the inadequate interpretation of the CT findings, which cannot be taken for granted when LN are of borderline sizes. In such cases additional diagnostic procedures are necessary. Purpose: To compare the diagnostic accuracy of MR (Magnetic resonance) images with MSCT (multislice CT) for preoperative T-staging in patients suffering from cardiac cancer. Materials and Methods: MR and MSCT were performed in 25 cases of cardiac cancer diagnosed by biopsy prior to operation. MR and MSCT scans were performed on two different days. MR sequences included FSET1W, FSET2W, FSE T1W with fat suppression and dynamic enhanced FSPGR with fat suppression; MSCT was applied with dynamic triphasic contrast enhancement. All these findings were prospectively analyzed by two doctors separately and correlated with the surgery pathological findings. Statistic work was performed with SPSS. Results: According to histopathologic staging, the accuracy for T1-staging detected with MR and MSCT were 70% and 55% respectively, 75% and 62% for T2staging, 87% and 69% for T3-staging, 89% and 60% for T4-staging. Compared with MSCT, dynamic enhanced and delayed MR with fat suppression was superior for revealing the involvement of esophagus and aorta, early stage of invasiveness and providing more evidence in T2 from T3 or T3 from T4 staging (P < 0.05). Among these MR plain scan sequences, T1W with fat suppression was outstanding in depicting the gross features of the tumor, presence of ulceration, and adjacent lymph node swelling. Diagnostic accuracy determined by ROC analysis was marginally higher with MR scan than with MSCT scan in T-staging of cardiac cancer. Conclusion: MR is superior in T-staging of cardiac cancer and can be used to optimize the therapeutic strategy, thus avoiding unnecessary operation. Multidetector CT and virtual endoscopy of the esophagus S. Mazzeo, D. Caramella, E. Neri, P. Giusti, C. Cappelli, R. Bertini, A. Belcari, C. Bartolozzi; Pisa/IT Purpose: To assess the diagnostic capabilities of multidetector CT in various esophageal pathological conditions. Methods and Materials: Thirty-three patients underwent a multidetector CT study after esophageal distension by means of effervescent powder administered after induction of hypotonia. All acquired images were post-processed with 2D and 3D software tools. The CT data was compared with the results of conventional radi-ology (33), endoscopy (28), or surgery (14) . Follow-up ranged between 4 and 15 months. Results: Esophageal distension in the upper and middle third was classified as "good" in 32/33 cases (97%); in the lower third, esophageal distension was "good" in 21/33 cases (64%). Final diagnoses were: leiomyoma (6), squamocellular carcinoma (6), adenocarcinoma (4), esophageal infiltration by thyroid cancer (2), benign polyposis (2), chronic esophagitis (5), post-sclerotherapy stenosis (1) , no abnormalities (7). When good distension was achieved, the thickness of unaffected esophageal wall was < 3 mm (range between 1.5 and 2.4 mm, mean 1.9 mm). Pathological wall thickening was observed in 25/33 cases (76%) with values ranging between 3.6 and 36 mm (mean 9.6 mm). Spiral CT demonstrated 21 true positive cases and 7 true negative cases. There were 4 false negative cases and 1 false positive case. Sensitivity was 84%, specificity 87%, diagnostic accuracy 85%, positive predictive value 95%, negative predictive value 64%. Conclusions: Evaluation of the esophagus with multidetector CT proved to be a promising and easy to use technique, allowing panoramic exploration, virtual endoluminal visualization, accurate longitudinal and axial evaluation, and simultaneous evaluation of T and N parameters. (IBD) . To describe the technique of barium tagged dark-lumen MRC. To outline the advantages, disadvantages and limits of the method. Background: Conventional colonoscopy (CC) is the most widely used method for the assessment of the extension and the activity of IBD. However, CC is an invasive technique and requires long-lasting bowel preparation. Furthermore, not infrequently the examination of the entire colon and terminal ileum wouldn't be possible due to severe pain or fecal residue. These disadvantages are eliminated with barium tagged dark-lumen MRC which makes this examination more tolerable and acceptable by patients. Imaging Findings: Ten patients who present with symptoms of IBD underwent CC first and subsequently MRC. For fecal tagging, barium sulphate-containing contrast agent is given with meals, beginning 48 hours before the examination. For MRC the colon was filled with 2000 mL of diluted barium. After intravenous administration of 0.1 mmol/kg Gd-DTPA, coronal T1-weighted three-dimensional gradient-echo sequence is performed. Additional fat-saturated axial two dimensional gradient-echo and coronal true-FISP sequences are obtained. Colon segments are interpreted seperately (rectum, descending, transverse, ascending colon, caecum) when assesing the extent of the disease. Bowel wall thickening and congestion of marginal vascularity are considered as signs of the disease. Out of sixty segments, 50 of them had colonoscopic correlation. Of these in 42 (84%) the extent of disease correlated with CC. Non-correlation of findings of MRC and CC was detected in 8 (16%) patients. Conclusion: Barium tagged dark lumen MRC can be used for the assesment of the extent of IBD. Evaluation of CT gastric virtual endoscope (VE) findings: Comparison with real gastric fiberscope (GF) lesions K. Inamoto, K. Kouzai, K. Hamada; Osaka/JP Learning Objectives: To check VE findings compared with 66 GF lesions in 63 cases. To learn about images of VE and to consider possibilities to use VE clinically. Background: GF is an invasive examination for patients. If VE can be used for checking pathologies of gastric diseases it will be beneficial to detect malignant changes of the stomach in their early stage. Procedure Details: MD-CT images were obtained on the same day as GF with Somaton Sensation 16, Siemens, Erlangen, Germany. Thin slice CT images with 1 mm thickness were reconstructed to VE images by surface rendering and volume rendering with Advantage Workstation 4.0_0.3 with Volume Analysis Voxtool 3.0.26e, GE, Milwaukee, WI.USA. Results indicated that VE images succeeded in showing subtle alteration of mucosal folds. Gastric cancer, polyp, ulcer, erosion and gastritis were clearly visualized. By comparison studies between VE and GF, a sensitivity 92.7%, specificity 90.9%, positive predictive value 98.1%, negative predictive value 71.4% and accuracy 92.4% were calculated. Conclusion: 3D MD-CT examination of the stomach is noninvasive except for radiation exposure. It will be expected as a new technique of the stomach examinations. Gastrointestinal stromal tumor: Current concepts and imaging characteristics J.H. Lee, K. Kim, C. Park, W. Jeong, J. Lee, E. Kang, I. Cha, H. Seol; Seoul/KR Learning Objects: To provide an in-depth review of gastrointestinal stromal tumors (GIST's) with their epidemiology, histopathology, clinical manifestations and the most up-to-date therapy. To describe radiologic features of GIST's. To discuss differential diagnosis of GIST's throughout the abdomen. Background: Gastrointestinal stromal tumors (GIST's) are unique neoplasms that occur throughout the gastrointestinal tract, mesentery, omentum, and retroperitoneum. They are the most common mesenchymal neoplasm of the gastroin-testinal tract and are defined by their expression of KIT (CD117), a tyrosine kinase growth factor receptor. The expression of KIT is important to distinguish GIST's from other mesenchymal neoplasms such as leiomyomas, leiomyosarcomas, schwannomas, and neurofibromas and to determine the appropriateness of KIT-inhibitor therapy. Imaging features of GIST's vary depending on tumor size and organ of origin. Since most GIST's arise within the muscle layer of the gastrointestinal tract, they most commonly have an exophytic growth pattern and manifest as dominant masses outside the organ of origin. Procedure Details: The purpose of this exhibit is to provide an in-depth review of GIST's with their epidemiology, histopathology, clinical menifestation and differential diagnosis. This exhibit will also reflect our experience in the radiologic evaluation of patients with GIST's, with emphasis on the typical findings present on small bowel series, ultrasonography and CT (including 3D images using multidetector CT). Examples of unusual GIST's and pathologic correlation as well as the most up-to-date therapy will be included. Conclusion: After interacting with this exhibit the radiologist will have an enhanced understanding of GIST's including histopathology and radiologic features. Imaging of jejunal and ileal primary tumors with pathologic correlation B. Rodríguez-Vigil, M. Lamas, T. Berrocal, J. Fernández, V. Tarín, A. Alvarez; Madrid/ES Learning Objectives: To illustrate the spectrum of usual and unusual primary neoplasms involving the jejunum and ileum. To evaluate the efficacy of barium studies, US, CT and MR imaging in the management of these tumors. To understand the radiologic findings on the basis of pathologic correlation. Background: Preoperative diagnosis of jejunal and ileal neoplasms can be a challenge for both clinicians and radiologists. Symptoms are nonspecific and endoscopy is commonly unsatisfactory. Since early diagnosis is crucial for prompt therapy, imaging plays an essential role. Tumors develop in all histologic components of the small intestine including epithelial cells, lymphoid tissues, lymphatics, vessels, nerves, and muscle. Imaging Findings: We retrospectively reviewed the imaging findings of jejunal and ileal neoplasms from our digestive pathology database. Findings were correlated with pathology in all cases. Specific neoplasms addressed include benign (adenoma, leiomyoma, lipoma, familial polyposis, hemangioma, lymphangioma and fibroma); and malignant neoplasms (adenocarcinoma, carcinoid tumor, lymphoma, leiomyosarcoma, direct extension to the small bowel from extraintestinal tumors, and metastasic lesions). Enteroclysis is the primary and most effective radiologic modality in the evaluation of these neoplasms. CT should be the complementary radiologic modality and used for staging. MRI may help in specific cases. Pitfalls, diagnostic difficulties and differential diagnoses are emphasised. Conclusions: Evaluation of patients with small bowel neoplasms frequently requires multiple imaging modalities for diagnosis and treatment planning. Because of the characteristic imaging appearances of many of these tumors, this exhibit will help the radiologist in training to better understand and recognise jejunal and ileal neoplasms. Imaging findings of sigmoid diverticulitis: A pictorial essay of anatomy, pathology, differential diagnosis and radiologic treatment options M.C. Freund, J. Bodner, E.M. Gassner, M. Rieger, A. Gschwendtner, W.R. Jaschke; Innsbruck/AT Learning Objectives: To understand the anatomy and pathology of sigmoid diverticula and of the mesosigmoid. To be familiar with the typical findings of different imaging modalities in sigmoid diverticulitis and its complications and differential diagnosis. To be familiar with percutaneous and endovascular radiologic treatment options including abcess drainage and embolization for diverticular bleeding. Background: Sigmoid diverticulosis and diverticulitis represents a commonly encountered disease in western countries. An exact diagnosis is a prerequisite for further therapy. Imaging Findings: Different imaging modalities are proposed for detection of self-limiting or complicated sigmoid diverticulitis e.g. abdominal radiography, contrast enema, ultrasound and even catheter angiography. During the last years CT has evolved to be a primary diagnostic imaging modality in patients with left lower abdominal pain. This pictorial essay will demonstrate the relevant anatomy of the sigmoid, mesosigmoid, and vascular supply as well as the typical pathology of the diverticula and its inflammatory complications including diverticulitis, peridiverticulitis, perforation, contained abcess in the mesosigmoid or rarely free intraperitoneal perforation with peritonitis, as well as fistula formation, obstruc- The Learning Objectives: To depict the CT imaging spectrum of the faeces sign, which is a consequence of small bowel occlusion, and to illustrate its causes. Background: Abdominal CT scan has been shown to be the most valuable technique, in confirming the diagnosis of small bowel occlusion and to depict the site, level and cause of occlusion. Very few studies have focused on the contents of the bowel. Particulate faeces-like material mixed with gas bubbles within the lumen of a dilated small bowel loop is always a pathological condition. It is the result of a delayed intestinal transit. To access prevalence, characteristics of this CT sign, and differential diagnosis, we have reviewed 87 CT scans of small bowel occlusion over a period of two years. Imaging Findings: Our analysis suggests that the small bowel faeces sign is probably more frequent than the previous reported studies, in demonstrating 11 cases of small bowel faeces sign mainly observed in the ileal loops, and pointing to the site of occlusion. Faeces sign appeared as tubular gas bubbles mixed with particulate matter with no capsule in dilated segments of small bowel loop, due to adhesions, closed loop, and tumours (adenocarcinoma, carcinoid). Differential diagnosis of two phytobezoars is also illustrated and discussed. Conclusion: Small bowel faeces sign may not be confused with colonic segments leading to a failure to recognize the exact level of obstruction. Moreover, it represents a sentinel sign in determining the site of occlusion and consequently the cause of the obstruction. Imaging appearances and predictors of disease response in metastatic gastrointestinal stromal tumours (GIST) treated with Imatinib S. Cox, B. Lanka, M.B. Taylor; Manchester/UK Learning Objectives: To evaluate changes in radiological appearances in patients with metastatic GIST treated with Imatinib. To highlight any specific imaging features that can be used to predict disease relapse. Background: Imatinib (Glivec, STI-571) is a KIT tyrosine-kinase inhibitor drug, recently developed and found to be effective in the treatment of metastatic GIST. We reviewed the pre-and post-treatment imaging findings on CT in ten patients. The duration of treatment varied from two to forty one months. The pre-treatment, eight and sixteen weeks scans were reviewed, along with the scans at the time of any relapse. The sites of metastases, size of lesions and cystic change were assessed. Imaging Findings: Metastases were present in the liver and peritoneum in seven patients each; mesentery and retroperitoneum in four and two patients respectively; splenic, renal and subcutaneous in one patient each. One patient had progressive disease at eight weeks. Nine patients responded to treatment. The maximum reduction in size of the metastasis was at eight weeks. Most metastases underwent cystic change with treatment, particularly in the liver and peritoneum. Two patients are known to have relapsed at fourteen and fifteen months. In both cases, cystic metastases developed more solid components prior to disease progression as indicated by an increase in the tumour volume. Conclusion: Ninety percent of the patients responded to treatment. Cystic change in the liver and peritoneal metastases correlates with disease response to Imatinib. An increase in solid components may be a useful predictor of disease relapse. CT appearances of neoplasms of the small bowel as a cause of obstruction S. Sadiq, D. Markham; Swansea/UK Learning Objectives: This poster presents a pictorial review of the CT appearances of primary and secondary tumours of the small bowel in patients presenting with obstruction, including neoplasms that are the lead point of an intussusception. Background: Patients presenting with small bowel obstruction in two district general hospitals over the last twelve months and who were subsequently investigated by CT were selected. The imaging features of those with a neoplastic aetiology were reviewed. Image Findings: The imaging reflects recent studies examining the incidence of primary small bowel tumours. Adenocarcinoma, non-Hodgkins lymphoma, carcinoid and leiomyosarcoma comprise the majority. Secondary tumour deposits also lead to small bowel obstruction. We demonstrate those that metastasize intraperitoneally (such as ovarian carcinoma), haematogenously (such as melanoma), or by local tumour extension (such as liposarcoma and bladder carcinoma). Conclusion: It is well established that CT is a valuable diagnostic procedure in patients with acute small bowel obstruction. It is not only useful in distinguishing obstruction from ileus, but frequently establishes the cause of obstruction. Small bowel neoplasms are rare but have a high mortality since tumour-related symptoms occur late and are non-specific. Endoscopy is not feasible in most cases, as enteroscopy is limited to specialist centres. Small bowel contrast studies do not reach the high level of accuracy obtained in the evaluation of the upper and lower gastrointestinal tract. CT not only allows tumour detection, but demonstrates possible complications and offers the possibility of pre-operative staging in the acute or elective situation. CT in adult intussusception: Radiologic-pathologic correlation C. Triantopoulou, P. Maniatis, I. Siafas, N. Giannakou, C. Avgerinos, C. Dervenis, J. Papailiou; Athens/GR Learning Objectives: Review the CT characteristics of bowel intussusception in adults through a wide variety of cases. Emphasize the ability of CT imaging in narrowing the diagnostic possibilities and defining the cause of intussusception. Stress the need for familiarization with the different aspects of this rare entity. Background: Intussusception is a relatively common cause of intestinal obstruction in children but is a rare clinical entity in adults. However, there is a lead point in 80% of adult cases. 12 cases of adult intussusception were retrospectively reviewed. All CT examinations were conducted on a spiral unit with administration of both oral and intravenous contrast agent, using slice thickness of 5-7 mm anda pitch of 1. Site, level, cause and degree of obstruction as well as signs of threatened bowel viability were evaluated and correlated with surgical findings and pathology examination. Imaging Findings: 8 cases of ileocolic intussusception and 4 of ileoileal were revealed. In 9 patients findings included: 3 cases of polypoid lesions, 2 malignant neoplasms, 1 lipoma, 2 inflammatory diseases and in 1 adhesions due to preceding surgery. In the other three cases no underlying pathology was proven so they were characterized as idiopathic conditions. All neoplastic lesions were correctly depicted before surgery while in the case of lipoma a specific diagnosis was made. CT is a powerful tool in adult intussusception, providing valuable information regarding the involved enteric segments, the underlying pathology and possible local complications, thus assisting in preoperative planning. Diagnosis of perforation of stomach or duodenum on multislice computed tomography J.-I. Nishimura, T. Ohkoshi, Y. Yamamoto, T. Inoue; Yokohama/JP Learning Objectives: A review to determine the variety and relative conspicuity of findings in patients with perforation of the stomach or duodenum. Background: Multislice computed tomography (CT) gives us detailed information as thin-slice sagittal, coronal, and 3-dimensional images rapidly. A small volume of free air can be detected, and the perforation holes were predicted in some cases. During a 2-year period 21 patients with perforation of the stomach or duodenum underwent preoperative CT scans. There were 16 men and 5 women averaging 54.2 ± 15.6 (29 to 84) years old. All patients underwent to surgical treatment, and all sites of perforation were confirmed. Imaging Findings: Levels of perforation were the antrum of stomach (n = 1), body of stomach (n = 5), duodenal bulb (n = 14), and descending limb of duodenum (n = 1). CT images showed local extraluminal gas near the perforation sites in 17 patients (81%), local ascites near the perforation sites in 15 patients (71%), edematous wall of perforation sites in 19 patient (90%), dirty increased density in the fat tissue in 19 patients (90%), and a perforation hole in 8 patients (38%). Diffuse extraluminal gas and ascites were showed in 7, and 8 patients respectively. In 18 of 21 patients (86%), we could predict the level of perforation. Conclusion: Multislice CT is a valuable method in the diagnosis of perforation in stomach or duodenum. The diagnosis can be established rapidly with high sensitivity. Defecographic imaging of anorectal sphincter dyssynergia syndromes: Our experience in 680 subjects A. Nunziata 1 , A. Salzano 2 , P. de Feo 1 , A. de Rosa 1 , F. De Rosa 1 , M. Covello 3 ; 1 Naples/IT, 2 Frattamaggiore/IT, 3 Napoli/IT Learning Objective: Anorectal sphincter dysfunction can be responsible for evacuation difficulties and constipation; in addition, pelvic floor disorders can be associated. By using defecography associated with videoproctography, the evacuation time and the sphincters' opening time can be assessed, obtaining further information about the physiopathology of rectal empting and anal sphincter function. The aim of this study is to have functional radiological parameters of anal activity to detect anorectal sphincter dyssynergia syndrome. Background: On a consecutive series of 680 patients suffering from constipation we assessed by defecography combined with videoproctography 33 cases of sphincter dyssynergia syndrome (16 males and 17 females with mean age of 45 years, range of 17-34 years). All patients underwent clinical examination and endoscopy; 26 patients were investigated by anorectal manometry. Imaging Findings: In all patients defecography with videoproctography provided a sphinter opening delay > 40 s (normal values: 1-40 s) and increased evacuation time > 68 s (normal values: 3-68 s). Manometry revealed anal hypertonia in 13 cases. Conclusion: Defecography associated with videoproctography is an accurate, simple and non-invasive method to approach anosphincteral pathology, permtting study of this particular type of terminal constipation, which is difficult to demonstrate using other techniques. Background: GIST are rare mesenchymal tumors of the abdomen, for which an effective, molecular-targeted therapy with Imatinib Mesylate has been recently developed. Imaging Findings: 35 pts with advanced GIST (24/35 with liver lesions and 33/ 35 with peritoneal involvement) undergoing therapy with Imatinib Mesylate. All pts had a baseline MR, and then at 2, 4, 6, 12 months during treatment. Pts responsive to therapy (31/35) showed: A) tumor decrease in size (with an in-crease in tumor volume at 2 months from treatment start in some cases (17%) due to necrosis or bleeding): B) Hypointensity of the lesions on T1w images (lesion was hyperintense in rare case due to bleeding) and hyperintensity of the lesions on T2w images (correlating with the amount of degenerative tissue or necrosis): C) Hypovascularization of the lesions on contrast-enhanced T1w images in comparison to pre-treatment assessment, due to the presence of degenerative tissue or necrosis: E) Evidence of peritoneal fluid in all pts at the first months, reabsorbed in the following months. Conclusions: MRI is useful to identify tumor response to Imatinib Mesylate in advanced GIST as from the early months of therapy with the following indicators of treatment activity: A) Size of lesions; B) signal intensity; C) vascularization; D) amount of degenerative tissue or necrosis; E) presence of peritoneal fluid. Crohn's disease: Spectrum of findings on helical contrast enhanced CT enterography A.J. Madureira, R. Cunha, P. Varzim, F. Magro, I. Ramos; Porto/PT Learning Objectives: To illustrate the spectrum of imaging findings of smallbowel Crohn's disease at contrast enhanced spiral CT after oral hyperhydratation with isotonic solution (CT enterography). Background: Spiral CT has become one of the most valuable methods in the assessment of parietal inflammatory changes and extraluminal involvement in small-bowel Crohn's disease. The accuracy of this technique depends on the presence of well distended bowel loops. Procedure Details: After oral hyperhydration with 2000 mL of isotonic polyethylene glycol electrolyte-balanced solution, contrast enhanced CT of the abdomen and pelvis was performed with a collimation of 7 mm and 5 mm, respectively. The following CT findings were evaluated: wall thickening, parietal contrast enhancement, extraparietal anomalies (lymph nodes, vessels and mesenteric fat), and presence of inflammatory complications (abscesses, fistulas). The spectrum of findings of small-bowel Crohn's disease is thoroughly illustrated and discussed based on our experience with over 50 patients. Conclusion: This method provides important information about the extent and activity of small-bowel Crohn's disease and its extraluminal involvement and is a potential alternative to small-bowel CT enteroclysis. Bowel intussusception in adults: An imaging review H.D. Roach, J.M. Hanson, R. Bagree, C. Evans, A. Yong; Cardiff/UK Learning Objectives:To outline the mechanism and causes of intussusception in the adult population. To provide a review of the imaging findings in intussusception using several imaging modalities. Background: Bowel intussusception is more commonly associated with the paediatric population, but can occur in adults, affecting virtually any part of the gastrointestinal tract. In adults there is more often an underlying structural lesion, which acts as a lead point. Imaging Findings: Bowel intussusception has a classical appearance on barium studies and cross-sectional imaging and occasionally a lead point can be identified. Due to the underlying structural causes, surgery is more often required in adults than children, resulting in the availability of histopathologic specimens for correlation. However within the small bowel even in adults it has been shown that the majority of cases are self-limiting. In this exhibit, we review the imaging findings of intussusceptions affecting various sites in the gastrointestinal tract using different modalities. Conclusion: Bowel intussusception is less common in the adult population, but is often associated with underlying structural lesions. The imaging findings are reviewed here. Can double contrast barium enema exams incidentally detect terminal ileum tumoral lesions? C. Gotta, S. Merola, E. Sanabria, M. Landi, S. Ballester, C.A. Dominguez; Buenos Aires/AR Learning Objectives: To describe a number of radiological signs, found in barium enema double contrast exams in 28 patients, that are specific or suspicious of terminal ileum tumoral lesions. Background: Since 1972 there have been few reports about radiological signs in double contrast barium enema exams that can help in the diagnosis of terminal ileum pathology. Some of them use glucagon to improve the reflux of contrast material through the ileo-cecal valve in order to allow the visualization of the Reviewing the available literature, there are no reports which describe specific radiological signs on this matter. Procedure Details: A total of 28 cases of tumoral terminal ileum pathology were found. All lesions were seen for the first time at the double contrast barium enema, and lately examined and characterized by the follow through or small bowel enema. In most of them abdominal computed tomography was performed. 20 cases had histological confirmation based on surgical specimens. Of the remaining 8 cases, 4 were lipomas with typical densitometric values diagnosed by computed tomography, thus these patients did not undergo surgery. The other 4 lesions described as polipoid did not have histological confirmation as the patients refused surgical resection. Conclusion: Double contrast barium enema can detect the presence of terminal ileum tumoral pathology even when not yet clinically suspected. There are a few radiological signs which allow the radiologist to recognize and diagnose it. Background: Magnetic resonance is a powerful diagnostic tool for abdominal imaging, particularly for extra-visceral tissue depiction. Newer pulse sequences, such as single shot fast spin echo (SSFSE) and steady state free precession (SSFP) with a water solution infusion via naso-jejunal tube can accurately depict the bowel lumen in a fashion similar to conventional double contrast enema. Furthermore 3D and 2D fast T1 weighted sequences with iv contrast administration allows the evaluation of wall involvement. Imaging Findings: Findings are summarized into lumen abnormalities, wall involvement and extra-luminal alterations. Corresponding DCSBE are shown and compared. Signs of disease activity at MRE plus conventional MRI are stressed. Contribution of different pulse sequences is evaluated. Conclusions: MRE plus conventional MRI is feasible in the diagnosis, staging and follow-up of Crohn's disease. Subtle mucosal lesions are still poorly depicted, compared to DCSBE. Extra-luminal involvement is superbly showed, particularly by new SSFP sequences. Disease activity signs seem to be the added value of magnetic resonance in Crohn's disease assessment. Diagnosis and staging of colorectal carcinomas using multislice CT colonography (MSCTC): Pictorial essay with pathologic correlation R. Iannaccone, A. Laghi, C. Catalano, A. Lamazza, F. Mangiapane, S. Trenna, D. Marin, A. Schillaci, R. Passariello; Rome/IT Learning Objectives: To assess the role of MSCTC in the detection and staging of colorectal carcinoma. Background: 150 patients affected by colorectal carcinoma underwent colonoscopy and MSCTC on the same day. 100 patients free of colonic lesions were included as a control group. CT parameters were: collimation, 4 x 1 mm; effective mAs, 80-165; and kVp, 120. MSCT colonography was performed before (prone position) and after (supine position) intravenous administration of contrast material with a 60-sec delay-time. MSCTC images were interpreted by two radiologists on a workstation. The results of MSCT colonography were correlated with colonoscopy and with the results of the histopathologic examination performed on the resected surgical specimen. Intra-operative ultrasonography was used as the reference standard for the presence of liver metastases. Sensitivity and specificity for tumor detection and staging accuracy (according to the TNM classification) of MSCTC were calculated. Imaging Findings: Surgery revealed 164 carcinomas (150 primary and 14 synchronous lesions) in 150 patients. Colonoscopy failed to visualize the entire colon in 21 patients due to obstructive neoplasms and missed all 14 synchronous carcinomas. MSCTC provided a complete evaluation of the colon in all cases, correctly identified all primary and synchronous carcinomas (164/164; sensitivity, 100%), and yielded three false-positive diagnoses (specificity, 98.8%). MSCTC also detected 21 polyps (18 true-positives and three false-positives). Overall, MSCTC correcly staged 136 of 150 primary tumors (overall TNM staging accuracy, 90.6%). Conclusion: MSCTC can be proposed as a comprehensive diagnostic test for the pre-operative evaluation of patients with known, or strongly suspected, colorectal carcinoma. Gastrointestinal To present the characteristic features of malignant GIST and correlated these with histopathologic findings. Background: In our pathologic database from 1998 to 2002, we found 31 patients with GIST and retrospectively reviewed their radiologic findings. Thirty one CT, four US, and four barium studies were included. Imaging Findings: Involved organs were as follows; 13 in the small bowel (42%), 10 in the stomach (32%), five in the rectum (16%), two in the mesentry (7%) and one in the colon (3%). On histochemical analysis, eight were classified as benign (26%), six as borderline (19%) , and 17 as malignant (55%). Mean tumor size was 7.1 cm (1.2 cm-22 cm): Benign (mean;4.3 cm, range;1.2 cm-10 cm): Borderline (mean;6 cm, range;5 cm-9.3 cm): Malignant (mean;8.9 cm, range;4 cm-22 cm). Multiplicity was demonstrated in one benign and one malignant tumour. Six cases showed microscopic metastasis to the surrounding lymph nodes without evidence on radiologic imaging. CT features were relatively smooth margination and homogeneous enhancement of smaller tumors. Poor margination with surrounding infiltration, central necrosis or ulceration was seen in larger tumors. No evidence of intestinal obstruction, peritoneal seeding or ascites was demonstated. Barium examination showed a well demarcated, smooth marginated tumor with normal overlying mucosa. Some ulceration was seen in larger masses (Bull's-eye sign). US features were welldemarcated homogeneous hypoechogenicity of small masses, hyperechoic foci of ulcerated masses. The characteristic radiologic findings of immunohistochemically KITpositive malignant GIST were large tumor size, poor margination, central necrosis or ulceration. The clinical significance of each feature and differential points from benign GIST or other conditions will be discussed. Learning Objectives: To illustrate CT findings of common and uncommon duodenal diseases with pathologic correlation. To demonstrate a comprehensive CT anatomy of the duodenum and adjacent organs. To describe the pitfalls on CT interpretation of duodenal diseases. Background: The duodenum may be involved by secondary process as well as primary pathology because it is close to adjacent organs including the stomach, pancreas, liver, gallbladder, hepatic flexure of the colon, aorta, IVC, right kidney and adrenal. Duodenal pathology can be overlooked on CT interpretation but understanding of CT anatomy of the duodenum and adjacent organs may be helpful in the diagnosis of various duodenal pathology. Procedure Details: Helical CT during the portal phase with water as an oral contrast agent was performed for better detail of duodenal lesions. We reviewed CT findings with pathologic correlation in 41 patients with various duodenal diseases. Duodenal diseases were classified as follows; congenital (duplication, malrotation, diverticulum, and annular pancreas), trauma (intramural hematoma, iatrogenic perforation by endoscopy), inflammatory (perforated peptic ulcer, secondary process by pancreatitis or cholecystitis), primary neoplasms (lipoma, adenoma, adenocarcinoma, lymphoma, and gastrointestinal stromal tumors), secondary invasion of adjacent neoplasms (pancreas, stomach, colon, and gallbladder), bezoar, and postsurgical afferent-loop syndrome. Conclusion: Helical CT during the portal phase with water as an oral contrast agent provided a comprehensive view of the duodenum and adjacent organs. Understanding of CT anatomy and the pitfalls on CT interpretation was helpful in the diagnosis of various duodenal diseases. To investigate utility of MR volumetry for resectable rectal cancer before and after preoperative concurrent chemoradiotherapy. Methods: 104 patients with respectable locally advanced rectal cancer underwent preoperative concurrent chemoradiotherapy. Among them, 78 patients (55 men and 23 women; median age 55 years; range, 27-75 years) who had MRI before, and 1 month after concurrent chemoradiotherapy were enrolled into this study. Radiation of 45 Gy/25 fractions was delivered to the pelvis, followed by a 5.4 Gy/3 fractions boost to the primary tumor. Chemotherapy was administered concurrently with radiotherapy and consisted of 2 cycles of 5-FU (500 mg/m 2 / day) and leucovorin (20 mg/m 2 /day) for five days during the first and fifth weeks of radiotherapy. Surgery was performed 4-6 weeks after the completion of chemoradiation. MR volumetric examinations for tumor volume before and after chemoradiotherapy were perfomed in workstation software using T2-weighted axial images. Results: According to Dworak grade, grade 1 was present in 26.9% (21/78), grade 2 in 44.9% (35/78), grade 3 and 4 in 14.1% (11/78), respectively. Primary tumor downstaging occurred in 57.7% (45/78). The mean tumor volume was 21.1 cm 3 (1.4-80.3 cm 3 ) in MR volumetry before chemoradiotherapy and 6.5 cm 3 (0-34.8 cm 3 ) in after chemoradiotherapy. When the tumor volume reduction rate was correlated with the Dworak grade, mean tumor volume reduction rate was 58.8% (15.90-100%) in grade 1, 66.1% (0-94.8%) in grade 2 and 73.9% (34.5-100%) in grade 3 and 4. The tumor volume reduction rates demonstrated statistically significant differences among Dworak grades. Conclusion: In MR volumetric evaluation for rectal cancer before and after preoperative chemoradiotherapy, tumor volume reduction rate is well correlated with histologic reduction grade. Functional The rectum was insufflated with air. We used T2-weighted HASTE sequences at rest, squeeze and strain, in the axial and sagittal planes. We also performed a dynamic study using a T2-weighted HASTE modified sequence, acquiring a single mid-sagittal slice, repeated every second for 20 seconds, starting with the patient at rest then in squeezing and finally in straining. MR findings were compared with evacuation proctography, considered as gold standard. Rectocele and pelvic floor descensus were graded either with the standard reference values, and with modified values obtained from normal volunteers. Results: MRI vs evacuation proctography identified 13/15 rectoceles, 25/28 anorectal junction descents, 7/9 rectal prolapses, and 4/6 diskinetic pubo-rectalis syndromes. MRI detected additional findings in 30% of patients (4 enteroceles, 10 uterine descents, 11 cystoceles, 4 perianal pathologies-abscesses, anal fistulas). MRI, using specific reference values provided 90% sensitivity, 93% accuracy, 84% NPV for the anorectal junction descent, while using conventional values provided 63% sensitivity, 75% accuracy and 57% NPV. Conclusions: Defeco-MRI requires a short examination time, is well accepted and gives reliable information for the diagnosis of posterior pelvic disorders. Specific reference values should be used to correct the bias of the supine position. Correlation between MR findings and pathology in evaluation of the affected bowel wall in Crohn's disease F. Maccioni, M. Colaiacomo, A. Bruni, A. Cocco, S. Parlanti, F. Siliquini, M. Marini, A. Marcheggiano; Rome/IT Purpose: To correlate MR findings with the corresponding pathologic specimens obtained at the level of the pathologic wall in patients with Crohn's disease (CD). Method and Materials: 27 patients with known CD underwent MRI after oral administration of a superparamagnetic contrast, using T2-weighted plain and fatsuppressed HASTE sequences, and Gd-enhanced T1-weighted FLASH sequences on axial planes. Degree and pattern of wall signal, wall thickness and abnormalities of perivisceral fat were evaluated. Disease activity was evaluated using standard clinical scores. Endoscopic or surgical pathologic specimens were obtained in all patients (GS) . MR findings were inter-correlated and correlated with pathologic findings (GS) either prospectively or retrospectively, with a sideby-side analysis of results. Results: High wall Gd-enhancement and high T2 wall signal were observed in patients with active disease and diffuse transmural inflammatory cells infiltrates at GS (n. 14). In patients with active disease a layered pattern of Gd-enhancement was observed, associated with either submucosal oedema or fibrosis at GS (n.8); in this group of patients, however, T2-weighted images showed high or low wall signal in presence of oedema or fibrosis, respectively. In patients with non active disease poor Gd-enhancement and low T2 wall signal were observed and Preoperative evaluation of early gastric cancer for laparoscopic gastrectomy by 3D-CT angiography using 16-row multislice CT angiography S. Kumano 1 , H. Miki 1 , T. Mochizuki 2 ; 1 Onsen-gun/JP, 2 Ehime/JP Purpose: The purpose of this study was to determine the efficacy of 3D-CT angiography (3D-CTA) using 16-row multislice CT (MSCT) in the pre-operative simulation of laparoscopic gastrectomy for early gastric cancer. Method and Materials: Twenty patients with early gastric cancer underwent CT examination using 16-row MSCT (0.625-mm x 16). 2 mL/kg of 300 mgI/mL contrast material was intravenously injected at a rate of 4 mL/sec. Timing for the arterial phase scan was determined by using a test bolus injection. Portal phase scan was performed 70 s after the start of bolus injection. For 3D-CTA, CT images of 0.625 mm thickness were reconstructed at 0.625 mm intervals. With a computer workstation, 3D-CTA was produced using volume rendering and maximum intensity projection techniques. Results: 3D-CTA demonstrated the left gastric artery (LGA), right gastric artery (RGA) and left gastric vein (LGV) in all cases. 3D-CTA also demonstrated the LGA arising from the celiac trunk in 19 cases and from common hepatic artery (CHA) in one case; the left hepatic artery (LHA) from the LGA in two cases; an accessory LGA from LHA in one case; and the RGA from the proper hepatic artery in 13 cases, from the CHA in five cases, and from the LHA in one case. Regarding the venous system, 3D-CTA demonstrated LGV flowing into portal vein in 10 cases, splenic vein in 9 cases, and the junction of portal and splenic veins in one case. Conclusion: 16-row MSCT 3D-CTA clearly demonstrated the vascular anatomy in all cases that is necessary for laparoscopic gastrectomy, and was thought to be useful for the preoperative simulation of laparoscopic gastrectomy. Douglas pouch hernias: Evaluation with entero-colpo-defecography M. Estienne 1 , M. Moretti 1 , M. Valle 1 , P. Meinero 2 , O. Brunetti 1 ; 1 Lavagna/IT, 2 Santa Margherita Ligure/IT Purpose: To assess the usefulness of entero-colpo-defecography (ECD) in the evaluation of Douglas pouch hernias and to improve the technique by a simple and non-invasive method. Methods and Materials: 73 female patients (mean age: 63 years) with clinical symptoms of obstructed defecation underwent ECD. Our standard technique includes: 500 mL of diluted barium suspension given orally at least 1½ hours before examination; a small gauze opacified with iodamide placed into the vagina; rectal filling with 200 mL of thick barium paste. Static and spot lateral radiographs of the pelvis are obtained at rest, during squeeze and push, and during and after evacuation. If widening of the rectovaginal space (RVS) is observed during the dynamic phase, in the absence of an enterocele, a barium sigmoid enema is performed and further lateral films are obtained at maximum straining. Results: Widening of RVS was observed during ECD dynamic phase in 16 of the 73 patients (22%). Thirteen of these patients had small bowel loops prolapsing into RVS (enterocele). For the three remaining patients, in which the widening of RVS could not be explained by enterocele, we performed a sigma barium enema demonstrating the presence of a sigmoidocele. We did not find a peritoneocele without bowel contents. Conclusions: Douglas pouch herniations may account for symptoms of obstructed defecation. Defecography alone is not able to evaluate the hernia contents and peritoneography is an invasive technique. Visualization of Douglas pouch hernias is improved by the use of our ECD technique allowing a correct identification of enteroceles and sigmoidoceles. were prospectively studied by MDCTC and compared with colonoscopy. All patients were referred to CT immediately after colonoscopy. CT was performed with 16 x 0.75 mm, 120 KV and 50 mAs in both supine and prone positions after colonic air insufflation. This method was well tolerated for all patients. Independently, two experienced radiologists interpreted axial, sagittal and coronal images and 3D endoluminal reconstructions (virtual colonoscopy). In cases of disagreement, the diagnosis was established by consensus. Sensitivity, specificity, predictive values and kappa test were analysed. Both methods were compared with Chi-Squared test. Results: In our series, the prevalence of colorectal polyps was 49%. When polyps were 5 mm in size or greater MDCTC had a 96% sensitivity, 97% specificity, 92% PVP and 99% PVN. The agreement between colonoscopy and MDCT was observed in 91%. No statistical differences were found between these methods. Conclusion: CT colonography is emerging as a potential alternative to conventional colonoscopy in the screening of colorectal cancer. 16 Row MDCTC represents a reliable imaging method to detection of colorectal polyps with a high accuracy, particularly when the polyp size is 5 mm or greater. This suggests an improvement over single slice CT. A. Kalogera-Fountzila, C. Kouskouras, A. Lefkopoulos, N. Fotiadis, D. Karanikolas, I. Tsifountoudis, A.S. Dimitriadis; Thessaloniki/GR Purpose: To prospectively evaluate the characteristic spiral CT features of intestinal ischemia and necrosis in patients with acute abdomen. Materials and Methods: Twenty patients, aged 15-92 (median 67), were examined in a three year period, using helical CT without oral contrast administration and after intravenous injection of contrast medium. The clinical manifestations consisted of acute abdomen and/ or sepsis in all patients. The diagnosis of bowel ischemia was confirmed with surgery, where colonic and/ or small bowel resection was performed in 18 patients within 24 hours. One patient with the presence of portal gas was found to be normal at surgery and one patient died before surgery and had a confirmatory autopsy. Results: The causes of critical intestinal ischemia were diverse, including superior mesenteric artery thromboembolism in 3 (15%) patients, inflammation in 5 (20%), intussusception in 1 (5%), volvulus in 2 (10%), adhesions in 4 (20%), HIV infection in 1 (5%) and unknown etiology in 5 (25%). Spiral CT identified necrosis of colon and small bowel in 9 (45%) patients, necrosis of small bowel only in 4 (21%), and of colon in 5 (26%). Suggestive findings included intramural air in 13 (65%) patients, thickening of the bowel wall in 14 (70%), thinning in 4 (20%), double or concentric ring sign in 8 (40%) and bowel dilatation in 13 (65%). Presence of increased density of mesenteric fat was noted in 7 (35%), mesenteric vein dilatation in 10 (50%), free intraperitoneal air in 3 (15%) and peritoneal fluid or blood in 13 (65%). Conclusion: Spiral CT can accurately demonstrate signs of bowel ischemia and is often helpful in determining the primary cause of ischemia or necrosis. A comparison of single and multi row CT colonography in the detection of colorectal polyps P. Vagli, E. Neri, S. Picchietti, G. Naldini, M. Rossi, C. Bartolozzi; Pisa/IT Purpose: To compare the diagnostic accuracy of single and multi row CT colonography (CTC) for detection of colorectal polyps. Materials and Methods: Between 1996 and 2003, seventy-two consecutive patients with a moderate to high risk of developing colorectal cancer underwent CTC followed by complete CC within 24 hours. CTC was obtained by means of single row CT (n = 20) and multi-row CT (n = 52). Sensitivity and specificity of single and multi-row CTC for detection of colorectal polyps was determined by means of lesion location in four colonic segments (cecum-ascending c-a, transverse t, descending d, sigmoid-rectum s-r). Results: All colonic segments were completely visualised in each patient both by single and multi row CTC study. CTC identified 63 polyps (< 6 mm) in 44 pa-tients (c-a N = 17, t N = 17, d N = 19, s-r N = 10) , and 33 polyps (6-20 mm) in 24 patients (c-a N = 5, t N = 3, d N = 12, s-r N = 13) . CTC generated 28 false positives (FP) for polyps smaller than 6 mm and 10 FP for polyps 6-20 mm. False negatives (FN) were 4 for polyps < 6 mm, and 2 for polyps 6-20 mm. Sensitivity of single and multirow CTC for detecting polyps were 80% and 89% respectively for polyps < 6 mm, and 83% and 94% for larger polyps 6-20 mm (p < 0.01). Overall sensitivity and specificity of CTC for small polyps (< 6 mm) was 88% and 87% respectively. Overall sensitivity and specificity increases for larger polyps (6-20 mm) at 94% and 96% respectively. Conclusion: Multi-row CTC demonstrated a higher diagnostic accuracy than single-row CT in detection of colorectal polyps. paring the two CT techniques, considering patient discomfort and respiratory artifacts. Results were compared with double-contrast small bowel enema and evaluated by two experienced radiologists. The integrated diagnosis showed 10 negative patients, 15 with signs suggestive for Crohn's disease, 1 with reflux ileitis, 1 with ischemic ileitis and 3 with non-specific ileitis. CT detected 48 positive loops (sensitivity 92%, specificity 77%, diagnostic accuracy 88%); conventional radiology showed 42 positive loops (sensitivity 93%, specificity 100%, diagnostic accuracy 94%). CT-enteroclysis false positives were due to poor bowel distention and false negatives to proximal bowel localization of disease; conventional study false negative cases were due to unseparable loops. Mild respiratory artifacts were present in 66% (12 of 18 patients) of SDCT examinations vs 16% (2 of 12 patients) of MDCT examinations. Conclusions: MDCT-enteroclysis in comparison with SDCT-enteroclysis reduces scanning time, respiratory artifacts and patient discomfort, allows a better spatial resolution, more evident on MPR, and improves pathological pattern representation. Detection and staging of gastric lesions combining axial CT and virtual endoscopy images S. Visconti, V. Panebianco, M. Celestre, T. Celano, D. Tancredi, F. Iafrate, R. Passariello; Rome/IT Purposes: The aim of our study was to develop a virtual endoscopy examination protocol for the stomach after CO2 distention, and to identify AGC lesions according to Borrmann's classification based on tumor morphology. Methods and Materials: Virtual endoscopy of the stomach was performed in 33 patients with gastric lesions. The stomach was distended with 6 g of top effervescent granules used for double contrast upper GI studies (Duogas, Bracco), after intramuscular injection of 20 mg of scopolamine butylbromide. All patients underwent a Spiral CT Volume Zoom examination (120/80/1 mm/1 mm/8 mm/0.l5 sec KV/mAs/slice-coll./slice-width/feed-rot/rot.time). In 7 cases spiral CT was repeated in a prone position because of a limited gastric distension by air. Real time endoscopy images were reconstructed using a volume rendering technique with a dedicated workstation and specific software (Vitrea 2.2-Vital Images), and evaluated combined with axial images by two radiologists. One week later a fiberoptic gastroscopy was performed in all patients. Results: Image quality was graded as optimal in 30 cases. In 3 cases the stomach was not distended. Virtual endoscopy correctly showed gastric lesions (ulcerative lesions n = 16, vegetating lesions n = 12, benign lesions n = 5). We found a good correlation with surgical specimens in 14 cases. The actual role of virtual gastroscopy combining axial CT and VE images is to evaluate the locoregional and distant extension (perigastric tumor involvement, distant metastasis) of tumors. It's potential roles are replacing barium studies and examining patients with surgical gastric exclusion. Traumatic bowel perforation after blunt abdominal trauma: Analysis of the CT findings according to the perforation site and the elapsed time since the trauma H. Kim, H. Shin, S. Park, S. Park, H. Kim, W. Bae, I. Kim; Cheonan/KR Purpose: To evaluate the efficacy of CT in predicting the perforation site and the differential findings according to the elapsed time from the trauma in patients with bowel perforation after blunt abdominal trauma. Methods and Materials: Abdominal CT's of 57 patients with bowel perforation after blunt abdominal trauma confirmed by surgery were retrospectively analyzed without knowledge of the surgical results. The interval from the trauma to CT was 2 to 72 hours (mean, 7 hours). The CT findings of traumatic bowel perforation including extraluminal air collection, segmental bowel wall thickening, localized inter-mesenteric fluid, bowel wall discontinuity, and mesenteric hematoma were analyzed. The predicted perforation sites were classified as: duodenum, jejunum, jejuno-ileal junction, ileum, and colon. Based on the mean elapsed time (7 hours), the patients were divided into the early lapse group (n = 37) and the late lapse group (n = 20), and the differential CT findings were analyzed. Results: Diagnostic accuracy of predicting the perforation site was: duodenum (100%), jejunum (81%), jejuno-ileal junction (100%), ileum (93%), and colon (20%). Extraluminal air collection was more frequently seen in the late lapse group (80%) than in the early lapse group (43%) (p < 0.05), whereas other CT findings showed no statistically significant difference in the incidence. Contrast-enhanced magnetic resonance imaging of the terminal ileum in children with Crohn's disease P. Paolantonio, A. Laghi, O. Borrelli, C. Miglio, M. Celestre, D. Marin, S. Cucchiara, R. Passariello; Rome/IT Introduction: To evaluate the diagnostic value of gadolinium enhanced MRI with polyethylene glycol solution as oral contrast agent (CE-PEG-MRI) in revealing inflammation of the distal ileum in children with Crohn's disease (CD) and in differentiating them from other inflammatory bowel diseases. Subjects and Methods: Seventy-five consecutive paediatric patients referred for suspected CD underwent ileo-colonoscopy with biopsy and CE-PEG-MRI. The distal ileal mucosa was assessed by endoscopic and histological scores. The CD activity was measured by means of paediatric Crohn's disease activity index (PCDAI). Results: Active CD was diagnosed in 26 cases, active ulcerative colitis (UC) in 18, spondyloarthropathy and indeterminate ileo-colitis in 11. In all CD patients CE-PEG-MRI showed a high concordance with endoscopy and histology. Of the 18 UC patients the CE-PEGMRI was negative in 15 and showed mild parietal contrast enhancement of the terminal ileum in 3 of the 7 patients with backwash ileitis. Among the group of SpA patients, CE-PEG-MRI was negative in 4 and revealed mild parietal contrast enhancement in 7. No increase in wall thickness in any of the UC and SpA patients was demonstrated. Sensitivity and specificity of CE-PEG-MRI were 84% and 100%, respectively. The test optimally correlated with endoscopic and histological scores (r: 0.94; r: 0.95, respectively) as well as with the PCDAI in the CD patient group (r: 0.91). Conclusions: High correlation of CE-PEG-MRI with ileal endoscopy, histology and PCDAI makes this test of great interest as a tool for monitoring the clinical course and the effect of therapy in CD patients. Small bowel sonography in celiac disease after oral administration of sonographic contrast medium P. Mirk, R. Foschi, I. De Vitis, L. Guidi, A. Vecchioli-Scaldazza, P. Marano; Rome/IT Purpose: To assess the usefulness of sonography in celiac disease after small bowel loop filling by sonographic contrast medium. Materials and Methods: 33 consecutive patients with clinical suspicion or diagnosis of celiac disease were prospectively examined by US before and after (30'-40') drinking of 500-750 mL of an isosmotic water solution of polyethilene glycol. 14 patients had celiac disease (positive histology or AGA or EMA antibodies); 19 patients had previous celiac disease but were clinically negative, or had other benign disorders, and were considered as normal. Results: After contrast administration intestinal loops were better or slightly better shown in 12/33 and 16/33 patients (36.3% and 48.4%), or unchanged in 5/33 (15.5%). Among celiac patients, observed intestinal abnormalities were: segmental dyskinesia; transient intussusception; reduced number of jejunal folds; increased number of ileal folds; hypotonic dilated fluid-filled loops; increased intestinal motility. Extra-intestinal abnormalities in celiac patients were: spleen size reduction; mesenteric lymphadenopathy; liver steatosis; free peritoneal fluid. 4 celiac patients had no detactable abnormalities (false negatives); there were no false positives. Overall accuracy was 87.8% (sensitivity: 71.4%; specificity: 100%; PPV 100%; NPV 82.6%) Conclusions: Small bowel filling by sonographic contrast medium improves US evaluation of wall thickness, mucosal fold pattern, and intestinal motility. Transient intussusception was the single most diagnostic sign, whereas other features were less specific and of limited value unless found in combination. Preoperative MRI and transrectal US in the staging, and post-irradiation therapy restaging, of rectal cancer I. Miucin-Vukadinovic; Sremska Kamenica/YU Purpose: The goal of the study was to determinate and compare the value of MRI and transrectal US (TRUS) in the staging, and post-irradiation therapy restaging, of rectal cancer. This study was designed to evaluate the down-staging effect of preoperative radiation. Method and Materials: 34 patients (range, 38-86) with biopsy-proven rectal can-cer underwent imaging using a 1.5 T scanner and transrectal US (7.5 or 10 MHz transducer) before, and after radiation therapy (50 Gy, a daily fracton of 2 Gy, 5 days a week).Tumors were staged according to the TNM staging system. Two observers independently scored the tumor stage. The standard of reference was histopathology (after surgical resection). Results: All patients underwent radiotherapy before surgery for rectal carcinoma. Before radiotherapy MR examination detected 20.6% T2 (B1), 41.2% T3 (B2), 8.8% T2N1 (C1) and 29.4% T3/4N1 (C2) tumors. Down-staging of one or more T stages occurred in 44.1% with tumor regression in 23.5%. The MRI tumor stage agreed with the histological stage in 86% of patients. TRUS correctly staged 81% of lesions. T category was correctly restaged after preoperative radiation in only 61.8%. Conclusion: Preoperative radiotherapy is becoming the standard of care for resectable, locally advanced adenocarcinoma of the rectum. MRI and TRUS enable selection of appropriate patients for preoperative radiotherapy. Preoperative TRUS can establish the depth of penetration of a tumor and showed less sensitivity for lymph node staging. MRI showed better diagnostic accuracy (with tendency for overstaging) then TRUS for interpretation of complete pelvic status in the pre-and post-irradiation period. Echographic efficacy evaluation of gastric ulcer treatment S. Pimanau, N. Mikhailava; Vitebsk/BY Purpose: The objective of this study was to investigate the possibilities of noninvasive abdominal echography in efficacy evaluation of chronic peptic ulcer pharmacotherapy. Method and Materials: 87 patients with gastric ulcers in the exacerbation phase were examined before the course of pharmacotherapy and after it. Ultrasound investigation was carried out after administration of 400-500 mL deaerated liquid. On echography a chronic gastric ulcer was visualized in 84 cases. In the acute exacerbation phase the peptic ulcer was deep, filled with echogenic contents, the ulcer edge being sharp and overhanging. Periulcerous infiltration was hypoechogenic, 50-90 mm long, 6-12 mm thick, and its area made up about 400-900 mm 2 . The peripheral edge of periulcerous infiltration seemed sharp. In the course of effective treatment both ulcer dimensions and periulcerous infiltration area reduced on echograms. Periulcerous infiltration reduction speed made up about 10 mm 2 /day. The reparative process was also accompanied by ulcer flattening. In cicatrization the ulcer was not visualized on echograms, a hypoechogenic stripe 3-4 mm thick generally remaining. In the absence of reparation, the echographic picture of the ulcer and periulcerous infiltration didn't change essentially. Parallel endoscopic study of the stomach revealed either coincidence with echographic findings of qualitative characteristics of the reparative process positive dynamics or its absence. In 6 cases the results of ultrasound and endoscopic investigations didn't coincide; echograms showed slight infiltration with a central small echogenic area at the site of ulcer regarded as ulcer reparation, while endoscopy revealed a red scar. Conclusion: Thus, abdominal ultrasound investigation of the stomach enables reliable evaluation of gastric ulcer dynamics in the course of conservative treatment. Comparison of multi-slice CT-colonography in ultra-low-dose technique with high resolution video-colonoscopy in the detection of colorectal polyps M. Cohnen, C. Vogt, K. Andersen, A. Saleh, A. Beck, S. vom Dahl, V. Aurich, D. Häussinger, U. Moedder; Düsseldorf/DE Purpose: To prospectively compare MSCT-colonography using an ultra-low-dose technique (ULD-MSCTC) with high-resolution video-colonoscopy (HR-VC) as the standard technique for detection of colorectal cancer and polyps. Patients and Methods: 115 patients underwent MSCT-colonography (ULD-MSCTC) after standardized oral bowel cleansing immediately before video-colonoscopy (HR-VC). Patients were scanned with an ultra-low-dose MSCTcolonography protocol (10 mAs, CTDIw eff: 1.14 mGy). After noise reduction using an mathematical algorithm by dedicated software, ULD-MSCT-colonographic images were analyzed by a team of two readers in a blinded fashion and the results were compared with the results of HR-VC. Results: 150 lesions were detected by HR-VC in 115 patients. Sensitivities for detection of polyps < 5 mm, 5-10 mm, and > 10 mm in size were 76% (73 of 96 polyps), 91% (30 of 33 polyps) and 100% (9 of 9 polyps) respectively. All colorectal tumors (4 of 4, 100%) were prospectively diagnosed. The sensitivity to detect flat lesions was 50% (4 of 8 flat lesions). The overall specificity was calculated at 87%. The calculated effective dose ranged between 0.75 and 1.25 mSv. Conclusions: ULD-MSCTC has an excellent sensitivity and specificity for the detection of colorectal lesions > 5 mm despite a significant reduction in radiation exposure. Defecographic The pelvic floor in straining state descended an average of 1.62 cm from the inferior margin of the ischial tuberosity, its broad range of position from -5.2 cm to 0.8 cm implying a wide variation of anorectal angle and perineal descent. Mild degree rectocele with less than 2 cm of depth was found in 12 out of 29 cases. Rectal intussusception was noted in six and rectal incontinence was seen in one. Formation of rectocele and intussusception during defecation was common in asymptomatic young volunteers. The wide range of defecographic measurements warrants the necessity of other complementary studies on anorectal function to improve the diagnostic accuracy. Therefore, the interpretation of defecographic findings should be made with caution and should not be used as the sole criteria for selection of a treatment modality. Right-side colonic diverticulitis: Sonographic and CT findings (differential diagnosis) E. Blanc, M.J. Martínez, T. Ripollés, M. Agramunt, C. Soto, R. Pastor; Valencia/ES Purpose: To describe the sonographic and CT features in right-side colonic diverticulitis and to differentiate this entity from other right-side acute abdominal conditions. Methods and Materials: 16 patients with a final diagnosis of diverticulitis of the ascending colon or cecum were retrospectively reviewed. Sonography was performed in all patients and CT in 13. The following findings were evaluated: the presence of an inflamed right colonic diverticulum, pericolonic infiltration, focal colonic wall thickening and the identification of a normal appendix. The diagnosis was confirmed by surgery, clinical course, or barium enema. Results: Sonography and CT showed pericolonic inflammation and focal colonic wall thickening in all cases. The inflamed diverticulum was seen with sonography and CT in 15 (94%) and 13 (100%) patients respectively. The normal appendix was identified with sonography in 7 (44%) and with CT in 5 (38%) cases. The initial diagnosis was: right-side colonic diverticulitis (n = 11), acute appendicitis (n = 2), perforated colonic carcinoma (n = 2) and an inflammatory mass (n = 1). Conclusions: Right-sided colonic diverticulitis is a condition that can clinically mimic other causes of right abdominal pain like acute appendicitis, perforated colonic carcinoma, salpingitis, ileocecal inflammatory pathology, epiploic appendicitis and omental infartion. In this series the most common sonographic and CT findings included the presence of a right colonic diverticulum with thickening of the adjacent pericolonic wall and pericolonic infiltration. Both ultrasound and CT can be extremely useful in the early diagnosis of this entity avoiding unnecessary surgery procedures, in a primarily benign and self-limiting condition that can be treated conservatively. An accurate scanning technique for detecting recurrent rectal cancer: Enhancement of early-phase dynamic helical CT J. Tanaka, S. Tsukuda, A. Heshiki; Iruma-gun/JP Purpose: To evaluate the usefulness of dynamic enhancement of helical CT in the detection of local recurrence of resected rectal cancer. In 142 patients with a history of curatively resected T2 or T3 rectal cancer, follow-up plain CT indicated that they had a loco-regional recurrent tumor; consequently, they underwent follow-up pelvic helical CT providing accurate early-phase contrast enhancement in the lower pelvic region. The patients were divided into four groups according to grade of contrast enhancement of the suspected mass-like lesion before and after contrast enhancement, and correlation between groups and results obtained by biopsy and/or surgery was assessed. If no correlation was found, patients were followed up for a period lasting from 400 days to two years. As of June 2002, results had been obtained for 80 patients; and correlation between these results and grouping by contrast enhancement ratio was analyzed. Results: All patients in the highest-grade group (n = 10) had local recurrence. When only the highest-grade group was considered positive, there were no false positives and only one false negative. Conclusion: Our results suggest that early-phase contrast enhancement is useful for accurately detecting recurrent rectal cancer. This can be easily achieved using SmartPrep function, and should be used to distinguish recurrent tumors from post-surgical scar tissue, because these two tissue types do not exhibit similar enhancement patterns. Staging of gastric carcinoma by MR imaging in vitro C. Sato 1 , S. Naganawa 1 , H. Kumada 2 , T. Miura 2 , T. Ishigaki 1 ; 1 Nagoya/JP, 2 Toyohashi/JP Purpose: To evaluate the accuracy of cancerous invasion to gastric wall with magnetic resonance imaging in vitro. Twelve specimens of gastric carcinoma were examined with a 1.5 T MR using a small loop surface coil. They were fixed in formalin within 2 days prior to imaging. The field of view was 30 mm, a matrix size was 256 x 256, and the section thickness was 2 mm. The T1-and T2-weighted images were obtained. Two radiologists evaluated the MR images independently, and consensus was obtained if there were any discrepancies between the two. Findings on MR images were compared with histopathologic findings. Results: MR images depicted the normal gastric wall as consisting of the 4 layers clearly. Cancerous invasion was detected in 4 of 12 specimens with mucosal invasion, 3 with submucosal invasion, 2 with the invasion to muscularis propria, 2 with subserosal invasion, and the rest that extended into the serosa. The MR imaging-determined grade correlated with the histopathologic findings for 11 of 12 tumors. The overall accuracy was 91.6%. Conclusion: MR imaging has an accurate diagnostic capabilities for the evaluation of the cancerous invasion to the gastric wall in vitro. The results of the present study may encourage the further development of an endoscopic surface coil. Role To investigate the value of MRI in the overall assessment of Crohn's disease (disease activity, disease extension, complications). Method and Materials: 119 consecutive patients with Crohn's disease underwent MRI in the context of a clinical evaluation including biochemistry, endoscopy, histology and radiology. All patients underwent MRI after oral administration of a superparamagnetic contrast agent, using standard sequences (HASTE T2weighted, with and without fat-suppression and Gd-enhanced T1-weighted FLASH). Two independent radiologists evaluated MR images on printed films. Disease length, presence of strictures, fistulae, abscesses, phlegmons and any other abdominal complication were evaluated at the level of each segment. Gold Standard (GS) for morphological assessment were: Barium studies, CT or US, and surgery when performed. At the level of the affected segments bowel wall thickness, T1 wall Gd-enhancement, T2 wall signal, T2 fibro-fatty proliferation signal were evaluated and graded (0-3) to assess disease activity. GS for disease activity were endoscopy, biological activity and CDAI. Results: MRI detected 90% of overall disease length, 75% of fistulae, 92% of strictures; adhesions were overestimated. In 11% of patients MRI showed complications requiring surgery (1 hydronephrosis, 4 abscesses, 5 phlegmons, 1 pancreatic duct stone, 1 enterovesical fistula, 2 ovarian involvements). The following MRI findings were statistically correlated with the clinical and biological signs of active disease: bowel wall thickness (r = 0.59), wall Gd-enhancement (r = 0.84), T2 wall signal (r = 0.80), T2 fibro-fatty proliferation signal (r = 0.76). Learning Objectives: To recognize usual and unusual radiologic findings of pseudomyxoma peritonei with pathologic correlation. Background: Pseudomyxoma peritonei is a rare neoplastic condition in which gelatinous intraperitoneal fluid collections associated with mucinous disseminated implants are observed. Although a ruptured appendiceal mucocele is the most common cause, pathologies arising from other origins may cause this condition with various imaging manifestations. Imaging Findings: The usual imaging findings were of mucinous, fluid-like material spread over the peritoneal cavity with organ scalloping observed in the liver, splenic and mesenteric margins, with central displacement of small intestinal loops. Within the material, cyst-like round structures may be observed and clarified by the septal enhancement on contrast-enhanced images. Punctate, annular, or curvilinear calcifications may be disseminated. Dropping appendiceal mucocele or a rare urachal tumor located in the female pelvis may simulate an ovarian tumor and be misdiagnosed as gynaecological disease. Demonstration of the continuity to the cecum or urachus was the diagnostic clue. Localized disease in the female pelvis may simulate ovarian carcinomatous peritonitis, and scalloping of the uterine margin may suggest this condition. Because synchronous mucinous tumors of the ovary and the appendix may occur, careful observation to detect the slight irregularity of the omentum adjacent to the cecum is necessary to avoid overlooking an occult primary appendiceal lesion. Conclusion: To recognize various imaging findings is important to make the correct preoperative diagnosis. In particular occult appendiceal lesions must not be overlooked. Multiplanar observation on CT and MRI was important to recognize the complex organic-pathologic relationships to identify the primary neoplasm. Retroperitoneal cystic masses: CT findings D. Yang, H. Kim, J. Kang, T. Seo, H. Kim, S. Kim, J. Kim; Incheon/KR Learning Objectives: To illustrate the CT findings of the different types of retroperitoneal cystic masses. Background: Retroperitoneal cystic masses, which arise within the retroperitoneal space but outside the major organs of that compartment, are uncommon. However, the widespread use of computed tomography (CT) for evaluating abdominal and retroperitoneal diseases has increased the detection rate of retroperitoneal cystic lesions. In this exhibit, we conduct a literature review and present the CT findings of our own patients to illustrate the CT appearance of different types of retroperitoneal cystic masses. Imaging Findings: A variety of CT features were identified in various retroperitoneal cystic masses. The disease entities include cystic lymphangioma, retroperitoneal mucinous cystadenoma, müllerian cyst, cystic change of paraganglioma, epidermoid cyst, cystic teratoma, tailgut cyst, mucocele of appendix, perianal mucinous adenocarcinoma, cystic change of leiomyosarcoma after chemotherapy, pancreatic and nonpancreatic pseudocyst, lymphocele, urinoma, and hematoma. Conclusion: Knowledge of CT findings of various retroperitoneal cystic masses may be helpful for differential diagnosis. Learning Objective: Our purpose is to describe the CT and MR findings of cystic dystrophy of the duodenal and gastric wall in heterotopic pancreas (CDHP) which allows an accurate diagnosis of this pathology usually associated with chronic pancreatitis. Background: Cystic dystrophy in heterotopic pancreas is characterized by the development of cysts in heterotopic pancreatic tissue localized in the duodenal or gastric wall. Cyst formation is related to cystic dilatation of an anomalous duct bordered by pancreatic excretory epithelium, or to pseudocysts caused by pancreatitis of the heterotopic pancreas. We reviewed CT and MR findings in five patients with cystic dystrophy in heterotopic pancreas (CDHP). They underwent spiral CT (n = 5) and MR/ cholangio-MR (n = 2). Diagnosis was confirmed by endoscopic US in all cases. Three cases were pathologically proven after surgery. Imaging Findings: The CT and MRI findings of CDHP consists of cysts, (normally multiple), located in the inner wall of the second part of the duodenum and less frequently in the stomach. The duodenal or gastric walls affected are thickened and inflammatory changes are observed around the cysts. Signs of chronic pancreatitis are frequently seen. MR/ cholangio-MR shows high intensity lesions corresponding to the cysts. Conclusion: CDHP presents some CT and MR features which permit an accurate and reliable diagnosis. When a cystic lesion is found in the duodenal or gastric wall CDHP should be included in the differential diagnosis with other cystic masses such tumors or abcesses. , and thanks to its favorable influence on serum glucose and lipid profiles, this technique is the preferred treatment for patients with severe type I diabetes mellitus and end-stage renal disease (simultaneous pancreatic-kidney transplantation) . Therefore an understanding of the anatomic configuration and the spectrum of postsurgical complications is needed. Imaging Findings: We retrospectively reviewed computed tomographic scans (CT), ultrasounds (US) and doppler studies of 14 patients who had undergone pancreatic transplantation using portal-enteric drainage in our hospital between January 2002 and July 2003. We review the usefulness, limitations and potential pitfalls of CT and US. Acute postoperative complications, including acute rejection, transplant pancreatitis, peripancreatic collections and abscess, pseudocysts, vascular complications (thrombosis, pseudoaneurysm) and exocrine leaks, are depicted. Furthermore, CT-guided percutaneous biopsy and drainage is a safe and an alternative method for obtaining tissue from the transplanted pancreas with graft dysfuntion, and collections. Conclusion: Knowledge of normal anatomic configuration and the radiologic appearance of normal pancreatic transplant will allow proper interpretation and early treatment of the spectrum of portsurgical complications in this kind of pancreatic allograft. The more common current gastric bypass procedures include the Roux-en-Y procedure and bilio-pancreatic diversion with duodenal switch procedure. The more typical complications of these surgeries include anastomotic leaks and stenoses, both of which have been reported in the current literature. More atypical complications, however, have not been comprehensively demonstrated. Imaging Findings: Gastric bypass/gastric stapling is a common surgical procedure at our institution. We have encountered several atypical complications, documented with flouroscopic studies using water soluble contrast. We offer five unusual complications which include the following: Internal herniation through the small bowel mesentery, internal herniation through the transverse mesocolon, external herniation through the abdominal wall incision, enterocutaneous fistulas, Roux-en-Y configuration with anti-peristaltic inversion of the gastroenteric Roux limb, and incorrect anastomosis of the Roux limb with the excluded stomach (resulting in a Roux-en-O configuration). Conclusion: Our findings expand those of the current literature to include the more infrequent complications of gastric bypass surgery. In the fluoroscopic evaluation of post-operative gastric bypass patients, a thorough understanding of expected post-operative bowel configuration is essential. In addition to assessing anatomical abnormalities, it is equally important to assess for abnormalities of motility. In this study, we performed a retrospective review of the medical records and imaging studies of 37 patients with proven FMF, diagnosed between 1992-2002. Imaging Findings: The commonest clinical manifestation were recurrent peritoneal attacks with abdominal pain (75.6%) and fever (40.5%). Abdominal imaging findings included ileus (n = 12), focal peritonitis (n = 3), ascitis (n = 2), splenomegaly (n = 5), and hepatomegaly (n = 2). One patient developed fatal peritoneal mesothelioma, and 13.5% of patients developed amyloidosis with sonographic findings of renal parenchymal disease or cardiomyopathy. Arthritis was second in frequency occurring in 36.1% of patients. Radiographs were normal (n = 4) or showed joint effusion and soft tissue swelling (n = 4) due to synovitis. Two patients developed seronegative destructive arthropathy. Pleuritis was encountered in 13.9%. Polyarteritis nodosa (PAN) was present in 2 patients, multiple sclerosis in one, and autoimmune hemolytic anemia in one patient. Conclusion: FMF predominantly involves abdominal viscera but can affect other organs. The majority of patients have nonspecific imaging findings and the radiologic diagnosis is rarely considered. Amyloidosis, mesothelioma, and destructive arthropathy are potential serious complications of FMF. Polyarteritis nodosa, multiple sclerosis, and autoimmune hemolytic anemia are rare associations or coincidence with FMF. Mucosal associated lymphoid tissue lymphomas: Imaging evaluation with pathologic correlation D. Voultsinou, T. Gerukis, N. Staurogianni, K. Anastasiadou, A. Anagnostopoulos, P. Palladas; Thessaloniki/GR Learning Objectives: To identify the radiological features of extra nodal non Hodgkin MALT lymphoma. To illustrate the spectrum of appearance of the disease in its various locations in the human body. To list the various imaging strategies. To discuss the differential diagnosis. Background: Mucosal associated lymphoid tissue (MALT) lymphoma arises in extranodal mucosal lymphoid tissue and has only been recognized recently. It affects several extranodal structures such as the stomach, the lung, the eye and the salivary glands. It is generally low grade and has an indolent course, as it remains long confined to the initial site. In this exhibit we describe and illustrate the most common radiological patterns of MALT lymphoma. Imaging Findings: We retrospectively reviewed clinical and radiographic records in 17 cases with confirmed low-grade gastric MALT lymphoma. The study group consisted of 10 men and 7 women (mean age 62 years). The predisposing factors of MALT lymphoma, number and location of lesions, and course of the disease were evaluated. We determined the most probable diagnosis on the basis of the radiologic findings and correlated them to pathologic and immunohistochemical findings of endoscopy, biopsy and bone marrow examination.10 out of 17 patients presented with MALT lymphoma of the stomach, 2 in the parotid gland, 2 in the lung, 2 in the large intestine (sigmoid colon, rectum), 1 in ileocecal valve and 1 in the orbit Rectal MALT lymphoma coexisted in one patient, and parotid gland and lung lymphoma in 2 patients. All patients were treated with chemotherapy. The disease resolved in 15 patients. The correlation of imaging, endoscopic and pathologic findings significantly contributes to diagnosis and follow-up of MALT lymphomas, early diagnosis of which results in complete regression. To describe a new approach to CT colonography for detecting colo-rectal polyps with multidetector row CT (MDCT). To display the results and to present the benefits provided by this technique. Background: Virtual dissection‚ (GEMS) is an original application to display the entire inner surface of the colon without the need for navigation. The method consists of displaying the straightened and flattened colon using surface rendering. We performed 30 virtual colonoscopies with a GE LightSpeed 16 MDCT. The acquisition parameter and each step of the imaging procedure will be described. Procedure Details: All patients underwent CT colonography in both supine and prone positions, the following parameters were used: 120 kVp; 80-150 mAs; 2.5mm collimation; 1.25-mm reconstruction intervals and rotation time, 0.5-0.75 sec. The colon was assimilated to a cylinder manually defined. Time to display the straightened and flattened colon using surface rendering was about 5 minutes. Normal aspect, polyps and artifacts were displayed. Polyp detection was faster and easier with this method compared to axial images and the usual virtual endoscopy mode with forward and reverse viewing fly-through volume rendered movies. Conclusion: This method makes it possible to stretch the colon virtually and to cut it along its axis similar to a real dissection on the pathologist's (1) and Luschka duct (2). CE-MRCP succesfully revealed the origin of the leak in 7 patients. Conclusion: Contrast enhanced MR cholangiography with IV mangafodipir trisodium can accurately diagnose the presence and location of bile duct leaks in patients who have undergone laparoscopic cholecystectomy. Internal hernia of the anterior part of the abdomen: Imaging in the multidetector-row CT era N. Hongo, H. Mori, S. Matsumoto, Y. Okino, A. Adachi, A. Kaku; Oita/JP Purpose: Internal hernia of the anterior part of the abdomen (IHAPA) is difficult to diagnose preoperatively because of its rarity and lack of imaging landmarks. The purpose of this study is to clarify the CT features of IHAPA by CT, especially with multi-detector row CT (MDCT). Methods and Materials: The CT scans in 8 patients with surgically confirmed IHAPA through a transverse mesoclolon (n = 4) or an omentum (n = 4) were retrospectively reviewed; furthermore, the transverse mesocolic type was classified into intramesenteric type (n = 2) and transmesenteric type (n = 2). Special attention was paid to the herniated sac-like appearance, hernial orifice, running course of the omental fat and transverse colon. Results: The closed loop of the small bowel was observed in all cases. A sac-like appearance, enclosed by transverse colon was identified in both cases with intramesenteric type, but was not observed in other types of IHAPA. Fatty continuation between the hernial orifice and omentum was identified in two out of four cases with omental type of IHAPA. Furthermore, the transverse colon passed above to the hernial orifice in all cases with omental type, while this finding was not observed in any of the transverse mesocolic type. Conclusion: The relationship between the hernial orifice and transverse colon, and sac-like appearance enclosed by transverse colon are the diagnostic key of IHAPA on CT. Particularly, MDCT would become feasible to diagnose the IHAPA preoperatively, even though it lacks of vascular landmarks. Contrast enhanced MRI using oral PEG solution in the follow-up of patients with known Crohn's disease M. Scettro, A. Grasso, F. Monetti, G. Rescinito, G. Rollandi, C. Neumaier; Genoa/IT Purpose: Aim of our study was to analyze, in the context of an extensive evaluation, Crohn's disease activity index (CDAI), and conventional enteroclysis, the value of MRI to identify disease extension and complications in patients with known disease. Material and Methods: Abdominal MRI of 29 patients in a period of 12 months with a diagnosis of Crohn's disease were analyzed by two experienced gastrointestinal radiologists, in consensus, looking for any intestinal and extra-intestinal abnormality. MRI studies were performed on a 1.5 T (Intera NT, Philips) with a phased array coil. MRI was performed using a polyethylene glycol (PEG) solution 378 B D E F A G as oral contrast agent to distend the small bowel (CE-PEG-MRI), using standard sequences (SS-TSE T2 and TFE T1 with fat saturation after Gd-DTPA and Buscopan 10 mg i.v.) . Results: MR imaging had an overall sensitivity of 98% and a specificity of 93% for active disease. Bowel wall enhancement (ratio of signal intensity of abnormal to normal bowel > 1.3:1), bowel wall thickening greater than 3/4 mm and increased mesenteric vascularity were useful in identifying active disease. The experience shows that the method is complementary to conventional enteroclysis in the detection of superficial and transmural abnormalities in patients with Crohn's disease. In addition, CE-PEG-MRI can provide excellent information concerning mesenteric involvement, disease activity, and complications of Crohn's disease. Finally MRI may become a gold standard in the identification of recurrant disease. withdrawn by authors The number of X-ray based examinations (using a contrast medium) of the oesophagus, stomach, and large bowel, decreased by 34%, 94% and 80%, respectively. X-ray based examination of the small bowel and plain radiography of the abdomen remained unchanged. Endoscopies of oesophagus / stomach and the large bowel increased by nearly 350%. X-ray based examination of the biliary tract almost disappeared with US, ERCP and MRCP taking over. The annual collective effective dose for the all GI tract examinations was reduced by 61%, from 18.4 manSv in 1983 to 7.1 manSv in 2002. The shift in modalities used for diagnostic imaging of the gastrointestinal tract from X-ray examination to US, endoscopies and MRI resulted in a significant reduction in exposure to ionising radiation of patient, and need to be considered when discussing further development and structure of diagnostic imaging in general. Perfusional enhanced ultrasound in the diagnostic evaluation of Sicca syndrome G. Argalia, D. Salera, G. Giuseppetti; Ancona/IT Purpose: Sicca syndrome is a relatively common disorder especially among older women. It may be caused by an autoimmune disorder like Sjogren's syndrome (SS) or by several other illnesses. Our purpose is to evaluate the diagnostic possibilities of contrast enhanced ultrasound in the characterization of sicca syndrome. We studied 60 consecutive patients with sicca syndrome, 40 affected by SS (23 with primary Sjogren's syndrome, 17 with secondary Sjogren's syndrome due to connetivitis) and 20 patients with a sicca syndrome not related to SS. All patients were selected according to the European Community Study Group diagnostic criteria for Sjogren's syndrome (the gold-standard of the study) and underwent contrast enhanced ultrasound examination with timeintensity curve analysis obtained before and during saliva stimulus, salivary glands scintigraphy and labial gland biopsy. Results: 40 SS patients had an echo contrast enhancement before and during saliva stimulus significantly lower (p < 0.001) than the non SS ones. The 23 patients with primary SS showed a significantly lower enhancement during saliva stimulus than the secondary SS patients (p < 0.005); no statistically different enhancement was seen in basic conditions (p = 0.069). In the study group (60 subjects with sicca syndrome) the enhanced ultrasound showed a sensitivity of 87.5%, a specificity of 85% and an accuracy of 86.7% on the diagnosis of SS. Our experience confirmed the good diagnostic accuracy of salivary glands scintigraphy and labial biopsy. The preliminary results show this method is useful in the functional study of parotid glands in the characterization of sicca syndrome. Fusion imaging of 3D angiographies of arteries and veins around the stomach by multiphase fusion technique under a single-breath hold using 16 row multidetector row CT: Its usefulness for preoperative simulation and intraoperative navigation of laparoscopy-assisted gastrectomy M. Matsuki, H. Kani, I. Narabayashi; Takatsuki/JP Purpose: Gastric arteries and veins can vary between patients; therefore, it requires much time to ligate arteries, and veins can be damaged during regional lymph node excision under laparoscopy-assisted gastrectomy (LAG). We evaluate the efficacy of fusion imaging of three-dimensional angiographies of arteries and veins around the stomach by the multiphase fusion technique under singlebreath hold using 16 row multidetector row CT (MDCT) in the preoperative simulation and intraoperative navigation of LAG. Methods and Materials: Contrast-enhanced CT scan using 16 DAS MDCT was performed on 10 patients before LAG. Images at both arterial and venous phases were obtained under a single-breath hold. Three-dimensional CT angiographies at the arterial and venous phases were reconstructed using the volume-rendering technique and then fused. 1) The detectability of the left gastric artery (LGA), right gastric artery (RGA), left gastric coronary vein (LCV), right gastric vein (RGV) and Helens' gastrocolic trunk (GCT) on the multiphase fusion images was evaluated in comparison with the surgical findings. 2) In intraoperative navigation, the clinical usefulness of multiphase fusion imaging was evaluated. Results: 1. In nine of ten patients (90%), the multiphase fusion images could demonstrate clearly, simultaneously and three-dimensionally the LGA, RGA, LCV and GCT without a respiratory gap. 2. We could arrange and rotate a multiphase fusion image to correspond to the operative view, which was very useful in the intraoperative navigation of LAG. The multiphase fusion imaging is considered to be very useful in the preoperative simulation and intraoperative navigation of LAG. Three-dimensional endosonographic guidance of needle positioning in interstitial brachytherapy A.F. Christensen, M.B. Nielsen, S.A. Engelholm; Copenhagen/DK Interstitial brachytherapy is used in the treatment of anal carcinoma, so far without image guidance during needle positioning.The aim of the study was to describe a procedure for optimizing needle positioning guided by three-dimensional (3-D) endosonography. Twelve patients who received external radiation therapy for anal carcinoma were referred for interstitial brachytherapy under 3-D endosonographic guidance. The procedure was initiated by anal endosonography performed with a 10 MHz rotating endoprobe. Cross-sectional images of the anal sphincters were stored on a 3-D system during retraction of the endoprobe. Afterwards, any projection could be reconstructed. From this scanning the optimal positioning of the needles was determined. The needles containing radioactive isotopes were inserted through holes in an externally fixated disc. Repeated endosonography assured that optimal tumor coverage was obtained by adjusting the number, loading or position of the needles. In all patients endosonography was able to visualize the extent of the tumor and the position of each needle so that both the distance from needle tip to upper tumor border, as well as the distance from the anal orifice to the lower tumor border could be determined. In 8 patients endosonography showed a, at least 2 clock-positions larger circumferential tumor size than manual examination. This made an increase in number of needles necessary. In 5 patients endosonography influenced the extent of loading of the needles. In 2 patients endosonography led to a change in positioning of the needles. 3-D endosonography guidance of interstitial brachytherapy in anal carcinoma seems possible, which may influence the radiation coverage. To determine CT criteria that allows accurate classification of interstitial hernias. Methods and Materials: CT scans of 13 patients with surgically proved spigelian hernia (n = 7) or interparietal inguinal hernia (n = 6) have been retrospectively reviewed. CT assessment included: 1) Assessment of the hernial sac (anatomic situation, extension, content) and 2) assessment of the fascial defect (anatomic situation, relationship to the inferior epigastric vessels). Results: In all cases (n = 13), the hernial sac was located between the internal and external oblique muscles. The fascial defect was located at the spigelian aponeurosis, above the inferior epigastric vessels in the seven cases of spigelian hernia, and at the internal inguinal ring, lateral to the inferior epigastric vessels in the six cases of interparietal inguinal hernia. Conclusion: Assessing only the hernial sac does not allow accurate classification of interstitial hernias. Diagnosis is established by precise analysis of the anatomic situation of the fascial defect. The role of magnetic resonance cholangiography in patients with biliaryenteric anastomosis Y.A. Akhmetov; Almaty/KZ Purpose: The study was aimed at investigating the role of MR-cholangiography (MRC) in the examination of patients treated with biliary-enteric anastomosis. Methods and Materials: MRC was performed in 23 patients (13 female and10 male, mean age: 59.9 years) undergoing biliary-enteric anastomoses (18 hepatico-jejunostomies and 5 choledocho-duodenostomies). MRC was performed with a non-breath-hold 3D turbo spin echo sequence (TR = 5000 msec, TE = 700 msec, ETL = 128) with an acquisition time from 4 min to 6 min. 11 patients subsequently underwent percutaneous transhepatic cholangiography (PTC) in order to confirm the MRC findings and to perform a therapeutical procedure. 4 patients with choledochoduodenostomy were examined with ERCP. The remaining 8 patients, with no evident symptoms or signs of bile duct dilation, were examined during their surgical follow-up without the performance of any invasive procedure. The degree of bile duct dilation was correctly evaluated with good panomaric assessment of the ducts and site of anastomosis in all 23 patients. Both dilated and non-dilated bile ducts were well depicted. MRC correctly showed stenosis of anastomosis in 10 of 10 patients, 5-18 mm stones in 9 of 9 patients and bile ducts irregularities in 3 of 5 patients with cholangitis. Conclusion: MRC is a safe, noninvasive technique in the study of biliary-enteric anastomoses and can be used to the screening of symptomatic patients. MRCP images may serve as a guide for planning of interventional procedures. Cystic duct imaging using both magnetic resonance cholangiography (MRC) and 3D Learning Objectives: To describe the indications and diagnostic limits of each procedure, to present the steps taken to perform each procedure as well as the possible complications, and potential pitfalls. Background: The early diagnosis of breast cancer is a challenge in breast imaging work-up. To detect malignancy in non-palpable breast lesions without unnecessary open biopsies, percutaneous biopsy of the suspect lesion should be undertaken. Percutaneous breast biopsy can be performed under sonographic or X-ray guidance. Whatever method is used, certain principles apply. Exhibit Details: The exhibit will be divided into subsections focusing on the indications and diagnostic limits of each procedure, the necessary equipment for each method and the steps taken to perform each procedure through sample cases. We will focus on practical issues such as needle size, site of entry, number of tissue probes that we need to take according to the lesion type. Also the avoidance of complications, and other useful tips will be presented. A special reference will be made to the histological findings that require surgical excision and the potential pitfalls in case of false negative samples. We will also present a short time follow-up diagram for the histologically confirmed benign lesions. Conclusions: Whenever a non-palpable breast lesion is considered for biopsy, either X-ray or ultrasound guided procedures are performed. Each method has its indications, advantages and disadvantages, and the examiner should be familiar with those factors for proper procedure selection. The use of carbon marking after stereotactic 11-gauge vacuum-assisted breast biopsy and during advanced breast Results: Eleven cases were considered FN (6%). A) Four cases were found after 14-G core biopsies: two architectural distorsions initially diagnosed as radial scars proved to be malignant after surgery, and one case of microcalcifications, first diagnosed as adenosis, underwent 6 month follow-up corresponding to a ductal carcinoma in situ. Also a ductal carcinoma in situ was found inside a fibroadenoma (first diagnosed as fibroadenoma). B) Also seven cases were found after vacuum-assisted biopsies, all of them microcalcifications that were confirmed in the radiograph of the specimen: five cases were initially diagnosed as atipical ductal hyperplasia and corresponded to four ductal carcinomas in situ, and one infiltrating ductal carcinoma; the remaining two cases were first reported as ductal ectasia and interstitial microcalcifications, becoming two ductal carcinomas in situ (one of them was diagnosed 12 months later after core biopsy). The average diameter of the lesion was 31.5 mm. None of the lesions were removed completely. Conclusion: Results such as radial scar, atypical ductal hyperplasia, interstitial microcalcifications and ductal ectasia may occult a carcinoma after needle core biopsies. The percutaneous triple sample (FNAC, core biopsy, and cylinder smears) in breast cancer diagnosis: Results in 77 patients I. Vizcaino, V. Torres, S. Picó, E. Blanc, C. Soto, S. Isarria; Valencia/ES Purpose: To evaluate a combined method to sample tumoral tissue in breast cancer. A prospective study using at the same time FNAC, core biopsy and cylinder smears was performed in 77 patients. We used a 25 G needle (1-2 passes) and a thin-wall 16 G needle (2-5 cylinders, 1 mm/1 cm sized). Smears of core biopsy cylinders were systematically prepared to cytological examination. The lesions were targeted using palpation, ultrasound, coordinates plate, and a stereotactic device depending on the lesion. All patients had breast cancer. The results were evaluated regarding the sensitivity to breast cancer diagnosis. The overall sensitivity of three-way diagnosis was 99% (the false negative case was a non-palpable DCIS that showed necrosis in cylinder and no tumoral cells in both, FNAC and cylinder smears). The sensitivity of FNAC was the same as core biopsy: 86%. The sensitivity of cylinder smears was 95%. Benign tissue in cylinders with malignant cells in cylinders smears was seen in 7 cases (2 DCIS, 1 necrotic medullar carcinoma, 1 intracystic carcinoma and 3 IDC). Fibrous tissue was found in the cylinders of these 7 cases. The combination of FNAC, core biopsy and cylinder smears show a high sensitivity to breast cancer diagnosis. Cylinder smears must be obtained systematically in core biopsy in order to prevent the false negative results. Weak cohesion of tumoral cells can explain this phenomenon. Purpose: Mammographic follow-up of patients after conservative treatment for breast cancer by screen-film mammography is difficult and sometimes impossible due to the post-radiation and surgical changes. Digital mammography (DM), with post-processing tools, might facilitate the reading. The purpose of this presentation is to evaluate the accuracy of DM and to describe the post-therapeutic changes in these patients. Materials and Methods: DM (Senograph 2000D, GEMS®) was performed in 77 patients 3 and 6 months after conservative treatment (surgery and radiotherapy) for breast cancer. Mammograms were indepedently read by two senior radiologists. Both radiologists performed screen-reading, using commercially available post processing tools (magnification, zoom, contrast inversion, thickness compensation). They evaluated the overall image quality. The following features were also analysed: breast density (according to BIRADS classification), skin thickening, parenchymal changes with glandular oedema (4 grades), scar and microcalcifications. Results: All DM were considered as of diagnostic quality by both radiologists. Importance of glandular oedema was correlated to breast density (BIRADS 4, n = 16; oedema 4, n = 14), (BIRADS 3, n = 41; oedema 3, n = 48). Analysis of skin and dermal thickness was facilitated by the algorithm of thickness compensation. Visibility of scars (n = 54) and microcalcifications (BIRADS 2, n = 21; BI-RADS 3-4-5, n = 6) was improved by digital magnification and digital contrast variations. Conclusion: Digital mammography due to the post processing tools seems to facilitate dramatically reading of mammography in patients with previous conservative treatment for breast cancer, and helps to delineate post-therapeutic changes. The Conclusions: It appears that the achievable image quality of a system not only depends on detector characteristics but also on available combinations of target, filter and tube voltage. Therefore image quality comparisons show different results using optimized spectra for each digital system, compared to using the same spectrum for all systems. To show a short way to present breast MR dynamic imaging obtained using 1-mm 3 isotropic 3D acquisition and single-voxel proton spectroscopy. Background: During a standard breast MR exam, including a precontrast shorttau inversion recovery (STIR) or fast spin-echo T2-weighted fat-sat and a dynamic Gd-enhanced 3D sequence, at least 700 native and subtracted images are produced. Moreover, maximum intensity projections (MIPs) of a subtracted phase and dynamic curves must be shown. If performed, proton spectra could be given with localizing images, too. Procedure Details: Seventy breast MR exams were performed at our Department as follows: 40-slice axial STIR; 128 T1-weighted 3D gradient-echo coronal 1-mm partitions (384 x 192-mm field-of-view; 384 x 192 matrix; 1-mm 3 voxel) with 0.1 mmol/kg Gd-chelate and 120-s time resolution (4 postcontrast phases), giving 680 native and 512 subtracted for a total of 1192 images; single-voxel spinecho (TE 135 ms) proton spectroscopy. We present firstly an axial MIP of the first subtracted sequence similar to cranio-caudal X-ray mammography (XM) views, two lateral MIPs similar to lateral 90 degrees XM views, and a coronal MIP. Then, only selected images are presented: STIR, precontrast T1-weighted, and postcontrast subtracted images (morphology); percent enhancement-to-time curves for regions of interest (dynamics); proton spectra with/without choline peak at 3.14-3.34 ppm and lipids peaks (metabolism). Representative cases will be shown in correlation XM, ultrasound, and pathologic proof. Conclusion: Breast MR high-resolution imaging and proton spectroscopy can be effectively summarized in no more than 24 images (2 x 16-in-one films), 2% of the acquired/subtracted 1192 images. MR guided interventional procedures in breast pathology management I. Herraiz, L. Concepción, J. Ballesteros, A. Fernández-Moscoso, J. Gallego, M. García-Franco; Alicante/ES; presented by S. Lopez-Celanda; Alicante/ES Learning Objectives: To descibe MRI-guided core biopsy of MRI-suspected lesion, hook wire placement or clip marking for excisional biopsy of non-palpable, MRI-only visualized lesions. Procedure Details: All procedures were performed on a 1.5 T Philips Gyroscan Intera Unit. Standard CE breast MRI imaging protocol included a dynamic volumetric T1-weighted acquisition prior and after Gd-DTPA injection employing a bilateral surface coil. Localization was achieved either by employing a stereotatic device or by triangulation methodology with external markers with a flexible unilateral surface coil. Imaging acquisition was tailored to each case. Titanium clips (INRAD®) or nitinol (SOMATEX®). 15 G Titanium coaxial needles (SOMATEX®) and 16 G automatic biopsy gun were employed (TSK ACECUT®,). Our series includes 44 patients with 56 MRI suspected lesions. Reevaluation of them with conventional methods (mammography and sonography) allowed location of half of them resulting finally in a total of 36 MRI-guided interventional procedures. This includes 20 MRI-guided core biopsies in lesions measuring 5-12 mm, 9 MRIguided presurgical hook wire localization and 7 clip placements to assist location of a MRI visible single lesion. Pathologic evaluation resulted in 10 cases of infiltrative ductal carcinoma and 18 benign lesions. The only biopsy false negative result was in the smallest lesion (5 mm). Conclusions: All MRI-suspected lesions must be reevaluated by conventional methods. In MRI-only visible lesions we favor clip marking or hook wire location if size is smaller than 7 mm. In lesions highly suspicious for malignancy additional clip marking during core biopsy procedure is recommended. Background: Accuracy of pre-treatment diagnosis of breast carcinoma extension is essential in order to plan the most effective therapeutic approach. Extension of carcinomas can be difficult to interpret on 2D images, especially if their distribution is segmental or irregular. Also, additional multifocal or multicentric foci can be problematic to localize in respect to the main tumour and the anatomy of the remaining breast. It is furthermore important for breast surgeons to apprehend the extent of the disease in radiological images in order to plan the surgical approach. Procedure Details: T1-weighted FLASH 3D pre-and post-contrast images were obtained in patients diagnosed with breast cancer on core biopsy. Analysis of images was done with a dedicated software for breast MRI (Asymedâ). Parametric images for maximum enhancement speed, maximum enhancement, multiplanar and 3D reconstructions, speed of enhancement curves and enhancement curves are analysed in each patient. 3D images were viewed as video clips with a 360 degree rotation around both breasts. Maximum tumor diameter was measured in all images and distribution was reported following surgical anatomy. All shown cases have been histopathologically proven in respect to size and extension. Conclusion: Besides analysis of morphology and speed of enhancement curves, maximum enhancement speed parametric 3D images stand as a useful approach to tumor extension, giving additional information and an overall view of distribution of the disease in respect to breast anatomy. Background: The rate of breast cancer recurrence is 1-2% per year. Follow-up of patients after conservative surgery includes a periodic clinical examination and a mammography every 6 months during the first 2 years and every year thereafter. Post-treatment changes may mimic or obscure recurrent cancer. Diagnostic problems are encountered with conventional imaging and fine-needle aspiration cytology. Increased vascularity and vascular permeability occurs in recent scars and inflammation; however majority of scars 6 months after surgery do not enhance significantly at MRM while all malignancies do. Imaging Findings: In our series all cases of proved recurrence showed over 70% maximum signal intensity enhancement at minute 1 and plateau or washout dynamic curve at MRM. Only two cases of scar showed more than 70% maximum signal intensity enhancement at minute 1 and the curve in all benign cases was gradual. The quantitative data should be always correlated with the morphology of enhancement curve. Irregular shape or margins and inhomogeneous enhancement proved to be important criteria for recurrence assessment. Conclusion: MRM appears a valuable tool to differentiate post-treatment changes from recurrent carcinoma and to guide the pathological confirmation. Its high negative predictive value may have an impact on follow-up of treated breasts. The correlations between enhancement parameters and histopathological findings were analyzed using stepwise multiple regression analysis, Student's-T test and Spearman moments correlation coefficients. Results: Significant correlations were determined between the presence of lymph node metastasis and tumor size (r = 0.397, p < 0.01), contour characteristics (r = 0.369, p < 0.05), and edge characteristics (r = 0.495, p < 0.01). A highly significant correlation was found between histological grades and qualitative enhancement patterns (r = 0.403, p < 0.01). Statistically significant differences were found between the groups with and without lymph node metastasis regarding enhancement in the 1 st minute (p < 0.01) and TIC slope (p < 0.05). A significant difference was found between the histological grades I and III regarding all quantitative enhancement parameters, whereas no difference was found between the grades I-II, and II-III. Conclusion: DCE-MRI helps to predict prognostic factors of breast cancer by revealing qualitative and quantitative enhancement features of the primary tumor. Additional morphological factors further improve our ability to predict lymphatic metastasis. We measured the number of vessels, the major systolic velocity (PS), the end diastolic velocity (ED), the resistance index (RI) and the glosing index (PI) appearing in all the slices we took. We noted the maximum and minimum values of all the above parameters that appeared in the same mass in different slices and calculated the differences. Results: For the benign tumors the mean values for the differences between the maximum and the minimum number of vessels was (DIFFVES) 3.26 (P < 0.00), the DIFFPS was 3.23 cm²/sec (P < 0.00), the DIFFED was 2.38 cm²/sec (P < 0.01), the DIFFRI was 0.12 (P < 0,03) and DIFFPI was 0. Reliability of US-diagnosis of metastatically affected regional lymph nodes in the presence of female breast cancer E. Shevchenko, A. Zubarev; Moscow/RU Purpose: Analysis of false-positive and false-negative results of US in diagnosis of metastatic lymph nodes (l.n.) in breast cancer. Materials and Methods: 346 patients with breast cancer (stages T1N0-T3N2) were examined on HDI 5000 ATL Philips with morphological verification. 105 patients (30.35%) had metastatic deposition in regional l.n. Results: Precision of US-diagnosis of unchanged l.n. was equal to 0.86, specificity -60.7%, sensitivity -84.8%. False-negative results were found in 15 cases (4.3%). In B-mode the oval shape remained unchanged in all 15 cases, cortical layer and core were differentiated. Thickness of cortex: 0.15-0.3 cm, node size: 0.3 x 0.5 cm-1.2 x 0.9 cm. In 10 cases blood flow was located in portal region, 5 cases -1 longitudinal vessel in center of the l.n. Sizes of the l.n. with micrometastases were up to 1.2 cm. We had false-positive results in 27 patients (7.8%). Round shape was found in 11 cases, oval -in 12, in 4 patients 2 l.n. joined together in 1 irregularly shaped node. In 10 cases there was uneven thickening of cortex in one pole of node with size fluctuation. Differentiation of cortex and core was absent in 17 cases and echogenity was diffusely lowered. Subcapsular vessels were located in 14 cases, aberrant vessels -in 1, distortion of central vessel -in 6, local absence of perfusion -in 1. False-positive cases corresponded to sinus-histiocytosis, hyperplasia of lymphoid tissue. Conclusion: Only use of the full complex of US-symptoms of metastatically affected l.n. lets us improve the precision of diagnosis. Inter-and intraobserver agreement in breast ultrasonography: Significance of internal echoes at image interpretation J. Tsutsumi, K. Shimamoto, M. Ikeda, A. Sawaki, H. Satake; Nagoya/JP Purpose: To evaluate the significance of internal echoes among diagnostic US criteria for breast lesions. Materials and Methods: 100 breast masses (50 benign, 50 malignant) were interpreted by 6 radiologists and 20 radiological technologists using a four-point rating scale, and the kappa statistics were employed for analying interobserver agreement. To assess reproducibility in judgments, double reading was done in 50 cases, and a total of 150 cases were interpreted for each observer. US criteria included shape, border, boundary echoes, internal echoes (homogeneity and echo level), posterior echoes, lateral shadow, gland surface, depth-width ratio (D/W) and total impression in differentiating benign from malignant lesions. To evaluate the significance of internal echoes at US image interpretation, US images were modified to make the internal echoes invisible by painting with black color using the Adobe Photoshop. : ROC analysis showed a significant difference in diagnostic performance between the original US images and modified US images (p < 0.05). The kappa value of posterior echoes was highest whereas that of boundary echoes showed the lowest value in both the original and modified US images. Inter-observer agreement in shape, border, and category in the original images was significantly higher than that in the modified images (p < 0.05). Reproducibility in boundary echoes and gland surface was fair, and that in posterior echoes and the D/W was good. Can a mammogram dictate to you the diagnosis? A review of characteristic mammographic findings A.N. Chalazonitis 1 , J. Tzovara 2 , T. Vrakatselis 1 ; 1 Athens/GR, 2 Ioannina/GR Learning Objectives: Participants will obtain an approach to various mammographic patterns and improve their diagnostic skills in breast imaging. Background: Mammography is considered by far the single most important imaging modality for breast diseases. Except from radiologists with vast experience, many other physicians without specific knowledge are unable to discriminate normal from abnormal findings in the mammograms. Imaging Findings: The main aim of this exhibit is to provide a pictorial review of characteristic radiological findings in 15 different mammograms. Various examples due to different causes are illustrated and mammographic findings, as well as differential and final diagnosis are also discussed. All cases have been selected by reviewing our Hospital teaching files. Conclusion: Our exhibit will allow participants to challenge their skills in the detection of both normal and abnormal mammographic signs. Breast imaging and histopathologic correlation of fibroadenomas in patients with transplanted kidney: Different features from usual fibroadenoma E. Son 1 , E.-K. Kim 2 , K. Oh 2 ; 1 Sungnam/KR, 2 Seoul/KR Learning Objectives: To analyze the imaging and histopathologic features of fibroadenomas in kidney transplanted patients and to compare findings of fibroadenomas in kidney transplanted patients with those in a control group. Background: From 1990 to 1999, 1,438 patients underwent renal transplantation at our institute. All patients received immunosuppressive therapy with cyclosporin A and steroid after renal allograft. We examined ten female patients who were diagnosed with fibroadenomas during chemotherapy, and compared the data obtained with that of fibroadenomas in the normal population. Procedure Details: Twenty-two fibroadenomas developed in ten patients. Eight of the 10 patients had multiple fibroadenomas and 7 had bilateral fibroadenomas. The mean diameter of the fibroadenomas was 4.17 ± 2.5 cm. By mammography the lesions were spherical in shape and had a well circumscribed margin with a high density mass. None of the lesions showed calcification or spiculation. Sonographic findings of the masses showed relatively high echogenecity with higher L/T ratios than benign masses, however, features of homogeneous internal echo and well circumscribed margin were consistent with benign. Conclusion: The fibroadenomas that developed in patients with renal transplantation showed a tendency to be multiple, bilateral and larger than those in the control group. These fibroadenomas also exhibited a more rapid growth, a more spherical shape and an unusually high internal echo and higher L/T ratio than usual fibroadenomas. To present mammographic and ultrasonographic (US) findings in various types of reconstruction using autogenous myocutaneous flap after mastectomy or breast conserving operation. Background: Breast reconstruction is an integral part of a woman's breast cancer management and yields positive psychological benefits for the patient. Autologous tissue reconstruction has gained in popularity in part owing to adverse publicity regarding prosthetic implant safety. It can alter breast anatomy and architecture drastically. In this exhibit, we describe mammographic and US findings in the various types of reconstruction using autogenous myocutaneous flap after mastectomy or breast conserving operation. Procedure Details: Mammography and ultrasonography obtained in patients who had undergone reconstruction mammoplasty using the autogenous myocutaneous flap procedure were reviewed to facilitate recognition of both normal and abnormal postoperative appearances of the various types of reconstruction using autogenous myocutaneous flap after mastectomy or breast conserving operation. Normal mammographic and US findings include predominance of fatty appearance, surgical clips, and surgical scars. Abnormal mammographic and US findings include fat necrosis, calcifications, and locally recurrent carcinoma. US findings of fat necrosis were cystic, complex and solid appearing masses with circumscribed or ill-defined margins in peripheral portions of flap. US finding of locally recurrent carcinoma was ill-defined heterogeneous hypoechoic lesions in reconstructed breast, similar to those of primary breast cancer. Conclusions: Breast reconstruction using autogenous myocutaneous flap has increased in popularity with various methods. Mammography and sonography facilitated excellent visualization of normal and abnormal findings of various reconstructed breasts using autogenous myocutaneous flap. Extramammary pathology mimicking breast disease E. Rabanal, R. Rosell, J. Salvia, R. Garcia; Sabadell/ES Learning Objectives: To present the imaging findings in cases suspected initially of breast disease which turned out to have extramammary pathology. Background: We reviewed our records for the last ten years. During that time, 76,443 mammary studies were performed. All cases with extramammary pathology were selected. They were classified into two broad categories: those which had abnormal physical findings (palpable mass or skin thickening) and those with abnormal findings in the mammogram (calcifications, nodules and thickened lymphatics). Imaging Findings: Cases were classified as follows: Microcalcifications secondary to filariasis. We will see more of these cases due to increased immigration. It's important to know this entity to make the correct diagnosis and avoid unnecessary examination or biopsy. Uniform skin thickening and/or oedema, secondary to systemic disease (sclerodermia), congestive heart failure or lymphoedema. Palpable skin nodules (infected sebaceous cysts), simulating mammary abscesses. Chest wall disease: Empyema necessitatis draining into the breast. Extramammary (chest wall) lipomas and Dercum's disease. Neurofibromas in von Recklinghausen's disease. The imaging findings of these processes will be reviewed and their salient features described in order to suggest the correct diagnosis. Conclusion: It is important to know the features of extramammary disease in order to make the correct diagnosis, avoiding further examinations and unnecessary invasive procedures. The reality of microcalcifications in breast tissues shown by synchrotron radiation imaging J. Okamoto, Y. Kanemaki, K. Imamura, N. Ehara, Y. Inada, I. Maeda, K. Miyamoto, Y. Nakajima, M. Fukuda; Kawasaki/JP Purpose: The aim of this study was to approach the reality of microcalcifications of benign and malignant diseases using synchrotron radiation imaging, and to make a comparison with conventional X-ray images. Materials and Methods: Surgical and biopsied specimens fixed in wax blocks were imaged using synchrotron radiation (SR), and conventional mammography unit (CONV) as well. Studied were 98 patients (40 benign, 58 malignant). SR imaging was performed at SPring-8 in Japan in refraction-enhancement mode. CONV images were evaluated visually using a magnifying glass. SR images were inspected on a monitor without magnification. Morphology of microcalcification was categorized to 3 groups: small round, amorphous (Am), and pleomorphic (Pl). Results: 1,319 calcifications were observed in 98 CONV images and 9,225 calcifications in SR images. 7,906 of 9,225 (86%) were invisible in CONV images. SR imaging revealed that great numbers of specks were recognized collectively as a single calcification in CONV images, and 949 of 1,319 calcifications in CONV images were found to consist of multiple specks. The incidence was especially higher in Am and Pl types (602/755 and 187/204, respectively). Comparing malignant with benign diseases, there was a striking contrast in Am-type calcifications; majority of Am-type calcifications in malignant diseases were found as collectives of fine specks (84/432), to the contrary 69/170 in benign (p < 0.0001). Conclusion: Synchrotron radiation imaging showed that majority of amorphous and pleomorphic type calcifications, especially of amorphous type of malignant diseases, in conventional images were essentially collectives of multiple specks. Psychological perceptions of women due to mammographic follow-up B. Barreau 1 , R. Gilles 1 , S. Tastet Results: 129 women answered the questionnaire. All women were satisfied with the mammography and the medical staff except that the mammography was painful in 56 cases. For 24 women, the period between mammographic follow-up was too long. In 33 women, the quality of life was altered. Communications of the experience to a relative was frequent (100/129 cases) but satisfactory in only 25 cases. For 113 women, medical information was considered relevant. The median of the scale of stress was 5 (0-10). There is two pickaxes, one at 2, the second at 5. "Low-stressed" women could have an avoidance coping. "High-stressed" women could use a helplessness-hopelessness coping strategy. Conclusion: Women reported relevant medical information and comprehension of the short follow-up -mammography. They were reassured by the medical care, but the evaluation of the scale of stress was high, probably due to the diagnosis. Mammographic density changes in postmenopausal hormone therapy: Effects of various agents using a new scoring system S. Orguc, C. Göktan, G.Y. Ovali; Manisa/TR Purpose: To evaluate the changes of mammographic breast density due to postmenopausal hormone replacement with various agents using a new scale and to compare the new scoring system with the classical methods. Materials and Methods: 222 women who received hormone replacement therapy in Celal Bayar University hospital between 1999-2003 were examined with baseline and follow-up mammograms. The effects of various hormone regimens, selected according to the gynecological status, were evaluated by two radiologists. Wolfe classification and a new scoring system were used to assess the change of mammographic density. The new scale divides each breast into ten wedge shaped slices on the CC positioned mammograms. Change of density is scored according to the number of slices, which have an increase of density in comparison with the baseline mammograms. The results were statistically evaluated to compare the effects of various hormone regimens using a control group of 75 patients who did not receive any hormonal therapy. Statistical analysis was also carried out to determine the effect of using different scales. Results: Tibolone effected breast density is less than preparations containing oestrogen. Degree of mammographic change differs depending on the scale used. The new scale is more sensitive in depicting changes of breast density. Conclusion: Preparations containing oestrogen effect the mammographic density more than tibolone regimens. The new scaling system is highly efficient and objective in determining the changes of breast density. To evaluate sensitivity and specificity of positron emission tomography (PET) and 18-F-fluorodeoxyglucose (18F-FDG) in breast cancer diagnosis and to assess tumor dissemination. Materials and Methods: 62 patients were examined: 10 without mammary disease, 10 with fibrous cystic mastopathy, and 42 with breast cancer, which was hystologically proven. PET-scans (Ecat Exact 47) in "Whole body" mode were performed 90 min after intra-venous injection of 370-420 MBq 18F-FDG. The T/ NT ratio for radiopharmaceuticals was evaluated. Results: In all patients with malignant tumors the T/NT ratio for PET-18FDG was higher than 2.0 (M ± m = 7.2 ± 0.99). It was shown that PET has a high diagnostic accuracy in breast cancer detection with sensitivity 97% and specificity 100%. PET scanning in the "Whole body" mode was allowed to assess dissemination of tumor process with high accuracy. PET 18F-FDG sensitivity was around 87.8% to100% in diagnosis of regional and distant metastases. It was related to metastases localisation. Conclusion: PET with 18F-FDG has high diagnostic accuracy in diagnosis of breast carcinoma and staging of tumor extent. Results Women aged between 45-65 were invited in three rounds in the mentioned period of time. Bilateral mammography with double projection was performed, and read in a double blind manner, according to the strict, prescribed methods. If needed, additional mammographic X-ray, US, FNAB and core biopsy was performed. Results: The acceptance rate was low, around 35.7% (13532 women were screened during five years). We called back around 6% of the screened patients for additional X-ray examination (1.5%) or for US (4.5%). We performed FNAB in 3% of all cases (405 women). 301 cases were proven benign. The overall rate of hystopathologicly verified invasive cancers per 1000 women were 8 (104 patients). We could detect an increasing rate of small cancers and better lymph node state by the time, because around 88% of the examined women were already screened by us before, during the 5-year-period. Number of interval carcinomas was nine (0.07%). Conclusions: Comparing to European standards our screening program was the same, but the acceptance rate was lover. The high non-acceptance rates can be explained mainly by the cross-screening possibilities of Budapest, Hungary and because the high risk population is not informed well enough. However, due to the mental hygenic program running in Hungary, we could detect an increased number of inquisitive women. Tubular carcinoma of the breast: Clinical, mammographic and ultrasonographic findings F. Zandrino 1 , M. Calabrese 2 , L.E. Bacigalupo 2 , F. Musante 1 ; 1 Alessandria/IT, 2 Genova/IT Purpose: Tubular carcinoma is a well differentiated invasive adenocarcinoma, with a prevalence ranging from 1 to 10% of all carcinomas of the breast. The purpose of this presentation is to analyse its clinical, mammographic, and ultrasonographic features, with histopathological correlation. Materials and Methods: In a retrospective review of 472 consecutive histologically proven carcinomas of the breast, 14 pure (tubular component of at least 75%) tubular carcinomas were found (2.97%) in 12 women (age 54 ± 10 yrs). Results: Three lesions were palpable. On mammography, five were not detectable; the remaining presented as nodules with spiculated (3 lesions) or irregular (2) margins, spiculated nodules with microcalcifications (2), distorsion (1), or asymmetric density (1). On US, 1 lesion was not detectable; the remaining presented as hypoechoic lesions with irregular (12) or well defined (1) borders. For 12 tumours, diagnosis of carcinoma was made with cytology; in 2 cases core biopsy: in the first a complex sclerosing lesion with atypical cells was suggested, in the second differential diagnosis between tubular carcinoma and sclerosing adenosis was proposed. Lesion size was 10.1 ± 5.1 mm. Only in 1 patient were metastatic axillary nodes found. Conclusion: In our series, tubular carcinoma presented mainly as a non-palpable, small-sized lesion, with non-specific mammographic patterns and a hypoechoic ultrasonographic appearance. Lymph node metastases are rare, as previously reported in the literature. Dose distribution in tangential irradiation for breast H. Ohtani, S. Usui, Y. Jincho; Tokyo/JP Purpose: Skin injury, lung disease and conservation radiation therapy for breast is reported. In a previous investigation, local management and survival rates were reported on the face of treatment effect's records, but the real irradiation doesn't become clear. This report is to measure the dose distribution of the effect on the critical organ by tangential irradiation of the left breast. Materials and Methods: Measurement was performed with a semiconductor detector. Irradiation was performed with X-ray beams at 124 degrees. Irradiation field sizes were established 10×20 cm 2 to investigate influence by field sizes. Irradiation was done on the wedge of 30 degrees. Results: Dose equivalent was accurately measured with semiconductor detectors. From the results, breasts, thyroid gland, heart, both lung fields, kidney, ovary, and uterine doses become clear. The dose distribution at tangential irradiation of left breast was measured. Consequently, the breast in which a radiation injury tends to be encountered, lung field, and the dose of important internal organs could be obtained. The necessity to confirm the dose distribution in the body for tangential irradiation in breast preservation treatment, refers to a radiation injury, and this study estimates these doses. The To assess the influence of 24 days of repetitive hyperbaric simulations on the form and structure of single-lumen silicone gel-filled implants. Materials and Methods: 6 new implants from 2 different manufacturers and 2 removed implants were submitted for 68 simulated dives in a hyperbaric chamber, with an average of 3 dives a day and with a maximal depth of 18 m. A standard X-ray and MRI were performed before, after 11 and 24 days of repetitive diving, and 43 days after the experiment. MRI was performed using a 1.5-T superconductive magnet (Symphony-, SiemensAG, Erlangen, Germany) with a body and spine coil, and a gradient echo T1-W sequence (3D FLASH), slice thickness 2 mm. The prostheses were checked for bubble formation, volume changes, integrity and morphological appearance. Results: There were no significant changes in form, nor in shell integrity. After 11 days of repetitive diving, there were some tiny bubbles in the implants, confirmed by X-ray and MRI. After 24 days, there were significant bubbles in 4 of the implants (increase in implant volume up to 10%); in the other 4 there was a slight increase in number and volume of bubbles. There was no significant change in the bubbles 43 days after the last dive. The significant bubble formation in some single-lumen silicone gelfilled implants after 24 days of repetitive diving, raises concern about the influence of repetitive stress on the lifespan of implants in correlation with the number and depth of dives. Resection of non-palpable breast cancer using 3D imaging created by multislice helical CT: A new interventional technique to design resection lines in breast preserving surgery K. Oda, T. Kubota, H. Satake, A. Sawaki, T. Ishigaki, Y. Nimura; Nagoya/JP Purpose: We report a new method for an adequate segmental resection of nonpalpable breast cancer employing an interventional technique using three-dimensional images of contrast-enhanced CT. Materials and Methods: Eight patients with non-palpable breast cancer (DCIS 6, invasive carcinoma 2) were included in this study. Diagnosis of carcinoma was made by cytology, but the extent of the lesion could not be clearly shown by US. One hour before the operation, contrast-enhanced helical CT was performed using a Toshiba Aquilion (Toshiba Corp. Tokyo) with the patient in the supine position, following the insertion of VATS (Video Assisted Thoracoscopic Surgery) markers (Hakko, Japan) under US guidance. CT scan was performed 75 seconds after the injection of contrast medium. The detector row configuration was 4 x 1-mm. Maximum intensity projection (MIP) was performed on three-dimensional reconstruction (3D-CT). Using three-dimensional images of CT, anatomical relationship of VATS markers, nipple and carcinoma demonstrated as a well-enhanced focal-clumped lesion or segmental lesion was evaluated and lines of resection with 2 to 3 cm surgical margin were designed. Curative resection was confirmed in X-ray films of resected specimens based on the relationship between the lesion and the VATS markers in preoperative three-dimensional CT images. Results: In all 8 cases, adequate segmental resection with cancer free surgical margins was accomplished and the cosmetic results of the surgery were satisfactory. Conclusion: Three-dimensional images of contrast-enhanced CT with this interventional technique is a useful method to design resection lines for non-palpable mammary carcinomas. European breast screening performance: Does case volume matter? H.J. Scott 1 , A.G. Gale 1 , D. Wooding 1 , D. Walter 2 ; 1 Derby/UK, 2 Augsburg/DE Purpose: U.K. Breast Screening Radiologists typically read over 5,000 screening cases per annum, whereas in Europe this figure is much lower as in many countries national breast screening programs are in their infancy. The PERFORMS scheme in the U.K. permits Radiologists annual self-assessment of their filmreader skills. As part of the EU funded European Breast Cancer Network a number of German Radiologists have now read the current PERFORMS assessment set. We investigated whether real-life case volume affects reading performance by the comparison of matched groups of Radiologists from these two countries. We analysed the data from current sets of difficult recent screening cases. For each case individuals identified which key mammographic features were present, whether the case was abnormal and should be recalled or not. For this analysis the participants were matched on age, gender, film-reading protocols and years of experience. Assessment of case volume was elicited by questionnaire data. The Radiologists were compared on several key performance measures; cancers detected, correct recall and correct return to screen, signal detection performance statistics and real-life screening practice. Results: It was found that whilst the performance of the German Radiologists on the current test sets was excellent (correct cancer detection rate > 85%) on average they performed less well than their UK counterparts. We argue that this is closely related to the volume of cases read per annum by individuals within each country, and theoretically their performance will be equivalent as their case volume increases. The cytogenetic method of dosimetric control for screening mammography V. Demin, E. Djomina; Kiev/UA Purpose: It is advisable to study a degree of risk due to the unfavourable consequences of irradiation of the breast with screening mammography in Ukraine after the Chernobyls disaster. The correlation of cytological (cytogenetic) and physical findings were accomplished. The test-tubes with donor human blood were placed on upper and lower surfaces of breast of tissue-equivalent Aldersons phan-tom. The test-culture of lymphocytes of human peripheral blood were used for biological dosimetry. Physical dosimetry are realised with the thermoluminescent system ALNOR. The chromosome aberrations are becoming 13 + 2.5% on the upper surface of breast (normal control level is 3%) on mammography in two projections (upper-lower and lateral), The fragments of chromosome type are 7%, radiation markers -dicentric chromosome are 1.5%; equivalent dose is 6.08%. Conclusion: There is a risk of radiation induced genetic lesions in breast tissue after mammography. Instability genome is a basic radiation carcinogenesis. This is very real for women in Ukraine after the Chernobyls disaster. Efficiency of the multidetector row CT in the diagnosis of breast cancer and evaluation of intraductal spreading H. Kani, M. Matsuki, I. Narabayashi; Takatsuki/JP Purpose: The purpose is to analyse the efficiencies of multidetector row CT (MDCT) in the diagnosis of breast cancer and evaluation of intraductal spreading. Materials and Methods: Pathologically diagnosed 82 breast lesions from 75 patients were examined by MDCT. The lesions included the following: 68 invasive carcinomas, 2 noninvasive ductal carcinomas, 2 fibroadenomas, 3 papillomas and 7 other benign lesions. Non-contrast CT and contrast-enhanced CT scans at 60, 120 and 240 sec after the start of enhancement were performed using 4 row MDCT. The imaging was performed under the following conditions: 0.5-sec gantry rotation speed, 5.5 helical pitch, 1 mm slice thickness and reconstruction intervals of 1 mm. The items examined were as follows: 1) In time-enhancement patterns during four phases, the early enhancement and plateau patterns were defined as a malignant tumor and gradual enhancement pattern was defined as a benign lesion. Its ability in the diagnosis of malignant tumor was evaluated in the comparison with histopathologic findings. 2) The abnormal enhancement continuing to the tumor at 120 sec after the start of enhancement was estimated as intraductal spreading of breast cancer. The detectability of intraductal spreading was evaluated by the comparison with histopathologic findings. Results: 1. The sensitivity, specificity and accuracy of the diagnosis of malignant tumor were 95.4%, 63.6% and 89.6%, respectively. 2. The sensitivity, specificity and accuracy of the detactability of intraductal spreading of breast cancer were 87.0%, 81% and 83%, respectively. Conclusion: MDCT is very useful for the diagnosis and preoperative estimation of breast cancer. An exploratory study about mammographic practice (ACR 3 from BI-RADS) three months after a medical continuing education on breast cancer B. Barreau 1 , S. Tastet 2 , M. Deghaye 1 , V. Picot 2 , I. Brault 1 , P. Marelle 1 , L. Ceugnart 1 , D. Aucant 1 , S. Haber 1 ; 1 Paris/FR, 2 Bordeaux/FR Objectives: Evaluation of practices, three months after a medical continuing education, when abnormalities ACR 3 (probably benign) are detected on mammography. Materials and Methods: A questionnaire (33 items) about these practices was sent to 755 radiologists three months after medical continuing education (May-December 2002) . The answers were analysed with chi-square test. Results: 225 radiologists completed the questionnaire; 102 radiologists practiced breast screening; 211 used the BI-RADS classification; 204 radiologists followed-up the abnormality with a short interval, 36 made a biopsy and 11 overclassed the image; 148 radiologists asked for advice from other radiologists, 49 from an expert, 45 submitted to a multidisciplinary committe and 15 asked for a second reading. A short interval-follow-up disturbed 115 radiologists about an eventual unfavourable evolution of the abnormality and 57 radiologists about legal problems; 36 had difficulty in explaining to patients the short interval-followup. The median of the scale (0 to 10) of the radiologists perceived stress is 3. Conclusion: These French radiologists have consistent practices with the BI-RADS classification and the ANAES recommendations. They may have difficulties in explaining the procedure to patients. The radiologist's ethic is based on the "primum non nocere". C 391 B D E F A G Histopathological perspective on the first German mammography screening project: A two year review G. Gohla 1 , U. Sauer 1 , P. Hanisch 1 , W. Boecker 2 , H. Junkermann 1 , U. Bonk 1 ; 1 Bremen/DE, 2 Münster/DE Purpose: The aim of this investigation was to critically review the role of the histopathologist in a mammography screening project. Materials and Methods: The first model mammography screening project in Germany has been running in Bremen for the last two years. All women between 50 and 70 years of age have been offered mammography and any suspect findings were investigated by core biopsy. These cases were reviewed in the Pathology Dept. of the University Münster and discussed at a weekly multidisciplinary meeting. Lesions were classified using the 5 point B classification scale as recommended by the European Union. Results: In the first two years of the screening project, a total of 22000 women had mammography. Suspicious areas were detected and core biopsies were obtained from 401of these women. 46 % were classified B5 (malignant) 46% of these cases were classified B1,2 (regular breast tissue, benign) and 8% of these cases were classified B3 and B4 (atypia probably benign, suspicious of malignancy). In 90% of all cases there was agreement amongst the reviewing histopathologists, but in 10% there was no interobserver consensus. These disagreements centered on flat epithelial atypia, atypically hyperplasia and papillary lesions. The consensus amongst experienced breast histopathologists is satisfactory in clearcut cases, but it should be improved in less well classified lesions. These lesions are more likely to be seen in a screening situation and in core biopsies. In this area it is certainly advisable to cooperate closely with the clinician and radiologist. Usefulness of multi-slice CT for nonpalpable breast lesions with microcalcifications: Correlation with mammographic findings H. Satake, A. Sawaki, K. Shimamoto, S. Ishigaki, K. Oda, T. Imai, T. Ishigaki; Nagoya/JP Purpose: To evaluate the usefulness of multi-slice CT for nonpalpable breast lesions with microcalcifications, compared with mammographic findings. Materials and Methods: 40 cases with nonpalpable microcalcification of the breast recommended for biopsy on MMG. They included 26 malignant lesions (ductal carcinoma in situ, n = 18; ductal carcinoma in situ with microinvasion, n = 8) and 14 benign lesions (mastopathy, n = 6; intraductal papilloma, n = 2; other, n = 6). On multi-slice CT images, the presence of focal or segmental enhancement in the region consistent with microcalfications was regarded as positive diagnosis for malignancy. All mammographic and CT findings were assessed with a consensus between two radiologists. Results: 4 cases of benign lesions pathologically were assessed as "suspicious malignant" on MMG, while, in three of them, focal or segmental enhancement appeared on multi-slice CT. Although seven cases of breast cancer were assessed as "probably benign" on MMG, six cases acquired focal or segmental enhancement on CT. For cancer diagnosis, the sensitivity of MMG and multi-slice CT were 69.2% and 96.0%, specificity was 71.4% and 57.1%, and negative predict value were 58.8% and 88.9%, respectively. Breast conservation surgery with simulation using 3D CT images was performed successfully in 17 cases of breast cancer. The sensitivity and the negative predict value of multi-slice CT for nonpalpable breast microcalcifications were superior to those of MMG. When biopsy is recommended according to MMG, additional examination of multi-slice CT enables the indication for biopsy to be more optimized and is useful for planning the treatment. The value of magnetic resonance imaging in the assessment of adult patients with corrected transposition of the great arteries S. Shine, E. Kavanagh, C. We fully illustrate the morphology, contrast enhancement and mobility of myxomas in rare locations such as the right ventricle and unusual attachment to the tricuspid valve. Background: Although benign myxoma is the most common primary cardiac tumor (25%), it remains a rare finding with an incidence of 0.5 per million population per year in the western world. Myxomas are found in the left (75%) or right (20%) atrium and seldom in the ventricles. These pedunculated tumors typically arise from the atrial septum near the fossa ovalis and much less frequently from the mitral valve. Intracardiac obstruction and systemic emboli are the major complications. Imaging Findings: Myxomas in an uncommon cardiac location should be differentiated from other primary (malignant) and secondary (thrombus; metastasis) cardiac tumors. MRI allows visualization of the narrow pedicle, its attachment and the changing tumor shape and mobility during the cardiac cycle, unlike most malignant processes. In contrast to most thrombi, myxomas have low signal intensity on cine gradient-echo images and show contrast enhancement. The water-rich myxomatous stroma, fibrous stroma, calcifications and hemorrhage account for the heterogeneous T2-weighted SE images. Increased interstitial space in the myxoid region and inflammatory zones enhance after intravenous Gd-DPTA on T1-weighted SE images. Lobular tumor surface and higher volume increase the pre-and postoperative risk for systemic emboli. Furthermore, the exact location on MRI is most helpful in planning the surgical access. Conclusion: Myxomas in uncommon locations can be differentiated from other cardiac tumors by evaluating tumor morphology, mobility and enhancement. How to study with CMR a patient submitted to Ross procedure: A step by step follow-up protocol R. Ribes 1 , A. Luna 2 , J. Vida 1 , P. Caro 3 ; 1 Cordoba/ES, 2 Jaen/ES, 3 Cadiz/ES Learning Objectives: To describe an adequate protocol to study patients submitted to Ross procedure with MR. To identify and quantify postsurgical complications in this group of patients with MRI. B D E F A G Background: Ross procedure is widely accepted as one of the best methods for aortic valve replacement, especially in children and young adults. Ultrasound is usually used in their follow-up, but tit offers a limited evaluation of the right outflow tract, being important to discard homograft stenosis. MRI overcomes the limitations of ultrasound and may replace the number of digital subtraction angiograms traditionally performed in the follow-up of these patients. Procedure Details: We describe step by step our MR protocol, to study patients submitted tothe Ross operation. Examples of the MR features of common presentations and complications are shown from our series of 53 patients. Our protocol consists of the following steps: • Black-blood coronal and transverse turbo spin echo T2-weighted images. • CineMR gradient-echo sequences allow functional qualitative assessment of themotion of valves and chambers, the detection of either valvular regurgitation orstenosis, and areas of altered myocardial contractility or relaxation. We perform GRE-CineMR sequences in left two chamber, right two chamber, fourchamber, short axis (at several levels from the apex to the base), left ventricular outflow tract, right ventricular outflow tract, and aortic rootviews. • Phase contrast images are performed to obtain quantitative data about magnitude anddirection of blood flow through the right and left ventricular outflow tracts. Conclusions: CMR allows an accurate evaluation of patients submitted to Ross procedure and identification of the postsurgical complications. The causes of focal outpouching of the left ventricle are as follows: 1) true aneurysm; a chronic complication of myocardial infarction, which contains the endocardium, epicardium, and thinned fibrous tissue replacing the myocardium, 2) pseudoaneurysm; a consequence of rupture of the ventricular free wall due to acute infarction and confined by the pericardium, 3) diverticulum; a congenital outpouching of ventricular wall including all of three layers, and 4) hibernating myocardium due to chronic ischemia with paradoxical outpouching at systole. MR imaging is useful in differentiating these causes by using variable imaging sequences to evaluate the myocardial contractility, perfusion and viability. In this exhibit, we will show the usefulness of MR imaging to differentiate these pathologies using various MR imaging sequences. Imaging Methods and Findings: Cardiac MR imaging methods include; 1) cine imaging for wall motion analysis, 2) first pass myocardial perfusion imaging, and 3) delayed enhancement imaging. Images were obtained along the short axis and horizontal long axis of the heart. By analyzing the shape, contractility, motion, perfusion, and contrast enhancement, it is possible to differentiate the causes of the outpouching lesion of the left ventricle. Conclusion: Cardiac MR imaging is useful in differentiating various causes of focal outpouching of the left ventricle. Features of cardiac disease demonstrated on CT pulmonary angiography S. Conclusion: CTPA is an increasingly frequently used investigation for the detection of pulmonary embolism. Most patients investigated have pathology other than PE as a cause of their symptoms. Frequently information about the heart is yielded that provides important clues to determine the cause for the presenting symptoms and signs or reveals co-existing pathology. With this investigation being used more frequently in daily practise in many patients with unexplained breathlessness or chest pain it is important to have a clear understanding of the features of cardiac disease as seen on a CTPA. MRI has been done twice -10-20 days and 12-24 months after surgery. MRI was performed with a 1.0 T MR imager using ECG-gated T1-SE (or T1-TSE), bright-blood GRE-CINE-technique and phase-contrast MRI. Results: 9 pts (of 20) had a positive dynamic study of heart chambers dimensions and volumes in early postoperative stage. In the area of prostheses signal of low intensity was defined in all the patients (artifacts). Narrow flow of low signal intensity along the prostheses leaflets corresponded to normal function of prosthesis (46 of 50 valves). 4 pts had signs of mechanical valve dysfunction (3mitral paravalvular leaks, 1 -aortic prosthetic valve stenosis). MRI data were in agreement with the results of echocardiography. MRI was able to diagnose such postoperative complications as atelectasis (4), mediastinal haematoma (2), pleuritis (2). Conclusion: MRI could give an objective information about heart morphology (chamber dimensions, hypertrophy degree) and mechanic valve functioning (normal and abnormal flow) in patients after surgery. It can be safely performed in patients with artificial heart valves. Negative calcium scoring: Can it rule out severe stenosis? P.M. Carrascosa 1 , C. Capuñay 1 , P. Garcia Merletti 1 , P. Johnson 2 , S. Chandra 2 , R. Pissinis 1 , J. Carrascosa 1 ; 1 Buenos Aires/AR, 2 Cleveland, OH/US Objective: To determine the presence of stenosis greater than 50% (in at least one coronary vessel) proved by digital angiography (DA) in patients with a negative calcium score and correlate findings with CT angiography. Methods: 30 patients were evaluated. CTs were performed with a 4-row CT scanner. The calcium score was calculated according to the Agatston method. A calcified plaque was defined as a lesion of at least two adjacent pixels with signal intensity above 130 HU. The second enhanced acquisition was performed following the administration of 130 mL of non-ionic contrast with 4 x 1 mm collimation and 0.5 mm slice increment. DAs were performed on a digital angiographer. Meas- Car Car Car Cardiac diac diac diac diac urements were done by means of QCA. Stenosis was considered positive if it was greater or equal than 50%. Results: there were 14 patients with high grade calcium score. Eleven had positive DA for at least 1 coronary artery and in 3 cases the DA did not show severe stenosis. There were 14 patients with negative calcium scores (Grade 0), 5 had negative DA findings, and 9 had positive DA findings. In these patients, the contrast CT acquisition revealed that the cause of the stenosis was due to soft plaques. Conclusion: high grade calcium scores predict severe stenosis. Negative results do not exclude them. In this study the 33% of the patients had negative calcium scores but significant stenosis due to soft plaques. A contrast CT acquisition instead of the calcium score will be necessary to rule out all the severe stenosis. Positron emission tomography and 13N-ammonia application to evaluate myocardial blood flow in the asymptomatic patients with coronary artery calcification D.V. Ryzkhova, I.E. Itskovich, L.A. Tyutin, L.A. Kofal; St. Petersburg/RU The purpose of this study was to assess myocardial blood flow (MBF) in the asymptomatic patients with coronary artery calcification (CAC). Methods: 26 symptom-free patients with CAC were included in study. All of them hadn't any symptoms of CAD (chest pain, severe arrhythmia, heart failure) and myocardial infarction history. The patients with significant myocardial hypertrophy weren't included. The myocardial blood flow at rest (MBF rest) and during dipyridamole test (MBF stress) was evaluated by 13N-ammonia dynamic PET ("Ecat Exact 47", Siemens). The coronary calcium score (CCS) was measured by MSCT coronaroangiography ("Somatom Volume Zoom", Siemens) using the Agatston method. Results: Myocardial perfusion abnormalities during stress test were revealed in 9 patients with CAC, there were patients with silent ischemia (1 st group). We observed normal myocardial perfusion at rest and during stress test in the remaining 17 patients (2 nd group). The mean values of total CCS were less than 100 Units and close between the both group (89.27 ± 11.84 Units vs. 84.9 ± 9.44 Units, p = NS). MBF-values at rest didn't differ between the both patients' groups (76.58 ± 8.0 mL/100 g/min vs. 74.46 ± 9.25 mL/100 g/min, p = NS). MBF stress mean values were significantly decreased in the 1 st group (137.1 ± 35.6 mL/100 g/ min vs. 207.8 ± 39.7 mL/100 g/min, p < 0.005). The CCS less than 100 Units isn't a reliable marker of flow-unlimiting stenoses in asymptomatic patients.Soft lipid-laden plaques is a cause of myocardial ischemia in symptom-free patients with CAC and low CCS. These patients should undergo stress studies to detect silent ischemia. Detection and assessment of myocardial inflammation and fibrosis by Echo-densitometry and CE-MRI in patients with mild and medium myocarditis: Validation by WBC-MIBI SPECT M. Deryugin, I. Itskovitch, V. Soukhov, S. Boytsov, A. Svistov; St.Petersburg/RU Background: Echo-densitometry and CE-MRI are novel methods for assessment of inflammatory myocardial infiltration (IMI) and myocardial fibrosis (MF). The purpose of the current study was to validate these methods in patients with mild/medium myocarditis using WBC-MIBI SPECT. Methods: CE-MRI was performed in 53 patients using T1-weighted TurboFLASH inversion recovery. Inflammation was evidenced by use of threshold method (signal intensity > +2.0 SD). Left ventricle Echo-densitometry performed in long-axis views from left parasternal border at ES/ED with following percentage cyclic variation indexes (CVI) calculation. SPECT was performed 16-20 hrs p.i. of 750 MBq 99mTc-WBC and 10 min p.i. of 99mTc-MIBI. Results: All patients were divided into 3 groups based on scintigraphic data: first group -20 patients with diffuse leukocytes uptake that considered as IMI; in second group there were 21 patients with local leukocytes uptake and abnormal MP (IMI+MF); third group consisted of 12 patients with only MF. Control group patients (n = 7) had normal MP and no leukocytes uptake. CVI was 38 ± 10% in controls; 10.6 ± 21% in 1 st ; -5.2 ± 22% in 2 nd and -19 ± 23% in 3 rd group. CE-MRI was able to detect IMI in 88% of patients. Regression analysis revealed good correlation between IMI by CE-MRI and by WBC-SPECT (r = 0.70, P < .01). Furthermore, good correlation was found between CVI and 99mTc-MIBI uptake (r = 0.51, P < .01) both for IMI and MF detection. Conclusion: CE-MRI enables exact detection of IMI as compared to WBC-SPECT. The results of videodensitometry studies demonstrated that different types of IMI were associated with definite CVI percentage, while CVI became negative with MF appearance. One-year CT evaluation of pulmonary veins following percutaneous cryoablation in patients treated for atrial fibrillation B. Ghaye 1 , D. Szapiro 1 , C. Background: Pulmonary vein isolation (PVI), using radiofrequency energy, for treatment of atrial fibrillation (AF) has been associated with complications including pulmonary vein (PV) stenosis or thrombosis. The purpose of this study was to prospectively evaluate the PV morphology following cryoablation. Method: 50 patients underwent percutaneous PVI in 3 academic centers. Contrast-enhanced, single-slice or multi-slice spiral CT (1-2.5 mm thick slices) was obtained before, 3 and 12 months following PVI. All examinations were read blinded to the location(s) of ablation. PVs were evaluated quantitatively and qualitatively: the diameter at ostium and at 1 cm from ostium were measured. The presence and location of luminal irregularity or thrombosis was also assessed. The aims of this study were comparison of the local myocardial contraction between the myocardium with DE and without, and evaluation of myocardial DE's prognostic significance in patients with congestive heart failure due to nonischaemic DCM. Materials and Methods: Delayed enhanced MRI and myocardial tagged images were taken in 27 patients (55 ± 16 yrs, 21 male) referred for congestive heart failure due to nonischaemic dilated cardiomyopathy, whose left ventricular (LV) end-diastolic volume index > 90 mL/m2 and LV ejection fraction < 50%. The patients were followed for a mean of 12 ± 6 months. Results: Myocardial DE was present in 13 patients (48%). In these 13 patients, the average amount of myocardial DE was 6 ± 11% of LV myocardium (2-54% of LV). Myocardial axial thickening was 13 ± 23% in the segments with myocardial DE, and 28 ± 27% without (p = 0.001). Myocardial circumferential shortening was 6 ± 10% in the segments with myocardial DE, and 10 ± 7% in without (p = 0.004 Electron beam CT (EBCT) in the detection of abnormal myocardial contrast enhancement in patients with recent and chronic myocardial infarctions T. Vesselova, V. Sinitsyn, S. Ternovoy; Moscow/RU Purpose: of the study was to determine the occurrence of low-density areas in the myocardium of the left ventricle (LV) in patients with myocardial infarction (MI) seen during non-invasive EBCT coronary angiography. Material and Methods: 35 patients (51.5 ± 12.0 years old) with ischemic heart disease and MI were included in the study. In 16 patients with first myocardial infarction (MI) EBCT was performed during first 2 weeks after coronary event. In 19 patients EBCT was done 12 months after an MI. EBCT angiography and venticulography were done with Imatron C-150 imager. Results: Low-density areas in LV myocadium were seen on EBCT images in all patients with MI. In 35% of patients these findings were accompanied by myocardial thinning and in 20% cases intracavitary thrombi were present. In 8.6% patients with transmural MI low-density myocardial regions were visualized on non-contrast images. In 22.9% patients with MI subendocardial low-density zones were seen. Results of EBCT were in agreement with myocardial scintigraphy. Characteristics of hypodense areas (HU values) in patients with recent and chronic MI were similar. Calcifications and significant stenoses of coronary arteries were found in all patients with old MI, the mean (SD) Agatston score was 293.5 ± 311.5. In patients with subacute MI the mean Agatston score was 194.9 ± 328.0 (NS). Four patients from this group had coronary score = 0. Conclusion: During EBCT coronary angiography most of the low-density areas corresponded to sites of previous myocardial infarctions. Some of these areas may correspond to hypo-perfused areas of ischemic, but viable myocardium. Progression of coronary artery disease in relation to coronary stenosis morphology: Quantitative coronary angiography analysis J. Saponjski, M. Ostojic, B. Beleslin, V. Vukcevic, M. Nedeljkovic, S. Stojkovic, A. Dordjevic/Dikic, I. Nedeljkovic; Belgrade/YU Objective: The aim of this study was to analyze progression and regression of coronary stenosis in relation to stenosis morphology. The study group consisted of 53 patients (43 male, 10 female; mean age 54 ± 11 years). Coronary stenoses were analyzed by quantitative coronary arteriography including percent diameter stenosis (%DS) and changes in obstruction diameter between two arteriographies. According to the Ambrose angiographic lesion morphology 4 groups were identified: Group I (n = 18)-simple concentric lesion morphology, Group IIa (n = 20) -simple eccentric lesion morphology, Group IIb (n = 22) -complex lesion morphology, and Group III (n = 6) with complex and multiple coronary stenoses. The follow-up period between first and second arteriography were similar for all groups (I, 8 ± 9 months; IIa, 11 ± 10 months; IIb, 7 ± 8 months; III, 6 ± 5 months; p = ns). Results: Progression of coronary artery disease was identified in 66%, 75%, 80% and 100% of lesions in Ambrose groups I, IIa, IIb, and III, respectively. On the contrary, regression of coronary stenosis was documented in 33%, 25%, 20% and 0% of lesions in groups I, IIa, IIb, and III respectively. However, comparing the lesions with non-significant and significant stenosis (cut-off point 50% DS), progression of coronary stenosis was higher for the lesions with DS < 50% for all groups (except group III where all the lesions were with DS > 50%), reaching statistical significance in group I (I, +0.52 ± 0.55 vs -0.24 ± 0.32 mm, p < 0.01; IIa, 0.61 ± 0.80 vs 0.13 ± 0.32 mm, p = ns; 0.66 ± 0.69 vs 0.33 ± 0.56 mm, p = ns). Conclusion: Coronary lesion morphology of simple type was associated with lower rate of coronary stenosis progression. Noninvasive The aim of this study was to assess coronary microcirculatory function in postmenopausal women. Methods: We measured myocardial blood flow (MBF) with a 13N-ammonia PET scan at rest, during cold pressor testing (CPT) for an indirect measurement of endothelium-dependent vasomotion, and during dipyridamole hyperemia (endothelium-independent vasomotion) in 16 postmenopausal women without coronary artery disease. 10 young healthy women served as controls. Results: Rest-MBF and hyperemic-MBF did not differ between the young and the postmenopausal women (rest: 76.3 ± 12.6 vs. 82.4 ± 14,.1 and dipyridamole: 220.3 ± 38.4 vs. 216.8 ± 34.9 mL/100 g/min; NS). Coronary flow reserve was similar between the two groups (the young women: 2.96 ± 0.91, the postmenopausal women: 2.71 ± 0.86; NS). CPT induced a similar increase of rate-pressure product in the young and the postmenopausal women (10580 ± 730 vs. 9659 ± 1653 beats/min/mmHg), CPT-MBF was significantly decreased in the postmenopausal women (64.2 ± 12.3 mL/100 g/min) compared with the young women (87.48 ± 14.7 mL/100 g/ min; p < 0.05). Conclusion: PET with 13N-ammonia during CPT is a noninvasive imaging technique to detect MBF abnormalities, which associated with endothelial dysfunction in postmenopausal women. Contrast-enhanced magnetic resonance imaging at true end-diastole to quantify reproducible transmural extent of myocardial hyper-enhancement Y.-J. Kim, B. Choi, K. Choe; Seoul/KR Purpose: To determine feasibility of contrast-enhanced MRI (ce-MRI) at true enddiastole (ED) free from limitation of time for inversion-recovery and trigger window for quantifying transmural extent of infarction. Methods and Materials: MRI was performed in 18 patients with myocardial infarction. Cine imaging and ce-MRI with same registered slices in short axis were performed. To allow true ED ce-MRI, ECG synchronization should use two RRintervals for one acquisition of a segment of k-space by setting the heart rate to half that of the true heart rate. Trigger delay time was adjusted to the RR-interval for imaging at ED and to the sum of RR-interval plus the time between R-wave and the end-systole (ES) determined in cine images for imaging at ES. Results: Wall thicknesses of the ED and the ES ce-MRI were greater than those of the ED and the ES cine images (7.5 ± 1.3 mm > 6.2 ± 1.4 mm, 9.4 ± 1.8 mm > 8.6 ± 1.8 mm respectively). Subendocardial hyperenhancement was detected in 13 patients. Among them, systolic wall thickening was observed with cine imaging in 8 patients and the transmural extent of hyperenhancement measured on ED ce-MRI decreased by 5-30% on ES ce-MRI proportional to the degree of systolic thickening of the epicardially nonenhanced myocardium. Transmural hyperenhancement in 4 patients showed no difference in thickness between enddiastole and end-systole. Conclusion: Ce-MRI at ED is constantly possible by using two RR-interval per acquisition of a segment of k-space and useful to avoid the variation in infart sizing with irreproducible cardiac phase other than end-systole in case of subendocardial infarction. Comparison of computed tomography (CT) and magnetic resonance (MR) for screening of pulmonary veins (PVs) complications of cryotherapy for percutaneous ablation of atrial fibrillation (AF) B. Ghaye 1 , D. Szapiro 1 , L.-M. Rodriguez 2 , C. Timmermans 2 , R.F. Dondelinger 1 ; 1 Liège/BE, 2 Maastricht/NL Purpose: To prospectively compare CT and MR for evaluation of potential complications, including stenosis or thrombosis of PVs, of cryoablation for AF. Methods and Materials: 21 patients underwent percutaneous cryo-ablation of AF. Cardiac spiral CT and MR were performed before the procedure, at 24 hours, and at 3 months following AF cryo-ablation. CT was performed with spiral CT (PQ 5000, Phillips, Eindhoven, The Netherlands) using 2 mm thick slices reconstructed every 1 mm, 1-s rotation time, 120 mA and 130 kV per rotation following IV peripheral injection of 120 mL of 30% iodinated CM. MR was performed on a 1.5 T Symphony VA15 system (Siemens, Erlangen, Germany) using a multi-slice T1-weighted dark-blood turbo-spin-echo pulse sequence and bright-blood cine trufisp sequence. All CT and MR examinations were quantitatively and qualitatively read blinded to the location(s) of ablation. Results: For CT, the mean diameters at LA-PV junction and at 1 cm from ostium were 1.6 (0. (1996.1-2002-6) . Associated cardiac and extracardiac anomalies were evaluated on fetal echocardiography. Postnatal diagnosis or autopsy were correlated with fetal echocardiography. Results: In 30 fetuses with right aortic arch, combined congenital cardiac diseases were as follows, TOF (8), VSD(1), and DORV with pulmonary stenosis (1) . Associated extracardiac anomalies were oligohydramnios(2), arthrygryposis(1), splenic cyst (1), and shortening of long bones(1). On postnatal echocardiography, previously non-diagnosed VSD were found on two neonates and TGA without VSD in one neonate. Overall incidence of combined cardiac defects is about 43.6%. Conclusion: Right aortic arch associates variable cardiac defects and extracardiac anomalies in about half of fetuses. Prenatal diagnosis of right aortic arch must be followed further echocardiography and targeted fetal sonography for exact diagnosis. Potential myocardial iron content evaluation by MR in β β β β β-thalassemia major patients treated by deferoxamine or deferipron M. Galia, M. Midiri, T. Bartolotta, A. Maggio, R. Lagalla; Palermo/IT Purpose: To evaluate the usefulness of MRI to assess myocardial iron content in patients with β-thalassemia major treated by Deferoxamine B mesylate (DF) or Deferiprone (L1) chelation therapy. Method and Materials: 72 consecutive patients with β-thalassemia major (35 treated by DF and 37 by L1) underwent, at enrollment and after one year treatment, heart MRI (1.5 T unit) with an electrocardiogram-triggered gradient-echo T2 weighted sequence. Liver MRI was obtained at the same time in all patients. Measurements of the heart to muscle signal intensity ratio (HSIRs) were compared between the two groups and with laboratory parameters, liver iron concentration (LIC) and liver to muscle signal intensity ratio (LSIRs). Results: HSIRs were significantly increased in DF (t = -2.8; p = < 0.01) and L1 group (t = -3.1; p = < 0.01) after one year treatment. No statistically significant difference in the values of HSIRs was present between the two groups at the beginning (p = 0.25; t = 1.13) and after one year treatment (p = 0.20; t = 1.28). HSIRs were inversely correlated to LIC (r = 0.52; p = < 0.001) but not to ferritin levels (r = 0.10; p = 0.18). A positive correlation was found between the variation of HSIRs and that of LSIRs (r = 0.52; p = < 0.001), and a mild correlation (r = 0.40; p = < 0.001) was found between the γ-glutamyltransferase levels and the HSIRs values. Conclusion: MRI is usefull to detect HSIRs variations during iron chelation therapy. Moreover it is non-invasive and easily repeatable. Application of 123-Iodine labelled 15-Iodinepentadecanoic acid for detection of myocardial viability in patients with CHD and resting regional LV dysfunction V. Soukhov, I. Savicheva, A. Partsernyak, A. Svistov; St.Petersburg/RU Purpose of this study was to assess 123-Iodine labeled 15-iodinepentadecanoic acid ( 123 I-PDA) -synthetic radiolabeled free fatty acid with the potence for detection of myocardial viability. Methods: 107 patients (80 male and 27 female, mean age 49 ± 8 yrs) who had history of myocardial infarction and resting regional left ventricular dysfunction were examined. Blood supply, regional myocardial oxidative metabolism and regional metabolic substrate utilization were assessed by SPECT at 3-5 and 35-40 min after i.v. injection of 400 MBq with 123 I-PDA. Echocardiography with low doses of dobutamine was used for measuring inotropic reserve. Results: Early 123 I-PDA SPECT demonstrated high specificity in diagnostics of perfusion defects (up to 85%). The delayed images showed foci of remaining higher activity in regions of ischemic, but viable myocardium. 387 of a total of 1050 myocardial segments had abnormal resting wall motion. In 189 of them no oxidative metabolism and inotropic reserve were detected, that indicated scarred myocardium. 314 of them were considered to be viable as they demonstrated both oxidative metabolism and inotropic reserve. Conclusion: 123 I-PDA as an agent for simultaneous perfusion and oxidative metabolism evaluation may be used for identifying myocardial viability. Diagnostic value of this method in combination with low doses of dobutamine echocardiography even in the cases of severe myocardial metabolic damage is nearly equal to PET with 18 FDG and should be applied for detection of viable myocardium. Comparison of MRI and nuclear medicine in detection and analysis of left ventricular infarction R.M. MacMillan 1 , T. Vakhtangadze 2 , M.R. Rees 2 ; 1 Philadelphia, PA/US, 2 Bristol/UK Aims: To compare standard SPECT perfusion imaging with last contrast enhanced MRI for the detection of infracted myocardium. Materials and Methods: 34 patients (13 female, 21 male) from two centres with proven myocardial infarction by ECG, clinical and echo criteria underwent stress/ rest Tc99 sestamibi Gated SPECT scanning with a dual headed gamma camera and late contract enhanced MRI on identical 1.5 Tesla scanners in each centre using a protocol which imaged 15 minutes after injection of 0.1 mmol/kg IV gadolinium. Analysis of segments used a 17 segment system, with a total of 578 segments analysed in both imaging methods. Results: 183 segments demonstrated scars on MRI and 132 segments demonstrated scars on isotope imaging. Comparison of isotope imaging to MRI showed that 8 segments who had scars on isotope scanning failed to show on MRI whilst 42 scars on MRI were not demonstrated on nuclear imaging. The majority of these scars were small or sub-endocardial. In some cases these scars had islands of functioning myocardium within them. Some scars seen as completely non perfused defects on nuclear imaging were demonstrated to be partial thickness scars on MRI. There was no significant difference in the findings from each centre indicating reproducibility and transferability of technique and findings. MRI was able to detect smaller scars than nuclear imaging and viable myocardium in proximity to scar tissue. Prenatal diagnostics of obstructive heart lesions G. Spanovic 1 , I. Jovanovic 2 , V. Parezanovic 2 , A. Zvezdin 1 ; 1 Novi Sad/YU, 2 Belgrade/YU Purpose: Aim of prenatal diagnostics of obstructive heart lesion is to make right decision about the way leading further pregnancy, and decision about the time, place and way of labor. Sensitivity and sensibility of fetal echocardiography are very high -between 95 and 98%. Methods and Materials: 2 648 fetuses were examined in period of seven years. 40 fetuses with the diagnosis of some obstructive lesions of the heart were investigated. Control group was made of 120 fetuses with normal echocardiograms divided into four groups according to gestational weeks. Echocardiographic techniques used: M-mode, 2 D and Doppler techniques. Results: Examination were made between 20 and 39 weeks of gestation. All cardiac structures show linear growth with progression of pregnancy. Both halfs of the fetal heart are the similar size. 32 obstructive lesions of the left heart and 8 lesions of the right heart were diagnosed. There is statistically significant difference in size of the left and right structures in fetuses with obstructive lesions according to each other and also the same structure of the normal fetal heart. Conclusions: Obstructive lesions of the left heart were diagnosed much more frequently (80%) than the obstructive lesions of the right heart (20%) in the examination material. Left heart hypoplastic syndrome was dominated lesion-75% of obstructive lesions of the left heart and 60% of all diagnosed obstructive lesions. Difficult obstructive lesions are progressive, have poor prognosis and present one of the indications for abortion. Background: Encouraged by beautiful cardiac multislice CT (MSCT) images presented at radiology and cardiology meetings, and by the favorable preliminary reports on high diagnostic value, more and more radiologists consider starting up their own cardiac MSCT program. The quality of the examinations initially obtained then, however, often does not live up to the high expectations. Procedure Details: A common cause for insufficent image quality is the poor attention to detail during image acquisition. In fact cardiac MSCT depends on the skill and dedication of the CT-technician. As an international training center for cardiac MSCT, we have noticed some common mistakes likely made by less experienced operators. Generally, the basic procedures issues tend to go wrong: e.g., positioning the patient, placing the ECG-electrodes, choosing appropriate filtering, applying basic cardiac anatomy and physiology knowledge, etc. We will provide a step-by-step "how-to" pictorial with tips and tricks for successful cardiac CT imaging, illustrated by many examples of "right and wrong". Issues addressed include handling of patient and workflow, data acquisition, and standardized image post-processing. Conclusion: A step by step approach to Cardiac MSCT scanning prevents scan failure. Tomographic imaging of sinus venosus defects with multidetector CT angiography (MDCTA) and magnetic resonance imaging-angiography (MRI-MRA) J.C. Hellinger, A. Napoli, F. Chan; Stanford, CA/US Learning Objectives: 1. Describe tomographic imaging techniques for assessment of sinus venosus defects (SVD). 2. Illustrate intra and extracardiac anomalies during MDCTA and MRI-MRA for SVD. Background: SVD with associated partial anomalous pulmonary venous return (PAPVR), accounts for 1-2% of congenital heart anomalies. Clinical presentation is nonspecific and thus, diagnosis relies on imaging. Transesophageal echocardiography (TEE) and digital subtraction angiography (DSA) have been established as standard for this purpose. However, both are invasive and not without risk. MDCTA and MRI-MRA are alternative noninvasive means to image these patients. MRI offers the additional benefit to assess shunt ratios with cine phase contrast (PC) sequences. In this exhibit, we highlight our experience with MDC-TA and MRI-MRA in 9 exams having surgically proven SVD-PAPVR. Procedure Details: Five exams were performed on 8 or 16 channel MDCT. Contrast was injected at 4 cc/sec, employing bolus trigger technique. Two of the 16-MDCT were retrospectively ECG-gated with 0.625 mm thickness. Non-gated studies were acquired at 1.25 mm, with a pitch of 1.35-1.375 and rotation time of 0.5-0.6 seconds. Sequences employed in the four MRI-MRA exams included ECGgated T1, balanced steady state free precession, PC, and 3D-SPGR angiography. 3D post-processing employed volume rendering and maximum intensity projection techniques. Conclusion: Anatomic defect size and location; number of abnormal veins) and dynamic evaluation for SVD-PAPVR corroborated TEE, DSA, and/or surgical findings. We identified on all MDCTA, a jet of contrast crossing the defect into the left atrium (CT shunt sign). Our preliminary experience indicates tomographic imaging is a reliable noninvasive alternative to TEE and DSA for assessment of SVD-PAPVR. To sensitize radiologists to the application of reformatting and 3D-reconstuctions in cardiac CT which depict the coronary arteries in a manner consistent with standard catheter angiography in routine clinical practice. To demonstrate a step by step approach to acquistion, optimized reconstruction techniques, and read-out algorithms in the evaluation of the coronary vessels. Background: Recent advances in the temporal and spatial resolution of MDCT have opened the door to the use of CT in routine cardiac diagnostics, which is evolving rapidly as a noninvasive method. CT coronary angiography has compared favorably with conventional catheter coronary examinations, however new reconstruction and visualization methods are continuously being developed and are often lacking in meeting the demands of the routine clinical setting. It is crucial that radiologists become attuned to the standard approach to the coronary angiogram used in clinical cardiology so that advantage is not lost in the competition to provide services. Procedure Details: In this educational module, we present a step by step assessment of coronary vessels based on 3D-reconstructions of isotropic MDCT datasets with special consideration to projections and visualization techniques which correspond with the standards of clinical cardiology. Optimization of time consuming 3D renderings of ECG triggered datasets as well as read-out algorithms are demonstrated in examples for normal coronary vessels in addition to representative cases of coronary artery pathology. The resulting effective temporal resolution is 94-188 msec (depending on heart rate and reconstruction algorithm). Larger volumes can be studied with isotropic spatial resolution and higher temporal resolution. The capability to scan larger volumes increases the feasibility and the accuracy of this technique in the visualisation of coronary artery bypass grafts (CABG). The scan protocol to evaluate CABGs with 16-row MSCT is described. Different types of conduits (arterial and/ or venous), artefacts (surgical clips) and distal anastomoses of the graft are illustrated with DSA correlation. Furthermore, atherosclerotic graft's disease (stenoses and occlusion) as well as native coronary artery disease is displayed with DSA. Conclusion: ECG-gated 16-row multislice CT coronary angiography with 0.375 s gantry rotation time provide improved image quality in the evaluation of CABG. Significance Objective: To compare the MSCT and PET results in studying the condition of myocardial blood supply and to decide advisability of using them together. Materials and Methods: 53 patients with suspected diagnosis of coronary artery disease were examined by MSCT and PET. MSCT data was obtained using Siemens Volume Zoom CT scanner. Retrospectively ECG-gating image reconstruction was conducted. PET was performed on Ecat-Exact-47 (Siemens) with 13N ammonia at rest and during pharmacological test with vasodilatators (adenosine, dipyridamole). Results: The first group comprised 16 (30.2%) patients without stenoses in coronary arteries according to the results of MSCT. PET also didn't detect reduction in perfusion of myocardial ischemic genesis in these patients. The second group included 10 (18.9%) patients with low-grade (< 50%) stenosis of coronary arteries. In these patients PET at rest and during stress didn't reveal a reduction in perfusion of myocardium. Invasive coronarography was not performed for the 1 and 2 groups. The third group included 23 (43.4%) patients with different grades of stenosis in coronary arteries, according to the MSCT. There was reduction in perfusion in the corresponding myocardial segments revealed during at rest and/ or stress-PET. There was invasive coronarography done for these patients, which confirmed the existence of stenosis. Methods and Materials: Ten volunteers (M:F = 8:2, mean age 55) without ischemic heart disease and 34 consecutive patients (M:F = 20:14, mean age 56) with ischemic chest pain underwent CT coronary angiography (Sensation 16, Siemens, Germany). Reconstruction was done around -400 ms from R peak and multiplanar reformation and volume rendering were included. Myocardial bridge was determined by demonstration of tunneled segment dip into myocardium. Invasive coronary angiography was performed in 12 patients. Results: Twelve tunneled segments in LAD were detected in two volunteers (20%) (n = 2) and 9 patients (26.5%) (n = 10). Nine were located in middle LAD (2 in volunteers, 7 in patients) and 3 in distal LAD (in patients). with 4 to 36 mm in length, 0 to 4.5 mm in greatest depth. The cross-sectional areas of tunneled segments were 39% smaller than those of the just proximal and 10% smaller than those of just distal to the tunneled segments. Calcification in LAD was detected in 1 volunteer and 4 patients with myocardial bridge but not in tunneled segment itself. Significant stenosis was detected in proximal LAD of two patients and mild stenosis in one patient which were confirmed by invasive coronary angiography. Five patients showed only myocardial bridging in LAD without coronary arterial stenosis. Conclusion: MSCT directly visualizes tunneled segment within myocardium and gives useful information about myocardial bridging and neighboring coronary arteries. Multi-detector row CT for the assessment of atrial septal defect and pulmonary venous drainage in adults G. Morgan-Hughes, A. Marshall, C. Roobottom; Plymouth/UK Purpose: To evaluate retrospectively ECG-gated multi-detector row computed tomography (CT) for the full evaluation of secundum and sinus venosus atrial septal defects (ASD), in adults, in comparison to trans-esophageal echocardiography (TOE). Materials and Methods: Twelve patients undergoing TOE for further assessment of presumed ASD, as a prelude to definitive treatment, also underwent retrospectively ECG-gated multi-detector row CT. The multi-detector CT scans were compared to TOE for defect and pulmonary vein visualisation. Secundum ASD sizing; measurements, before possible device closure, were compared, and virtual angioscopy of the right atrium was evaluated for direct, three-dimensional defect visualisation. Results: Larger secundum ASDs (greater than 2.0 mm) were well visualised with multi-detector row CT, but smaller defects and sinus venosus defects were not. For maximal secundum defect size there was a mean difference between the techniques of 0.9 mm (limits of agreement minus 5.5 to plus 3.6 mm). Overall there was moderate agreement for the defect and rim sizing measurements. Pulmonary venous drainage was universally fully and correctly evaluated with multidetector CT, which compared favorably to TOE. Virtual angioscopic visualisation of secundum defects was possible in 4 patients, but the images produced were considered of limited clinical value. Conclusions: Retrospectively ECG-gated multi-detector row CT offers alternative imaging of ASD in adults, allowing visualisation of significant secundum defects, pulmonary venous drainage and defect sizing. Further investigation, to establish the accuracy of defect and rim sizing measurements and to re-explore direct defect visualisation with advanced post-processing tools, is required. Detection of necrotic myocardial segments using multi-slice computed tomography: Comparison with nuclear medicine P. 1.3 mm slice width, 0.6 mm slice increment and 130 mL of non-ionic contrast (320 mgI/ml) administered with a delay scan of 18 seconds. NM and CTs datasets were reoriented perpendicular to the left ventricle long axis. Segmental analysis was performed on 18 segments within the short axis planes (6 basal, 6 mid-ventricular and 6 apical segments). A positive NM finding was defined as a perfusion defect within a segment at both rest and stress. A positive CT finding was defined as a hypo-intensive region within a segment. Statistical analysis was performed using a 95% confidence interval calculated by the exact binomial method. Results: 360 segments were evaluated on both NM and MSCT. NM detected 59 necrotic segments whereas MSCT detected 50. There were 50 true-positive, 281 true-negative, 20 false-positive and 9 false-negatives findings. The sensitivity was 84.7%, specificity 93.4%, positive predictive value 71.4% and negative predictive value 96.9%. Conclusion: MSCT showed high sensitivity and specificity for the detection of myocardial necrotic segments compared with NM. Evaluation of myocardial bridging by multislice computed tomography P.M. Carrascosa 1 , C. Capuñay 1 , M. Vembar 2 , P. Johnson 2 , R. Pissinis 1 , J. Carrascosa 1 ; 1 Buenos Aires/AR, 2 Cleveland, OH/US To determine the usefulness of multiphase reprocessing MSCT coronary angiography in the identification of Myocardial Bridging (MB) and the detection of related ischemia. Methods: 220 patients were studied. CTs were performed in a 4-row CT scanner with 4 x 1 mm collimation, 0.5 mm slice increment and 130 mL of non-ionic contrast. Ten patients with MB diagnosed with MSCT were evaluated with Nuclear Medicine (NM). Rest and stress studies were performed with 30mCi Technetium 99m Sestamibi. Segmental analysis were performed on 18 segments within the short axis plane (6 basal, 6 mid-ventricular and 6 apical) in both methods. Positives NM findings were defined as a perfusion defect within a segment at both rest and stress. Positives CT findings as hypo-intense region within a segment. Results: All the MBs were placed in the LAD. DA detected 11 cases, whereas MSCT only 10. The sensitivity was 90.9% and the specificity 100.0%. In 3 cases the MB of the LAD had greater diameter in the 95% phase and they were compressed in the 75% phase. Six cases showed ischemia in the NM studies. There were 4 true-negatives, 5 true-positives and 1 false-negatives findings. The sensitivity was 83.3% and Specificity 100%, Positive predictive value was 100% and the negative predictive value was 80%. Conclusion: MSCT can detect the presence of MB in coronary arteries. It is essential for this identification a multiphase reprocessing of the CT data and can also detect the presence of myocardial perfusion defects. To predict the local, gonadal, thyroidal and eye dose with and without different protection devices in retrospective-gated multi slice CT of the heart. Material and Methods: Radiation dose was measured with an Alderson phantom and a digital dose meter with and w/o an infradiaphragmatic lead drape, a cervical lead protection and an eye shield. Measurements were done with the ionization chamber placed over the heart, uterus, thyroid gland and eyes. Helical CT of the heart was performed with an Aquilion MSCT (Toshiba). The dose was determined with slice collimation and pitch between 1 and 2.5 using constant voltages and current-time-products for retrospective gated CT. Results: Local dose over the heart ranged from 142 to 584 µSv. Gonadal dose was determined with 61 to 190 µSv w/o lead protection and 23 to 39 µSv using a circular infradiaphragmatic lead drape, meaning a gonadal dose reduction of up to 80%. With use of protection devices the dose to the thyroids could be reduced by 36.5% and 39% in terms of using an eye shield. Conclusion: Radiation causing gonadal dose in cardiac CT is predominantly extracorporal radiation and only in a lesser degree due to scatter radiation from inside the body. An effective dose reduction of 80% can be achieved by consequent use of a circular lead drape closely adapted to the inferior helical range. The use of organ adapted shields covering the thyroids or eyes mainly results in a decrease of the surface dose and is recommended as well for all patients receiving cardiac CT. Images were acquired using a 4-row spiral CT scanner with 0.5 s gantry rotation time. In all patients detailed clinical, ECG, US and scintigrafic (when available) data were collected in order to identify the presence of MI. When a patient with MI was found, MDCTA images were analyzed on both axial and multiplanar reconstruction in order to confirm the presence of an infarcted area. Results: Our study population included 33 patients who previously underwent coronary percutaneous transluminal angioplasty (PTA) and stent placement (a total number of 45 stents) and 14 patients with previous by-pass surgery. After clinical assessment, MI was found in 17 patient (9 septal, 4 apical, 3 anterior wall of left ventricle, 1 infero-septal). MDCT was able to detect the presence of MI in 14/17 cases (82.3%), showing a regional hypoattenuated area and wall thinning. In all cases, localization and extention of ischemic area were perfectly correlated with clinical known data. In two patients with sub-endocardial involvement, MI could was not detectable with MDCT. In one patient the presence of motion artefacts affected image quality and myocardial scar wasn't visualized. The presence of MI is usually well depicted with retrospective ECG gated MDCT. MDCT coronary angiography: Optimization of the image reconstruction phase Y. Nagatani, R. Takazakura, N. Nitta, M. Takahashi, K. Murata; Otsu/JP Purpose: To investigate the relationship between the heart rate and the optimal image reconstruction phase in MDCT coronary angiography. Material and Method: 37 patients underwent cardiac MDCT (8 DAS) (Aquilion8, Toshiba, Japan) to obtain coronary angiography. Scan data were subsequently reconstructed at 10 different kinds of phases in ECG wave. These methods can be classified as follows according to the used wave in ECG; 1).The center of the reconstruction phase is positioned at the peak of T-wave (method T-p), the end of T-wave (method T-e) and the midpoint of descending curve of T-wave (method Tm). 2).The end of the reconstruction phase is positioned at the peak of P-wave (method P). 3).The center of the reconstruction phase is positioned using nterval (method R30, 40, 50, 60, 70, 80) . All patients were classified into 3 groups according to their heart rates (HR) (group 1; HR < 60 (n = 14), group 2; 60 < HR; < 70 (n = 10), group 3; HR < 70 (n = 13)). Two radiologists assessed image quality in blind fashion and scored as follows (2:good,1:fairly, 0: bad). Bonferroni/dunn test was performed for statistical analysis. Results: In group 1, significantly better image quality was achieved in method P, RR70, RR80 than other methods. Among them, highest image quality was obtained by method P. The best result was obtained by method P in group 2 and Tm in group 3. Conclusion: Optimal image reconstruction phase in MDCT coronary angiography shifts from late diastolic phase to late systolic phase as heart rate increases. Assessment of aorto-coronary bypass grafts patency by 16 detector rows computed tomography G. Two out of five tumors (right atrium lipoma and aortic valve fibroelastoma) were discovered in a routine MSCT study of coronary arteries and left ventricle myxoma in an elective coronarography. Atypical left ventricle myxoma with mitral stenosis and epicardial cyst were primary visualized in transoesophageal echocardiography. Results: Both methods allows to evaluate tumors size, localization and structure. The biggest advantage of echocardiography was aknowledged possibility of evaluation of lesions mobility while the biggest advantage of MSCT was possibility of both 3D and 2D imaging in arbitrary planes using multiplanar reformations with evaluation of tumor relations towards adjacent tissues and simultaneous visualisation of coronary arteries. Conclusions: MSCT and echocardiography (TTE and TEE) are complementary methods in diagnosis of primary cardiac tumors. Usefulness of 16-slice multidetector row computed tomography (MSCT) in assessment of dilated cardiomyopathy S. Hosoi, T. Mochizuki, T. Haraikawa, J. Funada; Ehime/JP Purpose: The purpose of this study is to show the potential benefits of 16-slice MSCT for the diagnosis of DCM. We studied 30 consecutive patients, including 10 DCM, 10 coronary artery disease (CAD), and 10 patients with non-cardiac disease as a normal control. DCM was diagnosed on the basis of the clinical data by cardiologists. The MSCT system used in this study was a LightSpeed 16 (GE Medical Systems) with available gantry rotation speeds of 0.4 sec. All cardiac images reconstructed were divided into 10 phase data sets in a R-R interval on ECG. End-diastolic (ED) and end-systolic (ES) phase could be visually extracted, and the LV wall thickness and volume was measured. Moreover, the segmental LV wall motion was evaluated by the cardiac movie image which was reconstructed using the 10 phase data. Results: Image quality of MDCT were considered sufficient for this analysis. Concerning about the rate of coronary artery stenosis, DCM group were significantly less than CAD group (p < 0.01). In DCM group, both LV wall thickness of ED and ES were smaller than other groups (p < 0.01). LV volume between DCM and CAD group had no significant difference. LV wall motion in DCM group had a tendency to be diffusely hypokinetic. Conclusion: Using 16-slice MSCT, LV function and coronary artery stenosis was able to be evaluated and distinguished the features of DCM and CAD. This study revealed a potential ability of MDCT as a useful method for the diagnosis of DCM. Background: A variety of pulmonary complications occur in bone marrow transplant (BMT) recipients and are a major cause of morbidity and death. Imaging Findings: HRCT is useful in detection of pulmonary abnormalities, but these findings are generally non-specific. These complications, which reflect the immunologic status of the patients, occur in three phases. This pattern can be used to interpret CT scans. The neutropenic phase (up to 3 weeks after BMT) is characterized by fungal infections, alveolar haemorrhage, pulmonary oedema, and drug reactions. At CT, fungal infections like angioinvasive aspergillosis appear as nodules surrounded by a halo of ground-glass attenuation; alveolar haemorrhage and drug reactions, as bilateral areas of ground-glass attenuation or consolidation. The second phase (3 weeks to 100 days after BMT) is dominated by cytomegalovirus pneumonia, which appears as multiple small nodules with areas of consolidation or ground-glass attenuation, and pneumocystis carinii pneumonia again mostly as ground-glass attenuation. The late phase (more than 100 days after BMT) is characterized by bronchiolitis obliterans revealing bronchial dilatation and a mosaic pattern of attenuation, bronchiolitis obliterans with organizing pneumonia (BOOP), the CT findings usually being patchy consolidation or ground-glass attenuation and chronic graft-versus-host disease. Conclusion: If CT findings are considered in relation to the time elapsed after BMT, diagnostic options can be narrowed sufficiently to enable accurate diagnosis. Small pulmonary nodules: An easy approach to the differential diagnosis J. Rimola, X. Gallardo, E. Castañer, J.M. Mata, A.M. Quiles, P. Bermúdez; Sabadell/ES Learning Objectives: To know the anatomy of the secondary pulmonary lobule, which is essential to the interpretation of high-resolution CT (HRCT). To learn an easy way to approach the differential diagnosis of small pulmonary nodules. Background: A wide variety of pathologies may present with small pulmonary nodules, which are defined as rounded opacities smaller than 1 cm in diameter. Differences in appearance, distribution and attenuation of nodules provide useful clues for correct diagnosis. Helical CT and HRCT enable correct identification and characterization of small nodules. Imaging Findings: We illustrate different examples of multinodular lung diseases in an easy-to-understand way. A simple algorithm is used to help in the differential diagnosis. We classify nodules according to distribution (centrilobular, perilymphatic or random) and show the most representative cases of each pattern. We present a wide variety of entities, including: Infections such as tuberculosis (endobronchial spread or miliary TB), nontuberculous mycobacteria, fungus; sarcoidosis; tumors (lymphangitic carcinoma, hematogenous metastases); silicosis and coal worker's pneumoconiosis; hypersensitivity pneumonitis; cryptogenic organizing pneumonia; histiocytosis; etc. Conclusion: An easy way to assess multiple nodular opacities in the lung is useful to reach an accurate diagnosis. Differential diagnosis of unilateral hyperlucent lung M. Nishino 1 , K. Hayakawa 2 , H. Hatabu 1 ; 1 Boston, MA/US, 2 Kyoto/JP Learning Objectives: To review differential diagnosis of unilateral hyperlucent lung, understand pathological mechanisms causing the findings, and to be familiar with the imaging findings and clinical manifestations characteristic in each condition. Background: Unilateral hyperlucent lung on chest radiograph is seen with various pathological conditions. The conditions include both acute and chronic processes, and thus need accurate and prompt diagnostic evaluation. The findings on chest radiograph can provide clues to differentiate various causes of this condition and help to achieve proper management. Imaging Findings: We present cases of unilateral hyperlucent lung, emphasizing specific imaging findings along with characteristic clinical manifestations. The cases include proximal interruption of pulmonary artery, pulmonary hypoplasia, Swyer-James syndrome, congenital lobar emphysema, foreign body aspiration, and Bochdalek hernia. Findings on chest CT which can confirm or support the diagnosis are also reviewed and discussed. Conclusion: Familiarity with the characteristic imaging findings of unilateral hyperlucent lung is essential for radiologists to make accurate diagnosis for appropriate patient management. Multislice CT of primary and multisystemic pulmonary vasculitis: A patternbased approach to differential diagnosis K. Marten 1 , M. Prokop 2 , P. Schnyder 3 , E.J. Rummeny 1 , C. Engelke 1 ; 1 Munich/DE, 2 Utrecht/NL, 3 Lausanne/CH . Clinical and radiologic features of these tumors are often indistinguishable from those of malignant tumors. However recognition and early diagnosis of these lesions may allow for conservative treatment and excellent patient outcome. The aim of this study is to illustrate the CT findings of variable benign tumors of tracheobronchial tree and correlate with the pathologic findings. Imaging Findings: This study included 15 patients with benign tracheobronchial tumors which were confirmed histologically by surgical resection (n = 13) or bronchoscopic biopsy (n = 2). The tumors were classified the anatomic locations of the lesions into trachea (n = 4), bronchus intermedius (n = 1), lobar bronchus (n = 8), and segmental bronchus (n = 2). Pathologic diagnoses were hamartoma (n = 5), leiomyoma (n = 3), lipoma (n = 2), schwannoma (n = 2), amyloidoma (n = 1), inflammatory polyp (n = 1), and bronchial adenoma (n = 1). CT demonstrated all tumors confined in the tracheobronchial lumen. 10 of 11 bronchial tumors occluded the bronchial lumen completely, resulting in distal parenchymal collapse. To enhance the limitations of chest X-ray and axial chest CT slices in estimating the volume of pleural effusions. This interactive presentation will allow the reader to test himself, comparing his own subjective estimation to the real volume computed from 3D shaded surface displays (SSD). To outline the usefulness and ease of post-processing with spiral CT to obtain a true assessment of the pleural fluid volume. Background: Assessment of the volume of pleural effusions is very imprecise both on chest X-ray and axial chest CT slices. The amount of fluid may be required by clinicians for therapeutic purposes. 3D SSD of the effusion provides rapid computation of its volume. In this exhibit we will recall the physiopathologic mechanisms involving the preferential locations of pleural effusions. We will show pleural effusions of various volumes on chest CT along with the corresponding chest X-rays and the precise volume of the effusion computed from 3D reconstruction. Procedure Details: Various cases of free or collected pleural effusions on spiral chest CT (CT Twin and MX 8000 IDT), are presented, including coronal and sagittal reformations. CT images stand along with the corresponding chest X-ray, obtained in the upright and supine position, and with the computed volume of the effusion using 3D reconstruction. Conclusion: Pleural volumetry is readily available using spiral CT data recontruction. It should be more often used, to assess the amount of fluid to withdraw with thoracocentesis, before drainage or for monitoring in intensive care unit patients. Lung consolidations in various clinical entities: Clinico-radiologic correlation presented in an interactive CD-ROM in HTML format S. Mylona, S. Tandeles, L. Thanos, S. Lyra, P. Ellinas, N. Mpatakis; Athens/GR Learning Objectives: To present lung consolidations as found in CT and plain radiographs in various clinical entities. To give a differential diagnosis based on clinical and radiologic features. Background: Radiologists often encounter lung consolidations in plain radiographs and lung CT. There is a broad spectrum of clinical entities, which either present as lung consolidations or involve lung consolidations. Clinical information and radiologic features help to approach the right diagnosis. Procedure Details: 30 cases are presented in a question and answer format using HTML resources in an interactive CD-ROM. Reference is made to proper diagnostic work up and to other relevant clinical information. Histopathological confirmation is presented where it is needed. Conclusion: Radiologists must be trained to deal with patients presenting with lung consolidations using clinical and radiological features. HRCT patterns of cardiogenic pulmonary edema E. Chambrier, S. Zafatayeff, Y. Badachi, P.A. Grenier, C. Beigelman-Aubry; Paris/FR Learning Objectives: To be familiar with typical and atypical HRCT appearances of pulmonary edema based on 50 patients. To emphasize the role of HRCT in suggesting this diagnosis in the setting of acute dyspnea, especially if pulmonary embolism is suspected. Background: Pulmonary edema, a frequent cause of acute dyspnea, can be clinically difficult to detect. HRCT is crucial in suggesting this diagnosis, particularly when pulmonary embolism is suspected. Actually, bolus intravenous injection of iodinated contrast in case of pulmonary edema may worsen heart failure and lead to patient death. Imaging Findings: The HRCT signs of pulmonary edema are usually divided into interstitial and alveolar patterns, and both can be associated. Classic signs of interstitial edema, which accounts for 70% of cases, are peribronchial and peribronchovascular thickening, septal lines, ground glass opacity, pleural effusion, cardiac enlargement and pulmonary veins dilatation. Alveolar edema is characterized by bilateral, patchy or coalescent areas of airspace consolidation, predominantly basal and perihilar. Butterfly pattern is found in 5% of cases. Atypical patterns are due to preexisting lung or heart disease, such as right upper lobe edema related to mitral regurgitation, or heterogeneous distribution of edema due to preexisting lesions of emphysema or constrictive bronchiolitis. Highly selected cases will be used to illustrate typical and atypical patterns. The varied HRCT appearances of cardiogenic pulmonary edema have to be recognized in order to delay the performance of angioCT of pulmonary arteries if pulmonary embolism is suspected. Smoking-related interstitial lung diseases: Radiologic-pathologic correlation A. Hidalgo, T. Franquet, A. Giménez, R. Pineda, M. Madrid; Barcelona/ES Learning Objectives: 1. To review the radiological findings of smoking related interstitial lung diseases and their pathologic correlations. 2. To provide some radiological clues for the correct diagnosis. Background: Interstitial lung disease (ILD) represent a heterogeneous group of lung disorders of known or unknown cause. Recently, it has been appreciated that cigarette smoking is related to the development of several ILDs including desquamative interstitial pneumonia (DIP), respiratory bronchiolitis-associated interstitial lung disease (RIBLD), pulmonary Langerhans'cell histiocitosis (PLCH) and idiopathic pulmonary fibrosis (IPF). Procedure Details: We reviewed the plain radiograph, CT, and HRCT findings of four intersitital lung disorders that have been linked to smoking. Several examples of the radiological forms of SRILD and their differential diagnosis are provided. We will also show how the radiologists can get the diagnosis through some clinical and radiological clues. The link between several interstitial lung disease and smoking has been recently indicated. Radiologists have to be aware of these entities and to suggest a diagnosis as accurate as possible by the knowledge of clinical context and the radiological features. The spectrum of CT appearances in pulmonary amyloidosis A. Aylwin, P. Gishen, A. Nicholson, S. Copley; London/UK Learning Objectives: To review the CT appearances of pulmonary amyloidosis. Background: Amyloidosis has three main histopathological subgroups, with typical imaging characteristics: 1) Tracheobronchial disease with plaques, nodules or circumferential thickening of the trachea or segmental airways; 2) Nodular parenchymal disease with single or multiple nodules demonstrating sharp lobulated margins, spiculated masses simulating tumours, and a rare form associated with Sjögren's syndrome and lymphocytic interstitial pneumonitis (nodules and lung cysts); and 3) Diffuse alveolar septal disease showing ground glass opacification, interlobular septal thickening, and traction bronchiectasis on HRCT. It is often possible to divide cases into localized amyloidosis with tracheobronchial deposition or nodular disease, or the systemic type with diffuse parenchymal disease or lymphadenopathy on the imaging findings, but cases demonstrating overlapping features are not uncommon. Procedure Details: The CT appearances of 8 cases of biopsy-proven pulmonary amyloidosis will be demonstrated. The spectrum of CT appearances of pulmonary amyloidosis of both localised and systemic types will be demonstrated. The CT features of localized and systemic disease may overlap. Thoracic Conclusion: Incidence and imaging features of these complications will be illustrated. Paraquat poisoning of the lung: A study of 47 patients with paraquat intoxication for 21 years A. Ichinose 1 , K. Kimura 2 , M. Tsuboi 1 , H. Saito 1 , T. Ishibashi 1 , S. Takahashi 1 ; 1 Miyagi/JP, 2 Akita/JP Learning Objectives: To analyze 47 patients who had taken paraquat intoxication and to compare those with 24% paraquat intoxication to those with 5% paraquat-diquat intoxication, especially with respect to the change of their chest X-rays and CT. Background: Paraquat is a widely used herbicide that has toxic effects on the lungs, liver, and kidneys. Paraquat has been known to induce acute pulmonary fibrosis, causing progressive respiratory failure and death. In Japan, 5% paraquatdiquat product has been used since 1986, in place of 24% paraquat product,. However, there is no report that compares the influence these products have on the lung. Procedure Details: There were 39 patients from whom chest X-rays were taken, and 22 of those (56.4%) had abnormal findings, which were composed of 10 ground-grass patterns, 4 reticulogranular patterns, 4 pulmonary edemas, 4 cardiomegalies and pulmonary congestions, 2 pneumothoraxs, and 1 mediastinal emphysema. Pulmonary edema was found only in the patients with 24% paraquat intoxication; in all cases, the plasma paraquat concentration was much higher than others. All reticulogranular patterns were found a few days later, and those in the patients with 5% paraquat-diquat intoxication were potentially reversible. Conclusion: 24% paraquat product has more influence on the lung than 5% paraquat-diquat product. Pulmonary fibrosis caused by 5% paraquat-diquat product is potentially reversible. Thoracic Parenchymal abnormalities, enlarged lymph nodes, pleural effusion, and pleural thickening were evaluated. In 46 patients who underwent surgical biopsy or autopsy, the CT-pathological correlation was performed with the actual specimens. Imaging Findings: On the CT scans, abnormal findings were seen in 60 patients (69.0%). The CT findings consisted of ground-glass attenuation (n = 37), centrilobular nodules (n = 25), thickening of bronchovascular bundles (n = 22), and consolidation (n = 13). These abnormalities were predominantly seen in the peripheral lung parenchyma (n = 26). Pathologically, these findings corresponded with atypical lymphocytes infiltration along the interstitium and the alveolar spaces. Pleural effusion and enlarged lymph nodes were found in 22 patients and 27 patients, respectively. Conclusion: The CT findings in patients with adult T-cell leukemia/lymphoma consisted mainly of ground-glass attenuation, centrilobular nodules, and thickening of the bronchovascular bundles in the peripheral lung. These CT findings, though non-specific, are considered as suggestive of thoracic involvement in patients with adult T-cell leukemia/lymphoma. High resolution CT imaging of the lung for patients with primary Sjögren's syndrome C. Lohrmann, M. Uhl, K. Warnatz, N. Ghanem, E. Kotter, O. Schaefer, M. Langer; Freiburg/DE Purpose: To assess pulmonary abnormalities in patients with primary Sjögren's syndrome using high-resolution computed tomography (HRCT). The HRCT scans of 24 patients over a ten-year-period with diagnosis of primary Sjögren's syndrome were retrospectively reviewed regarding the presence, extension and distribution of 16 pathological findings. Results: 19 patients (79.2%) showed pathological findings and in 5 (21.8%) the HRCT scan was normal. A predominance of abnormalities in the lower lobes and subpleural areas was detected. Bronchiectasis, thin-walled cysts and small pulmonary nodules in 11 patients (46.2%), ground-glass attenuation and emphysema in 9 patients (37.8%), interlobar-septal thickening in 7 patients (29.4%), honeycombing in 6 patients (25.2%), bronchial wall thickening and tree-in-bud pattern in 5 patients (21.0%), mosaic perfusion in 4 patients (16.8%), and architectural distorsion in 3 patients (12.6%). Airspace consolidation, air trapping, large nodules (10-30 mm) and masses (> 30 mm), mediastinal lymph node enlargement (> 15 mm) and free pleural fluid were seen each in 1 patient (4.2%). In 8 of 11 patients (73%) with thin-walled cysts areas of ground-glass attenuation were detected. Conclusion: HRCT seems to be contributive to the characterization of the wide variety of lung abnormalities in primary Sjögren's syndrome. Airway disease alone or in association with the presence of varying degrees of interstitial disease represent the main findings in accordance with earlier reports. Unexpectedly, almost half of the patients have thin-walled cysts on the HRCT scans, which etiology is unclear but could be associated with areas of ground-glass attenuation indicating lymphocytic interstitial pneumonia. Investigation of the bulky hilum: How accurate are radiologists at detecting hilar pathology on the chest radiograph? S. Desigan, D. Murray; London/UK Purpose: To determine the accuracy of radiologists in detecting hilar pathology on chest radiographs. Materials and Methods: A retrospective study was performed, analysing the chest radiograph and computed tomography (CT) findings of 15 patients, all of whom had initially been referred for thoracic CT as part of the investigation for a "bulky hilum" as detected on chest radiography. 15 radiologists, comprising 7 consultants and 8 specialist registrar trainees who were blinded to the initial CT findings, were asked to assess the chest radiographs for the presence or absence of a hilar mass and their recommendations for clinical follow-up in each case were recorded. They were then scored for accuracy as compared to the thoracic CT results. The results showed marked variation between observers in the two groups. The participants had an accuracy of 55%, sensitivity of 68% and specificity of 51%. Positive predictive values of registrars and consultants were 34% and 45% respectively. Negative predictive values were 67% for registrars and 76% for consultants.The group as a whole detected only 3 out of 5 hilar masses confirmed by CT. The wide range of responses demonstrates the very subjective nature of interpretation of the lung hila on chest radiographs, and the difficulty involved in correctly identifying or excluding hilar masses on chest X-rays. One of the most useful aspects of this study has been to provide feedback to individuals for educational purposes and personal audit. B D E F A G M. Paslawski, W. Krupski, K. Krzyzanowski, J. Zlomaniec; Lublin/PL Purpose: The aim of the study is to evaluate the diagnostic value of HRCT in revealing small bronchiectases and bronchiolectases in patients with previously diagnosed pneumoconiosis. The study comprises a group of 38 patients, 21 men and 17 women, aged between 23 and 74 years, with pneumoconiosis in which HRCT was performed. HRCT was performed in all patients in the prone position, from the level of the apices to the level of the diaphragm. The collimation of the scans was 2 mm, with 1 cm intervals between sections. The HRCT examinations were assessed retrospectively by two radiologists, and the presence and character of bronchiectases were noted. Results: Bronchiectases were seen in 22 patients (58%). In 15 of them the "signet-ring sign" and "tram track sign" were seen, with lack of normal tapering. Bronchi were visible in peripheral lung areas, within 2 cm from the parietal pleura in 10 patients. 4 patients had varicose bronchiectases with the typical "string of pearls" appearance. In 2 patients, cystic bronchiectases were seen, presenting with the picture of "cluster of grapes". Conclusions: Bronchiectases is very often seen in patients with pneumoconiosis, especially in advanced stages. HRCT is the modality of choice to diagnose the presence of small bronchiectases and bronchiolectases. Typical HRCT patterns include "signet-ring sign", "tram track sign", lack of normal tapering, and visible bronchi in peripheral lung areas, within 2 cm from the parietal pleura. In varicose bronchiectases, the "string of pearls" appearance, and in cystic bronchiectasis, the "cluster of grapes" appearance are typical. Introspective Background: SPNs occur on 1 in 500 chest radiographs with 30% being due to lung cancer. Conventional imaging is fairly effective in determining the nature of the SPN, although 15-20% remain indeterminate following CT scan. The SPN will often have needle biopsy either via bronchoscopy or percutaneously which have a recognised complication rate of 5-10%. Depreotide is a Tc-99m labeled analogue of somatostatin with affinity to receptors types 2, 3 and 5. Various tumours including lung cancer, breast cancer, lymphoma and neuroendocrine tumours express these receptors. We undertook a retrospective review of one years' referrals for depreotide imaging comparing the results with subsequent biopsy or surgical histology where available. Additionally we assessed if the referring clinical question had been answered. Results: 24 depreotide studies performed, with 18 showing increased uptake within the SPN. 6 patients (25%) with positive studies had had a previous indeterminate lung biopsy thus enabling planning of further biopsy or wedge resection with frozen section. Depreotide and histology agreed in all 17 patients who had subsequent histology of the SPN (16 malignant, 1 benign). Further biopsy was avoided in 5 out of 6 patients with negative studies. Specific answers were given to the clinical referring question in 23 cases. Conclusion: Depreotide effectively determined the nature of the SPNs with ability to avoid biopsies in the 25% of patients with benign disease and to prompt further invasive investigation following an indeterminate biopsy. Pleural invagination in progressive massive fibrosis (PMF) in silicosis and mixed dust pneumoconiosis H. Arakawa, K. Honma, H. Shida, H. Mori, Y. Saito; Tochigi/JP Purpose: Invagination of the pleura often accompanies progressive massive fibrosis (PMF) in pneumoconiotic lung. To elucidate the relation between PMF and the pleura covering them, we conducted a retrospective study comparing CT and autopsy findings in silicosis and mixed dust pneumoconiosis (MDP). The study group was an autopsy series of 58 consecutive patients with complicated silicosis or MDP. CT images were examined to determine the location, shape, composition and size of PMF, distance between the lesion and the covering pleura, presence of pleural thickening, a band-like structure between the lesion and pleura, and pleural effusion. Autopsy data were reviewed for the presence of pleural thickening and invagination and were compared with the CT findings. Results: We identified 120 PMF lesions. Pleural invagination was found in 39 (32.5%) PMF and was always associated with pathologically determined pleural thickening. CT images showed pleural thickening in 36 (92.3%) and invagination in 17 (43.6%) lesions. 13 lesions were associated with ipsilateral pleural effusion (p < 0.01). Statistical analysis revealed pleural invagination was associated with pleural thickening (p < 0.001) and proximity of the lesion to the pleura (p < 0.01) but not with radiographic profusion of pneumoconiotic opacities, or the shape, composition, size of PMF (p > 0.05). 5 PMF were radiographically identical to rounded atelectasis. Conclusions: Fibrous thickening of the pleura and invagination into the adjacent PMF are not uncommon in advanced silicosis and MDP. Some lesions resemble rounded atelectasis. CT is beneficial in assessing these pathologic features. Imaging The aim of this teaching exhibit is to illustrate a spectrum of usual and unusual cystic diseases involving the lung, and to evaluate the efficacy of plain radiographs and computed tomography (CT) imaging in the diagnosis and management of these conditions, with emphasis in high resolution CT (HRCT). We retrospectively reviewed the imaging findings of patients with diffuse cystic lesions involving the lung from our data base of thoracic pathology. A cystic lesion was defined as an air-containing, well-defined space, variable in size. The pertinent embryology and pathologic basis of the radiographic findings are discussed. Pitfalls, diagnostic difficulties and differential diagnoses are emphasised. Results: Specific topics addressed include diffuse cystic diseases of the infancy (bronchopulmonary dysplasia, pulmonary interstitial emphysema, types I, II, and III congenital cystic adenomatoid malformation, chronic eosinophilic pneumonia, and pneumatoceles), and diffuse cystic diseases of the adulthood such as honeycomb lung (secondary pulmonary fibrosis), Langerhans cell histiocytosis, pulmonary lymphangioleiomyomatosis, tuberous sclerosis, and lymphoid interstitial pneumonia. We also include pulmonary diseases simulating cysts such as congenital diaphragmatic hernias, diffuse bronchiectasis, and emphysema. Conclusions: HRCT is an adequate imaging modality to assess diffuse cystic disease of the lung, allowing an excellent visualisation of the cysts as well as other secondary findings (distribution, size, location, and wall thickness). Because many of these disorders have characteristic imaging appearances, this exhibit will help practising radiologist to better understand, recognise and differentiate cystic diseases involving the lung. Beware the normal chest X-ray in suspected lung cancer: A pictorial review of the potential pitfalls A.K. Basu, K. Jeyapalan, J. Entwisle, R. Bhatt; Leicester/UK Purpose: To demonstrate that a standard PA chest X-ray can be falsely reassuring in patients where there is a high index of clinical suspicion for lung cancer. We reviewed the patients with suspected lung cancer whose chest X-rays were radiologically normal and had further CT cross sectional imaging. Emphasis was placed on the hidden review areas on a standard PA chest X-ray, e.g. the mediastinum, the apices, behind the diaphragm and behind the heart. We present a pictorial review of these hidden areas and illustrate the potential lesions not seen on a "normal" chest X-ray. Results: CT can often demonstrate lesions not visible on chest X-ray. Conclusion: A normal PA chest X-ray may be falsely reassuring in patients suspected of having lung cancer. Therefore in patients with a high index of clinical suspicion a CT should be carried out despite the normal PA chest X-ray with careful review of the hidden review areas. Should a chest radiograph be requested in all cases of febrile neutropenia admissions? A study in a university hospital A.V. Acharya, A.K. Burnett; Cardiff/UK Purpose: To evaluate the clinical utility of obtaining chest radiographs, in the absence of chest symptomatology, in patients admitted with acute neutropenic sepsis. Methods: Prospective study of 35 in patients with febrile neutropenia admitted to the Haematology ward was carried out in this university hospital over a period of 4 months. Symptoms & signs, chest X-ray findings and changes in management because of these findings were assessed in these patients. We also conducted a questionnaire survey of haematologists of South Wales regarding obtaining chest radiographs in these patients. Results: Chest radiographs were obtained in 88.5% of the patients at the time of diagnosis of febrile neutropenia but only 22.8% of the patients had chest signs/ symptoms. If chest signs/symptoms were present, 37.5% had abnormal chest X-rays and this influenced change in clinical management. In the group where chest signs/symptoms were absent, radiographs were normal and no change in management resulted from a chest radiograph. The survey of haematologists suggested that majority of them (58%) requested chest radiographs in acute neutropenic sepsis irrespective of presence or absence of chest signs or symptoms. In neutropenic patients with no chest signs/symptoms, a chest radiograph on admission is not likely to be abnormal and is unlikely to change the management. On the basis of our study we suggest that the chest radiographs in these patients in the absence of clinical signs or symptoms, are of little value. This would however not exclude the possibility that other imaging approaches would be of clinical value. Low To evaluate the usefulness of low dose thin-section CT by multidetector-row CT (MDCT) for lung cancer screening in both the determination of malignancy or benignancy and the differential diagnosis. Methods and Materials: 73 cases with pathologically proved solitary pulmonary nodules, which sizes were less than 3 cm in diameter, were entered into this study. After the routine full dose thin-section CT (1.25 mm collimation, FOV 20 cm, pitch 3:1, 120 kVp, 200-mA/rotation, 0.5 second/rotation, high-spatial frequency algorithm), additional two kinds of low dose helical thin-section CT (2.5 mm collimation, pitch 6:1, 40-(in initial 36 cases), 20-(all 73 cases), 10-(in remaining 37 cases) mA/rotation) were scanned using a MDCT scanner (LightSpeed QXi, GE, Milwaukee, Wi). Using ROC analysis, an observer performance study, in which three observers indicated the confidence level for the determination of malignancy or benignancy for each nodule, was done. In addition, three observers recorded the final diagnosis of each case. Accuracies of the final diagnosis were compared by McNemer's test. In the determination of malignancy or benignancy, there was no significant difference among these four kinds of thin-section CT (Full dose, 40-, 20-, and 10-mA/rotation; mean Az = 0.896, 0.874, 0.872, and 0.894, respectively). Accuracy of the final diagnosis by low dose thin-section CT (40-, 20-, and 10-mA/ rotation; 68%, 69%, and 69%, respectively) was significantly lower than that of full dose thin-section CT (81%) (p < 0.005). Conclusion: Efficacy of low dose thin-section CT by MDCT is comparative to that of full dose thin-section CT in determining whether small nodules are malignant or not. Lung cancer screening using low-dose spiral CT: Preliminary results in 404 asymptomatic smokers S. Giunta, M. Crecco, F. Facciolo, L. Carpanese, V. Cilenti, M. Caterino, P. Visca, M. Mottolese; Rome/IT Purpose: To evaluate the feasibility of lung cancer screening using low-dose spiral CT and to present initial baseline data from a non randomized screening trial using low-dose spiral CT. Methods and Materials: 404 asymptomatic smoker volunteers, aged 55 years or older who had smoked 20 packs-year or more, underwent baseline low-dose multislice spiral CT (Volume Zoom Siemens) of the chest without contrast material enhancement following the ELCAP protocol. Annual repeat screening was performed on 62 participants. Lesions up to 5 mm were deemed non suspicious and low-dose CT was repeated after 12 months. Results: At baseline, 559 non calcified nodules were identified in 204 participants. 21 nodules were larger than 10 mm. Biopsy of 14 lesions revealed NSCLC in 8 cases (5 adenocarcinoma, 1 squamous cell carcinoma, 1 large cell carcinoma, 1 adenoid cystic carcinoma). Of these 3 were stage I (37.5%); 2 stage II (25%); 2 stage III (25%) and one stage IV (12.5%). 6 were benign lesions (3 hamartomas, 1 lymph node, 2 fibrosis). In 2 cases the PET was negative, in 3 cases the nodules resolved after antibiotics; 2 participants refused biopsy. Conclusion: Low-dose spiral CT seems to be a promising method for screening lung cancer. Our preliminary cancer screening results with low-dose spiral CT, demonstrated a prevalence of asymptomatic cancers in 1.98% of a smoking population including a high proportion of early tumor stages. Pathological mismatched findings of specimens between CT guided biopsy and resection in Noguchi's classifications of small peripheral lung adenocarcinoma S. Yoshida, H. Ue, S. Itou, Y. Murata; Nankoku/JP Purpose: We sometimes experience mismatched pathological findings of specimens between preoperative CT guided biopsy and resection in the Noguchi's classification of small peripheral lung adenocarcinoma. In this study we discuss the mismatched pathological findings in each case and explored the possibility of reducing the incidence of mismatch. We selected 9 cases, in which preoperative CT guided biopsy and consecutive resection were performed. Tumors were peripheral lung adenocarcinoma of 2 cm or less in diameter. The final diagnosis by resected specimen of these cases were 3 type B, 4 type C and 2 type F peripheral adenocarcinoma. We compared HRCT findings of them to identify the CT density in each tumor. Results: Though the final pathological findings show 3 type C tumors, the specimen by CT guided biopsy show only type A or B tumors. Further more, though the final pathological findings show 2 type F, not having a replacement growth pattern, the specimen also show type A or B, having a pure replacement growth pattern. Conclusion: Pathological mismatched findings between CT guided biopsy and resection were observed. Additional CT image comparison between mediastinal and lung window settings gave us probable information about the tumors having replacement growth patterns or not. Before performing CT guided biopsies, image recognition about the solid density helped us choose the most suitable biopsy site. With more thorough information derived from HRCT and biopsy on the types of tumors patients have, physicians can offer patients more accurate prognosis. Purpose: To analyze high-resolution CT (HRCT) findings in asthmatics and control subjects, and to evaluate the relationship between HRCT findings and pulmonary function tests in asthmatic subjects. To try to evaluate the correlation between the bronchial wall thickening (BWT) with pathologic findings and reflect the thickness of epithelial basement membrane on basis of the HRCT findings. Materials and Methods: Using HRCT, the author analyzed the ratio of BWT, the frequency of bronchial dilatation, the extent of air trapping and centrilobular nodules. In addition, the author assessed HRCT findings of 52 asthmatic patients for correlation with pulmonary function tests and then obtained bronchoscopic biopsy at the second divisional branch of 12 patient among the 52 asthmatics. The author measured the thickness of the epithelial layer and basement membrane after H-E stain and then statistically compared with BWT on HRCT. Results: Among the total 52 asthmatics, BWT on HRCT showed significant correlation with FEV1 (p = 0.006) and TLC (p = 0.012). PEFR (p = 0.04) shows significant correlation with the air trapping on HRCT statistically. Among the 12 patient of 52 asthmatics, BWT on HRCT shows statistically significant correlation with basement membrane thickness on pathology, but not with epithelial layer thickness on pathology (p = 0.023, r = 0.642). The ratio of BWT between asthmatics and control subjects are significantly different on HRCT. The grade of BWT shows significant different FEV1 and TLC statistically, and that of extent of air trapping reveal significant different PEFR statistically. The BWT on HRCT reflect the thickness of epithelial basement membrane. Computer-aided diagnosis: A shape classification of pulmonary nodules imaged on high-resolution CT S. Iwano, T. Nakamura, T. Ishigaki; Nagoya/JP Purpose: The purpose of this study was to decide whether the computer image analysis could classify shape of pulmonary nodules like radiologists. Materials and Methods: Based on the high-resolution CT (HRCT) findings, two radiologists classified 70 pulmonary nodules (5-35 mm in diameter) into 7 types of shape: Round (n = 20), lobulated (n = 12), polygonal (n = 8), tentacle (n = 7), spiculated (n = 7), ragged (n = 8), and irregular (n = 8). On the other hand, an image processing computer software extracted several quantitative measures of the shape of each nodule from DICOM data of HRCT images. To identify the contour of the pulmonary nodules, -300 HU was used as the predefined threshold values. These quantitative measures were contrasted to the classification by radiologists. Results: As quantifiable features to characterize nodule shape, the circularity (= 4π*Area/ Perimeter 2 ) and the second moment were suitable. The combination of the circularity and the second moment could classify round, tentacle, spiculated, ragged, and irregular nodules. However, it was difficult to separate lobulated from polygonal nodules. Conclusion: Computer image analysis of HRCT could classify round, tentacle, spiculated, ragged, and irregular pulmonary nodules like radiologists. This method may be useful for the differentiation between malignant and benign nodules. HRCT of the lungs in cystic fibrosis: More sensitive marker of CF lung disease than LFT M. Polakovic, H. Kayserová, P. Boruta; Bratislava/SK Purpose: Our study was aimed at determining the usefulness of HRCT in evaluating pathomorphological changes of lung parenchyma, the reversibility of these changes, and correlation of these changes to pulmonary function and mutations in CFTR gene. Two HRCT examinations of the chest were performed on 63 CF patients (36 males, 27 females) with LFT (maximal interval: two weeks) in the period of 1999 to 2003. Follow-up studies were evaluated by a modified Bhalla scoring system and compared with initial studies. Lung function testing was performed on a Mir spiro-bank, using ERS 1993 (Zapletal) predicted values. In group with dF508/dF508 genotype (22 pts) the first examination mean score reached 8.7 (RL)/8.7 (LL), second 10.7 (RL)/9.7 (LL). Lung function tests were: First examination -FVC 73%, FEV1 74%, MEF50 69% and second one FVC 81%, FEV1 78%, MEF50 66%. For groups with dF508/other genotype (28 pts) and other/other genotype (13 pts) similar results were obtained. Conclusion: HRCT is a more sensitive method of evaluating pathologic process in lungs of CF patients than LFT. LFT is a more complex examination, and the results of pulmonary functions are modified by the physical status of the CF patient (nutrition, strength of muscle, acute exacerbation) and his/her ability to cooperate with spirometry (age). Severe mutations of CFTR gene in genotype are accompanied by an increasingly high HRCT score in spite of therapy applied and stable lung functions. High resolution computed tomography in the diagnosis of bronchiolitis obliterans syndrome after lung transplantation A.E. Berstad, T.M. Aaløkken, A. Kolbenstvedt, Ø. Bjørtuft; Oslo/NO Purpose: To evaluate the clinical value of high resolution computed tomography (HRCT) of patients after lung transplantation. Materials and Methods: HRCT with insp-and expiratory scans was performed in 36 patients (19 women, 10 single-and 26 double lung-, including two heartlung transplanted) who had survived for 11 months or more. The median followup time was 36 months (range 11 to 72 months). Air trapping was evaluated on expiratory scans constructed from two short spiral scans in two levels with minimum intensity projection (MINIP)-reconstruction. The degree of air trapping was classified on a 0 to 16 scale according to the affected surface area. A score of 3 or more was defined as significant air trapping. Results: 13 patients developed the bronchiolitis obliterans syndrome (BOS) as defined by reduction of pulmonary function test results to less than 80% of the best postoperative values after a median time of 12 months. 10 of these had an air trapping score of 3 or more. Among patients without BOS (n = 23), 7 patients showed significant air trapping. The sensitivity, specificity and accuracy of a score of 3 or more in the diagnosis of BOS were 77, 70 and 72% respectively. Bron-chiectasis developed more frequently in BOS than in non-BOS patients (69 and 39%, respectively). Conclusions: HRCT, including expiratory scans with MINIP-reconstruction, or development of bronchiectasis was of limited accuracy in diagnosing BOS after lung transplantation. HRCT indices and pulmonary function tests in patients with chronic bronchial asthma C. Kalogeropoulou, D. Kalampoka, P. Zampakis, I. Tsota, K. Spyropoulos, T. Petsas; Patras/GR Purpose: To quantitatively evaluate the presence and extent of low attenuation areas on chest high-resolution CT (HRCT) in patients with chronic bronchial asthma and correlate such findings with the pulmonary function tests (PFT). We examined 15 patients (M: 6 and F: 9, age 48.5 ± 11.55 yrs) with chronic bronchial asthma. All patients underwent inspiratory and expiratory HRCT as well as forced spirometry, maximum voluntary ventilation, somatic plethysmography and cardiopulmonary exercise test. HRCT images were evaluated for the presence and distribution of low attenuation areas. Objective quantification of low attenuation areas was obtained by determining the relative area of pixels representing lung tissue with a density below -910 HU (Pixel Index). The resulting pixel index was determined for a single slice at the upper middle and lower zone. Results: Pulmonary function parameters correlated well with pixel index during expiratory scan. There was significant correlation between the upper part of the lung and forced vital capacity (FVC),%FVC, forced expiratory volume in 1 sec (FEV1), maximum voluntary ventilation (MVV) and total lung capacity (TLC). The middle part of the lung correlated with FVC, FEV1, FEF25-75 and resistance. The lower part of the lung was also correlated with FEV1, FEF25-75, residual volume (RV) and total resistance. Pixel index during inspiratory HRCT scans did not correlate with pulmonary function tests. Conclusions: Expiratory HRCT in asthmatics correlates well with pulmonary functions, which suggests that in asthmatics substantial gas trapping may occur during expiration because of severe airway narrowing and/or airway closure. Thoracic imaging during treatment with pergolide R. Dore, A. Gervasio, M. Braschi, V. Vespro, G. Meloni, C. Nascimbene; Pavia/IT Purpose: Pergolide is a dopaminergic agonist widely used in the treatment of Parkinson's disease. Toxicity has been described in the form of fibrosis, inflammation of the pleura, retroperitoneal fibrosis, constrictive pericarditis and inflammatory lung infiltrates. We analyzed thoracic abnormalities in patients who have been taking Pergolide long term and the possible differential diagnosis. Hospital, "S.Matteo" IRCCS, a group of neurological patients treated with Pergolide underwent chest CT, because of clinical and chest X-ray abnormalities. We scanned each patients before and after intravenous injection of contrast medium; the lung parenchyma was evaluated with high resolution algorithm; three patients with pulmonary opacities also underwent FNAB. Results: All patients had round atelectasis associated either with pleural plaques of vary entity or with atypical and reactive pleural effusion. The thickest pleural plaques were located in the costovertebral angles, followed by the diaphragmatic pleura without effusion. In all the cases the pleural plaques in the parietal side were definetly irregular, linear in the lung side. Association with lung interstitial septal thickening was inconstant. Conclusions: Although our cases are few in number and need further validation, pleural involvement, either fibrotic or inflammatory, always seem to be associated with pulmonary abnormalities. CT pleural signs are non specific; differential diagnosis may include tumors, asbestos exposure and inflammatory disease; however the association with relevant lung round atelectasis is significant. These CT findings must be held in mind and thought to be due to toxicity in patients treated with pergolide. The chest radiological appearances of severe acute respiratory syndrome Methods and Materials: 54 patients with SARS confirmed clinically had serial chest plain films, 23 of whom also underwent chest CT scans. The radiological appearances and evolution patterns of SARS were analyzed retrospectively. Based on the extent and duration of the lesions on the chest plain films, the patients were classified into three types: Simple type (type I) in which the lesions were limited, progressive type (type II) in which more than three lungs fields were involved, and prolonged type (type III) in which the lesions remained for more than six weeks. The follow-up chest plain films and CT scans were analyzed comparatively in 18 patients of this group discharged from the hospital after clinical cure. Results: In 54 cases, on the chest radiography, 15 cases showed predominately pulmonary parenchymal lesions in the form of ground-glass opacity and consolidation, 5 cases showed predominately interstitial infiltration and 34 cases showed both parenchymal and interstitial lesions. The radiological appearances were nonspecific with good patient prognosis in type I (n = 12), and the radiological appearances were relative specific with high patient fatality rate (16%) in type II (n = 25). All of the patients (100%) in type III (n = 17) had residual lesions. CT was superior to the chest plain film on detecting residual lesions. The radiological appearances of SARS were relatively specific. The exact diagnosis of SARS must combine radiological appearances with the clinical, epidemiological and laboratory findings. HRCT To identify HRCT features that indicated predisposition to potentially fatal asthma and to evaluate serial follow-up HRCT scans of patients with nearfatal asthma (NFA). Abnormalities of the large airways (bronchial wall thickness) and small airways (centrilobular thickening and air trapping) were measured semi-quantitatively on HRCT scans of 24 non-NFA, 16 NFA, and 16 control subjects. In addition, these abnormalities were re-evaluated after intensive and relatively long-term (> 6-month) treatment with inhaled steroids. Results: Centrilobular thickening was observed in 36% of mild asthma cases, in 70% of moderate to severe asthma cases, and in 100% of NFA cases. Centrilobular thickening, but neither bronchial wall thickness nor the area of air trapping, was significantly increased in NFA, as compared with mild or moderate to severe asthma (p < 0.05, respectively). In the 7 non-NFA and 5 NFA patients who underwent follow-up HRCT scans, only bronchial wall thickness was decreased significantly in the NFA cases (p < 0.05), while bronchial wall thickness and centrilobular thickening were significantly decreased in the non-NFA cases. These small airway abnormalities were partially reversible in the both groups. Residual centrilobular thickening after long-term steroid treatment was significantly higher in NFA than non-NFA patients. The results of our study indicate that extensive small airway abnormalities may be associated with NFA, and that these abnormalities are partially reversible after the successful control of asthma symptoms. A. Kalogera-Fountzila, A. Haritanti-Kouridou, A. Lefkopoulos, G. Sevas, A. Tzinas, A. Sarafopoulos, A.S. Dimitriadis; Thessaloniki/GR Purpose: We prospectively studied AIDS and non-AIDS immunocompromised patients with lung infection in order to evaluate the HRCT findings, to characterize the infection and seek for differences in appearance of PCP in the two groups. Methods and Materials: 19 HIV positive patients were referred to the special infectious diseases unit and 11 non-AIDS immunocompromised patients were referred to the oncology unit of our hospital with a diagnosis of clinically suspected pulmonary infection. All patients were evaluated with HRCT (1.5 mm collimation, 10 mm interval, 140 kvp, 175 mAs, and 1-s scan time). All non-AIDS immunocompromised patients had bronchoalveolar lavage, sputum culture, or CT guided biopsy as well as did 10 of the HIV-positive patients which revealed PCP. In the rest of the patients PCP was confirmed after successful anti-PCP treatment. The data were calculated using the chi square test. Results: All patients in both groups had the typical findings of PCP, such as presence of ground glass appearance (patchy or diffuse), consolidation (focal or diffuse), bronchiectasis or bronchioloectasies, septal thickening, cysts and nodules. The incidence of consolidation, especially diffuse, was a significantly higher finding in non-AIDS patients (p = 0.029). On the contrary, presence of ground glass in a central/perihilar distribution (p = 0.017), septal thickening (p = 0.032) and bronchioloectasis (p = 0.032) was significantly higher in AIDS patients. Conclusion: HRCT findings of PCP in non-AIDS immunocompromised patients are more aggressive, with diffuse consolidation as the cardinal sign and are associated with a more advanced disease. Primary and secondary lung malignancies treated with percutaneous radiofrequency ablation: To describe the important CT findings to evaluate for therapeutic efficacy on follow-up CT after RF ablation for the lung cancer. The study group included 17 lung cancers and 4 metastatic nodules in 21 patients. All patients underwent follow-up helical CT examinations immediately, one month later, and then every three months after percutaneous RF ablation. Two reviewers interpreted the CT findings with consensus. The serial changes in the enhancement pattern, size, peripheral groundglass opacity, and other findings in the treated area were assessed on the follow-up CT. Sensitivity, specificity, and the positive predictive value for evaluating the complete ablation using enhancement pattern on immediate follow-up CT were determined using the Chi-square test. In the completely ablated group (n = 9), the ablated lesions demonstrated absolutely no contrast enhancement on follow-up CT and the mean percentage of ablated lesion size decreased at 3, 6, 9, 12, and 15 months (5.5%, 14.8%, 43.2%, and 43.2%, respectively) compared with immediate follow-up CT. In the partially ablated group (n = 12), the ablated lesions demonstrated varying patterns of enhancement and the mean percentage of ablated lesion size showed a gradual increase after the 6-month follow-up CT scans. Enveloped ground glass opacity surrounding the tumor was seen in 5 (23.8%) of 21 lesions on immediate follow-up CT. Conclusion: Of the CT findings of lung malignancy after RF therapy, the enhancement pattern and the change in size of the ablated lesion are the most important factors in determining whether complete ablation can be achieved. (IP) is an uncommon benign lesion characterized by an irregular growth of inflammatory cells. The purpose of this study was to evaluate CT findings of the thoracic inflammatory pseudotumor. Methods and Materials: Chest CT findings of pathologically proven seven thoracic IP were reviewed retrospectively. Mean age of the patients was 52 years old (35-62 years). Pre-and post-contrast enhancement CT were performed in all patients. Location and contour with margin of the lesion, pattern of contrast enhancement, calcification in the lesion, lymphadenopathy, associated parenchymal or pleural lesion were reviewed. Clinical findings of the patients were also evaluated. Results: Six were in the lung parenchyma (five in peripheral, one in central; four in upper lobe, two in lower lobe), and one was in the anterior mediastinum. Average size of the lesions was 6.7 cm (3-14 cm). Of the six parenchymal lesions, three revealed as ill-defined mass-like consolidation, two as well defined masses, and one as speculated mass. One mediastinal mass showed ill-defined margin. All lesions showed heterogeneous contrast enhancement. Three had eccentric calcification. None had satellite nodule. Four cases had adjacent pleural thickening or effusion. Lymphadenopathy was noted in one patient. They complained of mild fever (n = 3), hemoptysis (n = 2), coughing (n = 1), weight loss (n = 1). Four patients had past history of pulmonary tuberculosis. Conclusion: Thoracic IP showed variable CT findings. However, when dealing with a peripheral pulmonary mass with heterogeneous contrast enhancement without remarkable lymphadenopathy, the radiologists should always include IP among the entities of the differential diagnosis. Early To highlight the potential benefit of including FDG-PET in an early lung cancer detection protocol. Materials and Methods: From September 2000 to October 2002, 506 asymptomatic smokers (mean age 54.5 years, SD 8.65, mean tobacco consumption 42.55 pack-years) were studied with LDCT. Repeat short-term high-resolution CT follow-up was done for non-calcified pulmonary nodules (NCPN) < 10 mm to exclude growth. NCPN 10 mm or more were considered as potentially malignant and complementary FDG-PET scanning was recommended. Biopsy was recommended for NCPN found to be positive on the FDG-PET. Results: 144 NCPN were found in 101 (20%) asymptomatic subjects. The diameter of the largest NCPN was: 5 mm or less in 49 (48.5%) participants, > 5 -< 10 mm in 36 (35.6%) and 10 mm or more in 16 (16%). 13 subjects underwent FDG-PET exam (7 positive, 6 negative). Among the FDG-PET positive NCPN 5 were resected (lung cancer), 1 underwent fine needle aspiration cytology (FNAC) (non-specific / necrosis). The remaining subject refused further work-up. CT follow-up was decided for the other NCPN. Results will be updated after inclusion of more participants. This LDSCT based screening programme demonstrated a prevalence of 5 lung cancers in a population of 506 (0.99%) asymptomatic subjects at high risk, all with surgical stage T1N0M0. Addition of FDG-PET to the protocol may reduce the number of invasive procedures for histologically benign nodules. Technical aspects Postprocessing procedures after MDCT for airway and lung diseases A.-L. Brun, C. Beigelman-Aubry, Y. Badachi, P.A. Grenier; Paris/FR Learning Objectives: To be familiar with the postprocessing procedures after multi-detector row CT (MDCT) which can optimize the assessment of airway and lung disease. Background: Axial slices are considered as the gold standard for analysis of airways and lung diseases. Since the era of MDCT, excellent reformations, and 3D reconstructions have become available and frequently used in case of airway disease. Infiltrative and cystic lung diseases may also benefit from these techniques, provided that they are optimally used. Procedure Details: All 2D and 3D reconstruction techniques available were retrospectively applied on MDCT volume data set from patients with airway and/or lung disease, using various parameters. Optimized multiplanar volumetric reconstruction and 3D CT bronchography are particularly well adapted for assessing tracheobronchial stenosis and bronchiectasis. Maximum intensity projection is recommended for assessing small nodular and mosaic perfusion patterns. Minimum intensity projection is helpful: 1) To detect and assess ground glass opacity; 2) To visualize the airways within any lung parenchymal lesions, helping guide selective bronchial aspiration and bronchoalveolar lavage; and 3) To depict bronchial adenolectasia in patients with COPD or bronchiectasis. Virtual endoscopy is particularly helpful in depicting tiny nodulation of the tracheobronchial mucosa in granulomatous and malignant diseases. Highly selected cases will be used to illustrate the most striking additional information provided by postprocessing techniques in airway disease, infectious lung disease, and diffuse infiltrative lung disease. Postprocessing procedures in addition to axial slices allow an excellent assessment of tracheobronchial and parenchymatous diseases, particularly concerning their depiction, characterization and extent assessment. Volume rendering: Less-time consuming and accuracy technique in diagnosis of rib fractures E. Chavarri, C. Trinidad, E. Guerra, G. Fernandez, C. Delgado, P. Moreno De La Santa; Vigo/ES Learning Objectives: To asses the useful of volume rendering 3D images (VR) in the evaluation of rib fractures using a 16-slice multidetector CT. To compare VR and conventional images in determining the number and location of fractures. To describe the advantages of VR over conventional images. Background: Multislice CT has improved the resolution in evaluation of traumatic patients because it permits thinner slices and multiplanar reconstructions with near isotropic voxel. However, the number of images to be evaluated is greater and the diagnosis of rib fractures remains difficult due to the obliquity of costal arches in the axial view. We evaluated chest CT examinations in 54 patients with rib fractures. In this exhibit, we describe CT technique, reconstruction parameters and the advantages of VR over conventional images to ensure number and location of rib fractures. Procedure Details: A 16-slice multidetector CT was performed using the following parameters: 90 mAs, 120 Kv, 16 x 1.5 mm collimation, during a single breath hold. Images were reconstructed with 3 mm thickness, 50% overlapping and soft tissue kernel filter (B40). Two experimented radiologists analysed axial, multiplanar and VR images. The number of fractures, location and part of arch fractured (anterior, medium and posterior) was described. Conclusion: Volume rendering is more accurate than conventional images in determining the presence and location of rib fractures, particularly when arches are fractured in more than one site. Also, it is a less time consuming technique with better diagnosis confidence. We recommend its use in a routine practice for chest-CT in traumatic patients. C 409 B D E F A G Volume rendering 3D bronchography imaging of the airways with 16 multidetector row CT C. Trinidad, G.C. Fernandez, M. Rodriguez-Castilla, C. Martinez, E. Guerra, F. Tardáguila; Vigo/ES Learning Objectives: To describe the technique of 3D volume rendering bronchography (VR-B) with 16 multidetector row CT. To evaluate the usefulness of VR-B of the tracheobronchial tree in clinical practices comparing with axial and multiplanar reconstructions. Background: Multidetector row CT allows superior imaging resolution in axial and multiplanar images, and also contributes to advances in 3D-volume rendering that can now be feasible in clinical routine practice. In this exhibit, we will describe the CT technique and VR-B parameters to obtain good quality 3D images for visualization of central and small airways. In addition, we will evaluate the role of this technique in clinical practice and in different pathologies of the tracheobronchial tree. Procedure Details: 50 patients with airways pathology due to different etiologies were prospectively studied with 16-row multidetector CT. Images were acquired at end-inspiration during a single breath-hold with 16 x 0.75 collimation detector and reconstructed with 1 -2 mm collimation, 0.5 -1 mm increment (overlapping 50%) and soft tissue kernel filter (B30). VR-B images were showed using -150 to -750 UH window with, -526 to -250 UH window level, 35% opacity and unshaped. Conclusion: Good quality VR-B images are feasible in daily practice. In patients with benign stenosis of the central airways additional information in assessing length and degree is provided. This technique improves confidence diagnosis in extrinsic compression by malignancies. However, no additional benefit in the evaluation of endobronchial lesions and bronchiectasis is shown. Clinical Procedure Details: All scans covered from the vocal cords to the mainstem bronchi. CT parameters included a slice thickness of 2 mm, a reconstruction interval of 1 mm, a pitch of 3.5 mm, and a table speed of 7 mm per rotation. Data were obtained during a single-breath-hold acquisition in a craniocaudal direction. Twodimensional reformation images including multiplanar reconstructions (MPR), multiplanar volume reconstructions (MPVR), and three-dimensional reconstructions (external and internal rendering) were obtained at a workstation (Vitrea 2; Vital Imaging). The main applications of MSCT in airways disease as well as its limitations and pitfalls are emphasized. Specific topics addressed include congenital airways anomalies (anomalous origin of bronchi, vascular rings, tracheomalacia, bronchopleural fistula), extrinsic airways compression, tracheal and bronchial wall infiltration (bronchogenic carcinoma, angiosarcoma), intraluminal airways masses (carcinoid tumor), inflammatory diseases and posttraumatic and iatrogenic airways injuries. Conclusion: MSCT provides very high-quality image postprocessing (multiplanar and three-dimensional images), overcoming limitations inherent to SDCT. Additional benefits include preprocedural planning for bronchoscopy and surgery, and a more comprehensive spatial anatomy for both radiologists and referring physicians. Ultrasound: Guided aspiration of supraclavicular lymph nodes in patients with suspected lung cancer M. Kumaran, R. Benamore, R. Vaidhyanath, J. Entwisle; Leicester/UK Learning Objectives: To illustrate the utility of ultrasound-guided supraclavicular lymph node aspiration in the cytological diagnosis of lung carcinoma. We describe our preliminary experience in 19 patients over the last 4 months. Background: Lung carcinoma is the leading cause of cancer death in the UK. Histological diagnosis traditionally requires invasive techniques to obtain tissue, such as bronchoscopy, mediastinoscopy or image-guided lung biopsy. We have introduced this technique in patients who have at least N2 disease on staging CT. If positive, this helps both to stage the patient and provide a cytological diagnosis. It may prevent the need for more invasive techniques, such as percutaneous lung biopsy or mediastinoscopy. Procedure Details: All patients were scanned and nodes over 10 mm in size were aspirated under ultrasound guidance, using a 21 gauge green needle. A capillary "coring" technique was employed, without suction and aspiration. The samples were then expelled from the needle into cytospin fluid, for cytological examination. The procedure could be performed without local anaesthetic and as an out patient. Of the 19 patients examined, 16 had significant lymphadenopathy. Of these, 12 had positive malignant cytology, although 2 had indeterminate cell type. 4 samples showed no evidence of malignancy and PET confirmed no evidence of supraclavicular nodal involvement in 1 case. Conclusion: This is a promising non-invasive technique in the staging and diagnosis of patients with lung cancer. Simulated low radiation dose CT angiography of pulmonary arteries D. Tack 1 , V. De Maertelaer 2 , C. Suess 3 , P. Muller 4 , P. Scillia 2 , W. Petit 2 , P. Gevenois 2 ; 1 Baudour/BE, 2 Brussels/BE, 3 Forchheim/DE, 4 Charleroi/BE Purpose: To compare standard dose and simulated low-dose CT angiography of pulmonary arteries (CTPA). Raw data of CTPA acquired in 21 consecutive patients with pulmonary emboli (PE) were included. CT acquisitions (Volume Zoom, Siemens) were: 4 x 1 mm, 120 KV, 90 effective mAs. From the native raw data, four sets of simulated raw data were generated with 60, 40, 20 and 10 effective mAs, respectively. From each raw data set, CT slices were reconstructed with 1.25 mm thickness and 0.8 mm increment, and with a soft tissue kernel. Three readers who were blinded to the patients names and to the simulated mAs levels analyzed the CT series twice, in random order. PE in 6 central pulmonary arteries (PA) and 20 segmental PA were graded with a four-point scale. Agreements (Kappa statistics) and readers performances using 90 mAs as the gold standard were calculated. Results: All PE seen at 100 mAs were depicted at all lower radiation dose levels. Intraobserver agreements were independent from the radiation dose but strongly depended on the reader's experience. Agreements were good for central PE but only moderate for peripheral PA branches. Accuracy of low-and lower dose CTPA ranged from 95 to 100%, and were independent from the radiation dose (p < 0.001) but not on the reader. Conclusion: Reducing the radiation dose during CTPA is feasible with high accuracy, and may have less influence on CTPA interpretation than may have changing the reader or repeating a reading. Receiver operator characteristic analysis of observer performance in virtual bronchoscopy P. Maniatis, C. Triantopoulou, H. Labrakis, K. Malagari, I. Tsalafoutas, I. Siafas, J. Papailiou, D. Kelekis; Athens/GR Purpose: To evaluate the observer performance with the combined interpretation on a workstation of VB, axial, coronal and sagittal images against hard-copy films of thin section CT in low grade bronchial abnormalities using receiver operating characteristic (ROC) curves. Patients and Methods: 369 bronchial sections in 41 patients were evaluated in a prospective observer study using spiral CT data. Exclusion criteria included occlusions, high-grade bronchial stenoses (> 50%) and tracheal lesions. All patients underwent a spiral CT acquisition with 3 mm collimation. Two reconstruction intervals were used: 1 mm for virtual bronchoscopy and 2 mm for thin section CT. Both examinations were reviewed by two independent radiologists. The findings were correlated with those of flexible bronchoscopy and the statistical analysis was done with receiver operating characteristic curves. Results: A total of 62 lesions were identified by flexible bronchoscopy. Areas under curves for virtual bronchoscopy and multiplanar reconstructions were 0.972 and 0.949 for the two observers respectively, while areas 0.913 and 0.896 were provided from thin axial CT images (by the two observers respectively). These results differed at statistical significant level (p < 0.05 for the first observer and p < 0.01 for the second observer). The combination of multiplanar reconstructions and virtual bronchoscopy in simultaneous viewing on a workstation is particularly useful for the evaluation of low grade bronchial abnormalities at statistical significant level when compared to thin section axial CT images alone. B D E F A G Optimization of voltage combination for chest radiography in a new dualenergy subtraction system N. Bandai 1 , H. Tagashira 1 , M. Yoshimoto 1 , T. Kiriyama 2 , T. Maruyama 2 ; 1 Onsen-gun/JP, 2 Matsuyama/JP The new dual-energy subtraction system allows the fast (200 millisecond) acquisition of two, high and low voltage images using CsI:Tl amorphous silicon flat-panel technology. The purpose of this study was to determine the best combination of the voltage for the soft tissue of the chest radiography. The dual-energy subtraction imaging increases the sensitivity and specificity of the pulmonary nodule detection in the chest radiography by reducing the contrast of overlying the bone structures. The range of the high voltage is from 120 kVp to 150 kVp and the low voltage is from 60 kVp to 80 kVp, respectively. The physical factor such as contrast, density and graininess and the anatomical factor such as visibility of the vessel were evaluated by five radiologists using the normalized-rank approach. All rank orders were transformed to the distance scale by the statistical method. The ranking in the low voltage was better in the order corresponding to 60 kVp, 70 kVp and 80 kVp (p < 0.05). The ranking in the high voltage showed better in the order corresponding to 140 kVp, 150 kVp, 130 kVp and 120 kVp. There were significant differences (p < 0.05) except the distance scale between 140 kVp and 150 kVp. The best combination for the soft tissue of the chest in a new dualenergy subtraction system was 140 kVp (high voltage) and 60 kVp (low voltage). Spiral low-dose CT of the chest: A "one-stop-shop" modality for early detection of the leading causes of death G. Bastarrika, O. Cosín, J.C. Pueyo, Á. Alonso, D. Cano, J.J. Zulueta; Pamplona/ES Purpose: Spiral low-dose CT (LDCT) can identify very small lung cancers in high-risk individuals. The purpose of this study is to assess feasibility of quantifying coronary calcium using non ECG-gated LDCT exams performed in individuals participating in an early lung cancer detection programme (ELCDP). A comparative study was performed in 48 asymptomatic smokers included in an ELCDP (44 male, 4 female; mean age 59.7 years; SD 8.2). Subjects consecutively underwent a LDCT of the chest and an ECG-gated cardiac CT with a four-row MSCT scanner (Volume Zoom, Siemens, Erlangen, Germany). Standard parameters were employed: LDCT: 120 kV, 20 mAs, 1 mm slice, 1 mm coll., 6 mm table feed, 0.7 mm rec. interval; ECG-gated cardiac CT: 120 kV, 133 mAs, 3 mm slice, 2.5 mm coll., 3.75 mm table feed, 1.5 mm rec. interval. Retrospective reconstruction using the raw data from the LDCT was performed reproducing the specific ECG-gated CT parameters. Intraclass correlation coefficient (ICC), paired-sample t-test and Bland and Altman plot were employed for the statistical analysis. The paired sample t-test showed there was not a systematic bias in the measures of calcium (p = 0.31). The ICC for the overall calcium score and for the different main coronary arteries showed and excellent agreement (overall ICC 0.958, 95% CI 0.927-0.976). Conclusion: A clear correlation when evaluating quantification of coronary calcium with both CT techniques is observed. A single LDCT exam may be useful for early detection of leading causes of death: Lung cancer and coronary artery disease. Dual energy in digital chest X-ray: Material and Methods: Patients scheduled to undergo routine chest LD-MSCT were examined either without (10 mAs, 120 kV, 1.3 mm slice width fused to 3 mm effective width, spiral acquisition, n = 10) or with ECG-triggering (10 mAs, 2.5 mm slice width, axial incremental acquisition, n = 10, age-, sex-and BMI-matched) on a Philips MX8000 4-row MSCT scanner. Three independent radiologists scored axial slices at four different levels (carina, apical, mid-cardiac, basal), using a four-point scale for discrimination of pulmonary structures in the hilar region, the lung core and the subpleural region. Mediastinal structures were scored on a three point scale. Scores were compared using Wilcoxon's test. Results: For the more experienced CT radiologist, delineation of pulmonary structures did not improve significantly with ECG-triggering (p = 0.08), while improvement in the delineation of mediastinal structures was highly significant (p = 0.004). For the less experienced CT radiologist, there were no significant differences between LD-MSCTs with and without ECG-triggering for either pulmonary or mediastinal structures (p = 0.39 resp. p = 0.34). Although not formally evaluated in this study, both radiologists reported a higher quality of sagittal and coronal MPRs from non-triggered data due to lower susceptibility to breathing artifact. Conclusion: Results indicate that ECG-triggering improves delineation of moving structures (heart, mediastinum) in LD-MSCT of the chest. ECG-triggering improves delineation of pulmonary structures only in paracardial lung tissue. Results: Time-distance curves of the breathing-cycle using MRI correlated highly significantly with spirometry (p < 0.0001). VC calculated by the model was similar to VC measured in spirometry (5.00 L vs 5.15 L). tVC correlated highly significant with spirometry (p < 0.0001). Vertical parameters had a more profound influence on tVC change than horizontal parameters. Conclusions: Dynamic MRI is a simple non-invasive method to evaluate local chest wall motion and respiratory mechanics. It widens the repertoire of tools for lung examination with a high temporal resolution. Influence The aim of this study was to investigate influence of reconstruction filters on image quality in CT chest exams. Methods: 20 patients were examined with standard chest scanning protocol. After scanning, images were reconstructed with smoothing filter. Both set of images were filmed under the same conditions. In blinded assessment, three radiologists independently rated films for overall image quality and chest anatomic details (1 -unacceptable, 2 -substandard, 3 -acceptable, 4 -above average, and 5 -superior). For all exams and reconstruction filters image noise were measured in relation to the descending thoracic aorta. Results: For all three readers overall image quality was higher for standard filter. Image quality for standard protocol was 3.75 and for images reconstructed with smoothing filter 2.97. Average image noise for images reconstructed with standard filter was 36.4 and for images reconstructed with smoothing filter the noise was 15.8. All three radiologists rated greater chest anatomic details for standard protocol images. For both protocols the best-rated detail was that of the trachea and main bronchi (4.15 standard, 3.18 smoothing), and the worst was that of the esophagus (2.87 standard, 2.20 smoothing). The greatest difference between rates of the two protocols was for paratracheal tissue (3.41 standard, 2.27 smoothing) and the smallest for carina and lymph node area (3.31 standard, 2.67 smoothing). Conclusion: Standard filter is better in visualization of all anatomic detail in general chest exams including mediastinal structure and lymph node area. Greater image noise for image reconstructed with standard filters does not influence visualization of anatomic detail. Usefulness New quality assurance systems for the evaluation of detectability of lung nodules on the digital chest radiograph Y. Fujiwara, K. Higashimura, H. Kimura, H. Itoh; Fukui/JP Purpose: The goal of this study is to develop a new quality assurance system for evaluating detectability of lung nodule of the digital chest radiograph. Method and Materials: First, we made an oval shaped phantom, which simulated lung tissue such as muscle, fat, and pulmonary field. Then several nodules with variable CT values were inserted into the center of the phantom. Second, we took images of the phantom using CT and digital radiography (DR) with a flat panel detector.The contrast of the nodules relative to the pulmonary field were measured both on chest CT and DR. The relationship between contrast from CT and DR was analyzed in regression using 3 rd order polynomial. Finally, the same analysis was also performed on nodules from clinical cases with lung cancer (n = 70), and clinical data was fitted into the same polynomial line. Results: All nodules with the CT value less than 250 in the difference between nodules and lung field could not be detected on DR. The relationship between the contrast from CT and DR in clinical cases was also regressed with the same 3 rd order polynomial line from the phantom data. The current result is very useful for the evaluation of the detectability on chest DR. When one want to check it using variable nodules with known CT values, if the contrast of the nodules on DR is not regressed on above line, the assurance of DR might be problematic and/or DR system may need to be reconditioned. 412 B D E F A G Pulmonary thromboembolism: Acute versus chronic (Pictorial review) A. Oikonomou 1 , C.J. Dennie 2 , J.M. Seely 2 , F.R. Matzinger 2 , F.D. Rubens 2 , P.K. Prassopoulos 1 ; 1 Alexandroupolis/GR, 2 Ottawa, ON/CA Learning Objectives: To present the spectrum of imaging findings that allow the differentiation of acute pulmonary embolism (APE) from chronic thromboembolic pulmonary artery hypertension (CTEPH) based on chest radiography and helical computed tomography (CT). Background: Patients with a prompt diagnosis of APE may recover completely following anticoagulation therapy. In a minority, pulmonary emboli do not completely resolve leading to organization, artery obstruction and ultimately to CTEPH. Although the evolution process of APE to CTEPH has not been fully elucidated, the distinction of the two entities is critical since the treatment of APE is conservative, while CTEPH warrants pulmonary thromboendarterectomy. Imaging Findings: Radiographic findings of APE are nonspecific and include atelectasis, peripheral consolidation and pleural effusion. Localized lung oligemia with associated dilatation of a central artery is extremely rare. Right ventricular and central pulmonary enlargement, patchy oligemia and peripheral scars may be seen in CTEPH. The cardinal signs of APE on CT angiography are central or completely occluding arterial filling defects, which may be associated with peripheral airspace disease and pleural effusion. Eccentric filling defects adherent to the vessel wall, irregular intimal thickening, abrupt vessel narrowing or tortuosity are features of CTEPH. Dilatation of central arteries, abrupt vessel cut-off and peripheral scars are more common in CTEPH than in APE but arterial webs, bands and mural calcifications are only observed in CTEPH. If arterial findings suggestive of CTEPH are present, the addition of mosaic oligemia on HRCT is pathognomonic of CTEPH. Conclusion: CT allows differentiation of APE from CTEPH. Pulmonary hypertension: CT of the chest in pulmonary veno-occlusive disease A. Resten, S. Maître, M. Humbert, F. Capron, G. Simonneau, D. Musset; Clamart/FR Purpose: Pulmonary veno-occlusive disease is a rare cause of pulmonary hypertension and often difficult to distinguish from severe primary pulmonary hypertension. Unfortunately, medical treatment of the primary pulmonary hypertension by prostacyclin (PGI 2 ) can be fatal in veno-occlusive disease and an early pre-therapeutic diagnosis of this uncommon condition is critical. So, the aim of the study was to evaluate CT of the chest as a non invasive approach of this disease. We reviewed cross-referenced records from 1996 to 2001 in our departments of radiology and pathology and identified 15 patients with an initial pre-therapeutic CT and a pathologically confirmed pulmonary venoocclusive disease. CT scans were compared with the CT scans of 15 consecutive patients with a pathologically confirmed primary pulmonary hypertension. Results: Ground glass opacities were significantly more frequent in pulmonary veno-occlusive disease (p = 0.003), abundant, with a random repartition, and a preferentially centrilobular distribution (p = 0.03). Sub-pleural septal lines, and adenopathy were also significantly more frequent (p < 0.0001). The association of these three findings appeared to be quite pathognomonic of pulmonary venoocclusive disease as the cause of pulmonary hypertension (specificity = 100%) with a 66% sensitivity. Conclusion: On the initial pre-therapeutic chest CT, association of ground glass opacities (particularly with a centrilobular distribution), septal lines, and adenopathy are indicative of pulmonary veno-occlusive disease in patients displaying pulmonary hypertension. Caution must be taken before initiating vasodilatator therapy in the presence of such radiological abnormalities. .0 x 1.6 mm 3 ) was performed during and after a single injection of 0.1 mmol/kg body weight of Gadomer. Image data was compared to pre-embolism Gd-DTPA-enhanced MRI and post-embolism thin-section Multi-Slice CT (n = 2). SNR measurements were performed in pulmonary arteries and lung. Results: One animal died after induction of PE. In all other animals, perfusion MRI and MRA could be acquired after single injection of Gadomer. At perfusion MRI, PE could be detected by typical wedge-shaped perfusion defects. While the visualization of central PE at MRA correlated well with CT, peripheral PE were only visualized by CT. Gadomer achieved a higher peak SNR of the lungs compared to Gd-DTPA (21 ± 8 vs. 13 ± 3). Conclusion: Contrast-enhanced 3D perfusion MRI and MRA allow the assessment of PE using a single injection of the blood pool contrast agent Gadomer. C 413 B D E F A G Detection of pulmonary emboli with thin slice (3 mm) maximum intensity projection reconstructions of multi-detector CT pulmonary angiography S.K. Venkatesh, S. Wang, P. Goh; Singapore/SG Purpose: To compare thin-slice (3-mm) maximum intensity projection (MIP) reconstructions with 3 mm axial scans for detection of acute pulmonary emboli. Materials and Methods: Multi-detector CT pulmonary angiography (4 x 1 mm, 1.5 pitch; 0.5 sec) was performed in 18 patients. From each raw data set, axial 1 mm and 3 mm scans were reconstructed. Thin-slice (3 mm) MIPs in axial, coronal and rotational planes were reconstructed from 1 mm axial data using a 3D Workstation. The 90 data sets were reviewed for evidence of embolus on a per vessel basis by 2 radiologists with discrepancies resolved by consensus. Emboli demonstrated on the axial 1 mm images were taken as standard for comparison. Results: Pulmonary emboli were detected in 336 vessels (mean of 18.7 emboli per patient) with 35.8% in subsegmental arteries. The thin-slice MIP images demonstrated more emboli as compared to axial 3 mm images. Axial and rotational 3 mm MIP images detected most of the emboli (95.2% and 92%). Significant advantage of axial and rotational 3 mm MIPs over axial 3 mm images was seen at subsegmental artery level (92.5% and 89.2% versus 41.7%) (P < 0.05). Among the MIPs, axial MIPs detected the most number of emboli in upper and middle lobes, whereas the rotational MIP detected slightly higher emboli in the lower lobes. Conclusions: Thin slice MIPs are superior to axial 3 mm for pulmonary embolus detection. The advantage of MIPs is most significant at the level of subsegmental artery level and beyond. We recommend routine use of axial 3 mm MIPs in the detection of pulmonary embolus. Primitive angiosarcomas of the pulmonary arteries: Difficulties in CT diagnosis R. Dore, M. Mantelli, V. Vespro, D. Savulescu, G. DiGiulio; Pavia/IT Purpose: Primitive angiosarcomas of the pulmonary arteries are very uncommon tumors. The radiologist should consider them in the differential diagnosis with thromboembolic disease, in patients with clinical suspicion of pulmonary embolism, as early surgical treatment may be beneficial. Between 1993 and 2003, at our Hospital, "S.Matteo" IRCCS, we identified three cases of primitive angiosarcomas of the pulmonary arteries, subsequently confirmed at surgical examination, on chest CTs of patients with clinical suspicion of thromboembolism. We used a single-slice spiral CT scanner (24 sec., 3-5 mm collimation), with iv contrast injection at high flow rate. Both pulmonary parenchyma and vasculature were evaluated, along with the enhancement pattern of the endoluminal lesions. Results: In all 3 cases, the left main pulmonary artery was affected (the distal segment in one case and proximal segments in two). In one patient, the right main pulmonary artery was also involved. All the vascular lesions were occlusive, without anterograde flow and extravasal diffusion. In two patients, contrast enhancement of the endoluminal mass was better detected in the delayed scan. In one patient, contrast enhancement had a periferical distribution. In all the patients, there were no parenchymal signs of thromboembolic disease. Conclusions: Primitive angiosarcomas of the pulmonary arteries are associated with occlusion of the main pulmonary artery and lack of parenchymal signs. As the differential diagnosis between massive thromboembolic disease and primitive angiosarcoma may be difficult with monophasic CT scan, the evaluation of the contrast enhancement of intraarterial lesion in the delayed phase becomes fundamental. Purpose: To demonstrate the imaging features of chronic thromboembolic pulmonary hypertension (CTPH) on chest CT scans and to evaluate the correlation between the extent of mosaic pattern of lung attenuation and hemodynamic measurements. Methods and Materials: Chest CT scans of 50 patients with CTPH were reviewed to assess vascular and parenchymal changes. In all patients diagnosis was confirmed by surgery. The diameter of the main pulmonary artery (PA) and the ratio of the diameters of the main pulmonary artery to the ascending aorta (rPA) were correlated with mean pulmorary artery pressure and pulmonary vascular resistance. Mosaic attenuation was quantitated by adding the number of abnormal lobes (including lingula, score 0-6). This score was correlated with the hemodynamic measurements. Results were analysed by regression analysis and Spearman's correlation. Results: Thrombi were observed in the central pulmonary arteries in 79% of cases. In all CT scans a mosaic pattern of lung attenuation was found. Scars related to the pleural surface were identified in 69% of cases, bronchial artery collaterals in 60%. CT scans showed dilated PA in 98% and rPA ≥ 1 in 90%. Mean pulmonary artery pressure correlated more strongly with rPA than with diameter of PA. The score of mosaic attenuation showed a strong correlation with pulmonary vascular resistance (r = 0.66; p < 0.0001). To be able to recall the most common CT and MR intrathoracic manifestations in patients with breast cancer. 2. To be able to describe the radiologic features of this entity. 3. To be able to recall helpful clues for narrowing the differential diagnosis and appropriately directing patient management decisions. Background: Breast cancer is a common cancer in women and is second only to lung cancer as a cause of cancer-related deaths in women. The thorax is a common site of metastasic disease and complications related to surgery, chemotherapy, radiotherapy and autologous bone marrow transplantation. Imaging Findings: The purpose of this exhibit is to review the CT and MR findings of the various intrathoracic manifestations occurring in patients with breast cancer. These include complications related to direct extension of tumor, to metastatic spread, and complications secondary to treatment. The complications can be divided into those that affect the chest wall (chest wall invasion, chest wall metastases, axillary and internal mammary lymphadenopathy, local recurrence, postradiotherapy sternal and costal tumors, surgical complications), mediastinal and hilar manifestations (lymphadenopathy, abscess formation, lymphatic obstruction), pulmonary manifestations (lymphangitic carcinomatosis, pulmonary metastases, endobronchial metastases, neoplastic emboli, lung infections related to immunosuppressive therapy, obliterative bronchiolitis post bone marrow transplantation) and pleural manifestations (pleural effusion, pleural metastases). Conclusions: Knowledge of the full spectrum of radiologic manifestations of the thoracic complications of breast cancer is useful in diagnosis and in preventing diagnostic errors. Bronchogenic cysts: Range of radiological appearances F. Almolani, P.M. Logan; Dublin/IE Learning Objective: To review and illustrate the range of plain film, CT and MRI appearances of bronchogenic cysts. Background: Bronchogenic cysts are one of the congenital cystic lesions in the chest. It has variable appearances on imaging and overlapping features with other mediastinal lesions. It is often identified incidentally. Imaging Findings: We reviewed the imaging on 30 proven bronchogenic cysts. Plain radiographs and CT images were available for all cases. MRI images were available in 8 cases. Most of bronchogenic cysts have a classic mediastinal location and well defined margin on plain films, with homogeneous low density appearance on CT. However they can be found within the lung parenchyma, be cystic or cavitary, have thick walls and be seen to expand. On MRI, fluid levels can be demonstrated. Occasionally, they can be multiple or co-exist with significant unrelated pathology. Conclusion: Bronchogenic cysts have a wide range of imaging appearances and familiarization with these appearances is essential for appropriate inclusion of the diagnosis within a list of differential diagnoses. Imaging appearances of mediastinal cystic lesions S.P. Prabhu, K. Burney, P. Goddard; Bristol/UK Learning Objectives: To illustrate the radiological appearances of various mediastinal cystic lesions using various imaging modalities. Background: Cysts of the mediastinum constitute a small but important diagnostic group, representing 12 to 18% of all primary mediastinal tumors. Mediastinal cysts can be classified based on their aetiology, and include bronchogenic, oesophageal duplication cysts of foregut origin, mesothelial derived pericardial and pleural cysts, cystic thymic lesions, and other miscellaneous cysts. Neuroenteric cysts may develop by abnormal septation of the embryogenic germ cell layer, which closely associate with the vertebral column. In addition, mesothelial cysts, including pericardial and pleural cysts, and thymic cysts also occur in the mediastinum, as well as other rare cysts. Imaging Findings: Characteristic location and internal architecture of different mediastinal cystic lesions are used to aid the clinician in formulating a diagnostic plan. Plain chest radiographs can identify mediastinal cysts in a large proportion of cases. CT usually reveals well-circumscribed rounded masses of water density or a little higher and is useful in delineating the size, shape, and extent of the mediastinal masses. Characteristic fluid signal on MRI performed in selected patients differentiates the benign cystic lesion from solid mediastinal masses. MRI has therefore succeeded in providing valuable pre-operative specific diagnostic confirmation in regard to mediastinal cysts in selected cases. In this pictorial review, we review the radiological appearances on plain radiographs and cross-sectional imaging for the entire spectrum of cystic lesions of the mediastinum. Non-infectious radiographic manifestations of bone marrow transplantation: A pictorial review D. Beckett, J. Oliff; Birmingham/UK Learning Objectives: To illustrate the radiological manifestations following stem cell transplantation for haematological malignancy. To outline the incidence, clinical presentation and role of imaging within this patient sub-group. Background: Bone marrow transplantation (BMT) is a critical therapeutic intervention for a variety of pathological conditions. The complications of BMT include chemotherapy and radiation toxicity, graft versus host disease, recurrent malignancy and miscellaneous conditions. Complications of allogenic BMT manifest in a variety of clinical settings affecting all organ systems. Plain radiography, contrast enhanced studies, sonography, CT, MRI and interventional techniques are essential in diagnosing these complications and evaluating their response to therapy. Imaging Findings: Pulmonary manifestations include drug and radiation toxicity, bronchiolitis obliterans, bronchiolitis obliterans organizing pneumonia, lymphocytic interstitial pneumonitis and diffuse alveolar haemorrhage. Gastrointestinal presentation with veno-occlusive disease, typhlitis and pneumatosis intestinalis are also reviewed, as are central nervous, musculoskeletal and cardiovascular system manifestations. The spectrum of imaging findings following BMT is diverse. A firm understanding of the clinical presentations and incidence in combination with typical radiological findings is essential in the successful management of this patient sub-group. Thoracic manifestations of chronic renal failure A.M. Barnacle, P.G. Gishen, S.J. Copley; London/UK Learning Objectives: To review the radiological spectrum of thoracic manifestations of chronic renal failure, including the more unusual imaging appearances. Background: The effects of chronic uraemia are evident in a multitude of organ systems, including the pulmonary, cardiovascular and musculoskeletal systems. Imaging Findings: The poster illustrates common thoracic manifestations such as pulmonary oedema and uraemic pericarditis. More unusual manifestations of chronic renal failure such as metastatic pulmonary calcification, renal osteodystrophy, amyloidosis and peritoneal dialysis fluid collection within the mediastinum are highlighted. Plain radiographic and CT imaging findings of both these common and more unusual pulmonary manifestations are reviewed. The study illustrates the diversity of thoracic manifestations encountered in chronic renal failure patients and the less well recognised sequelae that should not be overlooked when imaging such patients. Background: While the availability of bone marrow transplantation is improving and increasing numbers of adults and children are undergoing the procedure for the treatment of a wide variety of malignant tumours and haematological disorders, it remains a procedure which carries with it a very significant complication risk. Despite prophylactic therapy, patients remain at particularly high risk for bacterial, viral and fungal infection in the post-procedure time period. Infectious complications are diagnosed and monitored using plain radiography, ultrasound, CT, MRI, image-guided biopsy and less often, nuclear medicine. Other commonly encountered complications requiring radiological investigation include hepatobiliary complications, veno-occlusive complications and graft-versus-host disease. Imaging Findings: This educational exhibit demonstrates the radiological appearances of the spectrum of common and unusual complications encountered by patients who have undergone bone marrow transplantation, as depicted using a wide variety of imaging modalities. Conclusion: While bone marrow transplantation is a life saving procedure it still retains a high degree of morbidity and unfortunately a wide range of complications can arise following the procedure. The role of the radiologist in using a number of imaging modalities to accurately diagnose and follow these complications remains an important one. Air-space pattern lung metastasis L. Herraiz, A. Cima Fernandez, S. Dieguez, M. Grande, M. Sanchez Nistal; Madrid/ES Learning Objectives: To identify and describe the imaging findings on air-space pattern in lung metastasis. Background: Lepidic pattern growth in lung metastasis is an uncommon manifestation of disseminated malignancies, mainly described in gastrointestinal adenocarcinomas. On CT, differentiation from other lung diseases as multifocal pneumonia, bronchiolitis obliterans organizing pneumonia (BOOP) and brochioloalveolar carcinoma (BAC) may be difficult, and diagnosis of BAC cannot be made with confidence if a primitive extrapulmonay adenocarcinoma has not been ruled out. Imaging Findings: We reviewed X-ray films and CT studies of 8 patients with proven air-space pattern lung metastasis. Metastasis was classified as air-space disease when it showed one or more of the following CT findings: Air-space nodules, including cavitating and pseudocavitating nodules; parenchymal consolidation containing air bronchogram and focal or diffuse ground-glass opacities. The primary tumors were colorectal adenocarcinoma in 5 patients; pancreatic adenocarcinoma in 1; adenocarcinoma of the ampulla of Vater in 1 and infiltrating duct breast carcinoma in 1. In 1 patient the diagnosis of pulmonary disease preceded the discovery of primary malignancy and was synchronous in 2 other patients. Cavitating nodules were seen in 5 patients; parenchymal consolidation in 3; ground-glass opacities were seen in 3; pseudocavitated nodules in other 3 patients; solid nodules in 3; nodules with air bronchogram in two; mass with air bronchogram in 2 and lymphangitic carcinomatosis in 1 patient. Conclusions: Air-space pattern is an uncommon manifestation of lung metastasis. Differentiation from BOOP, multifocal pneumonia and bronchioloalveolar carcinoma can be difficult because this can be the onset of the disease. Imaging of chest wall disorders J. Lee, K.-N. Lee, S. Kim, J. Lee, M. Roh; Busan/KR Purpose: To illustrate the radiologic features of a wide spectrum of chest wall disorders according to anatomic location. We have retrospectively reviewed the radiologic findings of patients with chest wall lesions pathologically proven by biopsy or surgery between January 1999 and July 2003. We excluded cases of pleural effusion or thickening, chest wall invasion by lung cancer or mediastinal malignant tumor, and secondary metastatic lesions. All patients had plain films and spiral CT scan with intravenous contrast enhancement. Several patients underwent supplementary MR with gadolinium enhancement. Results: Pleural lesions include empyema, tuberculous empyema, empyema neccessitatis, localized fibrous tumor of pleura, malignant mesenchymal cell tu-mor, malignant mesothelioma, pleuroblastoma, fibrosarcoma, angiosarcoma and asbestos-related pleural plaques. Muscle and subcutaneous fat are involved in Poland's syndrome, inflammation, abscess, tuberculous abscess, empyema neccessitatis, post-operative hematoma, epidermal cyst, intramuscular hemangioma, elastofibroma dorsi, pectoralis muscle fibromatosis, neurofibromatosis, malignant schwannoma, muscle involving NHL, subcutaneous T-cell lymphoma and extraskeletal Ewing's sarcoma. Rib lesions include chronic inflammation, osteochondroma, enchondroma, eosinophilic granuloma, and plasmacytoma. Sternal lesions include chronic inflammation and pigeon breast. A case of chondrosarcoma of the T7 vertebral body is also included. A wide of spectrum of disease processes affect the chest wall. The CT and MR imaging has enabled precise localization and differential diagnosis of chest wall lesions. Therefore, familiarity with these radiologic features will make accurate diagnosis possible and and allow for optimal patient treatment. Standardized In all patients 120 mL contrast-agent was injected with a flow-rate of 3.5 mL/sec, scan delay was 25 sec. Results: In 231 (69%) of 335 patients chest injuries were detected. The following posttraumatic thoracic injuries were revealed: In 97 patients (42%) emphysema, in 23 (10%) hematoma of chest wall; in 50 patients (21.6%) fracture of the thoracic spine, 177 (76.7%) fractures of the ribs, 29 (12.6%) of clavicle, 15 (6.5%) of sternum, 26 (11.3%) of scapula; 127 (55%) patients had a pneumothorax, 68 (29.4%) a hematothorax, 2 (0.9%) a tension pneumothorax; 93 patients (40.3%) had a lung contusion, 12 (5.2%) a lung laceration; 23 patients (10%) had a pneumomediastinum; 4 (1.7%) a rupture of thoracic aorta; 1 (0.5%) rupture of a supraaortal ar tery and 4 (1.7%) a rupture of diaphragm. No injuries of tracheobronchial system, esophagus or the heart were detected. Conclusion: A standardized MSCT examination protocol represents the preferred screening method in the evaluation of patients who have sustained chest trauma. Purpose:To find out important CT findings for the prediction of prognosis of thymoma with a survival analysis. Materials and Methods: 45 patients with thymoma, who underwent surgical resection, were retrospectively analyzed. Clinical data were collected from chart review. Preoperative plain and contrast enhanced CT was performed in all patients. Two independent chest radiologists evaluated CT images paying special attention to diameter, contour, shape, cystic or necrotic portion, calcification, mediastinal fat obliteration, invasion of adjacent mediastinal structure, thickening of adjacent pleura, infiltration of adjacent lung, infiltration of adjacent chest wall, pleural effusion, pericardial effusion, mediastinal lymphadenopathy, enhancement pattern, and degree of enhancement. Kaplan-Meier survival curves were generated. Influence on survival for each CT finding was analyzed by logrank test. Results: Cystic or necrotic portion, calcification, mediastinal fat obliteration, invasion of adjacent mediastinal structure, thickening of adjacent pleura, infiltration of adjacent lung, infiltration of adjacent chest wall, pleural effusion, pericardial effusion, mediastinal lymphadenopathy, homogeneous enhancement pattern and high degree of enhancement were seen in 40%, 43%, 71%, 39%, 12%, 6%, 10%, 6%, 6%, 2%, 70% and 56% of patients respectively. The CT finding that were most predictive of survival was calcification (logrank test: p = 0.001). Cystic or necrotic portion (p = 0.01), infiltration of adjacent chest wall (p = 0.001), and pleural effusion (p = 0.003) were independent predictors of long-term survival. There were no differences in survival for the other findings. Conclusion: Calcification, cystic or necrotic portion, infiltration of adjacent chest wall, or pleural effusion on CT suggest poor prognosis of thymoma. 416 B D E F A G Low attenuation splenic lesions found at chest CT: Differential diagnosis and investigation A.K. Choudhary, E.L. Senior, N.J. Screaton; Cambridge/UK Learning Objectives: 1. To illustrate the causes of low attenuation splenic lesions. 2. To discuss clinical and imaging features which aid diagnosis in patients with known or suspected malignancy. Background: Abnormalities of the spleen are commonly encountered during CT of the thorax and abdomen in patients with suspected thoracic disease, posing diagnostic difficulty particularly in patients with otherwise operable malignancy. We present a pictorial review of low attenuation splenic lesions in patients with suspected thoracic disease. The most common causes are benign (including pseudocysts caused by trauma, infection or infarction), infections (mycobacterial, fungal, hydatid), sarcoidosis, haemangiomata, and lymphangiomatosis. Malignant causes include lymphoma and metastases (lung, breast, melanoma, stomach, liver, colon). In patients with known malignancy, splenic metastases are rare in the absence of widespread metastatic disease. Although the morphological pattern on CT may suggest malignancy (multiplicity of lesions, irregular margins, enhancement and splenomegaly), other imaging studies may be complementary. On ultrasound focal anechoic lesions are typical of benign cysts while multifocal or diffuse solid lesions are suggestive of malignancy. On MRI heterogeneous lesion signal is suggestive of malignancy. In cases where morphological imaging is non-specific, FDG-PET may play an important role. The accuracy of splenic biopsy in indeterminate lesions approaches 90% but significant complications occur in 10.3%. Conclusion: Isolated low attenuation splenic lesions must not be considered synonymous with metastases even in patients with known cancer. Awareness of the differential diagnosis and further imaging permit accurate diagnosis and management. Evaluation . Whole-body MSCT scan were performed using the following protocol: 1) Native head and neck: 5 mm slice thickness, UM mode, reconstruction 2.5 mm; 2) Administration of 50-120 mL nonionic contrast media using automatic injector at flow rate of 4 mL/sec and Smart Prep feature; 3) Thorax, abdomen and pelvis scan: 3.75 mm slice thickness, US mode, reconstruction 1.8 mm; 4) Scan time under 1 minute; 5) Images were used for MPR and 3D-VR. Results: In management of polytrauma patients, time is of the essence. In 75 high-risk patients who were selected for MSCT examination following injuries were found: 12 cranial (sub and epidural hematoma, contusion, fracture etc); 63 thoracic (hematothorax, lung contusion, pneumothorax etc); 40 abdominal (contusion and hematoma of parenchymal organ, retroperitoneal bleeding); 34 aortic (rupture, dissection, periaortal hematoma); 68 fractures (mostly ribs -17 [22%] and pelvis -14 [18%]) Conclusion: In our hospital MSCT represents the major diagnostic tool in the management of high-risk polytrauma patients, reducing time spent outside of emergency unit. It is a fast and reliable method for diagnosis of skeletal trauma, parenchymal organs and aortic injuries. The radiologist becomes important member of the trauma team in management of acute polytrauma patients. Learning Objectives: To illustrate the fundamentals of digital imaging, the basic operations of image display and manipulation, the principles of image compression and filtering. Backgound: Radiological scanners generate digital images and image interpretation is performed using dedicated workstations. The knowledge of digital imaging, image compression and filtering is crucial to understand the new technologies and the post processing operations. Procedure Details: The structure of a digital image, the encoding algorithm, the operations for image display and manipulation, and the compression algorithms are described. A phantom and clinical cases are used to show the influence of these aspects on the quality and information of the images. Conclusion: Several aspects affect the information and the quality of digital images. The basic criteria for assessing image quality are defined. Web-based radiology-teaching library for board examination of radiologists with object-oriented database system N. We have developed a web-based radiology-teaching library for a board examination of radiologists in Japan. This library receives imaging cases from all of Japan via the Internet. The web-based radiology-teaching library is developed with an object-oriented database, and it is readily available with a simple operation to radiologists. The submission process makes full use of the Internet. The reviewers, who are expert radiologists, carefully review the submitted cases. When the reviewed case is sent back to the submitter with the reviewers' comments, the submitter should correct their text and images according to the reviewers' comments in order to obtain the reviewers' approval. The computer assists these processes automatically, and it enables submitters and reviewers to do collaborative work in registering cases without temporal or spatial restriction. Finally, approved cases can be registered to our library. Results: Up to August 2003, our radiology-teaching library has collected 1264 imaging cases in all subspecialties. In these cases, 616 cases have been registered. In August 2002, the board examination of radiologists in Japan has been performed with selected cases from this library in all subspecialties. Conclusion: Our library is readily available to radiologists who do not have much computer knowledge. Our web-based radiology-teaching library will be useful for the education of all radiologists. PACS: Ergonomic considerations C.L. Arnoldus, C.J. Zylak, M. Flynn; Detroit, MI/US Learning Objectives: Ergonomic issues associated with picture archivial and communication systems (PACS) should be addressed during the early phase of incorporation in the radiology department. This reviews how a large tertiary care teaching hospital addressed these issues. Background: Existing computer and alternator workstations in the radiology department were observed for six months. The radiologists were surveyed on workstation issues related to space, noise, lighting, and repetitive motion. A PACS ergonomic work group consisting of radiologists, physicists, and administrators accepted the task of addressing these issues and recommending solutions. Procedure Details: On non-ergonomic workstations, repetitive strain occurred. Of the forty-one radiologists on staff, four who used computer workstations extensively had elbow and shoulder tendinitis from extended periods of reach while manipulating images with the mouse. Carpal tunnel symptoms, neck strain from periods of flexion or extension, and eye fatigue were also experienced. Alternators placed near monitors reflected light and ghost images on monitor screens. Eye level evaluation of films was not possible with fixed monitor height. Crowded workstations and alternators were observed. Based on the findings, adjustable workstations with articulating keyboards, mousing surfaces with gel wrist rests, flat screen liquid crystal display (LCD) monitors, and multi-adjustable posture support chairs were evaluated. Placement of view boxes and ambient lighting issues were addressed. Adjustable height workstations for small group consultation and conferencing will be strategically located. Voice amplification is being considered. Conclusion: Ergonomic issues should be identified early before PACS transition to allow a workplace design to maximize workflow and minimize repetitive strain. withdrawn by authors In any single patient we use the same position during each scan to get proper images coregistration. During body scans patients were instructed to breath freely, but not deeply, and not to move. We used a dedicated system for image fusion that combines volumetric information from PET, CT and MRI to get proper coregistration in all cases. Conclusion: Metabolic and anatomical information can be combined precisely to asses anatomic locations of lesions and artifacts with proper coregistration obtained with separate scanners using dedicated software. Background: Current limitations with regard to medical image quality control and consistency have been discussed previously. We have recently suggested proposals to several American industrial and scientific bodies aimed to improve image quality performance criteria for both clinical and diagnostic images. Although some regional and national guidelines and regulations exist, practical universal standards have not yet been achieved. Procedure Details: This exhibit shows how international radiology and technical societies, regulatory groups, and standards agencies may collaborate in order to improve medical image quality performance and standards, including but not limited to (1) performance criteria for softcopy and hardcopy, (2) extending communication and control standards for the performance of output devices, and (3) initiation and support for research into the relationship between display physical metrics and diagnostic performance, to assess clinical consequences of variations in image quality metrics, and to define what constitutes image quality from a diagnostic perspective. The exhibit has presented some initial steps that will improve the consistency and reproducibility of medical images in electronic imaging systems. The international medical community has an opportunity to build upon the work of many regional and national efforts in a collaborative effort to improve medical image quality with anticipated benefits to patient care, medical practitioners, and the medical industry. 418 B D E F A G Modeling and simulation of the blood flow using multi-slice CT: Application of computational fluid dynamics S. Yamamoto 1 , S. Hamada 1 , T. Johkoh 1 , S. Murai 1 , S. Yoneyama 2 , S. Maruyama 1 , N. Tomiyama 1 , M. Komizu 1 , H. Nakamura 1 ; 1 Osaka/JP, 2 Tokyo/JP Learning Objectives: To understand the prediction based medicine model using computer fluid dynamics (CFD). To support the informed consent of the patient using four-dimensional display. To describe the technical procedure of CT scanning for blood flow analysis. Background: Aortic aneurysms or dissecting aneurysms are serious and lifethreatening conditions that requires early diagnosis and prompt surgical treatment. It is difficult to directly measure the blood flow and pressure without invasive examination. Computer simulation is one of the solutions for non-invasive diagnosis, or for comparison of pre-and post-operative measurement of the blood flow and pressure. In this exhibit we will describe the application of CFD based on four-dimensional vessel reconstructions from multi-slice CT data. Procedure Details: The volume data (0.5-2 mm slice thickness) was acquired from half-second multi-slice CT (Aquilion, Toshiba, Tokyo, Japan). Segmented vessels were converted surface display by Marchine Cubes Method. Input parameters of blood were applied as an ideal incompressible fluid. Steady and transient analysis of CFD was performed using commercially available software (AcuSolve, ACUSIM Software, Mountain View, CA) by a finite element method. Original program modules for image processing of both vector and medical (DI-COM) data was implemented on a commercially available workstation (Amira 3.0, TGS, San Diego, CA). Variable dynamic display of both steam line of blood and blood pressure was superimposed on the three-dimensional CT data (multi planer reformat, maximum intensity projection and volume rendering etc) Conclusion: Modeling and simulation applications to the blood flow could enable us to build rapid prototypes of the models for quick visual validations. Using remote ASP and internet-2 for integrating digital radiological images with a regionalinformation system in a new population-based purchasing system for public healthcare provision O. Barbero 1 , J. Guanyabens 1 , C. Rúbies 1 , J. Fernández 1 , J. Maideu 2 , I. Cerdà 2 ; 1 Sabadell/ES, 2 Vic/ES To learn about the improvements in health care management due to the implementation of several integrated HIS/RIS and PACS in a regional area.To learn how new technologies like Java, Internet 2, ASP and remote image archival can be used to improve health care management and provision. Background: A pilot project to evaluate the possibilities of digital radiology in the improvement of health care is underway within the framework of the Catalan Health Service's strategic plan to establish a system in the county of Osona(*), not far from Barcelona (Spain). The sharing of information forms the backbone of the project, the aim being to enable all authorized healthcare personnel to have 24-hour-a-day access to all digital information and images from examinations performed in all healthcare centers in the county, whether private or public. Procedure details: For the evaluation and analysis: 1. Improvements brought about in healthcare services; 2. Organizational impact; 3. Cost-benefit analysis; 4. Elements to take into account for the system's implementation and extension. From the technological point of view: 1. Remote ASP archive; 2. High-speed Internet-2 links; 3. Information systems integration based on Web, Java, XML and DICOM. The analysis and evaluation of the results of this innovative project and health care provision strategy will be presented in ECR. (*) The Health Care Ministry will pay a fixed amount of money per person and per year to all the health care providers of the area in exchange for public health care services. A new parameter enhancing breast cancer detection in computer aided diagnosis of X-ray mammograms K. Murase 1 , N. Tanki 1 , M. Iinuma 1 , H. Kubota 1 , M. Nagao 2 ; 1 Osaka/JP, 2 Matsuyama/JP Purpose: To introduce a new parameter enhancing breast cancer detection in computer aided diagnosis (CAD) of X-ray mammograms. We used the database of mammograms generated by Japan Society of Radiological Technology. This includes 17 patients with benign masses and 17 patients with malignant masses. The age ranged from 33 to 71 years (56.9 ± 11.0 years). The new parameter called 3-dimensional fractal dimension (3D-FD) was obtained from the slope of the graph with the logarithm of the cutoff value on the horizontal axis and that of the number of pixels with a gray level above the cutoff value on the vertical axis. In addition to 3D-FD, the conventional image features such as eccentricity (E) and curvature (C) were extracted. The conventional fractal dimension (C-FD) was also calculated using the boxcounting method. The artificial neural networks were used as a classification algorithm, and a receiver operating characteristic (ROC) curve and the area under the ROC curve (Az) were calculated to evaluate the diagnostic accuracy in the task of differentiating between benign and malignant masses. Results: When using E, C, C-FD and age as inputs, the Az value was 0.87 ± 0.07. On the other hand, when 3D-FD was added to inputs in addition to the above parameters, the Az value was significantly improved to be 0.93 ± 0.09. The 3D-FD is a new parameter which can enhance breast cancer detection in CAD of mammograms, because it is effective for discriminating between benign and malignant masses. Web computed radiography: A solution for X-ray examinations in Africa D. Soft tissue tumor distributed decision support system M. Robles, L. Marti-Bonmati, J. García-Gómez, C. Vidal; Valencia/ES Purpose: To provide distributed decision support services in soft tissue tumor (STT) to assist the radiologist. Previous studies have shown the capability of pattern recognition techniques to classify between benign/malignant character and different histological groups. Methods and Materials: Radiologist access to the STT distributed decision support services is achieved using a graphical interface, with four windows that offers the main system functionalities areas: 1. Access to local or distributed STT registers that contain the features to study. New data can be imported from Microsoft Access formatted files or other databases. 2. Statistical analysis that provides the graphical representation and reports of statistical and evaluation information like probability distributions per class, correlation studies, ROC curves. 3. Graphical representation of STT registers provides graphical representation of STT features from the protocol, using PCA-transformation, or feature selection. 4. Automatic classification access to STT classifiers distributed web-services, developed with pattern recognition technology. Results: A location independent and multi-platform system has been developed to provided decision support services for radiologists dealing with STT diagnosis. The system architecture considers the access from hospitals using local or distributed data and connections to clinical decision support servers. The nodes maintenance and upgrade are automatically controlled by the architecture. Conclusion: This system helps radiologists with novel and powerful methods in STT diagnosis and characterization. It provides access to distributed data, statistical analysis, graphical representation and pattern recognition classification. GRID technology will incorporate more facility, security and powered communications to the STT distributed decision support services. Integration of broadband teleradiology into picture archiving and communication system (PACS) Y. Zhao, K. Chen, Z. Yao, D. Wu, Z. Pan, B. Guo; Shanghai/CN Purpose: The availability of broadband wide-area networks (WANs) facilitates a range of new applications in healthcare. Teleradiology is increasingly integrated into picture archiving and communication system (PACS). This paper introduces a broadband telemedicine system for transmitting interactive audio and video signals, and high-quality medical images directly acquired from a hospital-wide PACS. Methods: A high-performance telemedicine system was developed over the existing metropolitan broadband multimedia network in Shanghai to exploit the possibilities offered by Internet Protocol (IP) over Synchronous Digital Hierarchy (SDH) technology to support real-time tele-consultation for medical imaging. A trial session was held with two channels of fiber-optic connection transmitting real-time duplex audio/video signals and high-quality DICOM images between Rui Jin Hospital and Shanghai International Convention Center, 10 kilometers apart. The system enabled direct retrieval of DICOM images from the PACS, and allowed to use interactive telediagnosis tools for image visualization and processing. Results: During the teleradiology session, DICOM images archived at the PACS were readily accessed without any loss of information. A number of functionalities of visualization software were utilized and tested, combined with real-time videoconference session. The system was proven robust, efficient and providing for high performance. Conclusion: The broadband telemedicine system under study has given us a useful insight about the potential of applying broadband technology in healthcare, especially the performance of videoconferences with telediagnosis of radiological images. With the close integration of teleradiology into a hospital-wide PACS, it yields sufficient sound and image quality for remote educational and clinical collaboration. Performance assessment of a wavelet contrast enhancement method in dense parenchyma based on simulated lesions S. Skiadopoulos, L. Costaridou, P. Sakellaropoulos, C. Kalogeropoulou, E. Likaki, G. Panayiotakis; Patras/GR Purpose: Evaluation of an adaptive wavelet-based contrast enhancement method in dense parenchyma based on simulated radiopaque lesions. Methods and Materials: Sixty normal mammographic images of dense breasts were selected from the DDSM database. Simulated radiopaque lesions of known image characteristics, such as low contrast (0.8%-5%) and unsharp contour (0%-80%), were generated and superimposed in dense breast areas. This resulted in a case sample that is difficult to achieve and verify with real lesions. All images with simulated lesions were processed by the wavelet-based method. Evaluation was carried out by an observer performance comparative study between the wavelet-processed images and original ones. The sample was presented to three experienced radiologists, classifying each simulated lesion with respect to contour type, using a five-point rating scale. A binormal ROC curve was individually fitted to the scores of each observer with a maximum-likelihood procedure and the area under the ROC curve (A z ) as well as the 95% confidence interval were calculated, for each technique. Results: Combining observers' responses, the A z values are 0.930 and 0.813 and their corresponding confidence intervals are (0.882, 0.961) and (0.743, 0870) for wavelet method and original one, respectively. This difference in A z values is statistically significant (Students' t-test, p < 0.05), indicating the effectiveness of the wavelet method. Conclusion: Improved contour characterization of low contrast simulated lesions sample is achieved with the use of the wavelet-based contrast enhancement method. Use of simulated lesions sample servers for verification purposes, required to assess the performance of various digital image post-processing techniques. Estimating the arterial compliance in early stages of atherosclerosis: Evaluation of a new index on the curve-fitted Doppler sonograms N. Erdogan, S. Kara, F. Dirgenali, M. Okandan; Kayseri/TR Purpose: To develop a computational method to define a new index to estimate the arterial compliance in early stages of atherosclerosis. The Doppler data was obtained from a nonstenotic arterial site (carotid artery) in patients with femoropopliteal atherosclerosis (n = 10) and healthy volunteers (n = 8) using the audio output of a commercial color Doppler ultrasound unit. The signals were transferred to a personal computer and two dimensional sonograms were plotted by fast Fourier transformation. Smoothing and curve-fitting operation is performed on the sonograms. A moving average method was used for smoothing and Interpolant-Cubic Spline was processed to make curve-fitting. The time interval between the first transmitted peak (t 1 ) and the second compliance peak (t 2 ) in the arterial waveform was evaluated as a new index. Our preliminary data showed no significant difference between healthy subjects and the patients with regard to the acceleration, resistivity and pulsatility indices, although a significant difference exists for the new index (11.0 ± 1.9 msec for patients vs. 33.0 ± 2.5 msec for healthy people). The proposed new index on the the curve-fitted fast Fourier transformation sonograms seems to be promising in assessing the cardiovascular risk by detecting the degree of compliance in atherosclerotic vessel walls before the overt clinical symptoms develop. However, its efficacy and prognostic implications need to be confirmed by large scale studies. The contribution of virtual endoscopy (VE), in the imaging of the upper airways and tracheobronchial tree A. Morichovitou, A. Manolitsas, S. Stratilati, I. Tsitouridis; Thessaloniki/GR Purpose: The purpose of our study is to demonstrate the contribution of virtual endoscopy in the imaging of the upper airways and tracheobronchial tree. We studied 43 cases, (26 male and 17 female, aged 32 to 71 years old, mean 51 yrs), with tracheobronchial diseases. The virtual endoscopy images were compared with those of actual endoscopy in 13 patients. The examinations were performed using a Picker PQ5000 spiral CT scanner and a Picker Voxel Q visualization workstation. Thickness: 3 mm, pitch: 1.5, overlap: 66% (1 mm). Results: CT virtual endoscopy depicted the anatomical structure of nasopharynx, larynx, trachea, and main bronchi in all patients as the actual endoscopy. The results show that virtual endoscopy can study the tracheobronchial tree as far as the segmental bronchi, and sometimes the subsegmental bronchi (in 6 patients). In addition, it can evaluate the extraluminal location of the lesions. 39 lesions in 36 patients were shown by virtual endoscopy (12 occlusions, 21 stenosis, 6 compressions) and in 7 patients the examinations were negative. The findings were always in agreement with those of the actual endoscopy and surgical findings. We studied the results of the two methods and describe the advantages and disadvantages of each of them. Conclusion: Virtual endoscopy can be used in the primary evaluation of the patient before actual endoscopy is performed. It can be used for preparing, guiding and controlling actual endoscopy or in the postoperative follow-up when immediate biopsy is not necessary. Pancreatic duct imaging using the curved thin-slab minimum intensity projection method T. Ogura 1 , T. Ikari 2 , T. Tachikawa 2 , A. Kamei 2 , K. Takano 2 , S. Asahara 2 , N. Fujita 2 , M. Shimizu 2 ; 1 Maebashi/JP, 2 Tokyo/JP Purpose: The recent wide use of curved MPR was applied for pancreatic duct imaging, but curved MPR requires a great deal of skill for the trace of narrowed and tortuous pancreatic duct. Mis-tracing on pancreatic duct has led to various artificial images such as false pancreatic stenosis. So novel curved thin-slab minimum intensity projection methods have been employed to obtain correct pancreatic duct image. The purpose of this study is to explain the protocol, reconstruction method, and describe the potential advantages and various problems of this method in the diagnosis of pancreatic diseases. Materials and Methods: Pancreatic duct image was reconstructed from three dimensional volume data using multidetector-row CT (QX/i, GEMS) scans. Axial images were taken with 1.25-mm collimation, a table speed of 3.75 mm/rot and 0.5 mm image reconstruction intervals. Image processing was performed with the Virtual place (M.I.Lab). Results: This method was successful in depicting a wide range of tortuous pancreatic ducts. Also the narrowed pancreatic duct is easily visualized, and even branch ducts. The characteristic of this method is that we can easily make a pancreatic duct image quickly and with little dependence on expert technique. In abdominal studies, this method enabled the visualization of the narrow, bending pancreatic duct, reducing false pancreatic stenosis, and also could be applied for screening examination for anomalous union of pancreaticbiliary ductal system in the future. Evaluation of the optimal scanning protocol for CT virtual endoscopy using a 16-slice scanner W. Wojciechowski 1 , W. De Wever 2 , A. Urbanik 1 , G. Marchal 2 , R. Chrzan 1 , J. Kozub 1 ; 1 Krakow/PL, 2 Leuven/BE Purpose: The objective of this study was evaluation of optimal scanning protocol for CT virtual endoscopy using a 16-slice scanner in a phantom study. Methods and Materials: Using the MDCT scanner SOMATOM Sensation16 (Siemens, Germany), CT-images of a phantom were performed, with diferent combinations of slice-thickness (0.75, 1, 2, 3, 5 mm), pitch (0.5, 1, 1.5), slice-collimation (16 x 0.75 and 16 x 1.5) and reconstruction increment (50% and 100%). The phantom consists of simulated round lesions of different size (diameter between 1 and 10 mm) placed into a thin-walled plastic tube of 6-cm diameter. Quantitative analysis was assessed by evaluation of changes in size and shape of the lesions and calculation of sensitivities. Qualitative analysis was perfomed by evaluation of lesion's blurring of stairstep artifacts and rippling artifacts. Results: Overall sensitivity was 100% with slice thickness 0.75, 1 and 2 mm and not dependent on pitch. The smallest lesions (diameter 1 mm) were not detected with slice-thickness of 3 and 5 mm. Image quality of endoluminal images was graded as optimal for slice-thickness 0.75 mm and 1 mm. There was no statistical significant difference in quality using a different pitch in these images. However mild rippling artifacts were documented together with an increase in pitch value. Conclusion: Slice-collimation and slice-thickness are the most important parameters in selection of on optimal scan-protocol for VE: slice-collimation of 16 x 0.75 and slice-thickness of 1 mm seem to be optimal. Pitch and increment are less important, although values of 1 and 50% seem to be optimal. Selection of optimal parameters is also depended on lesion size. Automatic Methods and Materials: Fully automatic and manual methods were developed and compared using in vivo studies. This tool allowed automatic determination of a region of interest (ROI) with background correction. By means of this technique, a ROI was set, corrections performed and calculation of different parameters (flow, stroke volume and velocity) and flow curves made. This tool was designed using MATLAB 6.5 (Mathwork, Inc, Natick, USA) with a friendly Graphical User Interface. Comparisons were performed by means of intraclass correlations (ICC). This model was validated in 20 patients, 11 men and 9 women, age range: 45-79 years-old. MR examinations were performed on a 1.5-T system (Gyroscan NT Intera, The Netherlands) with a phase contrast sequence. Image parameters were as follow 256 x 512 matrix; FOV, 160 mm; 3 mm slice thickness; TR 53 msec, TE 11, 2 excitations, flip angle 15° and 20 cardiac phases with use of peripheral retrospective gating. The automatic method performed significantly better than the manual analysis, ICC of 0.72-0.98 and 0.30-0.81, respectively. At the same time partial volume effect caused by inclusion of stationary tissue was corrected. Conclusion: Automatic setting of ROI flow measurements at the cerebral aqueduct is feasible with an adequate reproducibility. It makes the measurements independent of the radiologist, generalizing the calculus of flow parameters. Virtual duodenoscopy on the basis of high-resolution MRCP data for the simulation of ERCP procedures T. Yamagishi 1 , K.H. Höhne 2 , K. Abe 1 ; 1 Tokyo/JP, 2 Hamburg/DE Purpose: ERCP has been regarded as one of the most difficult endoscopic procedures for a trainee because of a high possibility of technical failures. Therefore, it is considered useful to prepare a rehearsal of ERCP. We present a virtual duodenoscopy for practical ERCP simulation. The HR-MRCP data sets are imported into the VOXEL-MAN program (Institute of Medical Informatics, University Hospital Hamburg-Eppendorf, Germany). An interpolated movie of the duodenal inner surface is computed by tracing where the endoscopic tip goes through to the duodenal papilla following the actual ERCP procedure. Three orthogonal radiological planes of the source MRCP are integrated into the movies, which are showing the conic extent of the endoscopic viewing field. The usefulness of making a prior simulation for a successful ERCP was evaluated. The post-processed endoscopic view is precise and realistic enough to execute a practical simulation of ERCP, following the actual procedures step by step, e.g., which angle and position of the endoscopic tip is best for the cannula insertion into the common bile duct. The movie created can indicate an ideal approach to the duodenal orifice in exactly the same way performed by ERCP experts. The radiological planes are useful as external images like X-ray fluoroscopy. A practical simulation of ERCP can be performed by a combination of HR-MRCP data and the VOXEL-MAN interactive visualization program. The presented method can provide useful information prior to actual ERCP. To review the physics of the interaction between the US beam, the "bubble" and the corresponding US image of the liver and portal system. To estimate the degree of portal hypertension through better visualization of collateral pathways using USCA. Background: A short historical review of the evolution of USCA is followed by a detailed presentation of the physics and technology of recent USCA. The interaction between the "bubbles" and the US beam is explained with analytical drawings and real-time US videos. Procedure Details: The technique and the protocol of the hemodynamic examination of the hepatic veins and the portal system are explained. A detailed anatomical review of the portal venous system is presented with special attention to the main collateral pathways present in cases of portal hypertension. The findings of imaging methods (US, CT, MR) as well as endoscopic methods are presented and their limitations are underlined. New non-invasive hemodynamic US imaging of the main collateral pathways (gastric and esophageal varices, splenorenal, splenogastric, retroperitoneal anastomoses, recanalization of the paraumbilical vein) are described and presented in images and videos after administration of second generation USCA. C 421 B D E F A G The benefits as well as the limitations of USCA, including those caused by artifacts, are thoroughly discussed so that an unbiased conclusion on new diagnostic possibilities in the study of the portal hypertension can be drawn. Clinical impact of liver specific contrast agents in liver imaging A. Ba-Ssalamah, M. Uffmann, S. Mehrain, S. Schweighofer, W. Schima; Vienna/AT Learning Objectives: To illustrate the usefulness of liver specific contrast agents in identifying morphological and functional features of focal liver lesions. To educate radiologists about new MR liver specific contrast agents and MR imaging techniques. To demonstrate the value of the combined use of liver specific and non liver specific contrast agents as a problem solving tool. Background: Liver specific contrast agents used in combination with non-specific gadolinium chelates may serve as a problem solving tool in the diagnosis of focal liver lesions. Hepatic focal lesions with atypical imaging appearances usually need further assessment, namely biopsy, particularly in patients with history of malignant disease. Liver specific contrast agents offer new opportunities for liver imaging and provide information about the functional and morphological features of focal liver lesion. Currently a variety of contrast agents, subdivided in different categories are available for clinical use in MRI of the liver. Procedure Details: In this exhibition, we describe the use of reticuloendothelial system-specific iron oxide particulate agents, hepatocyte-selective agents, nonspecific gadolinum chelates and the combined use of these contrast agents for a large variety of liver diseases.We distinguish between specific imaging characteristics for various liver diseases and nonspecific imaging characteristics that may be found in both malignant and benign focal liver diseases. The combined use of liver specific and non liver specific contrast agents is a valuable tool for the diagnostic work up of special focal liver lesions and may replace the invasive biopsy in the vast majority of cases. Doppler rescue: A review of the use of ultrasound microbubble contrast agents in the visualisation of the large vessels K. Satchithananda, M.E.K. Sellars, S.M. Ryan, P.S. Sidhu; London/UK Learning Objectives: Understanding of the types of ultrasound contrast agents available and nature of enhancement. Understand when these agents could be used to improve diagnostic images and cost effectiveness. An appreciation of the clincial appearances of "Doppler rescue" in different areas of vascular imaging. Background: Ultrasound (US) assessment of the vascular system remains an accurate imaging modality despite the advancement of Magnetic Resonance Angiography. US allows real-time, multi-planar and safe assessment of the vasculature which is convenient to both operator and patient. Limitations of US, es-pecially in the vascular system are well documented. Full diagnostic Doppler assessment is not always possible for a variety of reasons. Color Doppler assessment greatly improves vascular imaging and recent technical advances have further improved the capabilities of Doppler US. A further important development is the introduction of microbubble contrast, which allows previously non-diagnostic studies to become interpretable and avoids further imaging: termed "Doppler rescue". Image Findings: The use of microbubble contrast will be illustrated in the cerebral circulation using trans-cranial US, the extra-cranial carotid system, the liver vasculature, renal artery and the peripheral arterial system. Conclusion: Both color Doppler enhancement and low mechanical index B-mode non-linear imaging will be demonstrated. One Learning Objectives: Initial work-up of trauma patients is time-critical. Diagnostic demands require different examination techniques including unenhanced and several contrast enhanced scans for musculoskeletal, angiographic and parenchymal diagnosis. 16-channel MDR-CT overcomes previous technical limitations, which used to require thickening of slices or segmenting for whole body coverage. We therefore developed a multi-phase contrast protocol allowing acquisition of musculoskeletal, angiographic and parenchymal organ information in a single scan. CT technique and contrast protocol, advantages and limitations of this procedure are described and illustrated. Procedure Details: 12 consecutive trauma patients were examined on a 16channel MDR-CT (Philips, Mx8000IDT). After exclusion of cerebral hemorrhage application of iodine contrast media (400 mg iodine/ml, Imeron 400, Altana, Germany) was started with a bolus of 40 mL at a flow of 2.0 mL/sec, followed by a pause of 40 sec. Subsequently, a second 60 mL contrast bolus (3.5 mL/sec) is followed by a saline chaser. The CT-scan is initiated with a delay of 85 sec using a collimation of 16 x 1.5 mm, slice thickness of 2 mm and an increment of 1 mm. Results: This protocol provides excellent diagnostic image quality covering all issues of trauma work-up. Within a table time of less then 10 minutes all relevant pathologies were assessed as proved by further clinical follow-up. All fractures including two petrosal ones were detected. Parenchymal pathology included lacerations of liver, spleen, and kidneys. All arterial and venous hemorrhages were diagnosed without the need of additional diagnostic work-up. Intravenous, oral and, rectal contrast media for abdominal spiral CT examinations: When to use, how much, how fast, and when to scan A.N. Chalazonitis 1 , J. Tzovara 2 ; 1 Athens/GR, 2 Ioannina/GR Leaning Objectives: To optimise the choice of contrast media initiation parameters for abdominal single slice spiral CT examinations, tailored to each specific organ and to the most common clinical conditions. Background: Introduction of multi-slice spiral CT permitted greater flexibility in abdominal examinations. However single slice spiral CT still remains a powerful tool in routine imaging practice. Procedure Details: The aim of this exhibit is to describe lesion or organ behaviour before and/or after contrast material initiation in order to help the participant to understand why, when and how these agents should be administrated for optimal abdominal single slice spiral CT evaluation. Contrast volume, flow rate and scan delay before initiation, are discussed. The influence of patient weight and circulatory parameters such as cardiac output and inflow obstructions on contrast enhancement will be also analysed. Special techniques in order to achieve optimum GI opacification will be also discussed. Purpose: To compare hepatic signal intensity change using superparamagnetic iron oxide (SPIO)-enhanced MR imaging with scintigraphy using Technetium-99mgalactosyl human serum albmin (99mTc-GSA) and a visual grading score, in patients with hepatic dysfunction. Methods and Materials: Forty-six patients with hepatic dysfunction who underwent SPIO-enhanced MR imaging and scintigraphy with 99mTc-GSA were examined prospectively. In terms of clinical cirrhosis severity, 46 patients were classified into four group; 16 patients were classified as non-cirrhotic, 18 were classified as group A, 10 as group B, and 2 as group C (Child-Pugh classification). On MR imaging, T2-fast field echo (T2-FFE) images were obtained before and after the administration of SPIO. To assess the effect of SPIO, post contrast relative reduction in signal-to noise ratio (reduction-SNR) was calculated. The findings of 99mTc-GSA-scintigraphy were classified into 5 types according to visual grading score. The clinical cirrhosis severity, reduction-SNR, and visual grading score were analyzed with nonparametric methods. The clinical cirrhosis severity was positively correlated with visual grading score (Spearman rank test, P < .0001). There were significant differences between the clinical cirrhosis severity and the reduction-SNR on T2-FFE and between the visual grading score and the reduction-SNR (Kruskall-Wallis test, P < 0.0005, all comparisons). The index of blood clearance (HH15) was positively correlated and the receptor index (LHL15) was negatively correlated with the reduction-SNR on T2-FFE (Spearman rank test, P < 0.0001, all comparisons). Conclusion: To evaluate the reduction-SNR on SPIO-MR imaging is helpful in predicting not only Kupffer cell function but also hepatic function as assessed by 99mTc-GSA-scintigraphy. Are efficient contrast agents available for use with ultra-high field MR imaging? R.N. Muller, P.A. Rinck, L. VanderElst, A. Roch; Mons/BE Purpose: Molecular MR imaging requires specific markers exhibiting high relaxivities at ultra-high fields (3-11 Tesla). Although there are theories on the design of optimal paramagnetic centers, actual relaxivities are still below expectations. Methods and Materials: Measurements of relaxivites s -1 mM -1 ) to establish nuclear magnetic relaxation dispersion profiles of existing and possible future contrast agents were performed on two field cycling relaxometers and on a 4.7 T MR research machine. Results: At high field, r 1 and r 2 of small Gadolinium complexes are low and decrease; high-field relaxivities can be increased through reduction of molecular motion. To some extent, it is possible to increase the r 2 of small Dysprosium complexes. NMRD profiles of superparamagnetic particles reveal a high r 2 /r 1 ratio at ultra-high fields. However, one particle of 5nm contains around 2,500 iron ions, whereas one macromolecular complex contains one or a few gadolinium ions. Assuming equivalent relaxivites, the Gd complex should carry approximately 2,500 ions to present, per molecule, the same relaxivity as the magnetic particle which leads to a molecular weight increase of 400,000. Conclusion: For small complexes of Dy, r 2 can be modestly increased at high fields. Both r 1 and r 2 of Gd complexes can be enhanced at high fields by an increase of the molecular size, however, only r 2 keeps increasing. Superparamagnetic particles seem clearly more efficient. This fact will be of paramount importance in the context of molecular imaging. They will act as negative agents. Results: The contrast ratios of rat abdominal aorta and portal vein on the first to fifth contrast imaging were higher for NMS60 than those for Gd-DTPA with every injection doses. The peak contrast ratios of aorta and portal vein for NMS60 were 1.4-1.7 and 1.7-2.2 times as high as those for Gd-DTPA. The renal excretion of NMS60 was as fast as Gd-DTPA. Conclusion: NMS60 showed stronger contrast enhancement for the rat vascular system, especially the portal vein and provided MR angiograms of higher image quality when compared with Gd-DTPA at the same injection dose. 3D-FSPGR imaging was performed before and after 5, 15, 30, 60, 120 min. Delineation of popliteal lymph node (PLN) and lymph duct (LD) (extremity region, iliac, para aorti, thoracic duct) was examined.On the evaluation of LD, visual evaluation ("good visualization": ++, "visualization": +, "poor visualization": ±, "no visualization": -) was carried out. On PLN, SNR was calculated as follows: SNR = SI (PLN)/SD (noise). Results: In Gd-DTPA (125, 250, 500), Gd-EOB (125, 250) and Gd-BOPTA (125, 250, 500), grading of LD from lower extremity region to para-aortic region was "good visualization" or "visualization". In Gd-DTPA (50), grade of LD from lower extremity region to para-aortic region was "poor visualization". On the other hand, using Gd-EOB (50), Gd-BOPTA (50), we could see LD from lower extremity region to iliac region.We found only LD of lower extremity region in Gd-DTPA-DeA (50, 125).These grades were "good visualization" or "visualization". Each concentration besides Gd-DTPA (50), contrast enhancement of PLNs were very well. The PLN almost showed peak value after enhancement for most cases (24/26) in five minutes. We saw PLN very well after enhancement 30 minutes later, and, at the time of Gd-DTPA (500), Gd-EOB-DTPA (125, 250), Gd-BOPTA (250, 250, 500), Gd-DTPA-DoA (50, 125), SNR value was more than 20. Conclusion: Using hepatobiliary agents and extracellular agent we were able to do good MR lymphography. Optimized IV contrast administration protocols for diagnostic PET/CT imaging T. Beyer, G. Antoch, S. Rosenbaum, L. Freudenberg, T. Fehlings, J. Stattaus; Essen/DE Purpose: We compared different IV-contrast injection protocols for PET/CT-exams (dual-slice) to assess their efficacy in avoiding high-density artifacts on CT and subsequent false positives on corrected PET. Methods: Four groups of 10 PET/CT-referrals (370 MBq FDG at 90 min pi) each were investigated with/-out iodinated contrast (300 mg/mL) application: (A) without, (B) multi-phase 90/50 mL (3/1.5 mL -1 ) cranio-caudally with 30 s delay, (C) 90/40/40 mL (3/2/1.5 mLs -1 ) cranio-caudally with 50 s delay, and (D) 80/60 mL (3/1.5 mLs -1 ) caudo-cranially with 50 s delay. CT-based attenuation correction (AC) of the PET was applied routinely. CT image quality (Iq) was graded 1 (very good), 2 (good), or 3 (insufficient) by three radiologists. Image quality and artifacts were reported for head/neck, thorax, and abdomen. Two nuclear medicine physicians reviewed the AC-PET images for potential artifacts from IV-contrast without knowledge of the CT, and reported lesion-to-background (L/B) values for potentially related uptake on PET. All reviewers were blinded to the contrast protocol and patient names. Results: Average CT Iq was poorest (3.0) for protocol A across all regions, but improved to 1.4 (B), 1.0 (C), and 1.1 (D). High-density (> 1200 HU) CT artifacts were introduced only in the upper thorax in 73% (B) and 53% (C) of the patients. Mean L/B in corresponding artificial lesions was 1.8 and 2.0, respectively, thus resembling false positives. Protocol D resulted in artifact-free images. PET/CT Iq increased in the presence of IV-contrast agents. Highdensity artifacts from bolus injection may lead to false positives on AC-PET. The artifacts can be avoided by alternative contrast administration protocols (e.g. D). Contrast enhanced ultrasound in the evaluation of hepatic metastases treated using radiofrequency ablation: 24 hours, 1 and 3 months follow-up assessment G.A. Vorkas, I.A. Chryssogonidis, C.A. Papadopoulos, E. Syndouka, K. Lytras, L. Grassos; Thessaloniki/GR Purpose: This study evaluates the importance of periodic follow-ups in the assessment of hepatic metastases treated with radiofrequency ablation (RF) using contrast-enhanced sonography. Materials and Methods: 36 hepatic metastases in 17 selected patients were included in our study. All lesions were studied with CE-US using real-time, continuous scanning with Esaote Esatune equipment with the CnTI software, enabling non-destructive imaging at low MI, following intravenous bolus administration of 2.4 mL of a second-generation agent (Sonovue-Bracco). The enhancement patterns of lesions were assessed during the arterial, portal and late phases. The examination was conducted pre-ablation, 24 hours, 1 month and 3 months after thermoablation. Purpose: An up-to-date study showed that for high-risk patients the nonionic, dimeric radiographic contrast medium (RCM) iodixanol had less nephrotoxicity than the nonionic, monomeric RCM. The lower incidence of secondary effects is often attributed to the lower osmolality of the dimeric RCM. To compare the effect of dimeric iotrolan to monomeric iohexol and iomeprol independently of their osmolality, we have modelled the vascular activity of the RCM. In an organ bath, isolated segments of porcine renal arteries, uncontracted or precontracted by 10 micromol/L phenylephrine, were incubated with increasing concentrations of iotrolan-300, iohexol-300, iomeprol-150 and mannitol solution iso-osmolal to the RCM. Results: Expressed in terms of concentration of iodine in the buffer as well as in terms of concentration of the RCM-molecule in the buffer, iotrolan induced a significantly lower relaxation than the monomeric RCM (p < 0.05). There was no significant difference between the two monomeric RCMs iohexol-300 and iomeprol-300 (p > 0.05). The iso-osmolal formulation iotrolan-300 induced a smaller relaxation than the iso-osmolal formulation of iomeprol-150 (p < 0.05). Precontracted segments were strongly relaxed by all the RCMs as compared to mannitol (p < 0.05). Iotrolan had no significant effect on the basal tone of the vessel whereas iohexol and iomeprol induced a small relaxation effect. Conclusion: Independently of its osmolality and dilution effect, dimeric iotrolan causes less relaxation of isolated, precontracted segments of porcine renal arteries than monomeric iohexol and iomeprol. This effect can be attributed to the different biological properties of the monomeric and dimeric RCM-molecules. Ultrasound contrast agent in the study of traumatic splenic rupture G. Caruso 1 , G. Salvaggio 1 , G. Bellissima 1 , V. Ricotta 1 , G. Ascenti 2 , R. Lagalla 1 ; 1 Palermo/IT, 2 Messina/IT Purpose: To evaluate the role of ultrasound contrast agent (UCA) in the identification of traumatic splenic lesion. Materials and Methods: From May to July 2003, 20 consecutive patients were admitted to the emergency department for blunt abdominal trauma. Ultrasound examinations were performed with an ATL-HDI 5000 machine with a 5-2 MHz convex trasducer capable of fundamental and harmonic imaging. Patients were studied before and after UCA (2.5 mL of SonoVue®). Multi-detector computed tomography was used as the gold standard. All examinations were performed within 24 hours. Results: Ninety seconds after UCA administration, homogeneous contrast enhancement of the whole of the splenic parenchyma was observed in 16 patients. In four patients, no contrast enhancement was observed in a subcapsular splenic area: inferior splenic pole (n = 3) and mid-portion of the spleen (n = 1). Multidetector CT performed in the portal venous phase confirmed traumatic splenic rupture in four patients, and showed an unremarkable spleen in the remaining 16 patients. Conclusion: Ultrasound after SonoVue administration is useful in showing traumatic splenic rupture. Contrast-enhanced, wide-band phase-inversion harmonic power Doppler imaging of hepatocellular carcinoma J.R. Janica; Bialystok/PL Purpose: To determine whether examination of hepatocellular carcinoma by wideband, pulse inversion sonography offers excellent accuracy in depiction of specific characteristics of these pathologies. 424 B D E F A G Eighteen patients were examined. The presence of HCC was confirmed by ultrasound-guided biopsy or surgical resection. All patients, prior to enhanced sonography, had undergone B-mode gray scale sonography, color Doppler, and power Doppler examinations. After injection of 2.5 g of Levovist intravenously, analysis of contrast agent arrival was performed by wide-band, pulse inversion power Doppler sonography. The B-mode gray scale sonography, color and power Doppler sonography were non-specific for HCC in 4 cases in our examination. However, based on the wide-band, phase inversion power Doppler sonography findings, all patients with HCC were diagnosed. All typical anatomical features of HCC as chaotic appearance with irregular paths, breaks in calibre and arteriovenous shunts were clearly visible. In 2 cases, computed tomography had failed to disclose pathology while pulse inversion sonographic images were completely suggestive, which was later finally confirmed by histologic examination. Conclusions: Our data demonstrates the usefulness of wide-band, phase inversion power Doppler sonography in the diagnosis of hepatocellular carcinoma by visualizing all characteristic anatomical details. Characterization of small liver lesions with contrast enhanced harmonic sonography (CEUS) in patients with chronic liver disease P. Cabassa, R. Taranto Human comparative study on zinc and copper excretion via urine after administration of magnetic resonance imaging contrast agents J. Kimura, T. Ishiguchi, J. Matsuda, A. Nakamura, S. Kamei, K. Ohno, K. Murata; Aichi/JP Purpose: To evaluate the in vivo kinetic stability of magnetic resonance (MR) imaging contrast agents, excretion of zinc and copper via urine were studied for three gadolinium (Gd) chelate complexes. Methods and Materials: Urine samples were taken before, three hours, and six hours after intravenous administration of Gd-DTPA-BMA, Gd-DTPA, and Gd-DOTA at 0.1 mmol/kg to each of five patients who underwent contrast-enhanced MR imaging. Five patients who had non-contrast MR imaging were evaluated as controls. Urine was assayed for quantitative analysis of zinc and copper using atomic absorption analysis. Results: Gd-DTPA-BMA caused the highest increase in zinc excretion among the three agents, 1795 ± 1273 µg at 3 hours and 985 ± 434 µg at 3 to 6 hours. Gd-DOTA did not cause a significant increase in zinc excretion, 75 ± 39 µg at 3 hours and 78 ± 65 µg at 3 to 6 hours. Gd-DTPA caused moderate increase in zinc excretion, 665 ± 240 µg at 3 hours and 378 ± 173 µg at 3 to 6 hours. Excretion of copper did not show a significant difference between the three agents. The difference in zinc excretion among the MR contrast agents reflects in vivo transmetallation of the Gd chelate complexes and correlates with the respective stability of the contrast agent. Gd-DOTA was found to be the most kinetically inert among the three agents tested. Effect of contrast material pushed with saline solution using a dual injector on enhancement of abdominal aorta, portal vein, and liver parenchyma in multidetector row CT of the liver F. Tatsugami Low-high and high-low biphasic injection forms in CT examinations of the upper abdomen L. Martí-Bonmatí, E. Tobarra, E. Arana, S. Costa; Valencia/ES Purpose: Our objective was to analyze the influence of different biphasic injection rate protocols in abdominal CT. A double-blind, randomized, parallel group study was designed and conducted in 60 patients without differences regarding gender, age and weight. All of them were studied with the same CT helical protocol. Patients were randomly distributed into three groups: A) monophasic (120 mL at 2.5 mL/s); B) low-high biphasic (120 mL, the first 60 mL at a rate of 2 mL/s and the other 60 at 2.5 mL/s); and C) high-low biphasic (120 mL, the first 60 mL at a rate of 2.5 mL/s and the other 60 at 2 mL/s). All the patients were injected, through an antebrachial route, with 300 mg I/ml non-ionic contrast media. All CT scans were obtained at the portal phase with a fixed delay time of 55 seconds. Contrast enhancement was evaluated by attenuation coefficients measurements at liver, inferior cava and portal veins, renal cortex, superior aorta and aortic bifurcation. Results: The biphasic protocols obtained statistically higher enhancement at the aortic bifurcation (Anova, p = 0.003). However, there was no other statistically significant difference (Anova, p > 0.05) among the three protocols at the different levels. Although non-significative, enhancements following monophasic protocol were always higher than those obtained with biphasic protocols, with the exception of aortic bifurcation. Conclusion: Monophasic injection of contrast agents on helical CT of the upper abdomen gives higher enhancement of parenchymal and venous structures. No significant difference was observed between low-high and high-low biphasic protocols. Quantitative analysis showed a statistically significant difference between SI of myometrium on plain and Sinerem-enhanced MR images assessed by means of t-test. C/N between lesion and normal myometrium significantly increased following Sinerem administration. In four patients Sinerem-enhanced images provided additional information leading to more accurate T staging. Conclusions: Intravenous injection of Sinerem provides a significant decrease of SI of normal myometrium with higher C/N between neoplastic lesion and normal myometrium. Sinerem-enhanced MRI provides better evaluation of myometrial neoplastic invasion increasing the conspicuity of neoplastic lesions in patients with endometrial and cervical carcinoma. Further studies are necessary in order to realize the physiologic mechanism of myometrial uptake of Sinerem. Purpose: Verification of radiological methods with histology has always been difficult due to poor correlation of slice thickness, orientation and confinement to two dimensions. A method for a quantitative three-dimensional reslicing of histological sections is introduced (Patent pending EPA03008877.7) permitting exact matching of slice geometry. This will enable proper correlation with radiological data. HaCaTRas tumor (mouse) were examined by acquiring dynamic T1-weighted MR images and MR microangiography. The tumors were subsequently serially sectioned (5 ìm slice thickness) and vessels stained with immuno-fluorescence markers. Slices were digitally captured with a microscope, assembled in the sectioning plane and co-registered in the vertical axis. A ray-tracing algorithm performed three-dimensional visualization allowing the virtual re-slicing of the histological sections to create thick-slices (1.5 mm) in accordance with MRI slice geometry. Thick-slices were processed as parameter-maps of marker volume density, giving information beyond the area density signal of immuno-fluorescence images. Results: 3D-reconstructions of immuno-fluorescence images displayed diffuse angioarchitecture which is typical for malignant tumors. Resliced images revealed the exact architecture of vessel structures seen on MRA. Also, large single vessels could be clearly delineated on reconstructions. Parameter maps of vessel density in virtual thick slices matched well with MR-parameter maps. The quantitative 3D approach to histology essentially improves correlation of histological and radiological data due to proper matching of slice geometry. As this new method can be used with any histological stain, it provides a tool for verification of new molecular imaging techniques by means of histology. Monitoring A human fibrosarcoma (HT 1080) was implanted in nude mice and grown up to a size of 5-10 mm. Tumor bearing animals were intravenously injected with a vascular targeting agent (VTA) inducing selective thrombosis of tumor neovasculature (treatment group) or saline (controls) respectively. MRI (1.5 T) was performed using an ultrasmall superparamagnetic iron oxide agent (USPIO, SHU 555 C, Schering®) 4 hours after initiation of treatment. Iron oxide-induced change in R2* (∆R2*) was measured using a T2 w dual Echo-EPI sequence. ∆R2* values of tumor tissue were calibrated by ∆R2* of muscle for determination of the vascular volume fraction (VVF). Parametric ∆R2*-maps were calculated for visualization of tumor perfusion patterns. Correlative immunhistochemistry was performed for assessment of the treatment effects in both groups. Results: ∆R2*-maps revealed a clear reduction of tumor perfusion in treated animals compared to controls. Anti-angiogenic tumor treatment resulted in an approximate 80% decrease of iron oxide induced susceptibility effects. VVF was significantly reduced after injection of the thrombogenic peptide ( The in vivo detection of arthritis by autofluorescence using an antigen-induced arthritis (AIA) model was investigated. Material and Methods: For autofluorescence investigations of joints, a mobile fluorescence-detector was designed consisting of a lens/mirror system attached to a conventional spectrofluorometer and of optimized fiber optic cables leading to and from the site of investigation. Measurements were performed in 7 arthritic and 7 healthy mice. 15 AIA-and 3 healthy mice were used for histological examinations. Results: At the exudative stage (day 1) of AIA, a decrease of fluorescence signal intensities (arbitrary units, a.u.) for excitation wavelengths of 300 nm (emission at λ = 355 -365 nm; mean signal intensity 11.8 ± 2.0 a.u.) and excitation at 360 nm (emission at λ = 475 -485 nm; mean signal intensity 24.7 ± 3.2 a.u) were observed. Signals increased on day 7 (maximum of cellular infiltration; mean signal intensity 20.32 ± 7.59 for λ exc = 300 nm and 52.97 ± 12.0 for λ exc = 360 nm). Chronic inflammation (day 14 and 21) led to a signal decrease again. Signal intensities of NAD(P)H differed significantly (p ≤ 0.05) from controls at days 1 and 7. Conclusion: Arthritis influences autofluorescence signals in-vivo. The detected excitation/emission pairs can be assigned to collagen/elastin and NAD(P)H. Autofluorescence of NAD(P)H can be a helpful tool for detecting arthritis noninvasive and in real-time. Postpartum uterus: What is normal? What is pathological? Evaluation with ultrasound and CT I. Escape, J. Martinez, F. Bastart, L. Ortega, C. Solduga; Barcelona/ES Learning Objectives: To know the normal findings, mean diameters and evolutive changes in postpartum uterus and uterine cavity, in early, middle and late puerperium with ultrasound and CT. To differentiate them from pathological conditions. Background: The majority of postpartum patients undergo an unremarkable clinical course. A small percentage of patients develop serious complications in the abdomen and pelvis. Endometritis, the most common cause of fever in the postpartum period, complicates 2-3% of vaginal deliveries and up to 85% of cesarean sections. Post partum hemorrhage is most often caused by uterine atony and retained products of conception, and complicates 1-2% of vaginal deliveries. Imaging Findings: In early puerperium, uterus is most often retroverted and empty with fluid and debris in the cervical area. Intrauterine cavity increases on days 7-14 post partum with fluid and debris in the whole cavity and it may be normal to see an intracavitary echogenic mass. AP diameter of the uterus diminishes progressively in 6-8 weeks. Endometrial gas is occasionaly visualized after normal vaginal delivery in the immediate puerperium and disappears within 1-2 weeks. It can be difficult to differentiate from endometritis, which can progress to pelvic inflamatory disease. Endometrial stripe decreases during puerperium; if it remains thickened, complications such as retained products of conception or hypotonic uterus may be suspected. Doppler US can be useful for differentiating between them. We describe these features with ultrasound and CT. Conclusion: It is important to recognize normal postpartum uteral findings in order to differentiate them from pathological conditions. Pelvic floor dysfunction: Interest of MR imaging of ortheses and prostheses J. Villeval 1 , M. De Graef 1 , R. Guillon 1 , C. Courtieu 1 , A. Maubon 2 , J. Rouanet 1 ; 1 Montpellier/FR, 2 Limoges/FR Learning Objectives: To display the MRI appearance in static and dynamic conditions of intra-vaginal device and post surgical procedures used for the treatment of pelvic floor dysfunction. Background: We retrospectively analysed 26 MR exams performed before and after surgical treatment and 20 MR exams without and with intra vaginal device of 23 patients with pelvic floor dysfunction: Urinary incontinence (Tension-free vaginal tape n = 3, artificial urinary sphincter n = 4, intra vaginal device n = 10) and pelvic prolapse (intra vaginal device n = 2, promontofixation n = 2, prosthetic B D E F A G plaques Permacol and Polypropylène in recto-vaginal and uretro-vaginal wall n = 2). MRI consisted of T2 turbo spin echo, T1 turbo spin echo and dynamic single shot sequences. Imaging Findings: We will show the MRI appearances of the devices in static and dynamic conditions. Prosthetic plaques and Tension-free vaginal tape appear as low signal intensity structures which are difficult to visualize compared to promontofixation, artificial urinary sphincter and intra vaginal device. MR imaging represents a good functional post operative evaluation for prosthetic plaques and intra-vaginal device in pelvic prolapse with dynamic studies especially in cases of suboptimal post treatment outcome. Conclusion: A radiologist involved in pelvic MRI should be aware of the various surgical treatments of pelvic floor dysfunction in order to avoid misinterpretation and evaluate their functional results. MRI allows detection of complications for a better collaboration between radiologist and pelvic floor surgeon. Pathologies of the uterine endometrial cavity: Usual and unusual manifestations and pitfalls on magnetic resonance imaging M. Takeuchi Background: The endometrial cavity may demonstrate a spectrum of imaging manifestations ranging from normal, to that of a reactive, inflammatory, and benign and malignant neoplastic cause. Imaging Findings: Thickened endometrium or endometrial mass included benign endometrial hyperplasia or polyps, endometrial carcinomas or carcinosarcomas, and gestational trophoblastic diseases. Hyperintensity similar to the endometrium suggested rather benign hyperplastic lesions. Hyperplasia or polyps associated with adjuvant tamoxifen therapy tended to be large masses with cystic changes and prominent stromal proliferation. Myometrial thinning suggested malignancy but was occasionally overestimated because of the fragility of the myometrium with adenomyosis. Submucosal leiomyoma with edematous change may mimic endometrial mass, and demonstration of the continuity to the myometrium was the clue to its myometrial origin. Uterine sarcomas may involve endometrial cavity, and endometrial stromal sarcomas often showed endometrial masses with characteristic myometrial invasion. Adenomyomatous endometrial polyp may simulate endometrial stromal sarcoma due to arborescent smooth muscle components which resemble the preserved bundles of myometrium within the tumor on T2-weighted images. Fluid collection in the cavity was well visualized on MRI to distinguish between hydro-, pyo-, and hematometra. Conclusion: To recognize various imaging findings of the uterine endometrial cavity; it is important to make a correct preoperative diagnosis to avoid unnecessary or excessive surgical intervention and to preserve the fertility of the patients. Learning Objectives: To demonstrate wide variations of the fluid collection in the female pelvis with pathophysiologic correlation and evaluate the diagnostic clues to the differential diagnosis. Background: There are various situations with fluid collection in the female pelvis. Although physiologic ascites is often observed in the reproductive era, other pathophysiologic fluid collection with both benign and malignant conditions may occur. Imaging Findings: Mucinous ascites with organ scalloping in pseudomyxoma peritonei is characteristic. Hemorrhagic ascites, which shows high attenuation on computed tomography (CT) and is well visualized on magnetic resonance imaging (MRI) may be observed with malignant tumors, adnexal torsion or ruptured endometriosis. Lactate detection on magnetic resonance spectroscopy (MRS) may suggest its malignant condition. Non-neoplastic diseases such as ovarian hyperstimulation syndrome, pelvic inflammatory diseases, endometriosis, adnexal torsion and massive ovarian edema may cause accompanying fluid collection with adnexal enlargement. Benign tumors may cause ascites, such as Meigs' and pseudo-Meigs' syndrome, and malignant tumors may cause carcinomatous peritonitis with fluid collection. Ascites in postmenopausal woman is an unnatural finding and may suggest adhesion due to old inflammation or surgical procedure, or existence of hidden neoplastic disease. Ascites in a tumor-bearing woman may suggest an advanced stage of disease with occult tumor implants. Localized fluid collection like peritoneal retention cyst is observed in adhesive pelvis after surgery, inflammation or endometriosis with characteristic contour shape. Conclusion: To evaluate the nature or biochemical components of ascitic fluid by MRI and MRS may be helpful for the differential diagnosis. Recurrent ovarian cancer: Patterns and spectrum of imaging findings M. Moon, S. Kim, J. Cho, Y. Lee; Seoul/KR Learning Objectives: To illustrate the spectrum of imaging findings of the recurrent ovarian cancer. Background: Ovarian cancer is the most common cause of death among the gynecological malignancies. The treatment of ovarian cancer has traditionally been initial surgical staging and cytoreduction, followed by adjuvant chemotherapy. Then, a second look operation is performed to reassess the tumor status after first line chemotherapy. Once pathological complete response is defined, the management of ovarian cancer depends on non-invasive methods such as serology and cross sectional imaging. On the follow-up evaluation, identifying patients with minimal recurrent disease is important as it provides the best chance for complete clinical response and long-term survival following second-line chemotherapy. Imaging Findings: Recurrent ovarian cancer usually manifests as local recurrence, peritoneal seeding and nodal recurrence. Vaginal stump recurrence is the most common manifestation of the local recurrence. Peritoneal seeding presents as ascites, peritoneal enhancement, peritoneal nodularity, and/or mesenteric infiltration on cross sectional imaging. Nodal recurrence is most commonly seen in the external iliac group, which is not the presumed site based upon anatomic studies. Although hematogenous dissemination is less frequently seen in the recurrent ovarian cancer, hepatic or pleuropulmonary involvement is a relatively common manifestation of hematogenous spread. The unusual manifestations of hematogenous dissemination include metastases in the extrahepatic abdominal solid organs, bone, central nervous system, and abdominal wall involving subcutaneous fat or muscle. Conclusion: Familiarity with the patterns and spectrum of imaging findings of recurrent ovarian cancer will facilitate accurate diagnosis and prompt treatment. ing of cervical carcinoma. The particular advantages of MRI over CT include its multiplanar imaging capability and its superior depiction of soft tissue planes. Accurate staging of cervical carcinoma at presentation is essential from the point of view of prognosis and also for management planning, as patients who present with stage IIa or lower grade carcinoma proceed to surgery, and those with higher grade tumours are treated primarily with radiotherapy. Recurrent disease is also best depicted using MRI. Patients can present with or develop a wide variety of complications as a result of their tumour and MRI can be of particular advantage in the investigation of local complications. Imaging Findings: This educational exhibit illustrates the MR imaging findings of cervical carcinoma of all grades. We also demonstrate the MR imaging features of a wide variety of local and distant complications, including local invasion, fistula formation, small bowel obstruction and obstructive hydronephrosis. Conclusion: MRI is the imaging modality of choice for the diagnosis and staging of primary cervical carcinoma. It is also of benefit for the investigation of disease related complications and for the investigation of recurrent disease. The most common is serous papillary carcinoma. These tumors can show totally solid appearance, but mainly solid mass with some cystic portions is more common. They have unique imaging findings especially on MR in that papillary masses with branching pattern are frequently accompanied by peritoneal seeding masses. Serous surface papillary carcinoma of the ovary, a distinct subtype of these tumors, is mainly located on the surface of the ovary. Sometimes normal ovaries can be found inside papillary masses on MR, which is a very unique and striking appearance. Brenner tumor and endometrioid carcinoma are another subtypes of epithelial tumors that can show solid appearance. Extensive calcifications can be found in some solid Brenner tumors. Endometrioid carcinomas are sometimes accompanied by endometrial pathologies including endometrial carcinoma. Conclusion: Knowing these characteristics can help make correct diagnosis on CT and MR, especially differential diagnosis with metastatic tumors. Wide spectrum of uterine leiomyomas MR imaging: Radiologic and pathologic correlation H.K. Kim; Seoul/KR Learning Objective: To provide an in-depth review of uterine leiomyomas with their epidemiology, histopathology, clinical manifestations and the most up-todate therapy. To describe radiologic feature of usual and unusual appearance of uterine leiomyomas on MR image and histopathologic correlation. To discuss differential diagnosis of uterine leiomyomas from gynecologic and non-gynecologic disorder. Background: Leiomyomas are the most common uterine neoplasm and are composed of smooth muscle with varying amounts of fibrous connective tissue. Imaging features of uterine leiomyomas vary depending on tumor size, location, degeneration and other histologic findings, and specific types of unusual leiomyomas. Uterine leiomyomas are classified as submucosal, intramural or subserosal. The common types of degeneration are hyaline (> 60% of cases), cystic, myxoid, red and hemorrhage. Degenerated leiomyomas have variable appearances on T2-weighted and contrast-enhanced images. Specific types of unusual leiomyomas include lipoleiomyoma and myxoid leiomyoma, which have characteristic MR findings enough to differentiate from other gynecologic and nongynecologic disease. The differential diagnosis of leiomyomas includes adenomyosis, solid adnexal mass, focal myometrial contraction, and uterine leiomyosarcoma. The purpose of this exhibit is to provide in-depth review of epidemiology, histopatholoy, clinical manifestations and differential diagnosis. This exihibit will also reflect our experience in radiologic evaluation of patients with leiomyomas, with emphasis on the typical and atypical findings on pelvic MRI. Examples of unusual uterine leiomyomas, pathologic correlation as well as the most up-to-date therapy will be included. After interacting with this exhibit the radiologist will have enhanced understanding of uterine leiomyomas including histopathology and radiologic features. Experience of MRI in women with suspected and known endometriosis: A pictorial review R. Benamore, L. Grosvenor, A. Liddicoat; Leicestershire/UK Learning Objectives: Review of imaging features in women with endometriosis since introduction of a 1.5 T Magnetic Resonance (MR) scanner. Women were referred when they did not wish to undergo laparoscopy or where surgical intervention and visualisation was difficult. Background: Endometriosis affects women during the reproductive years between 25 and 29, with an estimated prevalence of 5-10%. Presentation range from pain (symptoms and severity do not correlate) to asymptomatic (diagnosed during infertility investigations). Endometriosis (functional glands and stroma outside normal endometrium) is characterised by deposits, endometriomas (cysts) and adhesions, commonly ovarian but is documented to involve any site within the peritoneum and extraperitoneum. MR is noninvasive with high sensitivity and specificity, small foci appearing hyperintense on T1 and variable signal on T2 weighted images. Endometriomas (> 1 cm) appear hyperintense on T1 and hypointensity on T2, with hyperintense foci on T2 dependant on age of haemorrhage. Fat saturation sequences are essential to improve lesion conspicuity on T1. We reviewed all women referred for investigation of suspected endometriosis, and for evaluation of disease extent and sites (notably recto-vaginal pouch) in known cases of endometriosis. Procedure Details: Sequences used were axial T1, sagittal T2, axial oblique fat saturation (tirm) and narrow section coronal T2 imaging. MR identified endometriosis involving ovaries, bilateral thick walled and unilateral endometriotic cysts, extra-ovarian disease within peritoneum and soft tissue. Fibroids and simple ovarian cysts were common, with evidence of concurrent endometriosis. Conclusion: MR detected small foci of endometriosis outside of the ovaries. There was a high incidence of other gynaecological pathologies allowing early review and treatment. 3D transvaginal sonography in uterine leiomyomas with hysteroscopic and pathomorphological correlation V. Gazhonova, K. Sokolskaya, T. Kurganskaya, A. Zubarev; Moscow/RU Purpose: To determine the possibilities of 3D transvaginal (TV) sonography in preoperative assessment of uterine leiomyomas and to correlate the findings with hysteroscopic, laparoscopic and macroscopic data. Method and Materials: 31 women with symptomatic uterine leiomyomas were evaluated before myomectomy and hysterectomy. Multiplanar images of the uterus were created in 3D TVS. Preoperative location of the leiomyomas, and interactions with uterine cavity, cervix and iliac vessels were assessed in each case. US results were compared with hysteroscopy in 6 pts, laparoscopy in 7, open surgery in 5 and pathomorphology data in 13 pts. Results: Surgical management was changed after 3D TVS examination in 8 cases. 3D coronal images allowed better location of the submucous and centripetal leiomyomas especially in multiple closely lying fibromyomas. 3D TVS results correlated with hysteroscopy in 91% (10/11) of cases vs. 64% (7/11). 3D Power Doppler TVS provided precise evaluation of the pedunculated submucous and subserous leiomyomas thus enabling adequate myomectomy. In comparison to macroscopic data of the uterus, 3D TVS were superior to 2D TVS in differentiation of the type of leiomyomas in 92% vs. 69% of cases, and in assessment of the interactions with the cervix in 100% vs. 62%. Multiplanar reconstruction of the coronal planes on 3D TVS improved determination of the uterine cavity interactions with large subserous-interstitial leiomyomas before laparoscopic myomectomy. Conclusion: 3D TVS is a useful complement to 2D TVS in preoperative assessment of leiomyomas. Accurate evaluation of the leiomyomas on 3D MPR can decrease the possibilities of intraoperative hemorrhage and uterine trauma. B D E F A G Treatment of the symptomatic large and multiple uterine fibroids by uterine artery embolization S. Speca, A.M. Costantini, C. Di Stasi, G. Tropeano, V. Summaria, P. Marano; Rome/IT Purpose: To evaluate the potential usefulness of uterine artery embolization as an alternative to traditional surgery (hysterectomy or myomectomy) for the treatment of symptomatic large or multiple fibroids. Material and Methods: 38 premenopausal women, aged 33-55 years (mean age 42.7), who presented with menorrhagia, pelvic pain, and/or mass-related symptoms due to large (< or = 12 cm) or multiple fibroids (> or = 3 cm) and were unwilling to undergo surgery or had an increased surgical risk, underwent bilateral uterine artery embolization. Before embolization all pts underwent to a complete clinical examination, a basal FSH and estradiol dosage, a vaginal and ureteral tampon, a Papanicolau test, a trans abdominal and trans vaginal ultrasonography and color Doppler flowmetry. For embolization we used polyvinyl alcool particles, Embosphere or Spongostan. Detailed clinical and ultrasound follow-up were obtained at regular intervals (1-31 months). The procedure was technically successful in 37/38 patients. A mean clinical follow-up of 14 months for pain, mass-related symptoms and menorrhagia was done. 95% of the patients treated reported a marked to complete symptomatic improvement. Only 1 patient experienced no changes in her symptoms. Nobody had immediate or late complications. A median reduction of 65% in the uterine volume and a median decrease of 78% in the dominant fibroid volume were observed in 28 patients who had follow-up ultrasounds for up to 6 months. Conclusions: In our experience artery uterine embolization may provide an important therapeutic alternative for women with symptomatic large or multiple fibroids who desire to avoid surgery. How to conduct quantitative evaluation of uterine neoplasms using Gddynamic contrast-enhanced MRI K. Hayasaka, Y. Tanaka Materials and Methods: 53 women with histopathologically proved cervical carcinoma underwent preoperative T2-weighted fast spin-echo, dynamic imaging using gradient-echo and postcontrast T1-weighted spin-echo MR imaging with a phased-array surface coil. The axial plans in each sequence were reviewed at separate sessions by three radiologists blind to the histopathologic data. Results: For the conspicuity of tumor, dynamic and T2-weighted images showed high detectability more than postcontrast T1-weighted images. Most appropriate enhancing time in dynamic study was 90 seconds. In assessing parametrial invasion, the accuracy of T2-weighted, dynamic and contrast-enhanced T1-weighted MR imaging was 76.1%, 79.9% and 78%, respectively; no statistically significant difference was observed. Conclusion: Dynamic imaging is useful in assessing tumor visualization, and the most adequate enhancing time in dynamic study is 90 seconds. But in diagnosis of parametrial invasion, the addition of dynamic MR images does not improve the accuracy compared with T2-weighted images alone. (16), on clinically progressive disease (8) or patient death (21). 15 patients had undergone previous surgery (14 radical hysterectomy, 1 trachelectomy). 30 patients had non-surgical treatment (chemo and/or radiotherapy). A recurrent mass was identified in 45 patients (mean size 5 cm, 1.4-9 cm). On T2W, the recurrence was hyperintense in 87%. In the post-surgical group, the recurrence was in the vaginal stump in 12 patients (80%) with parametrial involvement in 13 (87%). In the non-surgical group, the recurrence was in the cervix in 20 patients (67%) with involvement of vagina in 57% and uterus in 40%. Uterosacral ligament and/ or pelvic sidewall involvement was present in 18 patients (40%). Bladder invasion was suspected in 22% and rectal in 20%. Nodal enlargement was seen in 53%. Bone metastases were present in 4 patients while 13 had DXT changes (3 sacral insufficiency fractures). Recurrence in the pelvic muscles was also seen. Conclusion: Recurrent disease in patients with cervical carcinoma usually involves the cervix or vagina, however can present with varied manifestations. Knowledge of the site and pattern of disease recurrence can help in early and accurate detection of recurrence. Hysterosalpingography: Is still useful in the diagnosis of peritubal pathology? S. Deftereos, J. Manavis, G. Alexiadis, G. Kafetzis, P. Prassopoulos; Alexandroupolis/GR Purpose: To reevaluate the role of hysterosalpingography in the diagnosis of adhesions related to infertility and in patients managment. Materials and Method: 54 consecutive patients with more than two years infertility underwent hysterosalpingography (HSG), followed by laparoscopy. Patients with infertility related to uterine abnormality were not included. Diagnosis of peritubal adhesions was based on the presense of the following six imaging findings: Convoluted tubes, vertical tubes, loculation of contrast medium in peritoneum, halo effect, ampullary dilatation or fixed laterodeviation of the uterus. Results: In total, 92 tubes were delinated. No abnormality was detected in 7 tubes on both HSG and laparoscopy. Laparoscopy disclosed adhesions in 51 tubes. Diagnosis of adhesions was made in 46 tubes (18 correct, 28 false positive), when the presence of one abnormal sign on HSG was considered as criterion; and in 40, when two or more signs are present (33 correct, 7 false positive). Ten live births five to eight months after hysterosalpingography occured. Conclusions: Accurate diagnosis of adhesions on HSG requires the presence of at least two abnormal signs. The six-month interval between HSG and laparoscopy might be shortened when adhesive peritubal involvement is radiologically suspected. Laparoscopy is less indicated when no abnormality is detected on HSG. withdrawn To illustrate CT-urographic patterns of neoplasia of the collecting system. Background: Conventional excretory urography and conventional computed tomography (CT) were considered the standard techniques used to examine patients with urinary tract neoplasia. Multi-detector row CT offers high speed of acquisition and high resolution images, allowing axial and 3D urographic acquisitions. Imaging Findings: 15 pts with transitional cell carcinomas were analysed. All patients underwent unenhanced and post-contrast CT axial scans, followed by a urographic acquisition in the excretory phase (2 mm collimation, 1.5 mm reconstruction interval). 3D reconstructions of excretory phase images were created with on an independent workstation using a MIP algorithm. Neoplastic lesions were visualised as solid papillomas in 3/15 cases, as wall thickening of the collecting system in 11/15 cases and as solid tissue in the renal sinus in 1/15 case. Lesions were more evident on the source axial images of the excretory phase urographic acquisition. In the post-contrast images, the lesions resulted quite vascularized. Urinary tract dilation was evaluated in 13/15 patients. Dilation was better evaluated on the 3D MIP CT-urographic images in the case of normal renal excretory function and on the source axial images of urographic acquisition in the case of functionally excluded kidneys. Conclusion: CT-urographic axial and 3D images combined with conventional CT imaging allowed good evaluation of urinary tract neoplasia. The more frequent pattern was the wall thickening of the collecting system (74% cases), associated to urinary tract dilation (87% cases). Renal Background: LC is a minimally invasive surgical technique for patients with small renal masses; MR provides an effective tool for imaging follow-up of renal lesions treated with LC. Methods and Materials: 32 pts with 41 renal masses underwent renal LC. All patients underwent follow-up MRI 24 hrs after surgery, and at 1, 3, 6 and 12 months. MR examinations were performed using GRE T1w, TSE T2w and ce FS-GRE T1w sequences. Two radiologists reviewed MR images for i) signal intensity, ii) size, iii) vascularization, and iv) perinephric changes after treatment. Imaging Findings: a) T1w images showed 25 isointense cryolesions, and 16 cryolesions isointense to renal parenchyma with hypo-or hyper-intense foci. On T2w images all cryolesions were hypo-intense with iso-or hyper-intense foci; b) 24 hrs after treatment all cryolesions were more than 1 cm larger than the original masses; cryolesions decreased in size of an average of 38% at 1 month, 46% at 3, 64% at 6, and 80% at 12 months; c) ce-FS-GRE T1w images showed complete ischemia of cryolesions in 38 cases; d) 6 cases showed a perinephric haematoma at 1, 3 and 6 months. The more significant MR pattern in the follow-up of renal lesions treated with LC were the decrease in size of the cryolesions over time and the complete ischemia of the cryolesions. (47), benign obstruction (24), not obstructed (7) and transplanted kidneys (18). Procedure Details: We used ultrasound-guidance in 139 cases and CT-fluoroscopy-guidance in 51 cases. The technique was standard Seldinger. Most patients received 6-or 10 F. nephrostomy catheters. We had 10 access failures, usually in patients with nondilated systems. We encountered 5 major complications (bleeding and two big urinomas) and only 20 minor complications. Catheter dislodgement was relatively frequent (32 cases). Conclusion: Urinary diversion at renal level is necessary in the following clinical situations: As short-term palliation in a terminal case, as a temporary measure prior to definitive diversion, to relieve obstruction where immediate surgical intervention is not feasible and for prolonged drainage where surgical intervention is not indicated. Since its first description in 1955, percutaneous nephrostomy has developed into a technique that is now routinely used for a wide range of clinical applications. Imaging of angiomyolipoma focused on the clinical issues K.-S. Cho, Y. Jung, S. Kim, J. Kim; Seoul/KR Learning Objectives: To discuss the role and findings of US, CT and MRI in the detection and diagnosis of angiomyolipoma. To discuss the complication of angiomyolipoma and confusion in differentiation from other malignant neoplasm. To discuss the clinical issues of angiomyolipoma including the natural history concerning growth, efficacy of biopsy for diagnosis, and association with tuberous sclerosis. Background: Angiomyolipoma is the most common benign neoplasm of the kidney and consists of mature adipose tissue, smooth muscle and thick-walled blood vessels derived from perivascular epithelioid cells. Although most angiomyolipomas are asymptomatic and cause no problem, some cases raise important clinical issues. (1) Angiomyolipomas may be complicated by risk of hemorrhage and cause confusion in differentiation from malignant neoplasm when they contain minimal amount of fat. (2) Angiomyolipomas are often related with the stigmata of tuberous sclerosis. (3) The natural history of this benign neoplasm has been controversial, with regard to growth on follow-up images. (4) The efficacy of biopsy for diagnosis is controversial when image findings are indeterminate. Procedure Details: In this illustration, we evaluate the role and findings of ultrasonography, computed tomography and magnetic resonance imaging in the detection and diagnosis of angiomyolipoma. Discussion will be focused on the important clinical issues. Conclusion: Multi-detector row CT is the most accurate diagnostic modality for evaluation of angiomyolipoma especially in cases with minimal amount of fat in tumor or associated with complication. MR can differentiate minimal fat angiomyolipoma from small renal cell carcinoma. Characterization To understand how to further characterize incidentally detected renal masses found on CT by using the appropriate modality with optimal techniques. Backgrounds: Due to advances in CT technology and its wide spread use for imaging a variety of abdominal conditions, small renal masses are being incidentally detected more frequently on CT. Since at least half of renal cell cancers are detected incidentally by imaging, the cost and time for further imaging of small renal masses may increase. In addition, some renal cell cancers may be cystic and it is important to have a strategy for dealing with cystic renal lesions that do not meet the CT criteria for simple cysts. Imaging Findings: We will discuss and show a variety of small incidental renal masses detected on unenhanced and single phase contrast-enhanced CT. Topics discussed will include the following: CT criteria for distinguishing lesions that do not need further imaging for characterization from lesions that require further imaging for characterization; technical considerations affecting imaging findings; updated Bosniak classification for cystic lesions; pitfalls in interpretation; and an algorithmic approach for "indeterminate" masses by using ultrasound, dedicated renal CT, MRI, or percutaneous biopsy. The majority of small renal masses incidentally found on CT can be characterized or managed through an appropriate diagnostic pathway. Color-duplex imaging (CDI) and magnetic resonance angiography (MRA) in reno-vascular disease L. Olivetti 1 , G. Rozzi 1 , P. Pecchini 1 , P. Ravani 1 , L. Grazioli 2 , E. Botturi 2 , I. Laparoscopic cryoablation of small renal cell carcinoma: Medium term outcome. G. Cardone, P. Mangili, A. Cestari, G. Balconi; Milan/IT Purpose: To determine safety and efficacy of laparoscopic cryoablation in the management of small renal cell carcinoma and to assess its medium term outcome. Methods and Materials: 27 patients underwent laparoscopic cryoablation of 29 tumors between July 2000 and June 2003. All treatments were delivered under laparoscopic US guidance. Patients were followed up clinically, biochemically and by MR imaging 24 hrs after surgery, and subsequently at 1, 3, 6, 12, 18 and 24 months. Results: 24 hrs after treatment all cryolesions were more than 1 cm larger than the original masses; cryolesions decreased in size by an average of 38% at 1 month, 46% at 3, 64% at 6 and 80% at 12 months following cryoablation. Early post-procedure MR images showed complete ischemia of all cryolesions. Follow-up (mean 16 months) revealed no evidence of recurrence in 24/27 patients. One patient showed local recurrence at 12 months, one patient demonstrated an metachronous nodule in the same kidney at 12 months and another patient showed a pancreatic metastatic nodule at 6 months. No significant rise in creatinine was noted post-procedurally. After surgery, retroperitoneal effusion was found in all cases; 6/29 cases showed an intralesional haematoma, 28/29 cases showed low signal intensity foci due to haemostatic material and 3/29 cases showed a perilesional haematoma at 1 and 3 month follow-up. Conclusions: Our medium term experience suggests that laparoscopic cryoablation is a safe, well tolerated and minimally invasive therapy for small renal cell carcinoma, and MR is an effective imaging technique in the follow-up of renal lesions treated with laparoscopic cryoablation. Results: Echographic findings postbiopsy were normal, or with loss of corticomedullary differentiation, enlargement and gross edema. Clinical indication in transplanted kidneys was deranged renal function, and in native kidneys, nephrotic syndrome. Acute rejection was the most frequent diagnosis in transplanted, and focal glomerulosclerosis in non transplanted kidneys. We observed 17 cases (13% of all procedures) of postbiopsy complications (5 haematomas, 5 perirenal collections, 3 decreased vascularization, 2 arterio-venous fistulaes and 2 deranged renal function), but none of them were significant. 3 of them (7.8%) were in native kidneys, and the remaining 14 cases (18.59%) were in renal allografts. We show an alternative way to perform the procedure in order to minimize patient risks and maximize results. We conclude that complications may be more frequent in renal allografts than in native kidneys. The complex preoperative assessment of patients with renal masses with complex MRI-study I. Platitsyn, E. Zaytseva, A. Zubarev, V.V. Gazhonova; Moscow/RU Purpose: To study possibilities of complex MRI-study in patients with renal masses in preoperative planning of renal surgery. Material and Methods: 30 patients with renal masses detected by US were evaluated with complex MRI-study. Complex MRI-study included MRI before and after CE, 3D CE-MRA and 3D CE-MRU using fast 3D MRA GRE sequence were performed with 1.0 T system (Magnetom Harmony, Siemens). DSA was used as diagnostic correlation as a gold standard. The obtained MR-data were compared with the results of surgical operation and histopathology. The renal tumors were identified with MRI-study in 26 patients; 4 patients had cystic lesions. Hypervascular masses were found in 20 patients, hypovascular masses in 6 patients. In one cases of cystic lesion detected with MRI-study the patient had hypovascular cysto-solid masses. Next, renal vascular variants were revealed: Unilateral ARA were detected with 3D MRA in 9 cases, with DSA in 10 cases; Bilateral ARA -in 2 and 2 cases (consequently); triple unilateral ARA -in 1 and 1cases (consequently); multiple ARA -in 1 (4 arteries) and 1 (5 arteries) cases (consequently); the sensitivity of 3D CE-MRA was 92%. 3D CE-MRU provided high-quality images of the urinary tract in all cases. MRstudy showed an almost complete correlation with results of operative treatment, histopathology and DSA. Conclusion: Complex MRI-study allows noninvasive preoperative assessment of renal tumors localization, morphology and vascularisation, renal arterial system, renal parenchyma, urinary tract and perirenal region. It is valuable for planning of renal surgery. In all cases, the 3D free-breathing sequence was superior to the breathhold RARE sequences in terms of spatial resolution, with equivalent contrast, and without significant motion artifacts. As a result, the level and length of stenoses were always better demonstrated with the 3D sequence than with the breathhold RARE sequences. MIP reconstructions allowed analysis of the entire urinary tract with different projections. The duration of the 3D sequence (3 minutes) was comparable to the overall duration of the RARE sequence, which requires several slice positioning to explore the entire urinary tract. Less T2-weighted sequences (HASTE and truFISP) were superior to 3D sequences to analyse the cause of obstruction, as they visualised the ureteric wall and the adjacent structures. The 3D turbo spin echo sequence is robust and especially useful in case of tortuous ureters. This sequence has now replaced the RARE sequences in our protocol. HASTE and TruFISP sequences remain useful to analyse the ureteric wall and the adjacent structures. Prenatal ultrasonographic findings of multicystic dysplastic kidney: Emphasis on cyst distribution M. Moon, J. Cho, M. Song, Y. Lee; Seoul/KR Purpose: We retrospectively analyzed multicystic dysplastic kidneys to evaluate the prenatal sonographic characteristics, emphasizing the distribution of cysts. A total of 43 cases was included in this study. The sonographic assessment included the site of the involved kidney, the size of the multicystic dysplastic and the contralateral normal kidney, the distribution of cysts, and associated anomalies. According to the distribution of cysts, multicystic dysplastic kidneys were categorized as subcapsular and random distribution, and interobserver agreement was determined using cross table analysis. The largest longitudinal diameters of the multicystic and the contralateral normal kidney were measured and data were plotted on the normal reference chart. Results: Multicystic dysplastic kidney was left sided in 55.8%, right sided in 34.8% and bilateral in 9.3%. Subcapsular distribution of cysts was observed in 68.2% (n = 15) for radiologist 1, 59.1% (n = 13) for radiologist 2. Interobserver agreement was excellent (k = 0.697). The longitudinal diameter of the multicystic dysplastic kidney was above the 95% in 68% and that of the contralateral normal kidney was normal in 70%. There were major anomalies in 2 cases and fetal karyotyping was offered in 18 cases including 2 cases with associated major anomalies. The results were always normal. Conclusion: Subcapsular distribution of cysts in multicystic dysplastic kidney is more common than random distribution, so the distribution of cysts may be helpful in the prenatal diagnosis of multicystic dysplastic kidney. Tubular extraction rate of MAG3 in patients with impaired renal function S. Beatovic, E. Jakšic, R. Han; Belgrade/YU Purpose: To analyze whether clearance of mercaptoacetyltriglycine (MAG3), which is equal to its tubular extraction rate (TER) could serve as a sensitive parameter of renal function impairment. Methods and Materials: Investigation was carried out in 107 patients, who were divided into nine groups, according to the diagnosis and the degree of renal failure. Dynamic renal scintigtraphy was performed 20 minutes after i.v. injection of 150-220 MBq of MAG3. TER was determined by single-sample, volume distribution method using the standard solution of labeled MAG3. Results: Results of TER were correlated with blood urea nitrogen (BUN), serum creatinine (Cr) and creatinine clearance (CCr). Significant linear correlation between TER and CCr was found (r = 0.76; p < 0.0001). Correlation between TER/ BUN and TER/Cr was exponential (r = -0.78 and r = -0.82, respectively; p < 0.0001). Conclusion: Analysis of our results show that TER is a more sensitive parameter than CCr, Cr and BUN, especially in mildly deteriorated function. In advanced renal failure, the sensitivity of TER is similar to the sensitivity of BUN and Cr. Daily We found some significant correlation between pulsatility indices (PI), resistance indices (RI) and renal volume (TRV), with creatinine blood level (Cr) in the patients with normal evolution, if we correlated the parameters using 12-day data. There was significant correlation between RI and Cr in patients with NF (12 days, p = 0.04). In the patients with ATN there was significant correlation between TRV and Cr (12 days, p = 0.02). Significant correlation between TRV and Cr was found in RD evolution (12 days, p = 0.032) and between PI and Cr (20 days, p = 0.029) in patients with rejection. These results confirm the findings obtained by dissection in five cadavers. The analysis of CT scans of retro-extraperitoneal pelvic processes demonstrates the inferior extension of the renal fasciae to the pelvis. These fascial planes serve as pathway for the spread of retro-extraperitoneal processes from the abdomen to the pelvis and vice versa. One can so explain, for example, the occurrence of an abcess in the prevesical space in case of sigmoid diverticulitis. To investigate the effect of alpha-blockers on prostatic blood flow and by means of power Doppler image quantification. Materials and Methods: 11 patients suffering from lower urinary tract symptoms (LUTS) were treated with alpha-blocker for 5 weeks. Transrectal power Doppler ultrasound (TRPDUS) of the periurethral prostate as well as comparative cystometry were performed before and after therapy. For TRPDUS an Acuson Sequoia 512 (Acuson, Mountainview, USA) fitted with a high frequency transrectal probe (EC10-C5) was used at standardized machine settings. Color pixel density (CPD) was calculated with computer assistance from transrectal power Doppler images using Scion Image image analysis software. CPD and standard urodynamic parameters were recorded in each run at filling volumes of 0 mL, 100 mL and maximum cystometric capacity. In presence of NaCl, mean CPD rose by 8% at 100 mL and by 27% at full distension, whereas with KCl filling, mean CPD rose by 30% at 100 mL and by 42% at full bladder capacity. After therapy, mean CPD was significantly increased at empty bladder by 44% compared to mean CPD before therapy. During NaCl filling, mean CPD rose by 50% at 100 mL and by 77% at full distension, while in the presence of KC1, mean CPD rose by 77% at 100 mL and by 103% at full bladder capacity. Conclusions: Using TRPDUS and CPD, relative changes of periurethral prostatic blood flow could be quantified. Alpha-blocker lead to a significant increase of prostatic blood flow. These results may explain the therapeutic effects of alphablockers on LUTS. Superselective Results: Using grey-scale TRUS, 32 prostate tumors were hypoechoic before treatment. Using 3D PD TRUS, 19 tumors (46%) were hypervascular before treatment. During treatment the tumors' echogenicity increased gradually, focal fibrosis was detected; the degree of vascularity decreased gradually. In 12 months the fibrosis was not revealed in 15 (36.5%) tumors and the hypervascularity was revealed in 5 (12.1%) patients that correlated with negative clinical response to hormonal treatment in 5 patients. Conclusion: 3D TRUS is an informative method in the assessment of the response to hormonal treatment of PC. Methods: Seven patients with adenocarcinoma of the prostate were scanned supine on a 1.5 T system. Prior to IMRT and during the 7-week treatment course, 5 mm transverse, coronal and sagital HASTE-T2-weighted images of the pelvis were acquired weekly. The bladder and rectal volumes, position of the prostatic margins, and center of prostate (COP) relative to the bony pelvis were measured. Results: All pre-treatment positions were within a 3.6 mm range from the ontreatment mean position in each patient. The COP variability in the AP, CC and mL directions were 2.6, 2.4 and 1.5 mm, respectively. The largest prostatic margin variability was 3.2 (posterior) and 2.6 mm (cranial and caudal). Beyond a rectal volume of 57.1, a strong correlation was found between rectal volume and anterior COP movement (p = -0.90). A weak correlation (p = -0.31) was found between bladder volume and cranial COP movement. Beyond 160.8 mL, the mean variability of the cranial and caudal margins increased up to 1.3 mm, between 300 and 400 mL 4.4 mm, and above 400 mL 6.6 mm. The pre-treatment prostate positions were representative of ontreatment positions. A 5.3 mm CTV expansion in any direction was sufficient to ascertain 95% coverage of the CTV within the PTV, assuming a rectal volume < 57.1 mL (rectal suppository) and bladder volume around 150 mL (voiding followed by drinking 500 mL of water to keep small bowel away from treatment field). Local Results: There was no significant difference between the number and severity of complications in the group with local anesthesia compared to the group without anesthesia. There were no significant side effects caused by the infusion of the anesthesic drug. However the infusion of the drug may cause a degradation of the TRUS image. Air bubbles are sometimes infused with the drug causing a "fuzzy" image, which results in a degree of difficulty in guiding the needle. A thorough TRUS examination of the prostate prior to the anesthesia helps the radiologist in planning the biopsies in advance and thus guiding the needle to the appropriate area, even through a "fuzzy" image. Conclusion: US-guided local anesthesia, before TRUS biopsy, is useful for assuring patient cooperation during this often painful procedure and essential if TRUS findings call for a large (more than 10) number of biopsies. Conclusion: Conventional MR images combined with pyelo-urographic techniques allowed a good evaluation of urinary tract neoplasia. More frequent patterns were solid papillomas or wall thickening of the collecting system (90% cases), associated with collecting system dilatation (85% cases). There is a "difficult zone" located 2-5 cm below the iliac vessels. Examination with mild compression is used to solve this problem. Color Doppler sonography is valuable to distinguish the ureter from vessels. Conclusion: Abdominal sonography is a cheap and informative method in the diagnosis of ureteral disorders and may replace traditional technologies. Trauma of the urinary system: Spectrum of findings at helical CT A.J. Madureira, C. Tavares, L. Melao, I. Ramos; Porto/PT Learning Objectives: To review and illustrate the spectrum of imaging findings associated with blunt and penetrating trauma to the urinary system on helical CT. To discuss the importance of an appropriate technique and the major pitfalls encountered. Background: Injury of the urinary system is a common complication of major abdominal trauma. Helical CT is a powerful imaging modality in the evaluation of patients with suspected injuries of the adrenal gland, kidney, ureter and bladder. The renal injury CT classification system is valuable and clinically important as it serves as a guide for patient management. Procedure Details: The authors present a comprehensive review of the imaging findings in common and rare traumatic lesions of the adrenal gland, kidney, ureter and bladder based on the experience of a Level 1 Trauma Center. The indications for helical CT are discussed and a special emphasis is placed in the use of an appropriate technique and discussion of the major pitfalls that may be encountered. Conclusion: Helical CT is a useful modality in the diagnosis, grading and followup of patients with trauma to the urinary system. Helical CT protocols should be optimized and adapted to the clinical situation in question. Characterization Learning Objectives: This poster will present the anatomical waxes dedicated to urogenital anatomy which are displayed at the museum "La Specola" of Florence. Background: Teaching gross human anatomy is traditionally based on demonstration and study of the different organs and systems directly on corpses. However, availability of specimens for this purpose can be difficult for a variety of problems and, at present, anatomical models made of plastic material and electronic files are used in most schools of medicine. These problems have been always present in the history of medicine. To overcome this, in 1771, a special laboratory was established at the "Imperial Regio Museo di Fisica e Storia Naturale" of Florence to create a collection of anatomical waxes, copied from anatomic dissections, to enable three-dimensional anatomic studies with schematic drawings and captions indicating anatomical details. Imaging Findings: From 1771 to 1893, the laboratory prepared a large number of models, and the collection in Florence consists of about 1500 pieces. In the collection there are over 200 preparations, showing the complete urogenital system in the male and the female. Special models have been created to demon-strate sectional anatomy, the internal structures of the kidney, the relationships of the prostate with the bladder base and the seminal vesicles, the penis, the vagina and the uterine cavity. Many waxes depict the gravid uterus and the foetus, with its vasculature and its relations with placental vessels. Conclusion: This allows the collection to be considered as the first 3D "textbook" of anatomy in medical history. Characterisation of adnexal masses with magnetic resonance imaging A. Saini; London/UK Learning Objectives and Background: The accurate assessment of adnexal masses remains a challenge. To determine key differentiating features of adnexal masses, we retrospectively reviewed the magnetic resonance (MR) characteristics in 45 patients and correlated their appearances with the findings at histopathology. Imaging Findings: Benign solid lesions were characterised by fat, haemorrhage or fibrous components. Mature teratomas (n = 4) possessed high fat content. Haemorrhage was a predominant feature of endometriomas (n = 7) but also seen in some malignant tumours. Fibromas (n = 2), cystadenofibromas (n = 3), benign Brenner tumours (n = 2) and fibrothecomas (n = 1) that have a similar fibrous component shared a distinctive short T2 relaxation. Benign cystic lesions comprised serous or mucinous cystadenomas (n = 5), were recognised as thin walled uni-or multilocular cysts. Borderline (n = 4) and malignant epithelial tumours (n = 8) were predominantly cystic and distinguished by papillary projections and the secondary features of malignancy, such as ascites, rather than their tissue signal intensity. Malignant solid primary ovarian masses were less common. Clear cell carcinomas (n = 2) were recognised by a predominantly solid mass with more modest cystic elements. Granulosa cell tumours (n = 2) had variable amounts of cystic change and intratumoural haemorrhage. Immature teratomas (n = 1) contained circumscribed foci of variable signal-intensities. Inflammatory masses (n = 3) also presented as complex adnexal cysts. In these cases, the clinical history and examination was key in making the diagnosis. The ability to manipulate tissue contrast with MR imaging makes it an invaluable tool in the assessment of complex adnexal masses enabling characterisation and identification of features associated with less common pathology. To discuss the imaging features so that when this tumor is encountered the diagnosis may be considered. To correlate the pathologic characteristics with the imaging findings. To discuss the key elements to be included in the differential diagnosis and to provide examples of them. Background: Urachal adenocarcinoma is an extremely rare malignant neoplasm that develops from embryonic remnants and has a variable clinical course. Clinical, pathologic and imaging findings were retrospectively evaluated for 6 patients with urachal adenocarcinoma referred from 4 centers. Imaging studies (CT, n = 6; MRI, n = 2) were reviewed for morphologic features, such as tumor size, homogeneity, margins and degree of enhancement. Imaging Findings: The mean tumor size was 3.5 cm. The tumors were heterogeneous in 4/6 patients, with irregular margins in 6/6, calcifications in 1/6 and strongly enhanced in 6/6. All tumors extended anteriorly from the bladder dome; endoscopy was normal in all cases. Enlarged lymph nodes were visible in 2/6 patients. Histologically proven invasion of the bladder dome was detected in 2/6 patients and invasion of the anterior abdominal wall in 1. 3D reconstructions in the sagittal plane (n = 2) evoked a urachal mass and assessed its relationship with the urinary bladder, umbilicus and rectus muscles. All tumors were resected. Conclusion: Multimodality imaging is essential to obtain an early and accurate diagnosis of urachal adenocarcinoma. Multiplanar CT and MR give the best assessment of the extent of tumor invasion. Reduction of ionising radiation exposure to patients due to new imaging technology for medical diagnostics of the urinary tract: A retrospective study covering 20 years in a Norwegian referral hospital A. Nyquist 1 , I. Børretzen 2 , H. Olerud 2 , B. Bjørnarå 1 , T. Gudmundsen 1 ; 1 Drammen/NO, 2 Oslo/NO Purpose: To examine possible changes in ionising radiation doses to patients (collective effective dose) undergoing diagnostic imaging procedures of the urinary tract over the last 20 years in view of shift in modalities from conventional X-ray examination to ultrasonography (US). Retrospective study of all patient files for the period from 1983 to 2002. The number of plain radiographs, intravenous pyelography (IVP), ultrasonography (US), computer tomography (CT) and magnetic resonance imaging (MRI) examinations were registered. For each type of examination the mean effective radiation dose were obtained from the Norwegian Radiation Protection Authority (NRPA) as published in 1997. The number of plain radiographs of the lower abdomen covering the urinary tract increased by approximately 50%, IVPs were reduced by 70%, and CT examination decreased by 40%. MRI examinations did not play any significant role in examining the urinary tract. US of the urinary tract increased from 8 in 1993 to 1129 in 2002. This shift in modalities from totally X-ray based procedures, to nearly exclusively US often supplemented with one plain radiograph, caused a decrease in the annual collective effective dose for this group of patients with 66% from 6.8 manSv in 1983 to 3 manSv in 2002. The shift in modalities used for diagnostic imaging of the urinary tract from conventional X-ray to almost exclusive use of US, resulted in a significant reduction in exposure to ionising radiation of patients, and need to be considered when discussing further development and structure of diagnostic imaging. Comparison of the adrenal vein sampling value between primary aldosteronoma and nonfunctioning adrenal adenoma: Evaluation with receiver operating characteristic ( , voiding cystourethrography, urethroscopy and biopsy. Combined retrograde and voiding SUG with saline and echocontrast media Levovist® were used in 16 pts with urethral obliteration and chronic suprapubic catheters. The transperineal or transrectal ultrasound was performed to evaluate anterior and posterior urethra respectively. The images obtained allowed detailed morphology assessment of the urethra at different levels. Results: Compared with RUG, the SUG more accurately measured stricture length and diameter that was confirmed by measurements at optical urethrotomy (11 pts) and urethroplasty (12 pts). The introduction of contrast agents enhanced the visibility of the flow in the most strictured segment (less than 0.4 mm), which was diagnosed by RUG as urethral obliteration in 5 pts. The CE SUG accurately diagnosed diverticula (5), false passages (3), which were confirmed by urethroscopy in all pts. Conclusion: Our preliminary results show, that the combined retrograde and the voiding power Doppler sonourethrography with ultrasound contrast media might be an effective support in diagnostics and in the planning of treatment of patients with complex strictures and urethral obliteration. CE SUG is an informative method in the differential diagnostics of patients with urethral obliteration and complex strictures. Differentiation of adrenal adenomas from metastases with unenhanced CT using a scoring system H. Gufler 1 , G. Eichner 1 , A. Results: Attenuation values on unenhanced CT were significantly lower for adenomas than for metastases (9.8 ± 12 HU versus 32.8 ± 24.9 HU, p < 0.05). The combined score parameter including all CT criteria showed the largest area under the ROC curve. The highest predictive power suggested by the model was calculated with a cut-off point at 7.05 for benign lesions with a sensitivity of 1.0 and a specificity of 0.9688. At 6.75 points the scoring system yielded a sensitivity of 95.8% and a specificity of 96.9%. Conclusion: Compared to densitometry alone, diagnostic accuracy in the differentiation between adrenal adenomas and metastases is improved by including all CT criteria in the evaluation. The presented scoring system is simple but efficient and easy to use in the clinical routine. ESWL of the unusually located stones in pediatric patients Z. Siric, M. Radovanovic, A. Slavkovic; Nis/YU Aim: To show the possibilities of lithotripsy in the treatment of bladder and urethral stones in pediatric patients. In a twelve year period, we treated 92 pediatric patients, aged from 8 months to 14 years, by ESWL. In 3 children, stones were located in the urinary bladder, and in the urethra in another 2. All of them were male patients; we decided to use ESWL instead of invasive methods of treatment. ESWL procedures were performed under general anesthesia in 4 and under sedo-analgesia in 1 patient. During treatment, the patients were placed in the prone position (patients with bladder stones) or in a modified supine position (perineal approach for urethral stones). An average 3000 shock waves were applied per patient with a maximal energy of 3.0 kV. Average duration of treatment was 35 minutes. Results: Successful fragmentation was achieved during the first session in 4 patients. In 1 patient with a urethral stone, the fragmentation was not satisfactory and the treatment was repeated 7 days later. Complete elimination of stone fragments was achieved during the first 3 days in the patients with successful first treatment, but was not achieved at all in the patient with repeated treatment. Cystoscopy was performed and the stone was found within a urethral diverticulum. There were no complications in our patient group. Conclusion: ESWL in our experience seems to be useful as a non-invasive method in the treatment of stones with in unusual locations. It could be recommended in male patients without anatomical variations of bladder and urethra. Methods: This is a retrospective study of helical CT of 42 patients that showed iliopsoas abnormalities (11 neoplasms, 12 abscesses, 14 hematomas, 2 cases of atrophy and 3 of calcifications). The study group included 33 men and 9 women, 9-90 years old (mean 58 years). All studies were obtained over a 10-year period. Final diagnosis were correlated with different CT features to determine findings that could be used to differentiate these abnormalities. These included enlargement of the iliopsoas muscle, irregular margins and fat infiltration, attenuation of the lesion, calcification, bone fracture and associated adenopathy. Result: Psoas pathology is more frequent in men (p < 0.05). Low attenuation and heterogeneity are the most reliable CT features of iliopsoas abscesses (p < 0.05). The sensitivity and specificity of low attenuation for the diagnosis of abscesses are 24% and 92% respectively. The specificity of heterogeneity for the diagnosis of abscesses is 100%. Bone fracture is useful for the diagnosis of hematoma (p < 0.05). Bone fracture is 53% sensitive and 85% specific for diagnosis of hematoma. Conclusions: Low attenuation, heterogeneity and bone fracture are helical computed tomography features useful for differentiating iliopsoas pathology. Results: All masses were classified correctly by both analysis. The mean percentage of signal intensity on subtraction images were 200 ± 63 (means ± SD) and nonadenomas 29 ± 7 (means ± SD), respectively. The difference between two groups was statistically significant (t test, p = 0.000). Our results show that chemical shift subtraction imaging is an objective technique that allows the adrenal adenomas to be differentiated from the other tumors. The objectivity of the technique may help the unexperienced radiologists to improve their interpretation. 13 patient (56%) had uretheral dilatation. The MRU visualized the dilatation and determined the obstruction level in 13 cases (100%). The excretory urography detected uretheral dilatation and determined the obstruction level in 10 cases (77%). The MRU detects with great accuracy the dilatation and also, obstruction level in patients with obstructive uropathy and could be used as an alternative to excretory urography in specific cases. Oro Objective: Many congenital dysplasias of the osseous labyrinth have been identified. Differentiation of these dysplasias is essential for patient management. The purpose of this study is to describe the imaging findings which can be found in anomaly of the inner ear. We retrospectively reviewed imaging findings of 11 children with congenital sensory neural hearing loss (8 male, 3 female, mean age 5.0 years, age range 1-14 years) who had CT (n = 8) and MR imaging (n = 10). CT was performed on a GE Hispeed/i scanner (General electric medical systems, Milwaukee, Wis, USA). 1.0 mm thick direct coronal axial sections were obtained with bone algorithms. MR was performed on a GE Signa MR/i with temporal T2 FSE thin section 1 mm scan and routine brain axial, coronal, FLAIR, FSE T2, SE T1, coronal FSE T2, sagittal SE T1 weighted images. Results: There were cochlear aplasia with large vestibule (n = 1), cochlear hypoplasia (n = 1), Mondini malformation with large vestibular aqueducts (n = 1), Mondini dysplasia with large vestibule (n = 1), large vestibular aqueduct and endolymphatic sac (n = 5), small internal auditory canal (n = 1) and large vestibule (n = 1). Four cases were involved unilaterally. Seven cases had combined deformities. Five cases had cochlear implant. Conclusions: Both CT and MR can be used to look at inner ear malformations, but often both techniques are complementary. CT is preferred when associated middle or external ear malformations must be excluded. MRI is preferred when subtle changes in the membranous labyrinth or abnormalities of the nerves in the internal auditory canal must be visualized. Purpose: Benign paroxysmal positional vertigo (BPPV) is probably the most common cause of vertigo and the most common peripher vestibular disorder. BPPV has been postulated to be the result of freely floating debris of degenerative otoconia in the endolymph of a semicircular canal (SC), canalolithiasis or debris that becomes adherent to the cupula of the semicircular canal. The key in determining the diagnosis of BPPV is still examination performing positioning manovers and the use of Frenzel glasses. Differential diagnosis can be difficult. The aim of this study was therefore to provide a new diagnostic approach by 3D-NMR technique. Our special interest has been if there was a structural change in the SC or the cupula, which could be identified in patients with incurable vertigo compared to those with self-limited disease. Methods and Materials: We investigated 10 normal and 10 BPPV subjects using a 1.5 T GE MRI with 3 D data set: TR 4320, TE 238, 1 mm slices, 512 x 512 matrix, 22 x 22 FOV, 1.0 NEX. Results: All BPPV patients had pathological filling defect of the SC before therapy which must be considered as an anomaly canalolithiasis. We postulate there must be structural changes in its lumen which makes the endothelium adhesive which is recognizable in HR-3D-MR as a filling defect. Conclusion: A significant improvement in quality of high-resolution MRI of the inner ear using CISS could be obtained at 3.0 T despite potential drawbacks. To obtain at 1.5 T, the same SNR would require approximately double measuring time, optionally increasing the risk for an accidental head movement which may prove detrimental at high resolution. (2), dysplasia of the vestibule with or without abnormality of the lateral SCC (2), Mondini-deformation (2), cochlear dysplasia and absence of cochlear nerve (1) and dysplasia of the modiolus (1). One patient showed labyrinth hemorrhage at the time of MRI. Ten cases presented typical clinical features of a progressive hearing loss. In 6 patients a constantly moderate or profound sensorineural hearing loss was present since early childhood. One patient was deaf. One patient suffered from a Pendred syndrome. Conclusion: A large vestibular aqueduct is a common finding in patients with suspected inner ear malformation. Nevertheless, especially in isolated LVA, it is sometimes missed in routine work. Even if there is no therapy, an early diagnosis is needed to explain to the patient, the cause of hearing loss, the prognosis and behaviour which can possibly delay progression. Color Digital radiography density measurements in differentiation of periapical granulomas and radicular cysts I.K. Rozylo-Kalinowska; Lublin/PL Purpose: The differentiation of periapical granulomas and radicular cysts is crucial for decision on conservative or surgical treatment and therefore influences the success and long-term results of the treatment. Although radiograms are a valuable diagnostic tool, relying solely on the evaluation of these images may lead to mistakes in the choice of treatment. The aim of the study was determination of possibile applications of digital radiography density measurements in differentiation of periapical granulomas and radicular cysts of inflammatory origin. The material consisted of 355 digital periapical radiograms obtained using Digora, RVG and Dixi 2 digital radiography systems in patients aged 20 to 84, divided into two groups: 259 granulomas and 102 radicular cysts. By means of Digora 2.0 software, maximum and minimum densities were measured along a line and the difference between these densities was calculated. The largest dimensions of the lesions were measured both perpendicular and parallel to the root canal axis. Results: The differences between the results for granulomas and cysts were statistically significant. When the difference of densities exceeded 85.6, the lesion was a cyst and when it was below 45.9, a granuloma was diagnosed. Combined application of two criteria, namely the calculated difference between densities and the largest dimension, increased diagnostic possibilities of radiological differentiation of granulomas and radicular cysts. Conclusion: It was proved that to some extent it was possible to differentiate granulomas and radicular cysts by means of digital radiography software. Ameloblastomas D E F A G X-rays, CT and MRI. The use of 3D-CT and Dentascan proved especially helpful in determining tumor dimensions. Histological examination of the lesions showed that 6 were of the follicular type, 3 presented as mural ameloblastomas, 2 were squamous type, 1 plexiform and 1 was a malignant ameloblastoma. Results: In 1 patient the extension of disease was proven inoperable. In 7 patients various types of mandibulectomies along with immediate reconstruction were performed. In 3 cases of mural ameloblastomas local excision only was performed, whereas in 2 patients the mandibular defect was reconstructed with a titanium plate. Conclusion: In large monolocular lesions treatment can be conservative surgery, whereas in large multilocular lesions radical surgical treatment that includes segmental ostectomies with immediate reconstruction of either vascularized or autogenous bone grafting is the treatment of choice and produces the best post operative results. The interpretation of the 3D reconstruction images and the Dentascan are of great importance when such an operation is decided upon. Differential growth in vestibular schwannoma G.C. Bockeler, V. Nandapalan, T. Lesser, H. Lewis-Jones; Liverpool/UK Purpose: MRI plays a pivotal role in the management of patients with vestibular schwannoma (VS), yet there are no universally agreed guidelines on the use of this expensive investigation. This study analyses the site, size and morphology of VS referred for possible intervention. Where clinically a wait-and-watch approach was chosen, growth of VS was determined on subsequent imaging. Methods and Material: MR images of 78 patients with unilateral VS referred to a tertiary centre were classified according to the site of VS with respect to the internal acoustic canal. A variety of measurements were obtained to determine the most sensitive method of measurement. Growth was expressed as absolute and relative change in the direction of the largest increase in size. Results: VS showed growth in 35% of patients, 63% remained static and 3% regressed. Growth was most frequent in VS with an intra-and extracanalicular component whereas purely intracanalicular VS showed no growth. The initial size did not predict growth. Growth rates were largest in predominantly extracanalicular VS. Conclusion: Our findings confirm previous findings of infrequent and smaller growth in purely intracanalicular VS and more frequent and larger growth in predominantly extracanalicular VS. An incremental delay in follow-up imaging of the former VS appears justifiable in the absence of new symptoms. Conversely most VS require close monitoring as even small changes in size may lead to symptoms necessitating invasive treatment. Sonographic Sialadenitis/sialolithiasis: Ultrasound is accurate in the assessment of acute and chronic inflammation and abscess formation. It has replaced sialography in many centres for evaluating suspected stone disease and duct dilatation. Granulomatous disease: Sarcoidosis and Sjögren's syndrome may both involve the submandibular glands. Ultrasound is able to delineate the phases of disease progression in Sjögren's and is also used in lymphoma surveillance in these patients. Other lesions of the submandibular space: Including adenopathy, cystic hygroma, brachial cleft cyst, ranula and lipoma may mimic submandibular gland lesions and are readily identified sonographically. Conclusion: Ultrasound represents a safe, widely available and accurate means of assessing the submandibular space and is able to delineate and characterize lesions. Ultrasound can be used to guide aspiration or biopsy and reduce the need for surgical excision. Ultrasound-guided core biopsy of the parotid gland: Results of 100 patients K.K. Lewis 1 , M. Williams 2 , D.C. Howlett 1 , G. Manjaly 1 , A.B. Moody 1 , N. Violaris 1 ; 1 Eastbourne/UK, 2 Brighton/UK Purpose: To evaluate the role of ultrasound-guided biopsy in the management of palpable parotid lesions. Materials and Methods: One hundred patients were included in this prospective study over a 5-year period. Initial ultrasound examination was performed using a 5-10 MHz high frequency transducer. Guided biopsies were taken under local anaesthesia (single operator) with a spring loaded variable throw (15 mm/22 mm) biopsy gun using 18 or 20 G needles with an average of 2 passes per patient. Results: In 100 patients, biopsy revealed 50 benign neoplasms, 24 malignant lesions (including 6 primary and 6 secondary lesions as well as 12 lymphomas) and 26 other pathologies including sarcoidosis, tuberculosis, reactive lymphadenopathy, Sjogren's and actinomycosis. Only 6 lymphoma patients needed surgery for further histological grading. Diagnostic accuracy was 100% for benign versus malignant pathology in the 54 patients who underwent subsequent surgery. There was 96% correlation between biopsy and operative histology with only two non-correlates. These involved misdiagnosis of squamous cell carcinoma and mucoepidermoid carcinoma. These would have required further histochemical staining for differentiation. Surgery was avoided in forty-six patients after biopsy diagnosis. There were no immediate complications of biopsy. Conclusion: Ultrasound guided biopsy gives 100% benign versus malignant pathological differentiation. It also has 96% correlation with operative histology. Correct pre-operative diagnosis influences the decision to undertake conservative or radical surgery and unnecessary surgery can be avoided. A core of tissue allows histopathological analysis where assessment of tissue architecture, tumour grading and immunochemical staining is possible. This is invaluable for accurate diagnosis. Contrast enhancement of the cochlear aqueduct in MR imaging: Its frequency and clinical significance T. Nakamura 1 , S. Naganawa 1 , H. Fukatsu 1 , Y. Sakurai 1 , I. Aoki 2 , A. Ninomiya 2 , T. Nakashima 1 , T. Ishigaki 1 ; 1 Nagoya/JP, 2 Tochigi/JP Purpose: There have been no previous reports on contrast enhancement of the cochlear aqueduct in magnetic resonance (MR) imaging. The purpose of the present study was to evaluate the frequency and significance of this finding. Methods and Materials: Thirty-one patients (15 men and 16 women; age range 18-81 years) with otologic symptoms (sudden sensorineural hearing loss, vertigo or tinnitus) were examined using contrast-enhanced imaging on a 1.5 T MR scanner. The normal ear served as the control. Two radiologists evaluated contrast enhancement in the area of the cochlear aqueduct. Result: Forty-eight of 62 ears (77.4%) showed contrast enhancement of the cochlear aqueduct, but no significant differences in the frequency of contrast enhancement were observed between patients with and patients without vertigo, tinnitus, sensorineural hearing loss, cerebellopontine angle tumors or a highriding jugular bulb. In addition, no gender or age-related differences were noted. Conculusion: Contrast enhancement of the cochlear aqueduct was frequently observed, but the frequency of enhancement in symptomatic ears was not significantly higher than in control ears. The results of this study may prove helpful in avoiding unnecessary examinations and potential diagnostic confusion. High-resolution MR imaging of basaliomas of the facial soft tissue with a microscopy coil H. Gufler, C. Zörb, W.S. Rau; Giessen/DE Purpose: To correlate the tumor extension measured on high-resolution MR images with histology. Patients and Methods: Five patients with basaliomas of the facial soft tissue were examined before surgery with high-resolution MRI using a 1.5 Tesla system with a 47 mm microscopy coil. Axial T1-and T2-weighted TSE images were obtained from all patients before Gd-DTPA application and additional axial and/ or sagittal T1-weighted sequences with and without fat suppression after CM application (FOV 60 mm, matrix 256 x 256, slice thickness 1.5 mm, acquisition time 5-7 minutes). Qualitative analysis of MR images was performed by two radiologists who measured the extension of the tumor and decided whether bone erosion or infiltration of the orbit or of the nasal cartilage was present. Results: T1-weighted unenhanced axial images proved to be the most useful sequences in predicting the extension of the basaliomas. For the evaluation of B D E F A G orbital invasion, additional sagittal T1-weighted unenhanced images were helpful. The extension of the lesions correlated well with the results on histology. In one case, however, nasal cartilage infiltration was not correctly diagnosed on the basis of high resolution MR. Conclusion: High-resolution MR imaging using a microscopy coil is a promising method to predict the exact extension of basaliomas of the facial soft tissue. Three Orbit MRI of the superior oblique muscles to measure the asymmetry in patients with IV nerve paresis M.A. Eleta, F. Shokida, F. Seclen, J. Gabriel, C. Zanchez, F.A. Eleta; Buenos Aires/AR Purpose: To evaluate the section of the superior oblique muscles (SO) in patients with unilateral congenital or acquired pareses to detect asymmetry and the relationship between the degree of vertical deviation and MRI measurements. Method and Materials: From March 1999 to September 2002, 32 patients underwent orbits MRI. Seventeen patients had unilateral SO muscle paresis: 13 congenital and 4 acquired. Fifteen patients had normal SO. The area of the superior oblique muscle in the section of maximun width was obtained in primary gaze position, supra and infraversion. Asymmetry of the superior oblique muscles was defined arbitrarily as the difference between both SO in the same patient and the measurement was compared with the values obtained in the normal group of patients. Results: Mean maximal difference was 14.2 ± 3.3 mm 2 (p < 0.01) between the healthy and paretic eye. In the normal group of patients it was 4.3 ± 1.6 mm 2 (p < 0.02). Eleven out of the 13 patients with congenital paresis showed asymmetry of the superior oblique (84. 6%). Asymmetry determination of the superior oblique muscles disclosed 76.5% sensitivity and 97% specificity. The relationship between vertical deviation and the maximal difference between the section of the normal versus the paretic eye was p > 0.05. Conclusion: Imaging of the superior oblique muscles in patients with congenital IV nerve paresis showed significant asymmetry in the section area with regard to the contralateral muscle. However, no correlation was found between the degree of vertical deviation and interocular asymmetry. High resolution gray scale and color Doppler imaging was performed in more than 100 patients using a high frequency linear array transducer. Various planes of imaging of the eye correlating with drawings of normal anatomy are shown. Views are used to illustrate the complex anatomical relationships. An overview of the normal anatomy and pathologic conditions is presented with clinical correlation. Results: Evaluation with high resolution gray-scale and color Doppler ultrasound can often determine diagnosis without further imaging procedures. US is sometimes insufficient to evaluating a deep structures of the orbit. Paradigmatic US images from different pathologic entities of the eye (for instance: intraocular foreign bodies, haematoma, cataract, vitreal pathology and ablation of the retina etc.) are shown. Conclusion: Adequate knowledge of the anatomy of the eye and orbit is needed to correctly limit the differential diagnostic possibility of pathology of the eye and orbit. US is an available method for an accurate diagnosis of the eye with CT, and preferably MR, being reserved for cases which require additional information about deep structure, or those with in which there is discrepancy between the sonographic and clinical diagnosis. Nasopharyngeal angiofibroma: The role of angiography in diagnosis and treatment A. Szymanska, R. Pietura, A. Drelich-Zbroja, M. Szymanski, M. Szczerbo-Trojanowska; Lublin/PL Background: Nasopharyngeal angiofibroma (NA) is a rare, benign, unencapsulated tumour affecting adolescent males. Surgery and radiotherapy are main treatment modalities. We evaluated typical angiography findings of NA, its role in defining tumour blood supply and treatment planning. Material and Methods: Forty patients with JNA (38 males and 2 females aged 12 to 57) underwent angiography. We assessed tumour vascular composition, its location in relation to the maxillary artery (MA), feeding vessels and feasibility of preoperative embolization. Relationship between stage of tumour, presence of intracranial extension and internal carotid artery (ICA) blood supply were statistically evaluated. Results: On angiograms, all tumours presented intensive inhomogenous blush. 97.5% of tumours were supplied by MA, 15% by ascending pharyngeal and 7.5% by the facial artery. In 30% of tumours, feeding vessels originated from the ICA and in 1 (2.5%) case from the vertebral artery. The relationship between ICA blood supply and tumour stage was statistically significant. ICA blood supply had no correlation with the presence of tumour intracranial extension. Two patients with abundant ICA supply were disqualified from surgery and underwent irradiation. In 2 patients with previous external carotid atery ligation, preoperative embolization of vascular recurrent tumour was not feasible. In 33% of cases MA was displaced by tumour lateral extension. Conclusions: Angiography shows typical features of NA (nasopharyngeal, highly vascular tumour supplied by MA), confirms diagnosis of this tumour and enables preoperative embolization. Analysis of tumour blood supply is useful in determining best therapeutic approach. Angiography visualises displaced MA, which helps the surgeon identify and ligate it during tumour removal. Is an increased capsular width a reliable indirect indicator of temporomandibular joint effusion? F. Tognini 1 , D. Manfredini 1 , V. Zampa 1 , G. Tognini 2 , M. Bosco 1 ; 1 Pisa/IT, 2 Parma/IT Purpose: To establish the most accurate cut-off value of ultrasonographic (US) capsular width which consents to discriminate between temporomandibular joints (TMJ) with and without magnetic resonance (MR) effusion. The study group consisted of 69 patients who sought treatment for temporomandibular disorders (TMD). All the TMJs (n = 138) were evaluated in order to detect the presence of effusion by means of US and MR. Ultrasonographic examination allowed measurement of the capsular width, in the sagittal-oblique scans, as the distance between the hyperechoic lines representing condylar surface and the glenoid fossa. After capsular width was measured, ROC curve analysis was performed to establish the most accurate cut-off value to discriminate between joints with and without MR effusion. Results: Diagnostic accuracy of US to predict MR evidence of TMJ effusion was good (area under the ROC curve = 0.817). US sensitivity was high for values lower than the cut-off value of 1.95 mm (true positive rate (TPR) = 83.9%; false positive rate (FPR) = 26.3%), while specificity was high for values higher than the cut-off value of 2.15 mm (TPR = 71.0%; FPR = 11.8%). Conclusion: Ultrasonography proved to be accurate in detecting the presence of effusion in the temporomandibular joint. Analysis of receiver operating characteristic curve seems to reveal that the critical area of capsular width indicating effusion is that around the value of 2 mm. patients were referred for CT angiography of carotid arteries in our institution. Of these patients, 10 were found to have carotid body tumors and were included in the study. All tumors were confirmed with several imaging modalities (US, MSCT, MR, digital subtraction angiography and somatostatin scintigraphy) and with histologic examination performed on the resected surgical specimen. Imaging Findings: The US (including power-and color-Doppler scanning), MSCT angiography, MR angiography, digital subtraction angiography and somatostatin scintigraphy findings of 12 carotid body tumors were reviewed. Tumors were unilateral in eight cases and bilateral in the remaining two patients. All lesions were well-defined (ranging in size from 1.0 to 6.5 cm) and located within the carotid bifurcation, causing splaying of the carotid branches. All tumors were highly vascularized (mainly by branches of the external carotid artery) and no sign of malignancy was identified. After pre-operative embolization, all lesions were surgically removed with no complications and were confirmed to be carotid body tumors at histology. The diagnostic possibility of a carotid body tumor has to be considered when a solid mass is detected within the carotid bifurcation. Imaging studies are essential to differentiate carotid body tumors from other masses of the neck (lymphadenopathy, tumors, cysts, etc). Imaging Background: Evaluation of cervical spaces is an important procedure for patients with cervical pathology because it assesses the prognosis of the patients and helps to select adequate treatment. Ultrasound, computed tomography and magnetic resonance play an important role in the imaging diagnosis of this area. However, before examination of pathology, a clear understanding of the anatomy of cervical spaces is essential. The neck is divided into eight regions, enabling the radiologist to examine all areas of the neck in a systematic way in order not to miss a lesion. Procedure Details: We have reviewed all the normal studies of the neck that were performed during the last year using at least one of the three techniques. We selected the most illustrated cases to describe the anatomy of the cervical spaces. The neck is a complex anatomic area. This education exhibit helps the radiologist to have a better knowledge of imaging of the cervical spaces. Preoperatively, the thyroid nodules were assesed in terms of number, compressibility, texture, complexity, margins, volume, vascularity, interactions with great vessels and the presence of thyroid, parathyroid and cervical lymph nodes. 3D USA multiplanar reconstructions (MPR) reslicing thyroid nodules for virtual surgery were created. US results were compared with intra-operative findings and final pathomorphology. Results: Fifty-three patients had operations (39 lobectomies, 7 thyreoidectomies including 2 with lympadenectomies and 7 thyroid resections). Six cancers, 26 adenomas, 15 colloid nodules, 14 goiters and 9 with thyroiditis were found. Demonstration of the nodules in three orthogonal planes by 3D USA and assessment of the nodule's character and vascularity helped to change surgical management in 8 cases; in 2 cases post puncture morphological diagnosis and in 9 cases operation was rejected. 3D USA was superior to conventional 2D in differential diagnosis of thyroid nodules. The preliminary decision to perform a lobectomy or a total thyroidectomy was based on variety of factors, many of which were delineated by detailed ultrasound examination. Preoperative evaluation of thyroid vascular anatomy and MPR of the nodules were of value for changing surgical management for thyroid resections and in rejecting the necessity of operation. Conclusions: 3D USA is a useful complement to conventional ultrasound that allows precise preoperative evaluation of thyroid nodules which influences surgical management. The value of MR imaging and MR angiography in the differential diagnosis of carotid space tumors P. Virtual laryngoscopy: Comparison with fiberoptic laryngoscopical findings Z. Celej 1 , A. Wygoda 1 , C. Przeorek 1 , W. Przeorek 1 , J. Baron 2 , A. Siemianowicz 2 ; 1 Gliwice/PL, 2 Katowice/PL Purpose: To evaluate the concordance between virtual and direct laryngoscopy in the estimation of laryngeal carcinoma staging. Material and Methods: Multislice CT and direct laryngoscopy were used to examine 10 patients with laryngeal carcinoma. CT data were obtained on a sixteen row detector (0.75 mm slice thickness, pitch factor 1) during free breathing and "e" phonation both before and after contrast enhancement. The patients were examined before radiotherapy and surgical treatment. Postprocessing was performed using multiplanar rendering (MPR) and virtual laryngoscopy (VL) as a surface rendering algorithm with boundary density of -600,-400 and -200 HU. All CT examination results (MPR and VL) were compared with fiberoscopy. Virtual images created at boundary density of -200 HU revealed better concordance to direct laryngoscopy. Every case of laryngeal carcinoma, even plain infiltration at T1 stage, was correctly diagnosed by virtual endoscopy. The disorder of vocal cord function was better demonstrated in fiberoscopy. Virtual laryngoscopy is complementary to fiberoptic endoscopy and should be combined with axial slices and MPR images for the estimation of laryngeal carcinoma staging. Ultrasound characteristics and histopathologic correlation in primary thyroid carcinomas C. To describe the technique and problems related to SPECT/ PET/CT/US image fusion in the neck region and to demonstrate the clinical relevance of the information gained by multimodality imaging on a series of 58 patients with neck tumors, lymph node metastasis, Graves disease and chronic ENT inflammations. Background: Small tumors or subtle changes in inflammatory diseases cannot be detected in only one imaging series. Multimodality imaging allows for a combination of functional and anatomical information in one dataset and therefore gives more detailed informations on distinct changes. Procedure Details: For reproducible immobilization of the patient, an individual mold of the patient's head, neck and shoulder was produced using the BodyFix vacuum device (Medical Intelligence, Schwabmünchen, Germany). Up to 8 modality-specific markers were reproducibly attached to the skin and to the mold. The data-sets were transferred to the TREON StealthStation navigation system (Medtronic Inc.) and image fusion was performed based on the markers and anatomical landmarks. Image fusion allowed precise correlation of suspicious tracer-enhancements to tumorous contrast-enhanced nodules on the CT images. In patients with Graves disease and ENT inflammations focal disease in homogeneous tissues was uncovered due to increased tracer uptake. US images were used for screening and to depict vascularisation. The presented method aids in the detection of tumors and lymph node metastasis in the neck area, influencing the surgical strategy in most patients. In patients with Graves disease and chronic inflammations the real amount of inflammation can be determined. Lemierre's syndrome (Necrobacillosis): The imaging findings S. Powell, M. Powell, D. Bakshi, J. Evans; Liverpool/UK Learning Objectives: The purpose of our poster is to demonstrate the imaging findings in the rare and interesting Lemierre's syndrome (necrobacillosis), to heighten clinincal suspicion and therefore allow more rapid diagnosis. Background: Lemierre's syndrome is the triad of pharyngitis, internal jugular vein thrombosis and pulmonary infection. The causative organism is Fusobacterium necrophorum. This is a commonly fatal disease requiring both the radiologist and clinician to keep an index of suspicion. The diagnostic findings include pharyngitis with direct local invasion into the lateral pharyngeal space and thrombophlebitis of the internal jugular vein. Metastatic infection is common and the usual site is pulmonary (80%). Imaging Findings: The imaging findings include pharyngitis with direct spread of infection into the lateral pharyngeal spaces. Internal jugular vein thrombosis and pulmonary infiltration leading to cavitation are the next most common findings.Other findings include pleural effusions, spinal and brain abscesses, septic arthritis and IVC thrombosis. A variety of imaging modalities are employed to assess the patient with disseminated Fusobacterial infection. Conclusion: Our poster aims to provide a comprehensive collection of imaging findings in Lemierre's syndrome. Lymph node staging in head and neck cancer: A pictorial review S. Connolly, H. Lewis-Jones, R. Hanlon; Liverpool/UK Learning Objective: The purpose of this poster is to describe and show the anatomical location of the lymph node levels as described by the American Joint Committee on Cancer. It will also cover some of the difficult diagnostic areas involved in reporting head and neck staging images. Background: As a radiological department attached to a large head and neck unit, we have wide experience of head and neck cancer. The extent and level of cervical node involvement is probably the most important prognostic factor for patients with a primary squamous cell carcinoma. Node level has also been shown to be a highly significant predictor of survival. Procedure Details: Using anatomical drawings and cross sectional images of pathology that we have encountered in our department, we will show examples of nodes in the described levels. The pictorial review will include examples of normal reactive nodes as well as typical examples of extracapsular spread, squamous cell cancer metastatic nodes and lymphoma. We will also depict some of the more unusual cases we have experienced, such as histologically proven recurrent metastatic nodes, which on imaging grounds appeared benign and cystic, along with some examples of intraparotid nodal disease. The pictorial review will allow greater understanding of the staging process of head and neck cancer and its implication on patient prognosis and survival. Ten patients with squamous cell carcinoma of the neck (T2-4, N2-3) planned for primary radiochemotherapy were examined at several time points in the course of the 6 weeks therapy (before, after beginning, and at 3 and 6 weeks). The examinations were performed with Aplio US-System (Toshiba) with 7.5 MHz broadband transducer. PD and ADF (either 2D and 3D) were applied pre and post application of ultrasound contrast agent (intravenous bolus of 2.4 mL SonoVue). The methods were compared by visual assessment. Results: Both CE ADF and PD are sufficient to depict blood supply. While PD delivers better B-Mode information, ADF allows continuous examination due to the lower MI thus giving more time to acquire 3D data set and determining signal intensity time curve after one bolus application of contrast. ADF showed less artifacts concerning blooming and cluttering in number and extent in almost all cases. In 5 cases, we were able to demonstrate a perfusion after 6 weeks of therapy but in 3 it was only possible using CE techniques. Conclusion: Although PD delivers more B-Mode information ADF is the method of choice since it has the same sensitivity for detecting blood vessels but allows continuous examination and is less susceptible for artifacts. Conclusion: Percutaneous islet cell transplantation appears to be a simple and clinical promising radiological intervention and an alternative to surgical pancreas transplantation in patients with type 1 diabetes refractory to insulin therapy. Imaging Findings and Procedure Details: Diagnostic imaging and interventional minimally invasive percutaneous procedures in disk diseases are reviewed through an interactive hypertext-based teaching file with images and movie demonstrations. CT, MR Imaging and discogram findings in disk pathology will be described including degenerative disk diseases, spondylosis, disk herniations, traumatic disk diseases, septic diskitis, and postoperative disk diseases. Techniques, indications, contraindications, complications and results of percutaneous minimally invasive procedures of intervertebral disk diseases will be described and illustrated. These procedures include percutaneous periradicular and epidural steroids injection, percutaneous diskogram, diskal biopsy and drainage, percutaneous radiofrequency and laser nucleotomy. Conclusion: For disk disease with appropriate indications, minimally invasive interventional radiologic procedures are able to relieve pain and to minimize the risk of disability. Colonic stents in acute malignant colorectal obstruction: 78 cases P. Bermudez Bencerrey, J. Falco Fages, J. Perendreu Sans, J. Fortuño Andrés, M. Alcantara Moral, D. Gil Bello; Sabadell/ES Learning Objectives: To illustrate our experience with colonic stents in the treatment of acute obstruction from colorectal cancer. To describe the results and complications of the procedure based on a series of 78 patients. Background: Colorectal cancer is an important health problem with a high morbidity and mortality rate. Between 10-30% of patients with colon cancer present with acute obstruction. 70% of acute obstructions are in the left colon and rectum, and only 40% of left sided carcinoma colonic obstructions can be treated with intraoperative lavage and subtotal colectomy. The rest of the patients need a temporary or, more probably, permanent colostomy with an important impact on quality of life. In this exhibit we will describe the use of colonic stents as a temporary treatment prior to elective surgery of left sided colon and rectal cancer and as a palliative treatment in the unresectable colon cancer. Between July 1997 and August 2003, 78 patients with acute colonic obstruction were treated with colonic stents in our department. The procedure, indications, contraindications, and the results are described and illustrated. Procedure Details: Plain abdominal radiography and abdominal CT was performed to all patients prior to the procedure. Two different types of colon stents were used: enteral Wallstent (Boston Scientific) and Hanarostent (MITech Co., Ltd.) Conclusion: Clinical resolution of the obstruction was achieved in 84%. Anastomosis was successfully performed in 95% of the patients undergoing surgery. Major complications developed in 13% (5 perforations, 5 obstructions and 3 migrations). Palliative treatment was effective in all cases. Saline injection of solid tumours prior to radiofrequency ablation: Our experience A.M. Camenzuli, A. Attard, J.C. Evans; Liverpool/UK Learning Objectives: 1. To outline the procedure we have adopted to instil saline into the tumour. 2. To describe the appearances of complete necrosis on the inital, early and late follow-up scans. 3. To describe the complications and patterns of recurrence of tumours after radiofrequency ablation. Background: The injection of saline to potentiate the effects of radiofrequency ablation in solid organ tumours in experimental models is well described in the literature. We have injected saline prior to ablation into primary hepatocellular carcinomas, colorectal metastases to the liver and primary renal cell carcinomas. Procedure and iImaging Details: Using either ultrasound guidance or CT and under general anaesthesia, we lace the tumour with 5 mL of 30% saline via a coaxial needle. A radioablation probe is then placed along the needle -the latter is then removed prior to applying the RF pulse. We routinely ablate the track along which the probe has travelled to avoid seeding. Routine follow-up with a dual phase abdominal CT scan is done at 1 month and 3 months. The appearances of ablated tumours, recurrences and complications are reviewed in this presentation. Conclusion: Saline infiltration is a safe and effective way of potentiating radiofrequency ablation of solid tumours in the liver and kidneys. Percutaneous Background: Renal abscess is a collection of purulent material confined to the renal parenchyma. It is often life threatening leading to septicemia and is difficult to manage only with the use of antibiotics especially in immuno-compromised patients. CT is currently the most accurate modality in detecting and following renal abscesses. Treatment with CT-guided percutaneous drainage and appropriate antibiotics can be very useful. In a period of two years we treated 13 patients with renal abscesses. We demonstrate the technique and discuss the indications and complications of CT-guided percutaneous drainage of renal abscesses. The procedure is performed with the patient in prone position under local anesthesia supplemented with minimal sedation. Initially a 22gauge Chiba needle is passed into the renal abscess under CT guidance. On confirmation of an abscess we use a pigtail trocar catheter of 8 to 10F for the drainage. Conclusion: CT-guided percutaneous drainage is an effective and well-tolerated method for the therapeutic management of renal abscesses. The imaging features and percutaneous drainage of mediastinal abscesses secondary to oropharyngeal infection S. Sadiq, S. Owen, R. Evans; Swansea/UK Learning Objectives: Oropharyngeal infection, such as dental abscess and acute pharyngitis, are recognised but rare causes of mediastinal abscess formation. We highlight the use of multimodality imaging and percutaneous image guided drainage. The hospital records of four such patients, including casenotes, microbiology data and imaging were reviewed. The clinical courses were followed in order to identify the causative pathogen and illustrate the imaging features and subsequent radiological interventional management. The patients presented over a two-year period. The age range of these patients was sixteen to forty seven. The primary aetiology in three patients was a dental abscess. The fourth patient had an acute pharyngitis. Image Findings: A combination of ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) of the neck and thorax was used to define the anatomical compartments involved. Radiological placement of an 8Fpigtail catheter using US or CT avoided a major surgical procedure in all patients. The common pathogen isolated was Streptococcus viridens. Patients were treated with the appropriate antibiotics and all made an uneventful recovery. Conclusion: An understanding of the anatomical spaces of the neck and their communication with the mediastinum is demonstrated and we recommend that in this condition, which has a high mortality when managed surgically, interventional radiology is an effective treatment option with a low complication rate. Complications occurring after drainage are not uncommon and add to the morbidity of the procedure. The authors display their experience in handling complications (remedial procedures with appropriate images) that occurred in 100 patients with malignant biliary obstruction, in whom PTBD and/or stenting was performed over a 2-year-period. The authors will also list precautions to be observed to prevent such complications. Procedure Details: Severe hemorrhage was treated by catheter repositioning, angiographic embolization of pseudoaneurysm and coil embolization of a portal vein branch rent via a PTBD tract. Cholangitis and bilomas required placement of additional drainage catheters. A migrated plastic stent was repositioned with vascular snare. A ring biliary catheter that broke during procedure, the proximal part lying in peritoneal cavity, was removed by image guided forceps, followed by replacement. Blocked plastic stents were removed endoscopically or via the percutaneous route by canulation with a guidewire followed by replacement. Ring biliary catheter and additional stents plastic/metallic stents were used for blocked metallic stents. Pericatheter leaks responded to flushing, wire passage or larger catheter exchange. Conclusion: It is important to be aware of complications that occur during PTBD and stenting, and how to deal with them before embarking on a full time biliary decompression program. Intellectual property: Development and protection C. Cook 1 , M. Rees 2 ; 1 Weston-super-Mare/UK, 2 Bristol/UK Learning Objective: To discuss the different methods of Intellectual Property (IP) protection. To review the methods of interventional radiology device product development. Background: There are many ways of protecting intellectual property. We discuss each of these in turn. We discuss the differences between the methods used in the United States and the European Union. We also discuss the methods of product development. Details: Trademark, copyright, patents are all reviewed. We discuss the need for patent attorneys and specialist IP management units. We describe the different types and levels of protection available. We also discuss specific means by which an idea can be developed, then protected. We look at the methods available to link with development companies, leading to manufacture. All the principles are specifically discussed with respect to the development of a interventional radiological device. There are numerous ways of protecting IP, and we describe each of these in turn. In addition we look at the means of developing and ultimately manufacturing a radiological interventional device. Purpose: Ethanol injection (PEI) and radiofrequency (RF) are the percutaneous radical therapies most frequently employed in Europe to treat liver tumors in non surgical patients. We present our experience in these techniques over the last 16 years at the Hospital Clinic in Barcelona. Since 1987 multisession PEI was applied in 328 patients with hepatocellular carcinoma (HCC) (uninodular ≤ 5 cm or multinodular 3 ≤ 3 cm). RF was performed in 114 patients since 1998: 73 HCC, 39 Metastasis and 2 others. CT and US (with contrast agents in the later years) were used for efficacy assessment. Results: PEI: Initial complete response (CR) = 70.4%. Extra and intratumoral recurrence = 20 and 22%. One, 3 and 5 year survival rates in Child A patients = 90, 58 and 38% and in Child B patients = 79, 35 and 12% (mean follow-up = 48 months). RF: CR in HCC patients = 67%. Extra and intratumoral recurrence = 19 and 17%. One, 2 and 3 years survival rates = 83, 68 and 52% (mean follow-up = 30 months). In patients with metastasis CR = 61%, with a recurrence rate = 41% (mean follow-up = 12 months). Major complications, that includes hemoperitoneum, liver abscess, needle-tract seeding and cardiovascular death are 1.5% in PEI and 6.1% in RF. Conclusion: PEI and RF are effective local curative methods in liver tumors, with more frequent major complications in the RF group. and excellent (7-10). The efficacy was also evaluated with the days until the patients unable to move started to walk again after PVP. Results: PVP was technically successful in all patients with three cases of minimal complications. The mean VAS score for 198 patients was 7.16 before PVP compared with 2.05 after the procedure. On the degree of improvement, the groups of ineffective, poor, effective and excellent consisted of 4.0, 9.6, 56.1 and 30.3% of patients, respectively. 166 patients (86.5%) could walk the next day after PVP and the mean value until ambulation was 1.56 days. Conclusion: PVP is a safe and effective treatment for relieving severe pain of osteoporotic vertebral compression fractures, leading to avoid various complications associated with prolonged immobilization in aged patients. Effect of vessel size on creation of pulmonary radiofrequency lesions in sheep: Assessment of the "heat sink" effect K. Steinke 1 , K.S. Haghighi 2 , K.K. Hazratwala 2 , D.L. Morris 2 ; 1 Basle/CH, 2 Sydney/AU Purpose: To evaluate the effect of vessel size on radiofrequency lesion creation in the lung with respect to potential for perfusion-mediated heat sink effect and for vascular and bronchial injury. Methodology: Radiofrequency lesions targeted to tissue encompassing a variety of vessels were created in vivo in the lung of 10 cross-bred sheep. The access was either open after thoracotomy along the 5 th intercostal space, or percutaneous. Acute, subacute and chronic changes have been investigated, with immediate, 96 hours and 28 days sacrifice of the sheep post ablation. Macroscopic and histopathologic analysis of the vessels and bronchi was performed. The degree of vascular and bronchial injury and viability of perivascular pneumocytes were recorded. Results: Heat sink effect, macroscopically indicated by invagination of the lung tissue between the vessel and the radiofrequency lesion, was not observed in vessels with a diameter less than 3 mm. Half of the vessels 3 mm or smaller were thrombosed, while the arteries of the same size looked to be patent. Macroscopically no vessel wall injury could be detected. All vessels 5 mm and above showed a certain extent of invagination, no clots were visible. Occasionally within the bronchial lumen small amounts of dark solid material was seen, macroscopically believed to be consolidated blood-tinged sputum. The histopathological results are expected soon. Conclusion: As already shown for liver vessels, lung vessels seem to also have a perfusion-related heat sink effect, consistently seen in vessels above 5 mm in diameter. Peritoneal seeding of hepatocellular carcinoma after radiofrequency ablation: Post-RF bleeding was detected in 4 cases. Two of these patients had hepatic arterial embolization performed due to severe bleeding. In terms of seeding pattern, massive perihepatic and ometal masses were seen in 2 cases and multiple small peritoneal nodules were noted in a further 2 cases. Other cases showed 1 small single mesenteric mass and 1 gastrohepatic ligament thickening. The rate of peritoneal tumor seeding after RF ablation of HCC was 2.7%. The capsular attachment, tumor bulging and post-RF bleeding seems to be risk factor of peritoneal seeding after RF ablation of HCC. R. Marcello, L. Broglia, M. Castellana, G. Gasparini, M. Castrucci; Rome/IT Purpose: The aim of our study was the evaluation of the SPIO contrast-enhanced MR pattern of malignant focal liver lesions treated with percutaneous radiofrequency ablation. Methods and Materials: 23 focal liver lesions were evaluated with Magnetic Resonance (1.5 Tesla Philips, The Netherlands), with SPIO (Resovist Schering, Germany) contrast media after RF percutaneous ablation. Lesions ranged in size from 1.6 cm. to 5.0 cm. MR examination sequences protocol was as follows: TFE T1W and FFE dynamic study before contrast media injection and after 15 and 40 sec SPIO IV administration; TSE T2W and SPIR TSE T2W before contrast media injection and after 10-13 min after SPIO injection. All patients underwent MR imaging evaluation after 10 days, 30 days and 3 months the procedure was carried out. The signal intensity appearance was examined in order to identify size, signs of absence, residual or recurrence of neoplastic tissue. The gold-standard was clinical and CT imaging follow-up. Results: SPIO enhanced sequences were superior in conspicuity, presence or absence and residual or recurrence of tumoral tissue. In 60% of lesions a homogeneous pattern was observed within the lesion with a hyperintense peripheral rim; in 20% of cases inhomogeneity of lesions was observed in examinations performed at 10 days. Residual tumor was depicted at 30 days examination as presence of hyperintense foci localized within the treated area. In this preliminary study SPIO appeared to be an efficacious contrast agent for detection and follow-up of percutaneous RF ablated focal hepatic lesions, especially on T2W and the 40 sec T1W dynamic MR study. Radiofrequency ablation of hepatic dome lesions G. Papaioannou, L. Thanos, A. Nikita, E. Alexopoulou, D. Loggitsi, D.A. Kelekis; Athens/GR Purpose: To present the additional difficulties and technical peculiarities of radiofrequency ablation (RF) for hepatic dome lesions. Materials and Methods: 19 patients with focal subphrenic hepatic lesions (8 HCCs, 11 metastases) underwent percutaneous CT-guided RF ablation. Electrodes with 7 or 9 active tips were advanced under CT-guidance. Although technically difficult due to the great needle angulation and penetration of a long hepatic portion, transhepatic route was followed in all cases. Transpulmonary penetration was considered high-risk due to the large diameter of the electrode. Results: All patients experienced mild discomfort during the procedure. Three complications were noted: 2 small subcapsular hematomas and 1 pleural effusion, which were treated conservatively. 75% of the HCCs and 81.2% of the metastatic lesions showed signs of complete necrosis immediately post procedure. Residual non-necrotic tumour was present in 4 cases and repetition of the procedure was required. Tumour recurrence was demonstrated in 2 patients (10.52%) on 1-year follow-up control and was treated with a new session of RF ablation. Overall, 25 RF sessions were performed. Conclusion: Hepatic dome lesions can be treated successfully with RF ablation. Careful planning and technical skill are required due to their location. Results: No treatment complications were noted. The patients recovered well post injection. CT performed in both children after three months showed ossification of the lytic lesions, allowing the cervical braces to be removed. Conclusions: To our knowledge no prior experience in endosteal cervical steroid injection has been reported. These two cases confirm the improvement of osteolytic lesions in children with LCH after treatment with endosteal infusion of steroids. Stabilisation of the cervical spine was particularly beneficial, as the children were no longer in pain and removed the need for cervical braces three months after the treatment. The influence of radiofrequency ablation on hepatic vessels in porcine liver K. Satoh, K. Nakamura, M. Hamuro, Y. Sakai, N. Nishida, Y. Inoue, R. Yamada; Osaka/JP Purpose: The objective of this study was to clarify the influence of radiofrequency ablation on hepatic blood vessels. Hepatic RFA was performed on 18 swine (mean body weight: 22 kg). The livers were removed either immediately following ablation, 1 week or 3 weeks after ablation. The patency of vessel was determined by CT, and the extent of endothelial disorder with diameter less than 1.0 mm was determined histopathologicaly. The portal vein patency rate of immediately, or 3 weeks after RFA were: 43.5 ± 6.9%, 11.7 ± 20.3% (less than 1.0 mm), 76.5 ± 20.9%, 75.5 ± 25.1% (3.0 mm and more). Hepatic vein patency rate were: 42.5 ± 21.0%, 5.6 ± 9.7% (less than 1.0 mm), 76.9 ± 14.1%, 75.6 ± 30.8% (3.0 mm and more). The patency rate was higher for larger vessel diameters. The patency rate of the portal and hepatic veins with diameters less than 3.0 mm was found to decrease with time. At 3 weeks after ablation, the patency rate for vessels with diameters of 3.0 mm and over were significantly higher (P < 0.05) compared to those of diameters less than 2.0 mm. Endothelialization were found in patent vessels from 1 week to 3 weeks after ablation. Conclusion: Endothelization was confirmed from 1 week to 3 weeks after RFA in patent vessels. Blood vessels with diameters of 3.0 mm and over maintain high patency even after RFA. It is therefore possible to maintain blood flow in the distal area of hepatic parenchyma following ablation for hepatic tumors, thus RFA has a limited impact on hepatic function. In three cases, a successful second trial after an initial failure was performed. The procedure was performed by means of a transhepatic (n = 63) or a transperitonea l (n = 76) access route. During procedure, the Seldinger technique was used (transhepatic approach, n = 63, transperitoneal approach, n = 62) in 125 patients, while in the remaining 14 patients the procedure were performed using a trocar technique with a transperitoneal approach. Chiba needles (20G, Mdtech, Denmark, n = 22), JELCO needles (16G, Johnson & Johnson, USA, n = 67) and Secalon catheters (16G, Ohmeda, UK, n = 36) were used for initial puncture of GB. Only minor complications such as abdominal pain (n = 16), hemorrhage (n = 2), referred pain (n = 4) occurred in 21 cases (15%). Abdominal pain is more frequent in transhepatic approach (18%) than in transperitoneal approach (7%), but not statistically significant (p = 0.061). Overall complication rate is lower in transperitoneal approach (8%) than in transhepatic approach (24%)(p = 0.016). According to puncture needle, there is no significant difference in complication rate between the Chiba needle (18%) and the 16 G needle (Jelco needle and Secalon catheter, 16%). Conclusion: Percutaneous cholecystostomy has proved to be safe and effective treatment for patients with acute cholecystitis. T.V. Bartolotta, T. Angileri, M. Midiri, F. Sorrentino, G. Sparacia, A. Carcione; Palermo/IT Purpose: To evaluate the CT role in treatment of lumbosciatalgia through chemonucleolysis with oxygen-ozone (O2-O3) mixture with periradicular and periganglionic technique. Materials and Methods: From January 2000 to June 2002, 145 patients (85 women, 60 men; age range: 30-75 years) with lumbosciatalgia, underwent intradiscal, periradicular and periganglionic treatment with O2-O3 mixture, corticosteroids and anaesthetics. The analysis of the results was made by Visual Analogue Scale (VAS) 1 day before treatment (T0) and, respectively, 4 weeks (T1), 3 months (T2), 6 months (T3) later. All the procedure was performed in a step-wise fashion and controlled by CT scans: from positioning the needle in the centre of the nucleus polposus to mixture administration within the nucleus and in periradicular and periganglionic sites. Results: In 125/145 (86.2%) patients a partial remission of the complaints just after the first treatment (VAS 6 at T1) was observed; VAS was 4 at T2 and at the last evaluation, six months later (T3), it was 2. In 20/145 (13.8%) patients VAS was 8 at T1 and another treatment was performed, with an improvement of VAS at T2 and T3 respectively of 6 and 3 in 15/20 cases. The remaining 5/20 patients did not show any improvement even after the second treatment and VAS ranged from 8 to 10 at T3. Conclusions: Chemonucleolysis with O2-O3 mixture with periradicular and periganglionic technique under CT guidance is a reliable and competitive method in treatment of lumbosciatalgia. Multiple In 22 patients with malignant biliary obstruction of the hilum and unavailable bilateral access, drainage of biliary tree was obtained with one percutaneous access through which multiple stent deployment was performed with a cross-positioning technique. The first self-expandable endoprosthesis was positioned in the common bile duct. Thereafter a balloon catheter was inserted along a previously introduced guide wire to dilate the mesh of the stent. After having removed the catheter, a second stent was implanted through the dilated wall of the first stent, across the hilum. Overall 47 stents have been cross-implanted. In 20 patients 2 stents have been inserted, in 1 patient 3 stents, in another patient cross-positioning of 4 stents was required. Results: No relevant complications have occurred. Patient survival and stent patency rates were comparable with those of multiple-access stenting technique. The procedure is generally more protracted implying an increased radiation exposure for both the patient and the operator. Conclusion: Biliary stenting with one percutaneous access and cross-positioning technique is a useful procedure in all cases in which bilateral access in not possible. It reduces the risks connected to multiple passages of liver parenchyma though at the expense of a longer time of exposure for both the patient and the radiologist. Results: In 10 (91%) patients pain relief was complete within one to two days after injection. One (9%) patient with multilevel hemangioma failed to respond. We did not observe any complications. Conclusion: Percutaneous vertebroplasty is a promising therapy for patients with painful vertebral hemangiomas. This method is effective, with low risk of complications, and may be appliciable to asymptomatic cases as a preventive treatment. Percutaneous A retrospective analysis was performed of 127 percutaneous nephrostomies in 107 patients (74 male, 33 female; age range: 6 days-16 years). Twenty patients had bilateral nephrostomies and 5 patients were recatheterized. The procedures were performed with sonographic and fluoroscopic guidance under sedation or general anesthesia. The catheters (5.7-10 Fr) were placed either with a Seldinger technique or an Accustick Introduction System. Results: Percutaneous nephrostmy catheters were placed due to UP junction obstruction in 37 patients, UV junction obstruction in 10 patients, posterior urethral valve in 7 patients, neurogenic bladder in 10 patients, congenital anomalies in 9 patients, trauma in 3 patients, stones in 14 patients, tumor in 1 patient and renal insufficiency in 6 patients. Pyonephrosis was detected in 17 patients. Nine dislodged catheters were replaced percutaneously. All procedures were carried out successfully. No procedure related mortality was seen. One patient arrested right after the procedure because of methemoglobinemia due to local anesthetic and treated with methylene blue. No other major complications were detected. Catheter dislodgement and infection were detected in 9 and 1 patients, respectively. Duration of catheterization was between 1 and 150 days. All the catheters were removed after medical, surgical or percutaneous treatments. Conclusion: Image guided percutaneous nephrostomy in pediatric population is a safe and effective procedure with low mortality, morbidity and high success rates. Percutaneous CT-guided facet screw fixation in lumbar spines: Technical aspect H.Y. Kang, S.H. Lee; Seoul Korea/KR Purpose: To report our experience of the technique of percutaneous CT-guided facet screw fixation of 18 cases in lumbar spines. The CT gantry has an angle tilt limitation of approximately 28.5 degrees, but the Z-axis (coronal) angle of facet joints is about 40-50 degrees. Thus under local anesthesia, positioning was head first, prone with cephalad elevation of upper body to compensate for the facet angle. After selecting the route of the procedure, the guide wire and fixed screws were inserted, after measurement of the size of fitting screw. This procedure was performed in 18 patients, with combination of anterior lumbar interbody fusion (ALIF, 16 patients) and cases of discitis (2 patients). Results: All procedures of facet screw fixation with ALIF were performed successfully, there were no definite malpositioning of screw or segmental instability on postoperative images at one month follow-up. In cases of discitis, the procedure were performed also successfully, but with more slightly decreased disc height on image at one month follow-up. The controlateral translaminar facet screw fixations were performed at the levels of L3-4 and L4-5, and ipsilateral transfacet screw fixations were done at L5-S1 level. Conclusion: Percutaneous CT-guided facet screw fixation in lumbar spines was a safe and reliable procedure for a method of spinal fusion. Minimally invasive management of benign biliary diseases A. Doros, V. Weszelits, A. Peter, A. Nemeth; Budapest/HU Purpose: Report our experience in treating percutaneously benign biliary strictures, fistulas, post-operative leakages, residual stones/sludge, bilomas and abscesses. In the last five years, 27 patients (20 women, 7 men, 18-68 years) with benign biliary diseases were referred to our interventional radiology unit. Twenty patients underwent laparoscopic or open cholecystectomy, six had residual stones, three had biliary fistulas. Twenty patients had hepatico-or duodeno-jejunostomy stenoses, four had cholangitis-induced liver abscesses, and three had chronic pancreatitis. Results: Forty percutaneous biliary interventions were performed with good longterm results. Strictures were dilated 22 times. Six metallic stents were placed into three patients. Two plastic stents were placed in one patient with a rendez-vous maneuver. Two fistulas were treated with drainage and glue. Five stones were removed percutaneously with balloons or Dormia baskets. One patient with chronic pancreatitis was treated with a metallic stent. Another patient underwent insertion of three metallic stents for intrahepatic stenosis. Of the four abscesses, two were surgically and one was percutaneously drained. One patient had two small abscesses treated with IV antibiotics. Conclusions: Percutaneous management is useful in selected benign biliary diseases. Dilatation, stone extraction, and abscess drainage can be performed successfully. In difficult cases combined surgical, endoscopic and percutaneous approach must be chosen. Role of aspiration-lavage in the treatment of abscesses in the gallbladder bed after laparoscopic cholecystectomy A.B. Stoian, Z.A. Sparchez, R. Badea; Cluj Napoca/RO Purpose: The evaluation of the efficacy of ultrasound guided aspiration followed by lavage with antibiotics in the treatment of gallbladder bed abscesses after laparoscopic cholecystectomy. Materials and Method: 20 patients with gallbladder bed abscesses were treated percutaneously between 2000-2002. The abscesses were located in gallbladder bed with extension into subhepatic area 35% (7/20). The volume of aspirated pus was 5-20 mL (average 15 mL). The first step of the treatment was the abscess puncture by a transhepatic 65% (13/20) or another approach 35% (7/20) using an 18 G needle (1.2 mm). After pus aspiration, the cavity was washed 2-3 times with a Metronidazol + Ampicillin solution, the amount of antibiotics once injected being half the amount of the aspirated pus. Oral or IV antibiotics (corresponding to antibiogram) were administrated for 7-10 days. In the case of fluid reaccumulation the treatment was repeated. Background: PTPE is a reliable tool to induce liver regeneration of the nonembolized lobe. This facilitates extended right resection in e.g. Klatskin tumor, HCC or liver metasases. Between 1998 and 2000 we performed 80 PTPE. In three cases we noted a failure in regeneration of segment II + III but a growth of segment IV after right lobe embolization. In 10 portal vein ligations which regularly spare segment IV the regenerative outcome was significantly reduced compared to PTPE including segment IV. Procedure Details: In 9/10 patients we use a subxiphoidal access to puncture the left portal vein under US-guidance, otherwise a transhepatic right intercostal access. Via 5F guiding catheters a 2.5F microcatheter is placed in each segmental branch in order to apply 5-8 mL histoacryl-lipiodol solution in total. Segment IV branches are difficult to reach because of the configuration of the Rex recessus anatomy. Since the left lateral segments lie adjacent, the emolization of segment IV is critical and has to be performed with the utmost care to prevent spill over of embolzation material. Conclusion: Segment IV turnes out to be the key for optimal portal vein embolization results. Although bearing the risk of embolization material displacement to segment II and III the better results clearly suggest application of this technique. 3. Palliation of duodenal obstruction via trans-oral route (n = 5) and trans-gastric route (n = 4). Procedural Details and Results: For group 1 and 2, and the trans-oral route in group 3, the technique is essentially an extension to the well established technique of oesophageal stenting of malignancy (except longer wires and catheters are used when more distal stenting is required). As more distal lesions are tackled, the intrinsic difficulty of manipulating long wires and catheters increases and gives way to the more direct transgastric route approach of group 3. This is also an extension to the well established technique of radiological insertion of gastrostomy using T-bar fixation. Failure of insertion occurred in 2 patients in the duodenal obstruction group via the trans-oral route. There were no immediate or delayed complications and no re-interventions were required. Five patients (30%) returned to normal diet, 6 patients managed semi-solid diet (40%) and 5 patients (30%) had no significant improvement post stent insertion respectively. The mean survival for groups (2) and (3) (i.e. primary carcinoma) was 58 days (range 10 to 224 days). Conclusion: Radiological placement of gastroduodenal stents is effective for palliation of upper GI malignancies. Impact of multi-detector-row-CT (16x) prior to angiographic intervention M.S. Juchems, S. Pauls, H.J. Brambs, A.J. Aschoff; Ulm/DE Learning Objectives: To demonstrate the additional impact of contrast enhanced multi-detector-row-CT angiography (MDR-CTA) compared to digital subtraction angiography (DSA) for planning of angiographic intervention. Backround: In selected cases a pre-interventional CTA can be useful to facilitate angiographic intervention. We selected four patients with different disease entities (pulmonary AV malformation; bleeding caused by hepatic aneurysmosis and from renal pseudoaneurysm after partial renal resection; hepatocellular carcinoma (HCC) prior to transarterial chemoembolization (TACE) with aberrant arteries) from our collective who underwent CTA prior to angiographic intervention. Procedure Details: All CT scans were performed using a 16 channel Multi-Detector-Row-CT (Philips Mx8000 IDT). Both multiplanar reconstructions (MPR) and slab maximum intensity projections (slab MIP) were performed. After CTA, patients underwent angiographic intervention (coil embolisation in the first three, TACE in the last case). MDR-CTA can demonstrate the exact extent and localize multiple vascular malformations, as demonstrated in the first case. In addition, MDR-CTA can not only find the cause of hemorrhage but also demonstrate the exact localization of the specific vascular pathology (2 nd and 3 rd case). These findings facilitate the intervention, resulting in decreased In three children, a renal artery stenosis between 80 and 90% due to fibromuscular dysplasia was discovered. In two of these three, the stenosis was unilateral and in one bilateral. In the remaining child, a long stenosis of unknown etiology was discovered. Procedure Details: In all patients, PTRA was performed after having exactly defined the morphology and the hemodynamics of the renal artery stenoses. In three children we have achieved very good. Results: PTRA was successful resulting in an increased diameter of the arterial lumen. PTRA was repeated and unsuccessful in one child with a severe stenosis and an emphasised "recoil" phenomenon. Autotransplantation was therefore performed. Reference is made to current controversies on this issue. Background: Endoluminal repair is an acceptable treatment modality for abdominal aneurysms. Implant selection is based on the aneurysm's neck anatomy, resulting in two main implant groups; those fixed above the level of the renal arteries, and those fixed below this level. Each group presents advantages and disadvantages that should be considered in the selection process. Type I endoleaks are the most common complications derived from implant selection. Procedure Details: In order to select the implant, the patient should undergo a contrast-enhanced abdominal CT scan with coronal reconstructions to image in detail the abdominal aorta, and measure the size of the aneurysm, the distance from the renal arteries to the upper border of the aneurysm, and several other measurements needed. Alternatives are abdominal aortic DSA and MRA. The two main features that will determine the fixation site are the neck's shape and distance. Sealing is always infrarenal. Suprarenal devices provide better fixation, although some series report small renal parenchyma infarcts, due to emboli. Infrarenal devices are easier to handle, provide for small corrections one placed, but cannot be placed in tortuous necks. Conclusions: Two main implant groups are used in endoluminal abdominal aneurysm repair, the suprarenal and infrarenal fixation devices. Proper patient selection is needed to decide which device is to be used, in order to minimize post-procedural complications. In-vivo transcatheter implantation of a new aortic stent-valve for the temporary relief of acute aortic insufficiency M. Hashimoto 1 , T. Kaminou 1 , P. Haage 2 , Y. Ohuchi 1 , K. Nakamura 1 , K. Sugiura 1 , Y. Noishiki 3 , R.W. Günther 2 , T. Ogawa 1 ; 1 Yonago/JP, 2 Aachen/DE, 3 Yokohama/JP Purpose: Acute aortic regurgitation is a life-threatening condition, particularly when associated with Type A aortic dissection or aortic ectasia. The aim of this animal study was the evaluation of a novel temporary stent-valve as a potential temporizing measure to prevent progression to sudden death until conventional surgical repair can be performed. An umbrella-shaped highly porous polyester mesh valve was placed in the subcoronary portion with the attached metallic stent fixed in the ascending aorta. The prosthesis (stent-valve) was implanted in 6 pigs via the right carotid artery through an 8Fr introducer. The efficacy of the valve was assessed by aortography, pressure measurement and electrocardiography. 1 hour after the implantation, the animals were killed and the stent-valve was subjected to macroscopic examination. Results: A severe peri-prosthetic leak and cardiac arrest due to the deep implantation of the stent-valve were seen in 1 case. Although, a few premature ventricular complexes were seen in 1 and slight blood stagnation in the Valsalva sinus was seen in two, excellent performance of the mesh valve was demonstrated in 5 of 6 cases. There was no significant thrombus formation inside the umbrella valve. The presented new temporary stent-valve shows promise for possible future clinical application. Further studies are necessary to assess valve thrombogenicity and coronary flow. Percutaneous (1996) (1997) (1998) (1999) (2000) (2001) (2002) (2003) with hepatic posttransplantation biliary complications who required treatment with interventional radiology techniques. 12 were pediatric patients and 12 were adults. Diagnostic percutaneous transhepatic cholangiography (PTC) was performed in all patients, followed by placement of an internal-external biliary drain in the same procedure. In 10 patients presenting with stenosis in the area of the anastomosis, dilatation with balloon angioplasty was also carried out. In 2 patients with biliary calculi, lithotomy was performed followed by expulsion of the calculi to the digestive tract. One patient presented with a massive biliary leak that did not respond to percutaneous drainage and required implantation of a metal prosthesis. Results: The transhepatic approach was used for the diagnostic study, for locating the cause of the complication and to carry out the therapeutic maneuvers required for its resolution. In the 24 patients studied, the initial outcome of percutaneous treatment was satisfactory (100% technical success) and in 16 of them (66%) it was the definitive therapeutic measure. Among the remaining 8 patients, 4 underwent surgical re-anastomosis and 4 re-transplantation. Drainage placement was beneficial in all patients, allowing elective surgical treatment once the infectious-obstructive complication was resolved. Conclusion: Interventional radiology plays an important role in the therapeutic management of hepatic post-transplantation biliary complications. PTC allows precise early diagnosis of the complication. The interventional technique reduces the need for reoperation, thereby reducing associated morbidity and mortality. A comparative study of transjugular intrahepatic portosystemic shunt and transcatheter sclerotherapy for gastric varices T. Ninoi 1 , K. Nakamura 1 , N. Nishida 1 , Y. Sakai 1 , T. Kitayama 1 , M. Hamuro 1 , R. Yamada 1 , Y. Inoue 1 , T. Kaminou 2 ; 1 Osaka/JP, 2 Yonago/JP Purpose: The rupture of gastric varices (GV) is a serious complication in patients with portal hypertension. Transjugular intrahepatic portosystemic shunt (TIPS) and transcatheter sclerotherapy (TS) are effective treatments of GV. The effects on the portal pressure completely differ in TIPS and TS. However, to our knowledge, no comparative study of the two treatments for GV has been reported. The purpose of this study was to compare TIPS with TS on GV bleeding and survival. Materials and Methods: A total of 139 cirrhotic patients with GV underwent endovascular treatment. Of the 139 patients, 104 without hepatocellular caricinoma were enrolled in this study; 27 patients were treated by TIPS, and 77 patients by TS. GV bleeding and survival rates were compared between the TIPS and TS groups. Multivariate analysis was used to identify the prognostic factors for GV bleeding and survival. Results: The cumulative GV bleeding rate at 1 year was 20% in the TIPS group, and 2% in the TS group (p < 0.01). The prognostic factor associated with GV bleeding was the treatment method. The cumulative survival rates at 1, 3, and 5 years, were 81%, 64%, and 40%, in the TIPS group, and 96%, 83%, and 76%, in the TS group, respectively (p < 0.01). The prognostic factors for survival were the treatment method and the Child-Pugh classification. Conclusion: TS may be more useful for GV than TIPS in consideration of GV bleeding and survival. Results: TPSAE was technically feasible in all patients without procedure-related complications. Despite significant higher injury grade (3.7 vs 2), higher rate of active contrast extravasation (38% vs 3%) and higher amount of hemoperitone-um on CT, secondary bleeding rate requiring splenectomy was lower in the TP-SAE group (2.7% vs 10%). Conclusion: TPSAE is a feasible and safe procedure in the treatment of splenic injury. TPSAE allows a non-operative management despite a selection of severe splenic injuries with one of the lowest reported secondary splenectomy rates. Recanalization of acute vertebro-basilar occlusion by a coronary waterjet thrombectomy device T.E. Mayer, G.F. Hamann, H. Brueckmann; Munich/DE Purpose: With a death rate of more than 50%, vertebrobasilar thromboembolism still remains a dangerous disease. This high rate can be mainly attributed to the overall failure of recanalization of 30%, depending on the extensiveness of the clot. This is especially in multisegmental occlusions, where the recanalization rate is very low and mortality is about 90%. We investigated the feasibility of using a coronary mechanical device based on the Bernoulli effect (Angiojet) for rapid recanalization. Methods: Ten patients with acute vertebrobasilar occlusion were included in the pilot study. Inclusion depended on the presence of multisegmental intracranial (8 patients) or any extracranial occlusions and coma lasting no more than 8 hours. Local intra-arterial fibrinolysis had failed in two patients before the Angiojet was used, and thrombolysis was administered to two patients afterwards (rt-PA). Five patients underwent additional intracranial balloon or stent angioplasty, and five received platelet inhibition by tirofiban. Results: Treament was primarily done with the Angiojet and succeeded in complete recanalization in 90% of the patients (97% of the vessel segments). Addition of fibrinolysis resulted in success in 100% of patients and segments. Three hemorrhages were associated with additional thrombolysis, tirofiban, or both. Seventy percent of the patients survived, and 60% had moderate to excellent outcome. The use of the coronary Angiojet in the vertebrobasilar system is feasible. A success rate of 100% recanalization was achieved in a pilot study. Compared to historical data of multisegmental thrombosis, the death rate was cut in half and good neurological outcomes increased. Experience of transradial and transulnar abdominal angiography and intervention T. Sato, M. Kajikawa; Hiroshima/JP Purpose: In coronary angiography and angioplasty, transradial and transulnar approach has currently been accepted as an alternative catheterization method to transfemoral or transbrachial approach. The purpose of this study was to report practical and clinical applicability of these methods in abdominal angiography and intervention. Methods and Materials: Between February 1999 and August 2003, 263 abdominal examinations were tried transradially or transulnarly in 167 cases. 111 cases were for liver or gall bladder tumor, 35 cases were for other abdominal tumors, 17 cases were due to gastrointestinal bleeding, 3 cases were for renal or superior mesenteric arterial thrombosis and 1 case was for ulcerative colitis. 193 examinations were with further intervention. 27 cases were examined twice, 14 cases were examined 4 times, 1 case was examined 4 times, 4 cases were examined 5 times, 1 case were examined 6 times and 2 cases were examined 7 times during this period, transradially. Results: Radial puncture was failed in 8 examinations (3.1%) and changed to brachial puncture. In 5 cases with weak radial pulsation, ulnar puncture was tried. In cases of hepatocellurar carcinoma, superselective catheterization was also available and transarterial chemoembolization was done. In cases of abdominal branch aneurysm, successful coil embolization was done in 3 cases and a femoral approach was needed on another occasion for complete embolization in one case. No puncture site hematoma was seen. Radial arterial stenosis was found in 2 cases at the next examination. No cerebrovascular problems were noted. Conclusion: Transradial and transulnar approach are alternative catheterization methods even in abdominal angiography and intervention. Pre-and post-operative CT scans before discharge, at 1, 3, 6 months and biannually thereafter were performed; pLA and pIMA were evaluated in each followup scan and the number of pLA was counted.These data were correlated with the frequency of EL-II. Pre-and postoperative volumes of the aneurysmal sacs were measured from CT data. Results: Median follow-up was 24 months (range 6-36 months).In total 706 CT scans were performed and analyzed. Six months after stent-graft implantation pIMA and/or at least 2 pLA were seen in 45 patients (50.5%); 11 patients (12.4% of the study cohort) had an EL-II. No EL-II was seen in patients without pLA/ pIMA. Three groups were identified and compared: patients without pLA/pIMA/ EL-II and patients with pLA/pIMA with/without EL-II. A tendency to minor mean volume loss in patients with pLA/pIMA and a significant trend to volume increase in patients with EL-II in later follow-ups was seen. Conclusion: There is a high incidence of pLA/pIMA in patients after EVR. Persistent lumbar and inferior mesenteric artery perfusion is associated with significantly higher EL-II rates after EVR of AAA. Significant differences in volume changes in later follow-ups were seen between patients with or without EL-II. Chemoembolization of hepatocellular carcinoma in candidates for orthotopic liver transplantation: Histopathologic findings S. Terraz, P. Majno, L. Rubbia, P.-A. Schneider, C.D. Becker; Geneva/CH Purpose: To evaluate the effects of selective transarterial chemoembolization (S-TACE) in patients with suspected hepatocellular carcinoma (HCC) before orthotopic liver transplantation (OLT). Materials and Methods: 36 candidates for OLT, with viral or alcoholic cirrhosis and a total of 64 nodules suspected to be HCC (1-5 nodules of 0.7-5.7 cm), underwent S-TACE with doxorubicine/lipiodol in 1-3 sessions. Catheter position was segmental or subsegmental in 71% and unilobar in 29%. Particles were added unless complete stasis was observed. The delay between S-TACE and OLT was 129 (5-500) days. Histologic findings of the explanted livers was correlated with all clinical, biologic and radiologic parameters. Results: Based on the final diagnosis, 58 nodules were HCC, five were regenerative nodules and one was focal nodular hyperplasia. We observed total or neartotal necrosis (> 90%) in 35 (60.4%) HCC nodules and no dissemination was present. Twenty-three HCC (39.6%) nodules were partially necrotic; in 13 of these, capsular and/or vascular invasion were present. One patient developed a pseudoaneurysm at the puncture site; no other complication was observed. Conclusion: S-TACE leads to complete necrosis in the majority of HCC nodules. OLT candidates with a long waiting period should be followed by repeated imaging studies, in order to be able to prevent tumor regrowth or spread by repeating S-TACE when necessary. Kasabach Merritt syndrome: Treatment with transarterial embolization K.S. Malagari, D. Antonopoulos, D. Loggitsi, D. Danassi, A. Rigopoulou, A. Sissopoulos, A. Nikita, G. Papaioannou, D. Kelekis; Athens/GR Aim: Kasabach Merritt Syndrome is a rare life threatening condition characterized by consumption coagulopathy, most often associated with liver hemangiomas. We report on the value of transarterial embolization in the treatment of this condition. Material and Methods: Two patients are included in the study (mean age 63 yrs, range 52-74). Both were women. Kasabach Merrit was the first manifestation of the liver lesion in one patient and a complication of a known cavernous liver hemangioma in the second. Hct values were 33% and 28%, PLT 4,000 and 5,400/ mm 3 , fibrinogen 98 and 77 mg/dl respectively. Spiral CT of the liver showed typical hemangiomas with a lace-like enhancing pattern (mean diameters 5 and 14 cm respectively). Patients were infused with platelets, fresh plasma, cryoprecipitates, aprotinin and antithrombin prior to embolization. One patient required also 6 units of packed red blood cells. Selective hepatic angiography was performed prior to embolization, followed by superselective injection of the feeding vessel(s). Microspheres of 300-500 microns were injected under fluoroscopic guidance until cessation of flow. The procedure was uneventful in both patients. Partial restoration of PLT cell count was observed from the following day and within a week fibrinogen levels and PLT levels were completely restored in one patient and partially to the other. Conclusions: Transarterial embolization may be life saving in Kasabach Merritt since it can safely control coagulation abnormalities and allows planning for more definitive treatment including surgical resection or liver transplantation for non operable hemangiomas. In vivo characteristics of microspheres injected into the hepatic arteries of rabbits: Angiographic and microscopic comparison of embosphere and beadblock M. Takahashi, Y. Saida; Tsukuba/JP Purpose: The authors presently utilize non-resorbable microspheres (MS) for the transarterial embolization (TAE) of hepatocellular carcinoma (HCC). To correlate their clinical features and in vivo characteristics, two different types of industrially-produced MS, injected into the hepatic arteries of rabbits, were microscopically compared. Eight Japanese-white rabbits were divided into four groups. Hepatic arteries were selectively catheterized by the femoral approach. In each group, Lipiodol, Embosphere (40-120 and 100-300µ) or BeadBlock (100-300µ) were injected. MS were prepared as a 10 mL suspension with contrast material, in which 2 mL MS were contained. Animals were sacrificed immediately after the injection. The liver was excised with ligation of all major vessels. Sections were made in the radiate plane along with hepatic arteries. Results: Lipiodol spread into the hepatic sinusoid and reached the central veins. They were found also in the peribiliary plexus (PBP). MS reached maximally Glisson's sheath but was not found around the PBP nor the sinusoids. Embosphere occluded the artery after an injection of some milliliters. Microscopically they were often clustered and compressed but their spherical shape was maintained. Smaller Embosphere penetrated deeper than larger one. BeadBlock once occluded the artery with a smaller amount of suspension than Embosphere. After a few minutes, however, the arterial flow resumed and additional injections were possible. Microscopically they formed casts and tend to reach deeper tissue than Embosphere of the same size. Conclusion: Embosphere is elastic but robust, while BeadBlock is plastic, forming casts in the vessel. These characteristics explain much of their features at the time of injection. The At another patient 30 hours after the implantation the rupture of common femoral artery aneurysm was stated. There were also observed certain post-hospitalization complications which included: a) clotting of stent-graft leg in 2 cases b) leak type I which demanded implantation of additional element of stent-graft in one case c) small leaks type I in 3 cases and type II in 2 cases which did not demand any further intervention-the type II leaks were observed in 3 cases 6 months after the operation d) the increase of parietal circular thrombus inside the main part of the stent-graft in two cases e) complaints connected with the internal iliac artery occlusion were declared by 4 patients. The catheter has four microsurgical blades that cut directly into the stenotic plaque during inflation. Recently they were proposed for the use in peripheral arterial system using a balloon diameter raging from 4 up to 5.5 mm. Material and Methods: Seven consecutive patients (mean age 58 years) were treated with cutting balloon PTA (CB-PTA) from June until September 2003. All of them had severe multiple, calcified stenosis of the femoro-popliteal artery, maximum 2 cm in length, never treated before. All patients had important associated risk factors such as insulin-dependent diabetes mellitus, hyperlipoproteinemia and smoking. Results: CB-PTA was technically successful in all patients, with lumen diameter improvement at least of 50% or residual stenosis less than 20%; moreover we never observed major dissection of the intimal plaque and we never required stent placement. Conclusion: CB-PTA in lower limb calcified stenoses is a promising technique that seems to be superior to PTA alone, without requiring stenting in femoropopliteal arteries. Aneurysm diameter in all patients were > 5 cm (average diameter were 6.9 cm, range, 5.5-10.4 cm). The mean follow-up was 17 months. Average hospital stay after the intervention was 7-9 days. Results: The stent-grafts were successfully deployed in all patients. Control spiral CT 24 hours after the procedure revealed endoleak in 5 patients (15.6%). Spiral CT follow-up on 7 th day following the intervention showed that in 4 patients endoleak spontaneously stopped and in one patient small endoleak was seen, but it also stopped within a month following the intervention. In two patients (6.3%) acute thrombosis of iliac graft extensions was diagnosed a month after the intervention. In both cases successful endovascular thrombolysis was performed with good clinical outcome. In one patient (3%), progression of atherosclerotic disease resulted in migration of the stent-graft two years after the placement of the graft. Reintervention was done with successful deployment of additional aortic extension of the stent-graft. Average reduction of aneurysm diameter was 8.2 mm (range, 0-32 mm). Conclusion: Endovascular treatment of AAA with Talent stent-graft is a safe and effective procedure. In patients with well defined indication it is safe alternative to open surgery procedure. Direct thrombin injection for non-femoral pseudoaneurysms R. Corso, M. Solcia, M. Castoldi, R. Vercelli, M. Intotero, A. Rampoldi; Milan/IT Purpose: Percutaneous thrombin injection under sonographic guidance has been shown to be an effective and well tolerated treatment for a iatrogenic femoral pseudoaneurysms. For these reasons some authors suggest thrombin injection as alternative treatment also in other body districts. We illustrate our experience, techniques and results in the ablation of pseudoaneurysms of different etiologies and locations whit direct thrombin injection. Materials and Methods: From June 2000 we treated six patients, age range 33-75 years, affected with pseudoaneurysms developed after iatrogenic trauma in three patients (arising from radial, posterior tibial and thoraco-acromial arteries), post-pancreatitis (splenic and superior mesenteric arteries) in two patients and in one patient after spontaneous rupture of renal angiomyolipoma in tuberous sclerosis. Two patients were anticoagulated. The diameter of pseudoaneurysms varied between 2.4-11.5 cm. After disinfection of the entry site, we slowly injected bovine thrombin (1000 U/mL of solution) percutaneously under ultrasound guidance in four cases, while in two cases we injected directly the thrombin in the pseudoaneurysm cavity with a fluoroscopically guided endovascular angiographic catheter. Results: All interventions were successful and showed no immediate or late complications. Doses of thrombin needed varied between 200-6000 units (0.2-6 mL of solution). A complete thrombosis of the pseudoaneurysm sac was accomplished within minutes of thrombin injection. No recurrence was seen at the follow-up. Conclusion: In selected cases, direct thrombin injection may be useful in treating non-femoral pseudoaneurysms resulting in rapid and persistent occlusion. In our limited experience it represents a safe and effective minimally invasive technique and an alternative to surgical repair. The Purpose: Bronchopulmonary sequestration is a combined lung and vascular anomaly witch is usually surgically treated. In those cases witch the anomaly is mostly vascular, coil embolization is a safe alternative to surgery. Method and Materials: Coil embolization of intrapulmonary sequestration was performed in three adult patients, two of them admitted with hemoptysis and the third one with low left thoracic pain and fever. The initial diagnosis was made by CT and confirmed with angiography. We embolised the feeding arteries using coils (from 3 to 6 mm, Cook). Angiography after embolization indicated almost complete occlusion and all patients were discharged the next day. Results: There were no immediate nor long term complications. Follow-up CT was performed six months and one year later, at witch time there was complete occlusion of the anomalous artery. All patients are asymptomatic at present. Conclusion: Arterial embolization of intrapulmonary sequestration with a predominant vascular component, is a less invasive method of occluding the anomalous artery in selected patients and is a safe alternative method to surgery. Emergency endovascular repair of ruptured hepatic artery pseudoaneurysm with coronary stent-graft: Two cases A. Park; Pusan/KR Purpose: To report two cases of successful emergent endovascular treatment of ruptured pseudoaneurysm from the hepatic artery using balloon expandable coronary stent-grafts. Materials and Methods: Case 1. A 65-year-old male underwent Whipple's operation for a cholangiocarcinoma in the distal common bile duct, but his postoperative course was complicated by serious blood loss from a ruptured pseudoaneurysm in the common hepatic artery. Using premounted coronary stent-grafts (Jostent, JoMed, Germany), the neck of the aneurysm was completely excluded. Case 2. A 66-year-old male underwent surgical treatment of a Klatskin's tumor and hepaticojejunostomy. Four weeks later, an episode of gastrointestinal bleeding prompted celiac angiography. Active bleeding from a small pseudoaneurysm in the right hepatic artery was controlled with endovascular deployment of a premounted coronary stent-graft (Jostent, JoMed, Germany). The final angiogram demostrated a total exclusion of the aneurysm with preservation of the arterial lumen. Results: Transcatheter embolization using a variety of embolizing materials has been considered the treatment of choice for true or false hepatic artery aneurysms. However stent exclusion of the hepatic artery bleeding in an emergent situation has been reported only in few cases. For patients with a compromised blood supply due to portal vein occlusion or exclusion of important collateral pathways by surgical operation, a stent-graft may become the procedure of choice. In emergent situations of hepatic artery bleeding, endovascular implantation of a stent-graft may be an alternative procedure to transcatheter embolization or surgical repair. Materials and biomaterials for interventional radiology T. Hasebe 1 , A. Shimada 2 , T. Suzuki 3 , Y. Matsuoka 3 , H. Yoshimura 2 , S. Kuribayashi 1 ; 1 Tokyo/JP, 2 Sagamihara/JP, 3 Hiyoshi/JP Learning objectives: 1. To describe the most often used interventional devices (ID) benefiting from the recent intensive research activity to improve their functionality or their biocompatibility. 2. To provide an update on the current status of new materials and biomaterials available in the field of vascular and non-vascular interventional radiology, including our original experimental data 3. To discuss the importance and the safety issues related to the use of biomaterials and coating materials concerning ID. Background: In the past decade, interventional radiology has allowed percutaneous access devices and therapeutic implants to be more reliable and effectively used due to the availabiliity of new materials. Currently, there are several passive or active stent coatings commercially available with good results in preliminary studies. These materials more often result from industrial research and less frequently from medical research. Procedure Details: In this paper, we discuss biomaterials currently available for use, together with new biomaterials for the vascular or non-vascular ID, such as, for example, the drug-eluting stents, coils for embolization, and biliary/ureteral catheters or stents. Finally, we discuss the future of biomaterial use in interventional radiology with the original data in our laboratory (e.g., antithrombogenic and biocompatible stent coating: diamond-like carbon). Conclusion: Biocompatible issues are very critical for ID in order to coexist with living tissue without causing harm. Considering the recent advances in new materials with biological effects, we believe the biomaterials will soon constitute a new core of interventional radiology. The radiologists should establish new research domains and complete new and effective products. Clinical usefulness of a unified multidetector-CT We can always generate a control image during intervention without repositioning the patient. We have performed highly integrated imaging diagnosis and interventional therapy with this system in more than 200 patients. Procedure Details: Angiography assisted multidetector-CT was performed for the diagnosis and the target therapy of hepatic, pancreatic, adrenal and renal tumors and uterine myomas. In addition, multidetector-CT assisted angiography and interventional therapy was performed for vascular recanalization, such as aortic and peripheral vascular stent therapy; for endovascular treatment of aneurysms and for percutaneous therapy of varices, with a variety of three-dimensional reformatting techniques. We also performed several interventional procedures, such as percutaneous biopsy, biliary and abscess drainage, with this system. Conclusion: We introduce our highly integrated intervetional CT system with technical merits to clinical use. Background: CT is the imaging method of choice to evaluate hemodynamically stable patients with significant blunt abdominopelvic trauma. Contrast enhancement is essential for the diagnosis of many visceral injuries in these patients. It has been demonstrated that contrast-enhanced CT is valuable in the detection of active extravasation of contrast material. The detection of contrast extravasation is critical because it indicates an ongoing, potentially life-threatening hemorrhage. Imaging Findings: The purpose of this exhibit is to review our experience with active contrast extravasation in patients with blunt trauma to the abdomen and pelvis. Findings of contrast-enhanced CT are correlated with those of conventional angiography. The role of angiography and transarterial embolization in patients with active extravasation on contrast-enhanced CT will be discussed. Conclusion: Contrast extravasation on CT can be used to localize anatomic sites of hemorrhage and to guide immediate angiographic or surgical intervention in patients with abdominopelvic trauma. State-of-the-art CT enables a more detection of contrast extravasation than is possible with conventional and single detector helical CT. For the presented in vitro study, peas (mean diameter 9.4 mm) were embedded within a gel-phantom in order to simulate small target lesions. Positional data of the patient and of the needle guide mounted to the robot arm were acquired via an optical tracking system (NDI Polaris). A preliminary CT calibration procedure allowed assignation of 3D coordinates to each 2D pixel of the particular CT scan for fast and accurate intervention planning. The best needle trajectory was defined graphically by simply selecting skin entry point and target point -appropriate position and angulation of the robotic arm were calculated and sent to the robot controller. After confirmation of the planning, the robot moved to the start position using different modes of motion. The coaxial biopsy was performed manually using a 17-gauge puncture needle, combined with an 18-gauge biopsy needle and an automated biopsy device. The complete intervention could be monitored and documented by means of superimposed information on the actual CT scan. To prove efficacy of biopsy the length of the harvested specimen, as well as the distance between actual needle tract and centre of the lesion was measured. Results: Biopsy specimens were successfully obtained from all 20 targets with only one needle pass necessary. Radial distance between needle trajectory and centre of the target was surpassing clinical requirements. Conclusions: Robotic assisted biopsies with high accuracy were feasible using CT guidance. A new laser guidance device for ultrasound guided percutaneous biopsy A.E. Samir, J. Koukounaras, P. U, A. Moorhouse, M. Brooks; Melbourne/AU Introduction: Ultrasound guided needle placement is usually performed by inserting a needle along a path in the plane of the ultrasound beam. This permits visualisation of the needle in "real time", allowing accurate needle placement. A novel laser guidance device that facilitates needle placement during ultrasound guided biopsy is presented. Methods: A laser module was constructed by mounting a laser diode in a nylon tube. A lens was used to transform the pencil laser beam into a linear alignment beam. The laser module was mounted on an ultrasound probe using a customdesigned clip that consisted of two polycarbonate half shells. The linear laser beam was calibrated to be coplanar to the ultrasound beam. No probe modifications were necessary. Fourteen biopsy operators performed eight free hand and eight laser guided biopsies each of capsicum-stuffed olives suspended in gelatine phantoms. Endpoints measured were: (1) time to biopsy, (2) sample quality and (3) perceived usefulness. The laser beam was visible on the surface of needles ranging from 14 to 22 gauge in size. When the needle was inserted colinear to the laser beam it was visible on the ultrasound image. A significant difference in procedure time or sample quality was not observed. However, 71% of operators stated that laser guidance had a positive effect on the procedure, and 79% said that they would use it in the future. Conclusion: A probe-mounted laser guidance device is perceived to facilitate accurate ultrasound guided needle insertion by the majority of operators in a pilot study. Planning of the intervention is on basis of CT-imaging data sets acquired immediately before an intervention. Spatial relation between imaging space and targeting device is either established by using of an optical tracker system or via robot registration based on a CT data set. After graphically selection of the target point and manual pre-positioning of the device, correct needle angulation will be set automatically by the system. During the intervention, the robot kinematic holds the needle guide in a defined position/ orientation to the patient's body -needle insertion will be performed manually by the physician. Results: The developed system is easy-to-use and does not interfere to the clinical work-flow. System accuracy and clinical relevance currently is being tested in a series of in vitro tests. The designed and realized prototype of a modular automated needle guide allows positioning of a biopsy needle based on an intra-operatively planning with good cost/benefit ratio. Effect of radiotherapy and ischemia on rat liver Z. Vigvary, P. Kupcsulik, A. Szijartó, O. Hahn; Budapest/HU Aim: The aim is to create a model of a liver resection combined with intraoperative irradiation for micrometastases. This combined ischemic-reperfusion and irradiation injury of the liver has not yet been investigated. Methods: Normothermic segmental liver ischemia were created on 250-280 g male Wistar rats. Rats were divided into four groups for 30, 45, 60 and 90 minutes of ischemia. Hepatic microcirculation was studied by laser Doppler Flowmeter. Histological alterations were followed. I, II, IV lobes were exposed to 0, 25 and 50 Gy of Cs-137 ã-radiation. ALP, ALT, AST, LDH, bilirubin and TNF-á tests were performed. Results: Reperfusion was assesed by post-ischemic flux plato maximum (PM), by area under the curve (RT) and by the time to maximum flux level (RMI). Flowmetery showed a nonlinear fashion of reperfusion according to ischemic period. After 30 and 45 minutes ischemia the rate of the reperfusion is almost the same. 60 minutes of ischemia represents an intermediate lesion in term of recovery. After 90 minutes, minirapid deterioration of flux (below 20% of control) was observed. Survival is rather determined by the length of the ischemic period, than the irradiation dose. Low dose irradiation (25 Gy) with short-term ischemia (30 min) did not result in increased liver enzymes and resulted only in minimal histological changes. The group of 25 Gy irradiation with normotherm, short-term ischemia seems to be tolerable for the tumor-free liver. Conclusion: Liver toleratse irradiation injury suprisingly well and preconditioning promotes restitution of liver circulation after ischemic injury. Purpose: The aim of the study was to assess radiation exposure to the radiologist incurred with CT fluoroscopy. The spectrum of indications and radiation exposures for the radiologist were assessed for an 8-month period. Scatter exposures were measured with and without radiation protection devices: without and with placement of a lead drape on the patient, with and without use of thin rubber radiation protection gloves. In addition, scatter radiation was determined for a combination of lead drape and radiation protection gloves. Results: There is a wide variety for the use of CT fluoroscopy ranging from diagnostic biopsy procedures to therapeutic interventions such as radiofrequency ablation of liver metastases and CT fluoroscopy-guided osteosynthesis of fractures. Scatter exposure rates to the hand of the radiologist ranged from 1 to 320 micro Sv per case without use of a lead drape and radiation protection gloves. The lead drape reduced the scatter exposure to the hand of the radiologist by 65 percent. Radiation protection gloves reduced scatter radiation by 36 percent. The combination of both radiation protection devices was most effective in decreasing the dose by 76 percent. Conclusion: CT fluoroscopy is a useful targeting method with a wide variety for interventional procedures. However, significant radiation exposures may occur. Therefore, the radiologists should be aware of different techniques of CT fluoroscopy guidance and the methods to reduce scatter radiation. Purpose: Workforce planning, deskilling scenarios and risk containment are generating a need for interventional training processes remote from patients. Fixed models lack ultimate realism, and animal models lack pathology with political problems in the UK. Virtual environments for interventional needle puncture training require accurate haptics, based on force relationships between tools and tissues, and visualization. To achieve this demands advancements in tissue segmentation, assignment of tissue properties and generation of synthetic images from abnormal patient anatomy and pathology. These challenges require wideranging expertise and will probably take over a decade to achieve fully. No existing simulator model covers interventional radiological needle access procedures (eg: targeted biopsy, nephrostomy, biliary and abscess drainage). Thus a substantive collaboration is essential to develop appropriate virtual training environments. Internet search highlighted key development areas and, together with conventional networking, relevant departments and individuals were located with major involvement in medical simulations. Results: The CRaIVE collaboration was established and comprised interventional radiologists, computer scientists, physicists, clinical engineers and psychologists. The key challenges of interventional procedures have driven specific proposals for accurate representation of haptics, from measured in vivo forces, within imaging-derived, immersive, simulated environments. Conclusion: Achieving effective simulator modeling for training and rehearsal requires research advances and further development in the underlying technologies. While currently beyond the scope of any research group or individual company, a substantive new collaboration, CRaIVE, aims to develop interventional radiological simulator models, initially based on a spectrum of interventional needle access procedures. and 72% (on low dose mode) reduction. Image quality measurements were consistently superior (90% higher resolution in fluoroscopy and 41% in DSA) with significantly more low contrast iodine targets and moving wires detected and a larger dynamic range or working thickness range. The results of our first clinical investigations give further evidence for superior image quality. Conclusions: On all modes, dose monitoring and image quality of the digital flat panel system compared favorably to the conventional image intensifier system. The results of our first clinical investigations on image quality based on our routine daily practice will be presented. Differential diagnosis of femoral head bone marrow edema pattern I. Kalaitzoglou 1 , P. Papadopoulou 2 , A.S. Dimitriadis 1 ; 1 Thessaloniki/GR, 2 Kavala/GR Learning Objectives: To present the imaging features which help in the differential diagnosis of the femoral head "bone marrow edema pattern". Background: Bone marrow edema of the femoral head is a non-specific MRI finding associated with various painful conditions of the hip like osteonecrosis, idiopathic transient osteoporosis, transient bone marrow edema syndrome, migratory osteoporosis and stress fracture. A total number of approximately 400 hip MRI examinations were performed in three different diagnostic centers from January 1997 to July 2003. Bone marrow edema was present in 80 cases. Procedure Details: MRI units used ranged from 0.5 to 1.0 Tesla and the examination protocols included T1 SE and T2 FSE fat-sat or STIR axial and coronal images, while sagittal images and contrast administration were reserved for specific cases. Patients with typical findings leading to the diagnosis of osteonecrosis or fracture were excluded. The remaining patients had non-specific bone marrow edema of the femoral head which was demonstrated as diffuse, ill defined, low signal intensity on T1W images, high on T2W and STIR images, and extended to the femoral neck region. In half of the patients follow -up examinations were also available. We selected and present the imaging criteria, at presentation and follow -up, which can lead to an early specific diagnosis. Conclusion: Bone marrow edema of the hip has to be correctly interpreted in order to avoid overtreatment in transient and self-limiting conditions. The presence of subtle subchondral lesions and the temporal evolution are usually key to diagnosis. Periosteal reactions: The spectrum of radiological appearances with histopathologic correlation I. Pinilla, D. Bernabéu, C. Martín-Hervás, A. Alvarez, A. Bravo, F. López-Barea; Madrid/ES Learning Objectives: The aim of this exhibit is to illustrate the spectrum of imaging features of periosteal reactions with plain radiography, computed tomography (CT) and magnetic resonance imaging (MRI) with emphasis in pathologic correlation. Imaging Findings: 1284 patients with histologically proved diagnosis of benign and malignant lesions in our institution between January 1991 and December 2002 were identified from the pathology data base. Imaging findings with plain radiography, CT and MRI were retrospectively reviewed and correlated with key pathologic features. The various patterns of periosteal reaction are arranged into the following categories: continuous (smooth, lobulated, and ridged shells, solid, single lamella, laminated or "onion skin", and parallel spiculated or "hair on end" reactions), interrupted (buttres, Codman triangle, lamellated, and spiculated reactions), and complex (divergent spiculated or "sunburst", and combined reactions). The most representative cases of each form of periosteal reaction are displayed. Specific topics addressed include benign and borderline bone tumors (osteoid osteoma, osteoblastoma, periosteal chondroma, aneurysmal bone cyst, giant cell tumor, Langerhans cell histiocytosis, and adamantinoma), primary malignant bone tumors (osteosarcoma, chondrosarcoma, Ewing's sarcoma and non-Hodgkin's lymphoma), skeletal metastases, and non-neoplastic conditions such as osteomyelitis and myositis ossificans. The changes in the periosteum are common and important imaging features of bone diseases. Recognizing and understanding the different radiological patterns and underlying histopathologic changes help the radiologist to narrow the differential diagnosis. This teaching exhibit gives an overview of the wide spectrum of radiological appearances of periosteal reactions together with histopathologic correlation. In MR images, spin-echo (SE) T1-weighted images (T1-WI) and T2-WI were obtained and Gd-DTPA contrast enhanced images were obtained in 5 cases. In these cases, the location, the radiographic findings, signal and enhanced pattern on MRI were analyzed. Imaging Findings: In 5 cases, the tumor located in epiphysis (45.5%), in 2 cases in apophysis (18.2%), in 3 cases in apo-metaphysis (27.3%), in 1 cases in epimetaphysis (9.0%). In all cases, the tumor was depicted as radiolucent area and in 5 cases, the sclerotic margin was recognized. In all cases, the tumor was revealed as iso-intensity comparing with surrounding muscle on T1-WI. On T2WI, in 7 cases, the tumor revealed as iso-intensity with bone marrow and in the other 4 cases, it revealed as low intensity. On T2-WI, in 8 cases, high intensity area was included which corresponds to the cystic degeneration. In all 5 cases, the tumor was moderately enhanced on contrast enhanced T1-WI. In 2 cases, T1-T2-prolonged lesion which is considered to be the reactive inflammatory change were shown in the bone marrow around the tumor. Conclusion: To analyze the image characteristics of chondroblastoma is important to approach the exact diagnosis of bone tumor. Chondrosarcomas Background: Parosteal osteosarcomas represent only 3-4% of all osteosarcomas, and have better prognosis than the classical osteosarcoma.They are frequently low-grade tumors, which may rarely dedifferentiate into high grade sarcomas. Imaging Findings: MR images performed on 1-1.5 T MR system of 10 histologically proven cases of parosteal osteosarcoma were retrospectively analyzed for the bones involved, location and the relationship between the signal intensity and the grade of the tumor.There were 8 females and 2 males. Ages ranged from 17 to 50 (mean 32.9). Most commonly affected bone was femur, on its distal end, posterior aspect (7). Histological grading was described as follows:Grade I: hypocellular stroma with subtle atypia; Grade II: mild increase in stromal cellularity and more prominent cytologic atypia, Grade III: marked pleomorphism with high cytologic atypia and mitotic rate, also called dedifferentiated type. Regarding the described grading above, 6 of our cases were Grade I (low), 2 were Grade II (intermediate) and 2 were Grade III (high). On MRI, all of the parosteal osteosarcoma cases were of hypointense signal intensity on T1-weighted images and were hyperintense on T2-weighted images with no exception. On gadoliniumenhanced images, heterogeneous contrast enhancement was observed. Conclusion: In our study, MRI signal intensity was the same in all of the cases; hypointense on T1-weighted images and hyperintense on T2-weighted images; regardless of the grade of the tumor. Giant cell tumor of knee: Imaging findings of the most common site V. Zampa, S. Giusti, C. Spinelli, S. Ortori, C. Bartolozzi; Pisa/IT Learning Objectves: 1. To describe imaging findings useful for an effective diagnosis 2. To discuss the main differential diagnosis with giant cell tumor (GCT) of knee. Background: GCT is a relatively common skeletal tumor. It is a benign but locally aggressive and destructive lesion composed of primitive histiocytes and large, multinucleated giant cells. The most frequent symptom is pain, local swelling, limited range of motion and pathologic fracture (10%). Location of GCT and age of patients suggest the diagnosis. It usually affects long tubular bones and, in particular around the knee, the most common site is distal femoral and proximal tibia (50 and 40% of all TGC). The main differential diagnoses include osteosarcoma (teleangectatic or fibrogenic), malignant fibrous istiocytoma, chondromyxoid fibroma and aneurysmal bone cysts. Treatment of choice is surgical resection but recurrence is frequent. Imaging Findings: On radiography GCT appears as an eccentric and geographic bone lysis, associated with a narrow zone of transition and lacking surrounding sclerosis. CT is superior to conventional radiography in outlining the extent of the tumor and in demonstrating cortical invasion but MR is currently the best imaging modality in determining extra-osseous extent, articular surface involvement and tumor recurrence with optimal definition of either osseous sclerosis or pseudocapsule. The signal characteristics of the lesion on the different MR sequences will be described to find out if they can help in differential diagnosis. Conclusion: Radiologic appearances of GCT is important in allowing prospective diagnosis, guiding therapy, and facilitating early detection of recurrence. Superscans: A pictorial review S.A. O'Keeffe, T. Geoghegan, W.C. Torreggiani; Dublin/IE Learning Objectives: The objective of this poster presentation is to pictorially describe the causes, findings and interpretative pathways of patients undergoing radionuclide bone scintigraphy resulting in a superscan. Background: A superscan is a radionuclide bone scan which demonstrates markedly increased, homogenous skeletal radioisotope uptake relative to soft tissues and is usually associated with absent or faint renal images. A retrospective analysis of all whole body radionuclide bone scans performed over a fiveyear period was performed to identify the presence of superscans. Analysis was based on review of reports identified on a computerised Radiology Information System (RIS). Images were reviewed in association with other relevant imaging and in select cases, with laboratory data and clinical notes. A variety of cases were then selected for this pictorial review. Imaging Findings: A total of 6222 whole body bone scans were performed in our institution in the last five years. 11 superscans were selected for inclusion in this pictorial review. The vast majority of superscans identified were related to metastatic disease of which prostate cancer dominated. Superscans were also identified secondary to hyperparathroidism, metabolic bone disease including osteomalacia and Pagets disease. Conclusions: In this pictorial review, we describe the patho-physiological pathways resulting in the appearances of a superscan. In addition, we pictorially demonstrate a variety of causes resulting in superscan. Finally, interpretative pathways of analysis and helpful signs are suggested. Usefulness of 3D reformations in the assesment of spondylolisthesis and spondylolisis of the lumbar spine E. Vilar Bonacasa, P. Sanchez Santos, J. Torres Nuez, G. Martinez Sanz; Teruel/ES Learning Objectives: To obtain images that provide a full and direct view of the pars interarticularis in order to determine the isthmal affectation in lumbar spondylolisthesis. Background: Nine patients with spondylolisthesis of the lumbar spine among 46 sent to our department for CT study during the last year were performed a volumetric acquisition from L3 or L4 to S1 instead of the conventional axial scanning. Later, a 3D image was obtained and modified in the work station, to achieve a view of the pars interarticularis from the vertebral canal. Procedure Details: Using this method, we obtained images wich allowed us to asses the isthmal affectation in a direct way in all patients. Moreover, it permits the study of the repercussion of vertebral bodies slide over the vertebral canal and the intervertebral foramina. Conclusion: Convencional CT has some limitations to determine exactly the type and degree of isthmal affectation in spondylolisthesis as well as its repercussion on intervertebral foramina. Helical CT, using volumetric acquisition with three-dimensional reformations can resolve those limitations. Morphology In these cases, the improvement of the skeletal pain were scored in five-levels by patients' interview from 5 = marked improved to 1 = worse and the duration of the symptom's improvement was monitored. Results: A total of 39 TAEs (mean 1.9 times) were performed. All procedures were technically successful. Skeletal pain was relieved in 17 patients (81%) between 3 = slightly and 5 = markedly improvement. In 15 of 18 patients with malignant lesions, the duration of pain relief ranged from one to 60 months (mean 8 months). No serious complications were observed except for a case with transient neurogenic bladder. Conclusion: TAE using SAP-MS was a safe and effective treatment for the pain control with long duration of unresectable bone tumor. Bone marrow edema at MRI: Diagnostic clue to the underlying cause of knee pain A. Blanco, M. Martinez, E. Parlorio, M.A. Corral, S. Torres; Murcia/ES Purpose: Bone marrow edema (BME) is usually associated with traumatic injuries of the knee but there are other conditions, often unsuspected, that can cause this pattern. Our purpose was to evaluate the patterns of distribution of BME in patients with knee pain and try to correlate them with their possible underlying cause. We retrospectively reviewed MRI examinations of 723 patients referred for knee pain, with or without history of trauma, during a 26month period. The examinations were performed in a 1.5 T unit using our standard protocol which included fluid-sensitive sequences. In some cases intravenous gadolinium was used. Results: 95 patients (13.1%) showed BME with variable distribution, resulting from: acute trauma (57), stress fracture (4), degenerative disease (19), spontaneous osteonecrosis (8) and osteochondritis dissecans (6) of the femoral condyle, soft-tissue infection (1), excesive lateral pressure syndrome (1), iliotibial-band friction syndrome (1), transient BME (3), tumor (4), and nonspecific (9). In many cases associated with trauma, the distribution of edema allowed to explain the mechanism of injury and predict with accuracy the soft-tissue abnormalities that may be present. Conclusion: BME patterns at MRI can help to establish the possible cause of knee pain. When there is a history of acute trauma, edema shows typical features that can give the clue to a possible mechanism of injury. On the other hand, if clinical data is not clear, the distribution of edema can orientate to other unsuspected pathologic conditions. Appropriate recognition is necessary for an accurate diagnostic and therapeutic orientation. Percutaneous Percutaneous thermoablations was performed with radionics cool tip RF generator system by using probes with 1 or 2 cm unprotected tip applied for 4 minutes in the center of the lesion. The procedure consisted of localizing the osteoid osteoma on CT imaging and positioning within the lesion a Kirschner wire, rigged on a hand-drill device. Once the nidus was engaged we proceeded to exchange the thread of Kirschner for a RF probe and emit the radio waves. Results: At a mean follow-up of 21 months the treatment has been considered effective in 91% of the cases. In four patients pain has subsequently recurred; one of these cases has been treated for a second time with success. In two cases procedural complications of minor degree, represented by limited cutaneous burns have occurred. Conclusion: In our experience CT-guided percutaneous radiofrequency treatment of osteoid osteoma proved to be effective in 91% of the cases. Deprived of severe complications it may represent an uncomplicated, minimally invasive, rapidly effective procedure, alternative to the surgical treatment. order to obtain the load-to-fracture, the specimens were tested destructively at side impact. Results: In the standard regions of interest, correlations between fracture load and BMD (BMC) ranged from R 2 = 0.64 to R 2 = 0.70, p < 0.001 (R 2 = .65 to 0.75, p < 0.001). For the newly defined ROI in the upper neck of the proximal femur, significantly higher correlations between BMD, BMC and fracture load (R 2 = 0.76 and 0.81, respectively; p < 0.001) were obtained. Only a weak statistical relationship between fracture load and FNAL was found (R 2 = .23, p < 0.001). Normalization of fracture load with respect to FNAL of the specimens did not significantly improve results. The mechanical competence of the hip highly depends on the BMD and BMC of the proximal femur. Of all the regions of interest analysed in this study a newly defined ROI in the upper neck showed the strongest correlation with fracture load. Under in-vitro conditions, only a weak association between mechanical strength and FNAL was observed. or secondary (n = 10) diagnostics were analysed visually. The final diagnosis based on histology, imaging and follow-up. Results: Histologically the primary lesions were ES (n = 10), PNET (n = 13) and osteomyelitis (n = 1). The sensitivity and specificity of FDG-PET for disease (presence of ET, and/or its metastases) were 95 and 75% respectively. FDG-PET and/ or other imaging modalities detected altogether 138 focal lesions. Sensitivity and specificity regarding focal lesions were 78 and 75%. This lower sensitivity is due to small lesions. WBS detected all 11 primary bone lesions present at WBS investigation, but only 8 of 70 bone metastases in four patients, while FDG-PET detected both the primaries and metastases. Conclusion: FDG-PET investigation is a valuable method in case of ET-s. Concerning the detection of bone metastases of ET-s FDG-PET is superior to WBS, while for the depiction of small lesions mainly represented by pulmonary metastases FDG-PET is less sensitive than helical CT. The determination of the role of whole body FDG-PET in the diagnostic algorithm needs further investigations. The role of an optimized MR protocol in the detection of osteomyelitis neighbouring metallic bone implants G. Michailidis 1 , N. Economopoulos 2 , C. Kontopoulou 2 , S. Argentos 1 , N.L. Kelekis 2 ; 1 Piraeus/GR, 2 Athens/GR Purpose: Osteomyelitis presents as a complication in a percentage of patients after metallic bone-implant placement. Early and accurate detection is crucial for proper treatment. Conventional MR images are usually severely degraded from intense artifacts, rendering interpretation often impossible. We report our results using an optimized MR imaging protocol in detecting foci of osteomyelitis near metallic bone implants. Materials and Methods: During the last year we examined 17 patients (12 men and 5 women, age range 25-70) with metallic bone implants and clinical suspicion of osteomyelitis. The MR protocol consisted of T2-weighted STIR and single shot turbo spin echo sequences. For T1 and T1 contrast-enhanced images we employed turbo spin echo sequences with slice thickness of 3 mm, echo train length > 10, minimum echo spacing and minimum TE. Diagnosis of osteomyelitis was based on the detection of one or more of the following findings: subperiosteal fluid, bone sequestrum, fistula and abscess. Results: All MR examinations were of diagnostic quality with minimal artifacts present. In 6 patients one or more of the above mentioned findings were present and were diagnosed with osteomyelitis. In the remaining 11 patients no findings suggestive of osteomyelitis were observed. Confirmation was obtained by followup and clinical outcome. Conclusion: With the use of an optimized scanning protocol MRI may overcome its limitations caused by metallic artifacts and is able to detect foci of osteomyelitis in patients with metallic bone implants. Primary Methods and Materials: 9 patients were included, aged 20 to 72 years old. Flat bones (pelvis = 2, sternum = 2) were involved as well as metaphysis of tibia (n = 3) and femur (n = 2). Pathologic diagnosis was obtained in all cases. Results: In long bones, tumor originated from the medulla, excentered and metaphyseal in location. In all cases, agressive patterns were present such as osteolysis, cortical break and tumoral extension in surrounding soft tissues, lack of peritumoral reactional osteocondensation. Periosteal reaction was present in one case. No calcification was noted. On MR imaging, tumors demonstrated intermediate signal intensity on the T2-weighted images with heterogeneous enhancement following gadolinium injection. Pathological findings included smooth muscle cells with interlacing fascicles of spindle cells, without osteoid production or cartilagineous matrix. Despite adequate surgical resection, metatastatic diseases appeared in 8 cases. Conclusion: Primary leiomyosarcoma of bone is a rare tumor which must be included in the diagnostic possibilities in case of agressive purely osteolytic lesion. Results: Patients included 32 females and 39 males (aged from 9 to 61 years) with pain in extremities. Osteogenic sarcoma was diagnosed in 34 patients, Ewing sarcoma -19, chondrosarcoma -11, bone lymphoma -7. In 7 cases on plain film bone damage wasn't detected. On bone scintigraphy, the majority of lesions showed greater than mild uptake, in 11 cases showed no uptake. At MR imaging isointense or low T1w signal and increased T2w signal was present in all cases. Specific cellular constituents (e.g. fibrous, chondroid, blastic or teleangiectatic components), can modify signal characteristics. Lesions that are primarily blastic, and, therefore, sclerotic on plain film radiographs, demonstrate low signal intensity on both T1-and T2-weighted sequences. Edema characterized by indistinct margins, is a poor indicator of malignancy. Conclusion: Study shows that there is overlap in the radiological appearances of primary malignant bone tumors especially in the early stages. Magnetic resonance imaging is shown to be a useful and sensitive modality in the detection and evaluation of bone tumors. MR imaging accurately assesses soft tissue and synovial involvement, as well as marrow infiltration, which may be radiographically silent. In patients with extremity pain MR imaging is necessary and MRI data wasn't correlated with conventional radiology. All of them were underwent lateral flexion-extension radiography and lumbar MR imaging. Differences of interspinous distances at flexion-extension radiography were analyzed at upper, lower, and spondylolisthetic segments. The MR features of the interspinous ligament were divided into 2 groups according to their signal intensities: Group 1, with inflammatory type presented as high signal intensity at T2-weighted image and low signal intensity at T1-weighted image, and Group 2, fibrotic or fatty type. The incidence of the interspinous ligament with the inflammatory type was analyzed on the spondylolytic segment and the upper and lower segment without spondylolysis, respectively. Results: Spondylolysis at L3, L4 and L5 levels were 3, 30 and 72, respectively. Of 105 patients, the inflammatory type of the interspinous ligament was 25 (24%) on the spondylolisthetic segment and 54 (51%) on the upper segment without spondylolysis (p < 0.05). The mean difference of interspinous distance on the spondylolisthetic segment and the upper segment were 8.4 mm and 10.0 mm, respectively (p < 0.05). In patients of isthmic spondylolisthesis, the upper segment without spondylolysis showed more inflammatory type of the interspinous ligament on MR imaging than spondylolisthetic segment probably due to interspinous hypermobility. Advantages of multislice CT in the diagnosis of traumatic osseous disease C. remaining cases, to assess the articular surface involvement and the real extension of the fracture. The isotropic MPR reconstructions carried out with the multislice CT scanners allow us to scan the patient in only one position, usually the axial plane, saving time and using less radiation dose. The MPR reformats takes an important role in the final diagnosis of many cases. The Consideration of positioning in radiography for the waist of the scaphoid bone fractures S. Matsubara; Hiroshima/JP Purpose: The most common type of scaphoid bone fracture is the transverse fracture of the waist (central 1/3). However, traditional positioning in radiography frequently fails to visualize bone fracture line. This may be caused by the fact that X-rays cannot be irradiated perpendicularly onto the scaphoid long axis. In this study, we searched optimal limb position for visualizing the waist of the scaphoid bone. Method: In 30 volunteers, the scaphoid bone was taken in the ulnoradial direction at 40°ulnar deviation (group A) and 40° ulnar deviation with the fist clenched (group B). Images measured the angle between the cassette plane and long axis of the scaphoid (C-S) and the angle between the cassette plane and the volar tilt (C-V). Result: The C-S angle in group A was 32.5 ± 9.9° and in group B was 15.8 ± 7.5°. The C-V angle was 12.1 ± 3.2°. We devised new positioning that lift distal side of forearm upward at about 30° in group A, at about 15° in group B. These positioning make the long axis parallel to the cassette plane. Especially, the later view was able to visualize the ulna-scaphoid joint more clearly without overlap of radius and scaphoid bones as compared to traditional method. Conclusion: In fractures of the scaphoid, in which early diagnosis is critical, optimization of first-choice X-ray imaging is a key factor, and an additional image involving a 15° scaphoid waist view will be useful. Background: MRI imaging is a very powerful tool in the evaluation of the ACL, with higher sensitivity than the clinical examination of the knee. Some of its lesions are well known and easily identifiable, but others require careful interpretation and familiarity with the spectrum of ACL pathology. Over 3000 knee MRI examinations performed in three different diagnostic centers from January 1997 to July 2003 were reviewed retrospectively. ACL lesions were found in approximately 200 knees. Procedure Details: MRI units ranged from 0.5 to 1.0 Tesla, and various imaging protocols were used, with T1 and T2 coronal and sagittal images obtained in all cases. Traumatic tears were the most common lesions identified. Tears were classified as acute or chronic, complete or partial. We illustrate and discuss the primary and secondary findings of ACL tears, as well as the imaging criteria in the evaluation of the postoperative ACL. We also present fractures of the anterior tibial spine with ACL avulsion, ACL ganglion cysts and mucoid degeneration, which are less commonly seen. In the examination of the ACL pathology the radiologist should evaluate multiple signs and be aware of some less common pathologies in order to effectively contribute to the clinical management. Ultrasound and X-ray findings in painful shoulder involvement in rheumatoid arthritis L. Rutkauskiene; Vilnius/LT Learning Objectives: To illustrate and compare conventional X-ray and ultrasonography diagnostical possibilities of painful shoulder in RA. Background: Up to 60 percent of rheumatoid patients have shoulder pain. A rational decision on the treatment of shoulder disease in rheumatoid arthritis depends on an accurate assessment of its cause and the extent of rheumatoid involvement. Imaging Details: A group of 25 RA patients, who reported a pain in the arm and/ or limitation of the active movement, were examined first with conventional anterioposterior and obligue -outlet -view with 12-15 angulation X-ray of both shoulders. The most common findings were: joint space narrowing, erosions, subchondral cysts, irregularities of greater tuberosity, deformity and flattening, superior migration of humeral head, erosions in acromioclavicular joint, sometimes soft tissues swelling. Ultrasonography study was performed with a 8. Results: Clinical signs and symptoms (pain and swelling) due to foot involvement were present in 3 (13%) of the patients while frequency of involvement was 21 (91%) with MR imaging assessment. The most common involved anatomical region was the hindfoot (83%) following by midfoot (69%) and ankle (22%). The MR imaging findings were bone erosions, Achilles tendinitis, para-articular enthesophyte, joint effusion, plantar fasciitis, joint space narrowing, subchondral sclerosis, soft tissue edema, bone marrow edema, enthesopathy of the Achilles attachment, plantar fascia attachment, and plantar ligament, subchondral edema, retrocalcaneal bursitis, subchondral cysts, subchondral fissures, and bone ankylosis. Conclusion: MR imaging may detect bone, soft tissue, cartilage, tendon, and joint abnormalities in AS patients, even if AS patients did not have clinical signs and symptoms of foot involvement. This imaging modality may be of importance especially early diagnosis of inflammatory changes in the foot. Additionally, familiarity of the typical MR appearances of foot involvement in AS patients may be helpful in narrowing the wide differential diagnosis of spondyloarthropathies. MR handle meniscal tear using the following criteria: a) bow tie sign; b) double posterior cruciate ligament sign; c) coronal truncation sign; and d) displacement of the free meniscal fragment. Results: in 54/676 cases a bucket-handle meniscal tear was identified. In 6 of these latter an infero-medial displacement of a free fragment of the medial meniscus was identified. In all 6 cases a lesion of the posterior horn involving the inferior articular surface was observed on axial plane. On coronal plane was observed the truncated triangle aspect of the peripheral, not displaced, meniscal portion. On all planes the displaced free meniscal fragment was identifiable as a little hypointense formation, medially to proximal tibial extremity, inferiorly to meniscal plane and deep to tibial collateral ligament. In all cases diagnosis was confirmed by arthroscopy. Conclusions: MRI allowed the detection of the infero-medial displacement of a free meniscal fragment thus helping the arthroscopic approach. High-resolution MRI of ulnotriquetral ligament injury and its anatomical variations with a microscopy coil T. Ueno 1 , H. Yoshioka 2 , T. Tanaka 1 , Y. Kujiraoka 1 , M. Shindou 1 , K. Ooyama 1 , Y. Saida 1 ; 1 Tsukuba-Shi, Ibaraki/JP, 2 Boston, MA/US Purpose: To demonstrate ulnotriquetral ligament (UTL) injury and its anatomical variations using a microscopy coil. Materials and Methods: 50 patients (26 males and 24 females with age ranging 14-67 year-old), who suffered ulnar side wrist pain and suspected triangular fibrocartilage complex injuries, were investigated in 1.5 T MRI system with a microscopic coil (47-mm in diameter). Axial and coronal T2*-weighted images, sagittal and coronal proton density-weighted images, coronal STIR images were obtained with a 50-mm FOV and a 1-1.5 mm of slice thickness for all patients. Result: UTL was identified in 49 patients and its injuries were found in 32 patients. Regarding anatomical variations, in proximal side, UTL always connected to volar radiocarpal ligament and disc proper. However, there were many variations of the attachment to triquetrum bone. In 26 patients, 2 bands attached to triquetrum at different site: one attached to the distal aspect of triquetrum, and another attached to a notch which was found at volar aspect of triquetrum. In 12 patients, one attached to proximal side of the notch. 3 patients showed separate 3 UTL bands. Conclusion: High-resolution MRI with a microscopy coil is a promising method to demonstrate UTL injury. It would be useful to know normal anatomical variations for understanding the mechanism of UTL injury. Pictorial review of diagnostic imaging techniques in hip arthroplasty follow-up J. Rimola, P. Melloni, R. Valls, P. Bermúdez, D. Gil, A. Massuet; Sabadell/ES Objective: To evaluate the spectrum of findings for plain-film radiography and other imaging techniques in patients with early or late complications of hip prostheses. We describe the usefulness of each imaging technique in follow-up. Background: Over the last 14 years more than 200 hip replacements have been performed in our hospital annually. All patients are followed up immediately after surgery, at 6 months and then yearly or when necessary, using plain films and sometimes sonography (US) and/or computerized tomography (CT). US and CT are used to confirm or rule out osteointegration of the prosthesis and complications such as periprosthetic abscess and/or hematoma. Imaging Findings: We analyzed radiological features of the normal and pathological evolution of hip prostheses. We describe early complications (affecting 5.2% of patients), such as infection, cement extrusion, and periprosthetic fracture, as well as late complications (affecting 9.2% of patients), including aseptic loosening, osteolytic lesions, heterotopic calcifications, migration of the acetabular component, femoral diaphysis fracture, and dislocation of the prosthesis. Conclusion: Plain films are essential for evaluation and detection of hip arthroplasties. US is usually used to guide percutaneous aspiration of soft tissue. CT enables correct assessment of osteointegration of hip prostheses. Results: With wrist arthroscopy as the standard of reference, average sensitivity and specificity of non-enhanced MRI, for tears of the TFCC were 0.82 and 0.77 respectively and 0.98/0.97/ for arthroscopy. Conclusion: MR imaging-plays a major role in evaluation and management of traumatic wrist injuries, improves clinicians diagnostic accuracy and reduces the need for arthroscopy. These preliminary results illustrate the ability of MRI to assess the integrity of the TFCC and suggests its use as the first imaging method following plain radiography in the evaluation of patients with chronic posttraumatic pain on the ulnar side of the wrist. Wrist arthroscopy is a more valuable technique in determining the location, size, and extent of ligament injuries within the wrist. High 18 patients (2 women, 16 men; mean age: 32 years) referred from E.R. for a suspect traumatic dislocation of the A-C joint. All patients underwent plain X-ray examination (conventional projections integrated by "outlet" view and stress projections) and HRUS scan (longitudinal and axial scan planes of interested ligaments) of both the interested and contralateral A-C joint. Ultrasonographic criteria of lesion were considered the absent recognition of the ligament and strong echostructural inhomogeneity A-C joint. Measures of A-C and coraco-clavicular (C-C) distances were drawn by means of both methods. Dislocation's degree was defined according with Rockwood's classification. Results: In 6/18 cases of indirect trauma, diastasis of the A-C joint (2-5 mm), was observed, whereas C-C joint was not involved and C-C ligaments were normal. In 12/18 patients with direct trauma, distracting lesion of the A-C ligament was observed in 4 cases, and involvement of both A-C and C-C ligaments with diastase of both joints was observed in the remaining 8 cases. A complete correspondence of the two methods was observed. Conclusion: HRUS enables early anatomical-structural changes detection and lesion's degrees assessment in acute traumatic lesions of the A-C joint, and could be considered more than complementary to X-ray exam in the emergency clinical setting, mantainig its role in the follow-up. Ligaments and AC joint soft-tissue morphology, acromioclavicular distance and coracoclavicular distance were evaluated. Sonographic findings were correlated with the results of conventional radiographic examination, which was performed in all cases with anteroposterior projections, taken with and without weights, and with "outlet" projection. Sonographically, all patients presented lesion of AC ligament with high amount of sero-hemorrhagic fluid inside and outside the joint. In 6/18 patients, which had indirect trauma, we observed AC joint dislocation with AC ligament lesion that was not associated to involvement of CC joint and ligament. In 12/18 patients, which had direct trauma, we observed lesions of AC and CC legaments with associated joints dislocations. Conclusions: Ultrasonography, if performed with appropriate technique and adequate transducer, is accurate in the evaluation of acute traumatic AC joint lesion and dislocation, integrating and correlating well with the informations offered by conventional radiography. Study of the MR imaging of the posterolateral structures of the normal knee C. Yu, K. Li; Beijing/CN Puropse: Through the study of the MRI appearance and localization of the posterolateral structures (PLS), to provide a practicable method for intactly displaying them. Methods: Thirty tibial bone specimens were observed to establish the bony landmark for localizing the knee. In 50 cadaver knees, the angles between lateral tibial plateau and the long axis of the individual structure of PLS were measured. Then we can determine the scan methods of the oblique MR images based on above results. The routine and oblique scans of T 1 WI were performed in 40 normal knees. The display effect and appearance of the PLS were observed in MRI. The lateral tibial plateau is a stable bony landmark for measuring and localizing of the knee. In the PLS, The fibular collateral ligament can be intactly displayed on 70° posterior coronal oblique images in 34 cases (85%). The popliteus can be better seen on either 60° posterior coronal oblique in 34 cases (85%) or 45° medial sagittal oblique planes in 36 cases (90%). The popliteofibular ligament can be intactly appreciated on both 60° posterior coronal oblique in 32 cases (80%) and 70° lateral sagittal oblique images in 34 cases (85%). Although the arcuate ligament and the fabellofibular ligament can occasionally be seen on routine and oblique images, their presence rate is low. The oblique MR imaging can intactly display the main structures of PLS, and can be an useful tool in diagnosing these structures' injuries. Patients are also asked for the presence of their prolonged physical activity in their life. Results: 5 patients had type II, 4 patients had type I and 3 of them showed Type III patellar shapes, out of 12. 2 patients had patella alta whereas all others stayed in normal range as patellar position. In 4 patients' case no other abnormalities were seen apart from the signs of iliotibial band friction syndrome and three of them had shown type III patellar shape. Conclusions: No apparent correlation was found between iliotibial band friction syndrome and patellar position. As it is much more rare in the normal population Wiberg type III patella showed considerably high prevalance in our study. Shoulder To assess by MRI the potential benefit and efficacy of selective meniscectomy combined with radiofrequency ablation in cystic degeneration of the lateral meniscus treatment. Materials and Methods: Sixty-one patients entered this study. 28 patients underwent arthroscopic selective meniscectomy and 33 patients underwent arthroscopic selective meniscectomy and radiofrequency treatment (Arthocare, Sunnyvale, CA) of the meniscal remnant. All of them were submitted three months later to MRI and clinical evaluation. In 15 case MRI examination was performed before and after the surgical treatment. MRI examination was performed using a dedicated 0.2 T (Artoscan Esaote Italy) and a 1.5 T superconductive unit (GE Signa Horizon USA) employing SE T1-w, SE T2-w and GE T2-w sequences on axial and longitudinal scan planes. In 7 case Arthro-RM was also performed. Clinical evaluation included physical examination and questionnaire. Results: Clinical evaluation did not show statistically significant discordance between the two groups. MRI follow-up after 3 months demonstrated a very clear decrease of the degenerative spots inside the meniscal remnant in the group with combined treatment respect to the group treated only with selective meniscectomy. Conclusion: In conclusion our experience considers MRI the method of choice in the evaluation of post surgical treatment of degenerative cystic diseases of the lateral meniscus of the knee. High-resolution ultrasonography of the extrinsic carpal ligaments: Examination technique and performance D.V. Guntern, N. Favarger, P. Schnyder, N.H. Theumann; Lausanne/CH Purpose: To develop an examination technique to visualize the extrinsic carpal ligaments by ultrasonography and to assess the performance of high resolution ultrasonography in the visualization of different parts of these ligaments. The extrinsic carpal ligaments of 9 wrists of 9 healthy volunteers were examined with a 15 MHz linear array transducer by two muskuloskeletal radiologists in consensus. An examination technique was developed for each extrinsic carpal ligament (radioscaphocapitate, radiolunotriquetral, palmar scaphotriquetral, dorsal scaphotriquetral, palmar ulnotriquetral, dorsal ulnotriquetral, dorsal radiotriquetral and radial collateral ligaments). Delineation of the proximal attachment, the body and the distal attachment of each ligament was evaluated as good, poor or absent. Results: With a profound knowledge of the anatomy, especially of the osseous landmarks, an easy and fast examination of the extrinsic carpal ligaments by high resolution ultrasound is possible. The more superficial ligaments such as the dorsal scaphotriquetral and the dorsal radiotriquetral ligaments are well visualized by high resolution ultrasound whereas ligaments in a deeper position, such as the proximal and distal insertion of the palmar scaphotriquetral and the distal insertion of the radioscaphocapitate are less well visualized. High resolution ultrasonography is an accurate method to visualize the extrinsic ligaments of the wrist. Direct MR arthrography of the glenohumeral joint with capsular distension using a posterior approach R. Drescher, J. Ludwig, F. Rubenthaler, O. Köster, G. Schmid; Bochum/DE Purpose: Evaluation of the clinical use of direct MR arthrography of the glenohumeral joint with maximum distension of the joint capsule in patients with glenohumeral instability using a posterior approach. Patients and Methods: Direct MR arthrography of the shoulder joint was performed on a 1.5 T system in 30 patients (12 women, 18 men, mean age 36 years). 17 right and 13 left shoulders were evaluated. All patients had anterior or bidirectional instability (18 posttraumatic, 12 constitutional). Using a fluoroscopically guided posterior approach, 10 mL iopamidol 250 M and 5 mL 0.2% mepivacaine were injected, followed by a 1% dilution of dimeglumine gadopentetate in 0.9% sodium chloride until full capsular stretching was achieved. MR sequences were T1-weighted spin-echo axial and oblique-coronal, fat-saturated T1 3D axial and oblique-coronal, and axial T2 Flash-2D. Results: Arthrography was possible in all patients. The total amount of intraarticularly injected fluid was 30-60 mL (mean 38 mL). No complications occurred. MR imaging showed significant capsule distention in 11 patients (37%) and ventral capsule defects in 5 patients (17%). 14 labral lesions (11 anterior, 3 posterior), 3 bicipital tendon lesions (1 complete, 2 partial ruptures) and 2 partial ruptures of the rotator cuff were noted. 13 patients underwent surgery. Regarding labral lesions, sensitivity of MRI was 88.9%, specificity was 75%, and diagnostic accuracy was 84.6% compared with surgical results. Conclusions: Glenohumeral direct MR arthrography allows accurate detection of labral and tendinous lesions. Maximum capsular distension allowed preoperative evaluation of capsular laxity as a source of shoulder instability. Anterior talofibular ligament injury: Evaluation with MR imaging J. Ishida 1 , J. Yoshigi 1 , H. Okizuka 2 , K. Ooae 1 , M. Takao 1 , T. Yoshizako 1 , K. Izaki 1 , N. Uchida 1 , H. Kitagaki 1 ; 1 Izumo/JP, 2 Himeji/JP Purpose: Inversion stress is most frequent injury of all ankles. ATFL is the weakest of lateral collateral ligaments and first to rapture. The purpose of this study is to evaluate the usefulness of high-resolution MRI for diagnosis of ATFL disruption divided into acute and chronic phase. Method and Materials: 32 patients suspected ATFL disruption underwent MRI (1.5 T). 18 cases were in acute phase (< 10 days) and 14 cases were in chronic phase (> 1 month). Axial spin-echo (SE) T1-WI (TR/TE = 720/20, FOV 18 cm, 2 mm/ 0.2 mm, 512 x 512, 2 NEX,) and axial fast SE T2-WI (TR/TE = 3500/96, ETL7, FOV 18 cm, 2 mm/0.2 mm, 512 x 512, 2 NEX,) were obtained with an extremity coil. ATFL disruption was diagnosed when either finding is positive:discontinuity, irregularity, non-visualization of AFTL, and high signal intensity lesion in ATFL on T2-WI. Results: Arthroscopy confirmed ATFL disruption in 14 cases in acute phase and 472 B D E F A G 12 cases in chronic cases. In acute phase, sensitivity was 93%, specificity was 100%, and accuracy was 94%. Only 1 false negative was seen. In chronic phase, sensitivity was 67%, specificity was 50%, and accuracy was 66%. 4/12 was false negative. Conclusion: In acute phase, MRI was accurate for evaluation of AFTL disruption. However, in chronic phase, MRI was less accurate because granulomatous tissue after disruption cannot be detected with MRI. CT arthrography of the shoulder A. Gligorievski, Z. Temelkovski; Skopje/MK Purpose: To present CT arthrography (CTA) as a new method in our practice in order to point out its advantages and to compare the results with conventional arthrography and MR arthrography. We describe the technique of the examination in detail, performed at the Institute of Radiology in cooperation with an orthopaedic surgeon and radiologist that form the diagnostic-therapy team. CTA performed with 18 patients, aged 25 to 62, 12 men and 6 women. Conventional arthrography was performed in 7 and MRA in 11 patients. Results: 7 patients presented with lesion of the glenoid labrum, 5 with rotator cuff lesion, 2 with a frozen shoulder, 2 with a Hill-Sachs lesion, 1 with biceps brachi tendon subluxation and 1 case with SLAP lesion. We report our first experiences and the results gained are compared to similar recent studies as well as to the conventional radiologic techniques. CTA is a method of choice in case of frozen shoulder and glenohumeral instability, but MRA is better in case of rotator cuff lesion. We can conclude that CTA is a sophisticated method of extreme diagnostic value in the evaluation of the humeral joint especially in case of glenohumeral instability. The invasiveness of the method is small, no complications have been noticed and compared to MR it is significantly cheaper and more available for the Medical Centers equipped with a CT scanner. MR imaging of the metatarsophalangeal joint with standard MR imaging: Evaluation of six patients with clinical suspicion of plantar plate disruption P. Hauser; Lausanne/CH Purpose: to report the MR Imaging findings of painful injured metatarsophalangeal joints (MTPJ) in case of clinical suspicion of plantar plate (PP) tear. A series of 13 patients with clinical suspicion of PP rupture of first (MTPJ 1) or second (MTPJ 2) ray underwent MR studies with 1.5 Tesla units with use of an extremity coil. The patients lay on their back with the ankle in plantar flexion and the toes in extended position. The standard MR Imaging protocol performed in all specimens consisted of T1 weighted spin echo sequences in sagittal and coronal plan and T2 fse fat satured sequences in sagittal, coronal and transverse plan. The examinations were interpreted separately by two musculoskeletal radiologists assessing whether or not a PP rupture and associated lesions were present. After the imaging study all the patients underwent surgical revision in a mean delay of one month. Results: Tears of the PP were visualized in 9 cases, degenerative lesions of the PP were visualized in two cases and two other cases showed no lesion. The MR Imaging results concerning PP rupture although allowed depiction of several associated lesions including injuries of the extensor hood, the collateral ligament complex, ostechondral lesions and joint deformities. Conclusion: Although surgical treatment is generally the rule for hallux valgus deformities, surgical repair is also often required in cases of traumatic injuries of the MTP joints. The force of accord between radiologists and surgical observation of PP ruptures is good. MRT monitoring of autologous hyaline cartilage grafts C. Müller, E. Grönewäller, C.D. Claussen, F. Schick; Tübingen/DE Purpose: Seven different MR sequences were compared to localize cartilage defects in knee and to evaluate the stage of maturation of the hyaline cartilage graft. Methods: MRT was performed in 19 patients aged 17-48 years with autologous transplantation of a hyaline cartilage tissue graft after a knee trauma. Examination dates were: before transplantation to localize the defect, and 6 weeks, 3, 6 and 12 months after transplantation to control the morphology and the maturation of the autologous graft. Standard T2-and proton-density weighted turbo spin echo (TSE) sequences, T1-weighted spin echo (SE) sequences, gradient echo (GRE) sequences with and without magnetization transfer (MT) pulses as well as experimental diffusion weighted GRE sequences (PSIF) were used. Results: For depiction of the graft short time after surgery T2-weighted TSEsequences showed the best results, to identify potential secondary damages before transplantation PD weighted sequences were superior. 6 and 12 months after transplantation spoiled 3D-GRE-sequences displayed the graft in high spatial resolution. From the diffusion measurements no statistically significant discrimination between cartilage and graft was obtained at any time, whereas, different images from GRE-sequences with and without MT pulse provided high contrast between cartilage and surrounding tissue. The quantification of the MT effect showed an assimilation of the graft to the original cartilage within 12 months. Conclusion: MRT should be performed before every transplantation because cartilage defects and secondary damages can be detected clearly. After transplantation MRT can easily identify the graft and detect hypertrophy or debonding in early stage. Quantitative macroradiographic study with fractal signature analysis measures bone loss in the rheumatoid arthritis hand L. Disini 1 , M. Foster 2 , J. Buckland-Wright 1 ; 1 London/UK, 2 Loughborough/UK Purpose: Fractal Signature Analysis (FSA), a computerised method of textural analysis, permits the separate measurement of changes in vertical and horizontal trabeculae based on the fractal dimension over a range of trabecular widths (fractal signature). We determined whether the FSA of high definition macroradiographs (X5 magnification) quantified differences in trabecular organisation at sites of osteopenia and erosion formation in the rheumatoid arthritis (RA) hand. Methods: Sixty-seven RA patients had macroradiographs of the left hand. The distal radius was scored and grouped from very mild (RA1) to moderate (RA4) disease. Macroradiographs were digitised and FSA of horizontal and vertical trabecular organisation were measured in the radius at sites of osteopenia, erosion formation and a mid-shaft site. The fractal signatures were compared to 11 healthy non-arthritic subjects using the t-test. Results: Compared to the non-arthritics, FSA at the distal radius in groups RA1 to RA4 measured a significant reduction (p < 0.05) in fractal signature at the osteopenic and mid-shaft sites, affecting small to large sized vertical trabeculae, and at the erosion site, involving small and medium sized horizontal and vertical trabeculae. The reduction was smallest in RA1 and greatest in RA4. Conclusion: FSA quantified the trabecular bone loss in the distal radius of RA patients of increasing radiographic severity based on a proportional reduction in fractal signature. Disease related bone loss involved varying trabecular widths with vertical trabeculae at the osteopenic site and both vertical and horizontal trabeculae at the erosion site. Potentially, FSA can distinguish changes consequent to bone-mediated RA drug treatment. The Results: The value of 3D CT reconstructions in external projections was the highest in revealing of the osteophytes of anterior margins of vertebral bodies; the anterior osteophytes were found in 33 (82.5%) patients on 3D CT images. The 3D CT reconstructions cut off in sagittal plane along the spinous process were the best imaging modality in evaluation of the osteophytes of the posterior margin of the vertebral body, which were seen in 34 cases (85%) and in evaluation of narrowing of the intervertebral foramens (14 cases -35%). Conclusions: 3D CT reconstructions are valuable in determining the localization and the extent of the cervical spine osteophytes. They are the imaging modality of choice in assessment of the degenerative narrowing of the intervertebral foramens. 3D CT reconstructions should be the integral part of CT examination of patients with the neck pain. Purpose: The aim of our study was to determine the incidence of JSpA in Croatian population in the last 6 years in relation to other rheumatic diseases and the presence of HLA -B 27 in children with JSpA. As the cause of JSpA is still unknown, the strong association with HLA -B 27 suggests genetically determined mechanism. Methods and Materials: The patients from 1 to 18 years of age diagnosed during the period 1997-2003 at Department of Paediatric Rheumatology, University Hospital Zagreb following strict criteria of European Spondyloarthropathy Study Group. We identified 681 newly diagnosed patients with rheumatic disease using hospital and outpatient records. Results: 69 were identified as having JSpA (9.8%) amongst 8,358 patients with rheumatic disorders. Sex ratio was 22 females against 47 males, mean age of 13.6 years. 55 patients had undifferentiated spondyloarthropathy (79.7%), 4 patients had Reiter's syndrome (5.8%), 6 had arthritis of inflammatory bowel disease, i.e. Crohn's (8.7%), two patients had psoriatic arthritis (2.9%), and two had ankylosing spondylitis (2.9%). Ocular complications were present in 24 patients (34.8%), enthesitis in 51 (73.9%), sacroileitis in 60 (86.9%) and peripheral arthritis in all 69 patients (100%), diagnosed radiologicaly. HLA -B 27 was present in 49 patients (71.1%). Conclusion: Our epidemiological study showed similar incidence of JSpA among other rheumatic diseases in childhood and adolescents (9.8%) compared to results of American, Canadian and British studies in which this incidence is 7.9 -9.8%. However, the presence of HLA -B 27 antigen is lower (71.1%). Postprocessing optimization of computed tomography data of acetabular fractures V. Moschenko, T. Shamova, A. Sklyarenko, I. Bobkova; Kharkov/UA Purpose: To study diagnostic opportunities of postprocessing programs -multiplanar (MPR) and 3D shaded surface display (SSD) reconstruction of CT data on acetabular fractures. Methods and Materials: 21 patients aged 15 -57 with acetabular fractures in various terms since the moment of trauma (from 2 days to 15 months) were examined. Plain radiographs and CT with the subsequent application of programs MPR and SSD were conducted. The acetabular fractures classification by Judet -Letournel was used. Results: Use of postprocessing programs allowed in 3 (14.3%) cases to specify a type of fracture and character of deformation of acetabulum, therefore in 2 (9.5%) -the originally prospective conservative treatment was replaced by operative. Considering complexity of choice certain reformations MPR and SSD for analysis and documenting of views, we used standard projections: for MPR -1) along anterior column, 2) along posterior column, 3) along both columns; for SSD -1) anteroposterior view of the pelvis; 2) direct projection (lateral view) of the acetabulum; 3) obturator oblique view of the pelvis; 4) iliac oblique view of the pelvis. In 18 (85.7%) cases use of only these projections was enough to establish the type of acetabular fracture. Conclusion: Use of MPR and SSD in CT data postprocessing allows establishing the type of acetabular fractures that defines a choice of treatment tactics. Our standard protocol of MPR and SSD reduces analysis time of research results and creates conditions for uniform perception of injuries by all participants of diagnostic process. Conclusion: Routine X-ray projections prove insufficient to establish a diagnosis in 1/5 th of the cases. Confusion is caused by overlaying of fracture edges and pelvic bone in the direction of X-ray beams. The latter makes hardly visible the small posterior fragment, too. Therefore, CT scanning is required for the diagnostic protocol of displaced femoral head fractures. Is Learning Objectives: To describe US and MR imaging findings of nerve infiltration by extrinsic masses, including lipomas, hemangiomas, non-Hodgkin lymphomas and ganglion cysts. To learn to differentiate between these pathologic conditions. To emphasize the role of US and MR imaging in the management of these lesions to further delineate the nature and extent of the process. Background: In addition to peripheral nerve sheath tumors (e.g. neurofibromas, schwannomas and malignant peripheral nerve sheath tumors), there are softtissue masses, such as hemangiomas, lymphomas and ganglion cysts, which do not originate from the nerve itself but may occasionally infold among the nerve fascicles and expand into the neural tissue. The intraneural growth of these masses is rare, may cause nerve dysfunction and local symptoms and should not be confused as the more common nerve sheath tumors. Imaging Findings: 12-5 MHz US and 1.5 T MR imaging findings for a series of eight retrospectively collected cases of masses infiltrating nerves are illustrated with emphasis about the different pathogenetic mechanisms of intraneural infiltration. Hemangiomas involved the median and ulnar nerves, ganglion cysts the peroneal nerve, non-Hodgkin lymphomas the sciatic and median nerves. Correlation of imaging findings with gross surgical views is provided in 6/8 cases. Conclusion: High-resolution US and MR imaging can detect nerve infiltration by extrinsic masses. Knowledge and recognition of the characteristic imaging features can aid in the proper diagnosis and treatment of these lesions. MRI of lipomatous soft tissue tumors: Radiologic pathologic correlation M. Pilavaki, D. Chourmouzi, G. Boulogianni, A. Drevelegas; Thessaloniki/GR Purpose: To study the MR imaging findings for each type of lipomatous soft tissue tumors and to correlate them with the pathological findings. We studied retrospectively the MR examinations of 36 patients with histological proven lipomatous soft tissue tumors. The histological types of the tumors were: 21 lipomas, 1 fibrolipoma, 1 lipoblastoma, 3 lipomatosis and 10 liposarcomas (4 well-differentiated, 5 myxoid, and 1 mixed type) T1-, T2-, and fat-suppressed and T1-weighted images after administration of gadopentetate dimeglumine were obtained. The signal intensity on different sequences, the internal characteristics, the presence of septa and other nonadipose component, revealed on the MR images and the degree of contrast enhancement of septa and nonadipose component were evaluated. Results: From the group of 26 benign lipomatous lesions 11 lesions were without a recognizable nonadipose component. 14 lesions had thin septa without contrast enhancement. In case of fibrolipoma areas of nonadipose component correlated with fibrous tissue. In the group of well-differentiated liposarcomas 1 had thin septa and 3 thick septa with mild contrast enhancement. The 6 remaining liposarcomas had thick septa with 5 of them having a nodular and globular non-fatty component with enhancement after the administration of paramagnetic agent. Conclusion: Statistically significant imaging features favoring a diagnosis of liposarcoma included the presence of thick septa, enhancement of septa and the presence of nodular or patchy nonadipose components. Imaging features suggesting benignancy included thin septa with no enhancement relative to muscle and no recognizable nonadipose component. Guidelines for diagnosis of soft tissue lipomatous masses (STLM) G. Chave, D. Ranchere-Vince, P. Meeus, P. Thiesse; Lyon/FR Learning Objectives: To clarify the steps of pretreatment diagnostic procedures in case of soft tissue lipomatous masses (STLM). To describe the MRI findings for lipomas and liposarcomas. To develop the principles of percutaneous biopsy. Background: Differential diagnosis between lipomas and liposarcomas, especially atypical lipomas is not always easy. Despite similarities, differential diagnosis can be reliably established employing image parameters. Nevertheless, the staging process of STLM culminates in biopsies, allowing to manage the proper treatment. Biopsies can be performed percutaneously using imaging guidance. An open biopsy with the resection of the entire mass is disputed when the STLM is composed essentially of fat on MRI imaging to avoid the misdiagnosis of benign lipoma. Each procedure must be carefully planned: an inadequate biopsy may fail to allow proper diagnosis, have a negative impact on survival, and ultimately necessitate an amputation to accomplish adequate margins of resection. Procedure Details: After the description of characteristics and different histological subtypes of lipomas and liposarcomas, we will describe the MRI findings for each diagnosis, according to a review of the litterature by illustrating with MRI imaging of patients followed in our center. We will develop the principles of percutaneous biopsies according to litterature and our experience. Conclusion: Accurate diagnosis of STLM is based on three factors: clinical presentation, radiological features and pathologic evaluation. The importance of careful planning and performance of biopsies cannot be overemphasized because errors may have a negative impact on survival and impede proper diagnosis. High Background: Clinical assessment of extensor tendon injuries is not straightforward because of the peculiar anatomy of these tendons made of several interconnecting layers and different attachment sites in the fingers. The development of very high-frequency "footprint" transducers has improved the ability of US to scan the extensor tendon complex in the fingers, allowing accurate depiction of the central and lateral slips of the extensor tendon, and the sagittal and lateral bands of the extensor hood. Imaging Findings: Paradigmatic 12-5 MHz and 15-7 MHz US images from a series of retrospectively collected cases with a variety of extensor tendon injuries in the fingers are illustrated, including partial and complete rupture of the central slip (boutonnière deformity), tears of the lateral slip, avulsion injury of the terminal tendon (mallet finger), injury of the sagittal band over the metacarpophalangeal joint with tendon instability (boxer knuckle). Dynamic US is essential to diagnose injuries of the extensor hood mechanism. Correlations of US findings with schematic drawings and the results from 1.5 T MR imaging are also provided. Conclusion: High-resolution US is promising for evaluating the extensor tendons complex in the fingers. It can identify and characterize a variety of abnormalities. By providing unique information on these tendons, US has potential for major impact on treatment planning. High-resolution US of tenosynovitis in the wrist and hand A. Picotti 1 , L.E. Bacigalupo 2 , R. Podestà 2 , G. Succio 2 , F. Pugliese 2 , S. Bianchi 3 , C. Martinoli 2 ; 1 Siena/IT, 2 Genoa/IT, 3 Geneva/CH Learning Objectives: To describe the spectrum of tenosynovitis of flexor and extensor tendons in the wrist and hand by means of high-resolution US. To correlate US findings with clinical features and MR imaging. To emphasize the role of US in the management of these lesions to further delineate the nature and extent of the process. Background: Tenosynovitis of wrist and hand tendons are common and account for a high percentage of orthopaedic consultations. They can be related to local causes, particularly overuse due to sport or occupational activities or may be the result of systemic musculoskeletal disorders. Imaging Findings: Paradigmatic 12-5 MHz and 15-7 MHz US images from a series of retrospectively collected cases with a variety of tenosynovitis in the wrist and hand are illustrated with emphasis on the pathogenetic mechanism of tendon disease, including de Quervain disease, intersection syndrome, extensor pollicis longus, extensor carpi ulnaris, flexor carpi radialis and flexor digitorum tenosynovitis. The main findings in infectious and hypertrophic tenosynovitis are also described and a spectrum of unusual causes producing them is reported, including foreign bodies and conflict with fracture residuals and osteosynthesis material. Conclusion: Due to its widespread availability, low cost and high spatial resolution, high-resolution US is an excellent tool for investigating a variety of tenosynovitis of the wrist and hand. Background: The patients with inflammatory myopathies (inclusion-body myositis (IBM) = 4, polymyositis (PM) = 3 and dermatomyositis (DM) = 1) underwent whole-body MR muscle screening examination. MR examination is performed at six different levels: neck, shoulder, abdomen, pelvic girdle, and upper and lower leg. T1-and T2-weighted images with and without fat suppression were performed for each level. Signal intensity of muscles, volume and the symmetry of involvement were quantified in 54 individual muscles on each side. Imaging Findings: IBM, DM and PM are rare diseases with clinical and histopathological similarities. IBM usually does not respond to immunosuppressive therapy. Therefore, it is necessary to distinguish these entities correctly. IBM is characterized by more frequent fatty infiltration, atrophy, inflammation, a distal predominance, and anterior group involvement. The finding of selective involvement of the medial gastrocnemius and of the vasti with sparing of rectus femoris is typical for sporadic IBM. The selective involvement of flexor digitorum profundus is also highly suggestive for IBM. T1, T2 and fat-sat images contain different but complimentary information. PM and DM predominantly affect muscle groups of the shoulder girdle and the thighs. A newly introduced MR technique provides an excellent overview of all diseased muscles in the body. Moreover, it helps us to distinguish IBM from other IIMs. MRI may help establish the diagnosis, suggest appropriate sites for biopsy, and enable assessment of disease progress or regression over time. Background: Elastofibroma dorsi is a rare, typically slow-growing, often bilateral, para-neoplastic formation. It's composed by fibro-elastic and adipose tissue and is selectively localized along the postero-lateral side of thoracic wall, under the scapula. The certain diagnosis is cyto-histological. MRI was the hitherto elective diagnosis. All cases of elastofibroma in our series were studied with US; some of them also with CT and MRI; in a retrospective analysis US allowed to suspect presence of elastofibroma in all patients: 3 of them underwent surgery that confirmed the diagnosis. Procedure Details: In our series the US examination, performed with 7.5-10 MHz linear probe, showed solid masses, sometimes in both sides, with badly visible margins, hypoechoic with inside hyperechoic stripes, obliquous from the transducer plan. Conclusions: In all cases US and clinical findings allowed the diagnosis of elastofibroma dorsi. The MRI, performed in 3 patients that underwent surgery, confirmed the US findings. The remaining 2 patients are undergoing follow-up with US. So, US findings, within site, slow growth and possible presence of bilateral masses, allow the diagnosis of elastofibroma dorsi, avoiding costly MRI. A comparison between ultrasound, echo-color-Doppler, and MRI in the evaluation of achilles enthesopathy in psoriasis: Preliminary results F. Maggi, F. Di Gregorio, C. De Simone, C. Pagliarello, M. Politi; Rome/IT Purpose: Psoriasis is often associated with Achilles enthesopathy. This study compares the efficacy of Ultrasound, Echo-Color-Doppler and MRI in the evaluation of early signs of Achilles enthesopathy in psoriatic patients. Methods and Materials: 22 consecutive psoriatic patients, 17 men, 5 women, mean age 48 years (age range 19-72), mean PASI score 14, entered the study. All patients underwent sonography of the Achilles tendon and peritendinous structures with Aplio (Toshiba) equipped with a linear multifrequence (8-13 Mhz) transducer; the study was completed with Color-Doppler analysis. An MRI study, before and after gadolinium, was then performed using E-Scan XQ (Esaote), 0.2 Tesla superconducting magnet. Axial and sagittal T1 and T2 weighted, sagittal GE and STIR sequences were obtained. After gadolinium, axial and sagittal T1 weighted sequences were obtained. Results: The more frequent US findings were microcalcifications inside the Achilles tendon (27% of cases) and signs of bursitis (27%), while uncommon there were degenerative lesions and signs of peritendinitis. Completion with Echo-Color-Doppler did not add significant data to US study. MRI imaging showed degenerative lesions and peritendinitis as well as US, but was not able to identify any microcalcification. All the alterations were identified in the basal study; administration of gadolinium did not allow any additional pathological finding. Conclusion: Our preliminary results show that MRI, especially with low magnetic field, is not sensitive compared to US in detecting early changes of Achilles enthesopathy in psoriatic patients, while Echo-Color-Doppler and enhanced MRI sequences had limited utility in diagnostic imaging of early stages of this pathology. Characterization High resolution US and MRI in the evaluation of plantar fibromatosis I. Gallesio, S. Parodi, R. Pastorino, D. Schettini, M. Falchi, E. Silvestri, G. Garlaschi; Genoa/IT Purpose: Plantar fibromatosis is a benign fibroproliferative disorder of the plantar fascia clinically presenting subcutaneous nodules in the foot sole. This study aimed to evaluate the application potential of US and MRI performance in detection of these lesions. Material and Method: 7 patient with palpable nodules suspected plantar fibromatosis were evaluated. The US examination was performed by means of a high resolution transducer through tranverse and longitudinal scans along with evaluation of intra-nodular vascularization by power-Doppler. MRI was performed by means of a 1.5 T unit with axial and sagittal planes. T1 weighted MRI images after administration of iv contrast medium were acquired from two patients. Results: 11 nodules were, overall, detected, most of them located in the medial plantar fascia. All nodules were oval-shaped, hypoechoic at US and hypointense at MRI. Considering number and size of nodules, US and MRI overlapped (were strikingly similar). Moreover, nodules showed hypervascularization at power-Doppler, confirmed at MRI with paramagnetic contrast medium. This pattern might suggest a different pathoanatomical condition of these lesions, as hypervascularization is a sign of an early stage lesion, featuring a large fibrovascular proliferation. No correlation was found between vascularization degree and symptoms the latter resulting from the neurovascular structures disorder. Conclusions: US associated with power-Doppler is the first choice method in the evaluation of plantar fibromatosis, able to detect number, size and activity pattern of nodules, leading to a pre-surgery diagnosis. In severe plantar fibromatosis MR is to be considered a complementary method in evaluation of the extent. Purpose: Conventional MRI is a well-accepted technique in evaluating soft tissue tumors. However it is not specific in differentiating benign and malignant lesions. In this study the differential value of the dynamic contrast enhanced MRI (DCE-MRI) was investigated. Methods and Materials: Turbo FLASH DCE-MRI was performed on 27 subjects (2-74 yrs) with soft tissue tumors. Enhancement in the 1 st min (E1), 2 nd min (E2), maximum enhancement (Emax), and time-signal intensity curve (TIC) slopes were calculated. Discriminant analyses were performed to reveal parametric differences of the benign and malignant lesions. Results: Histopathological diagnosis of benign (N = 9) tumors were hemangioma (n = 3), neurogenic tumor (n = 3) lipoma (n = 2) and desmoid (n = 1), whereas malignant lesions (N = 18) were classified as liposarcoma (n = 5), osteosarcoma with soft tissue component (n = 5), malignant fibrous histiocytoma (n = 5), synovial sarcoma (n = 2) and giant cell tumor (n = 1). For malignant lesions mean values for E1, E2 and Emax were 98%, 102%, and 119%, respectively. Mean TIC slope was 2.75. For benign lesions the above mentioned values were 43%, 66%, 76%, and 1.43, respectively. ANOVA based discriminant analysis was correctly classified 74% of the lesions to benign and malignant groups using E1, 78% of the lesions using E2 or Emax, and 82% of the lesions using TIC slope. The combination of the above mentioned parameters had resulted a 93% accuracy (p < 0.001). Conclusion: DCE-MRI parameters are the surrogate markers of tumoral microcirculation and tissue perfusion. These parameters may be used as key factors when deciding proper treatment alternatives and to reveal malignant transformations. The relation of flexor retinaculum laxity with age, gender, and hand dominance T. Altinok, H.M. Karakas; Malatya/TR Purpose: Carpal tunnel syndrome (CTS) is an entrapment neuropathy involving the median nerve within its fibroosseous tunnel at the wrist. One of the main radiologic parameters in diagnosing CTS is the palmar displacement (PD) of the flexor retinaculum In this study, possible physiologic factors that may affect the palmar displacement and decrease the sensitivity of this criterion were investigated. Materials and Methods: 160 normal wrists of 40 male and 40 female with ages between 20 and 58 (Mean: 39.6; SD: 11.2) were ultrasonographically investigated with 4-7 MHz linear transducer. PD values obtained were correlated with with age, gender, and hand dominance was analyzed. Results: There was no significant difference between different genders and between dominant and non-dominant hands regarding palmar displacement. When considering all subjects this parameter was varied between 0.50 and 3.70 mm (mean: 2.00; SD: 0.64). Palmar displacement exhibited a very strong correlation with age (p < 0.0001; r = .635 and r = .544, for dominant and non-dominant hand, respectively). When considering all subjects, linear regression between both factors was found to be 0.589 (p < 0.0001). The sensitivity of PD in diagnosing carpal tunnel syndrome was variously reported to be lower than other radiologic criteria. We have found this relative insensitivity to be originated from the age dependent laxity. The cut-off value of 2.5 mm given in the relevant literature must therefore be considered normal for the paients older than 55 years of age. The use of the normalization data presented may help to improve the sensitivity of the palmar displacement. Vascular soft tissue tumor discrimination with MR image findings by pattern recognition techniques C. Vidal, J. García-Gómez, L. Marti-Bonmati, M. Robles; Valencia/ES Purpose: To discriminate within soft tissue tumors (STT) those with a vascular origin from other histological groups by using pattern recognition techniques with MR image findings. A total of 346 consecutive patient with confirmed musculoskeletal STT from different European centres were examined with MR. T1and T2-weighted fat-suppression or STIR images were obtained in all subjects. The recorded variables were: age, clinical presentation, localization, size, shape, MR signal intensity, margins, homogeneity, edema, T1-hyperintense tracts, mul-tiplicity, target appearance, muscular atrophy, intratumoral hemorrhage, calcification, intratumoral fat, fibrosis, fascial relationship, bone alterations, vessels. The k-nearest neighbour (KNN), support vector machine (SVM) and decision trees (DT) were used to classify vascular from cystic, fatty, nervous, synovial and fibrous origin. The sample was splitted with 30% of cases used as test. Results: Efficacy of vascular in front of each histological group using KNN was high (nervous 0.95, cystic 0.93, fibrous 0.85, fatty 0.84 and synovial). Vascular vs. all other STT gave an efficiency of 0.97 with DT, 0.95 with SVM and 0.93 with KNN. Conclusion: Discrimination of vascular from nervous and cystic origin was easier than from fatty, synovial and fibrous STT. However, the overall values were very high. The computer assisted diagnosis in the discrimination of the vascular histological group from the others in STT diagnosis is possible by using pattern recognition techniques. Spring ligament chronic injury on MR imaging A. Iovane, M. Midiri, M. Galia, T. Bartolotta, R. Lagalla; Palermo/IT Purpose: To evaluate the usefulness of MR to depict spring ligament (SL) and to visualize its chronic abnormalities even when associated to injury of the posterior tibial tendon (PTT). Materials and Methods: MR images from 185 patients (102 female and 83 male; age range 35-62 years), with clinical suspect of injury of the PTT, were retrospectively examined for SL normal appearance and abnormalities. All exams were performed by a 0.5 T MR using T1 weighted spin-echo and T2 weighted fast spinecho sequences on the axial plane.10 asymptomatic control patients (7 female and 3 male; age range 33 -63 years), were examined in the same interval time using T1 weighted spin-echo and T2 weighted fast spin-echo sequences on an oblique plane (45°), parallel to SL. We evaluated if SL was totally or partially visualized, SL thickness and signal intensity. Results: In all control patients SL was completely visualized, 4-5 mm thick and homogenously hypointense. 120/185 patients had injury of PTT. Among these 120 patients SL was visualized in its medial portion in 78 patients of which 56 had chronic abnormalities of LS. At standard MR examination was not possible to visualize the inferior portion of SL in almost all 185 patients. Conclusions: MR seems to be an important diagnostic technique to evaluate SL abnormalities. The high association of SL lesions with PTT injury has to be known and considered when studying patients with proved advanced PTT injury in order to plan correctly the MR study to SL whole examination. Primitive muscular hydatidosis: A pictural review of 11 cases A. Konan, H. Rajhi, N. Mnif, M. Karray, M. Zlitni, R. Hamza; Tunis/TN Purpose: Soft tissue involvement by hydatid disease remains unusual even in endemic areas. In this report our aims are to review the imaging findings of muscular hydatidosis and underline possible peculiarity. We review retrospectively 11 patients (4 men, 7 women) who underwent surgery for primitive muscular hydatid disease. Imaging technique used included ultrasonography (n = 11), CT scan (n = 7) and magnetic resonance imaging (n = 4). Results: Ultrasonography found multiple anechoic and hypoechoic cystic lesions (n = 10), necrozing tumor-like lesion (n = 1). CT scan showed evidence of multivesicular cysts in all cases. MRI showed typical liquid lesions (n = 3), heterogenous signal due to scraps (n = 1) and evaluate accurately the extent of involvement. Conclusion: In our experience multivesicular cysts is the main lesion showed in primitive hydatidosis soft tissue. Ultrasound is still in routine relevant to detect muscular hydatidosis; CT scan and MRI confirme the diagnosis and are helpful to demonstrate the relation between cysts and adjacent structures and evaluate extent of involvement before surgical management. Results: 115 MRI showed degenerative signs. In 30% disc enhancement was peripheral, parallel to the end plates.The disk enhancement was at L4-L5 in 35% and L5-S1 in 47%. It was found in 86% of end plates inflammation and in 88% of fatty changes. It was found in 6% of stage II and IIIA normal or earlier degenerative stages, 21% of stage IIIB and 57% of IV stage latter degenerative stages. 10 biopsies were performed avoiding disc infection. 5 of the 15 MRI of patients with ankylosing spondylitis showed large contrast enhancement parallel to the end plates without end plates inflammation. 10 MRI of operated patients showed linear uptake parallel to end plates associated with enhancement in the posterior part of operated disc. 10 MRI of patient with infectious spondylitis showed central disk enhancement with end plates inflammation in 100% and vertebral abscess in 50%. Conclusion: Disc enhancement parallel to end plate is a disc degenerative sign in operated and non-operated disc. It may be present in inflammatory conditions as ankylosing spondylitis. Central disk enhancement appears to be an infection sign. Effectiveness of US-guided core needle biopsy in the diagnosis of musculoskeletal lesions I. Lecumberri, J.L. del Cura, O. Gorriño, I. López, A. Legorburu, D. Grande; Bilbao/ES Purpose: To evaluate effectiveness and accuracy of ultrasound (US) guided core needle biopsy in musculoskeletal lesions. Material and Methods: US guided core needle biopsies were performed in 111 patients with musculoskeletal lesions imaged by US. All lesions were tumors on US exam, except two that appeared as ill-defined alterations in soft tissues. Twelve were arising from or involving bone. Location of the lesions was axial in 54 and in extremities in 57. Results of core biopsy were correlated with the final diagnosis, that was based on the exam of surgical specimen in 53 patients who were operated on, and in clinical course in the rest. Results: No complications occurred. Core biopsy was considered diagnostic in 108 cases. Fifty-two lesions were finally diagnosed as malignant and 59 were benign. In 11 cases final diagnosis was different from that of core biopsy. Two lesions with non-diagnostic result were finally diagnosed as malignant and another one as benign. Five lesions, benign in core biopsy, were diagnosed as a different benign entity after surgery. Three lesions, considered benign after core biopsy, were finally diagnosed as malignant. US-guided core needle biopsy achieved 90% sensibility, 100% specificity, 100% positive predictive value and 95% negative predictive value to detect malignancy in musculoskeletal lesions. In US-visible musculoskeletal lesions, US-guided core biopsy can establish a diagnosis with great accuracy and frequently can avoid other explorations. Thus, it should be considered a stable technique in the management of musculoskeletal pathology. Extra-abdominal desmoid tumours in the post-partum period: Diagnosis and staging with ultrasonography and MRI L. Dogliotti 1 , M. Bazzocchi 1 , N. Gandolfo 1 , F. Pugliese 2 , F. Prefumo 2 , G. Serafini 1 ; 1 Pietra Ligure/IT, 2 Genoa/IT Purpose: The extra-abdominal desmoid tumour (EADT) is a rare disease more common in young females. This study describes the ultrasonographic features of EADTs, and compares them with MRI in the diagnosis and staging of the disease. A total of 12 lesions of the anterior abdominal wall and perineum have been assessed with ultrasonography and MRI. Six of them were subsequently diagnosed as EADTs at histology. Of these, 5 were located in the anterior abdominal wall and one, the largest, was embedded within the perineal muscles. All patients were female and reported being pregnant in the year preceding the diagnosis. Three had delivered by caesarean section. The ultrasound examination were performed with a 12-5 MHz multifrequency transducer. MRI imaging employed TSE-T1w sequences with and without gadolinium, and TSE-T2w sequences with and without fat suppression. Results: In the cases of EADT ultrasonography showed solid homogeneous masses, slightly hypoechogenic compared to the adjacent fibromuscular structures. In the 5 anterior abdominal wall cases, the margins were clearly identified on a transversal plane but spiculated and irregular along the longitudinal plane in 3 out 5 cases. The large perineal lesion (diameter 6 cm) appeared dyshomogenous, but margins were regular and clearly identifiable. At Color Doppler exami-nation, all lesions showed a rich vascularisation. MRI confirmed the fibrous nature of the lesions and helped in the differential diagnosis with endometriosis. Conclusion: EADTs appear as solid, homogeneous, clearly delimited lesion at ultrasonography. MRI is useful for excluding endometriosis in case of dyshomogeneous lesions. Retrospective analysis of ultrasound guided core biopsy in the diagnosis of soft tissue masses F.J. Perks, I. Beggs; Edinburgh/UK Purpose: to assess the accuracy of ultrasound guided core biopsy of soft tissue masses. We reviewed 65 soft tissue biopsies in 62 consecutive patients. Diagnoses were compared to the post excision diagnosis in 28 patients. All core biopsies were performed by the same radiologist using ultrasound guidance. Biopsies were performed as outpatient procedures. Results: 3 biopsies repeated. 56 (85%) biopsies diagnostic of a wide range of benign and malignant disease. 24 of 28 (86%) biopsies accurately representative of post excision histology. 28 biopsies diagnosed disease that did not warrant excision. 4 false negative biopsies when sampling liposarcoma, lymphoma, chondrosarcoma and metastasis. Overall sensitivity and specificity was 87.8% and 100% respectively. There were no complications. The purpose of this exhibit is to describe the imaging features of SAPHO in adults. This retrospective study included 24 patients (13 women, 11 men). All imaging procedures, radiographs, CT, MRI and scintigraphy, were reviewed. Background: SAPHO (acronym for synovitis, acne, pustulosis, hyperostosis and osteitis) is a syndrome of obscure cause, commonly considered to represent a seronegative spondylarthropathy, affecting especially young adults and children and leading to osteoarticular and skin manifestations. Osteosclerosis, cortical thickening, enlargement of bone, arthritis are the predominent radiologic pattern, but periostitis and soft tissue swelling also may be seen and these findings can simulate osteomyelitis, sarcoma, lymphoma. Imaging Findings: Of the 24 patients, topographic localizations were the upper anterior chest wall (82%), spine (50%), periphral bones and joints (46%), pelvis (30%), mandible (12.5%). The main radiologic findings correlated with hyperostosis, osteitis and synovitis. The radiologist plays a major role in the diagnosis: this exibit reviews the radiologic appearance of this syndrome and illustrates difficulties in differential diagnosis. Erdheim-Chester disease: Detection and staging with multimodality imaging A. Miquel 1 , E. Dion 2 , C. Graef 2 , Y. Menu 1 , P. Grenier 2 , J.-D. Laredo 2 ; 1 Le Kremlin-Bicêtre/FR, 2 Paris/FR Learning Objectives: To illustrate the clinical, radiological and histological spectrum of findings in Erdheim-Chester disease. To be able to recognise the disease in a patient with elementary symptoms. To describe the imaging modalities that are necessary for a precise staging of the disease. Background: Erdheim-Chester disease is a multisystemic histiocytosis associated with characteristic skeletal abnormalities. Bone (bone pain), skin (xanthomas), orbits (exophthalmos), pituitary gland (diabetes insipitus), retroperitoneum (hydronephrosis) and lungs may be affected by the disease. The relashionship of the disease with Langerhans cell histiocytosis is still unclear. Seventeen patients with Erdheim-Chester disease were evaluated between 1990 and 2001, using conventional X-rays, US, CT, bone scintigraphy and MRI. Radiological-pathological correlations were available in 15 cases. Imaging Findings: Osteosclerosis of long bones in lower limbs is the most common feature (15/17 cases) and should be a trigger for the diagnosis. MRI demonstrates replacement of the high signal of the bone marrow by a decreased signal on T1 and T2-weighted images. Atypical osseous manifestations include involvement of ribs, skull and pelvis; focal lytic lesions are seldom encountered (3/17). Visceral involvement may affect pituitary gland, orbits, pericardium, lungs, kidneys and retroperitoneum. Pathologic study shows accumulation of lipid-laden histiocytes and fibrosis. Conclusion: Bone lesions are rather specific and should suggest the diagnosis of Erdheim-Chester disease. Detection of visceral involvement, sometimes asymptomatic, requires imaging of brain, lung and retroperitoneum. Histological analysis is necessary to assess the diagnosis and differentiate the disease from other cases of histiocytosis, especially Langerhans cell histiocytosis. The Learning Objective: We aim to highlight the manifestations of myeloma using referrals from such specialities as haematology, orthopaedics and general medicine. The classical appearances of myeloma are presented with aids to enable the radiologist confirm the diagnosis and differentiate from other pathologies of similar appearance. Background: Multiple myeloma is the commonest primary malignant neoplasm and therefore as pathology the radiologist should be mindful of its many appearances. Imaging Findings: Through a pictorial review we show not only the classical appearances of myelomatosis on plain film and bone scans but we also present its' appearance on CT scan and MRI. The limitations and benefits of each modality are discussed. Furthermore we highlight the recent findings which show that not only is MRI better at staging multiple myeloma but compared to the dated "Durie and Salmon" criteria it negates the need for repeat blood and urine samples. Conclusion: Multiple myeloma may not always present with classical appearances and therefore it is paramount that a radiologist be aware of some of the unusual forms. Through an assortment of imaging modalities we present not only the characteristic appearance but also atypical varieties. Vertebral development: Normal and abnormal aspects-interactive A. Marinescu, A. Pavel, H.C. Ionescu, G. Iana; Bucharest/RO Learning Objectives: The program is conceived as an interactive lesson for those who wants to easy understand the vertebral development and also the pathology of an inadequate development. It is addressed to any radiologist in training. Background: The vertebral development consists in three stages: mesenchymal, cartilaginous and bony. During this development appear many centers of the future vertebrae (mesenchymal, chondrifications and ossifications centers).o:p> Procedure Details: Using a graphic presentation (originally and schematically) of the vertebrae for any stage and a color convention (the mesenchimal stage is represented in orange, the cartilaginous stage in blue and the third -the bony stage in pink); you can follow all the steps of the vertebral development. The program is interactive, meaning that you can follow the graphic presentation of the steps of the vertebral development, but also: • If you want to know more about the elements on the graphics, you can use the left button of the mouse clicking on the red sign. • Before "details" and you will get the information and explanations. Then, you can come back to the slide with the marks ü "details". • You can see, for each type of pathology which can occur in different steps of vertebral development, a graphic presentation and radiography (you press the left button of the mouse on the red sign before "pathology". Conclusion: All the radiology trainees in our department have been satisfied with the program, instead of reading some arid pages for this topic. Nevoid Background: Nevoid basal cell carcinoma syndrome (NBCCS) is a rare autosomal dominant inherited disorder with complete penetrance but variable expressivity. Although many radiologists are familiar with typical findings (e.g. major criteria) of this disease there are also findings that are only rarely demonstrable (e.g. minor criteria). Imaging Findings: We present NBCCS-findings of 5 patients. They include numerous pathologies such as multiple cutaneous basal cell carcinomas, odontogenic jaw cysts, ectopic calcifications of the falx cerebri as well as palmar or plantar pits. Characteristic images of the patients faces as well as bifid or fused ribs, vertebral anomalies, bridging of the sella turcica, flame shaped pseudocysts of the hands, lymphomesenteric cysts as well as increased frequency of tumors particularly medulloblastomas and ovarian fibromas that are also very important to recognise will be shown. The radiological findings are specific for this disease and may confirm the diagnosis in combination with the clinical presentation. Furthermore early diagnosis as well as periodical follow-up examinations is very important since the nevi after puberty turn out to be aggressive. Imaging with pathological correlation of sacral and presacral lesions S.A. O'Keeffe, T. Geoghegan, W.C. Torreggiani; Dublin/IE Learning Objectives: The objective of this poster presentation is to pictorially review the imaging of a series of patients with sacral and presacral lesions and to correlate these with pathology. Background: Presacral tumours are extremely rare accounting for less than 1 in 40,000 hospital admissions. There are many pathological causes as this is an anatomical area of embryologic fusion. A review of reports on the Radiology Information System (RIS) was undertaken to identify those patients who had pre- In this pictorial review, we describe the anatomical contents of the presacral space and correlate this with the possible pathological causes of a lesion in this area. In addition, the imaging and pathology of a selection of sacral and presacral tumours is presented and methods of analysis of imaging are suggested. Diagnosis Background: Chordomas are very rare tumors, for which standard medical therapies are lacking. Following detection of PDGF-R expression in tumor samples, it was decided to treat some patients with advanced chordoma with Imatinib mesylate on an individual basis. These patients were treated at the Istituto Nazionale Tumori, Milano, Italy, as from August 2002. Imaging Findings: Five pts with advanced disease (4 with sacral, one with clivus chordomas) undergoing Imatinib mesylate were evaluated with MRI at baseline, and then every 2 months. Four pts showed hints of tumor response. These were: i) minor and slow decrease in size in the pt with the longest follow-up, following a transient initial increase in size, which was seen in all pts; ii) hypodensity of lesions on T1w images and hyperintensity on T2w images; iii) hypovasculature of lesions on contrast-enhanced T1w images in comparison to baseline assessment. Conclusion: Actual responsiveness of chordomas to molecular-targeted therapy with Imatinib mesylate is left to be determined. However, preliminary observations suggest that MRI may be useful to assess tumor response. Signs of response may be subtle, likely depending on changes in tumor tissue rather than (or before) decrease in size. Groin pain in athletes: MRI findings F. Idoate Saralegui; Pamplona/ES Learning objectives: This exhibit reviews the RMI findings in athletes with groin pain. Background: Groin pain is a common complaint in athletes, particularly prevalent among soccer players. This condition is frequently multifactorial, and the differential diagnosis can cover a rather broad area of entities, mainly involving adductor muscle and tendinous group, pubic bone even inguinal hernia. Between January 1998 and August 2003, 90 athletes with groin pain were examined at our institution. The MRI findings of the possible causes of groin pain in athletes are described and illustrated. Imaging Findings: The examinations were performed in a 1 Tesla imaging system (Magnetom Impact Expert, SIEMENS) with a surface coil. T1-weighted spin echo and T2-weighted fat suppressed turbo spin echo images were obtained in axial plane; STIR a T2-weighted turbo spin echo sequences were performed in coronal plane. The pathological findings observed were: osteitis pubis, stress fracture of pubic bone, muscle tears (adductor, obturator, rectus abdominis, pectineus, iliopsoas, gracilis and rectus femoris groups), abdomino fascial abnormalities, inguinal hernia, bursitis and inflammation conditions of the spermatic cord. Conclusion: MRI depicts adequately the numerous pathologic entities related to groin pain in athletes. Infection Background: Prosthetic, graft or catheter infection, irrespective of location, invariably equates with a poor outcome. Modern aseptic technique, in addition to the use of antibiotic-coated prostheses, have dramatically reduced the incidence of such infection. Aggressive antibiotic suppression is effective in fewer than 30% of cases, the remainder requiring removal of the infected prosthesis, with associated morbidity, and occasionally, mortality. Clinical signs and symptoms are frequently non-specific, including lethargy, pyrexia and anorexia. It is for this reason that quite often the task of locating a causative factor relies upon the expertise of the radiologist. Imaging: Using a pictorial review we depict the numerous pitfalls in the radiological diagnosis of prosthetic and endovascular graft infections. In addition, a guide to radiological imaging of less frequently encountered infections, such as those of breast and penile prostheses, ventriculo-peritoneal shunts, intra-ocular lens, cardiac pacemakers and valves, will be provided. The limitations and benefits of Conventional Radiography, Digital Subtraction Angiography, Computed Tomography, Ultrasound, Magnetic Resonance Imaging and Radio-isotope Scintigraphy with respect to the site of infection will be explored in turn. The radiological diagnosis of infection of synthetic materials is notoriously difficult. The use of these materials for therapeutic, cosmetic and palliative purposes is ever-increasing. It is therefore of vital importance that the radiologist be aware of the advantages and disadvantages of available imaging modalities in arriving at a confident, swift diagnosis. A new method for radio frequency of lumbar disc in treatment of chronic low back pain N. Azulay 1 , M. Forgerit 2 , A. Moumouh 1 , E. Alava 3 , P. Vandermarq 1 , J.-P. Tasu 1 ; 1 Poitiers/FR, 2 Niort/FR, 3 Barcelona/ES Purpose: Treatment of chronic low back pains remains a challenge for physicians. Recently, radio-frequency heating of inter vertebral disc has been proposed, as an alternative to surgery. We propose here a new method of discal radiofrequency in which heated water is used to spread the thermal energy. Materials and Methods: Seventeen patients were included prospectively according to the criteria used in previous intra discal radiofrequency studies. The catheter is placed in the nucleus and heated water is used as thermal conductor to burn the annulus nociceptors. Intra discal pressure and impedance measurements were used to control the energy delivered during the procedure. Clinical results were evaluated by the Oswestry score. The treatment was scored as a success with at least a 50% pain reduction on global perceived effect on Oswestry score. The global Oswestry before treatment was 50.6 points and 25 points 480 B D E F A G after corresponding to a 50.6% improvement. On the 17 patients, 12 were successfully treated (71%). We have shown that injection of heated water is sufficient to spread thermal energy to the anular nociceptor. This method is technically more simple than previous techniques using anular needle, avoiding navigation of the catheter through the anulus. Ultra low dose CT in navigated closed reduction and percutaneous screw fixation of pelvic ring fractures H.G. Staedele, R. Huegli, S. Meckel, A.L. Jacob, H. Roser, P. Messmer, J. Roth; Basle/CH Purpose: To reduce radiation doses in image-guided pelvic closed reduction and percutaneous fixation CRPF without compromising guidance quality and procedural outcome. Prospective study including patients with pelvic ring fractures treated with CT-guided CRPF. Patients received 2 screws which were navigated over guide pins. Imaging modality used was a single slice scanner (General Electric, USA). Tube current was reduced by 50% with every step starting with routinely used scan parameters for diagnostic and interventional procedures (200 mA). If the image quality was good the next control scan was performed with 50% reduction of mA again. Results: 13 patients with 16 fractures underwent CRPF. 9 were males, 4 females, with a mean age of 39 years (range 23.3-88.9). Dose reduction was possible in all patients in 2 to 4 steps ending up in 50 mA (n = 3), 25 mA (n = 4) and 10 mA (n = 9) respectively. 10 mA is the lowest current provided by the CT. Number of misplaced screws was 0. Number of additional correction of guide pin was 0. Number of fallbacks to the next dose level was 0. Conclusion: By lowering scan doses no relevant morphological information needed for safe guidance of instruments and implants was lost. Scan protocols can be changed to lower mA values without compromising the safety of CRPF. Immediate procedural outcome was not affected. withdrawn by authors Pelvic painful syndrome in athletes: Diagnostic imaging evaluation L. Zugaro, F. Iannessi, A. Catalucci, A. Barile, C. Masciocchi; L'Aquila/IT Purpose: To describe the imaging features of the anterior and posterior painful syndrome in athletes. Materials and Methods: 28 athletes (23 males, 5 female) suffering from pelvic pain (groin pain = 13 and hamstring syndrome = 15) underwent MRI after plain film and ultrasound preliminary evaluation. In 5 patients CT evaluation was also performed. MR examination was performed using a 1.5 T unit (GE Medical System). Proton density, T1 weighted and T2 weighted sequences on axial and coronal planes were employed. In one case MRI was also obtained after surgical treatment. In all cases MRI demonstrated pathological findings: anterior painful syndromes were related to osteitis pubis, bursitis, inguinal hernia, post-traumatic muscular lesions and stress fractures. Hamstring syndrome was related to insertional pathology of hamstring tendons, inflammation disease of regional bursae and fibrotic changes of fatty tissue surrounding the ischial tuberosity. Conclusion: Anterior and posterior pubic painful syndromes are painful conditions often affecting athletes. MRI provides a correct evaluation of these syndromes enabling an adequate therapy. The value of qualitative and semiquantitative ultrasonographic findings in the differential diagnosis of superficial lymph node enlargements O.O. Okten 1 , N. Tuncbilek 1 , H.M. Karakas 2 ; 1 Edirne/TR, 2 Malatya/TR Purpose: The value of the gray-scale (GSUSG), color Doppler (DUSG), and power Doppler (PDUSG) ultrasonography in the differential diagnosis of superficial lymph node enlargements were evaluated. The study group was consisted of 36 males and 17 females (2-74 yrs old, mean age 36.1 yrs) in whom physical examination had revealed superficial lymph node enlargement(s). All patients were investigated with power Doppler USG (Sonoline Elegra Advanced, Siemens, Germany) using 7.5 MHz linear transducer. Longitudinal/transverse dimensions (L/T), edge characteristics and hilar echogenecity of lymph nodes were evaluated with GSUSG. Pulsatility (PI) and resistivity (RI) indexes were calculated using CDUSG. Vascular pattern described as hilar or non-hilar were determined by PDUSG. Above parameters were analyzed to determine their differential diagnostic values using ANOVA based discriminant analysis. Results: When clinical data and histopathological findings were combined, 31 subjects were diagnosed as lymphoma, and 22 cases were classified as lymphadenitis. Multiple comparison analysis of qualitative GSUSG and PDUSG features consisting of edge characteristics, hilar echogenecity and vascular pattern was able to differentiate lypmhomatous lymph nodes and lymphadenitis with 87% accuracy (p < 0.001). In contrary, semiquantitative features (RI, PI and L/T) were not able to classify lymph nodes (58% accuracy, p < 0.05). Conclusion: Semiquantitative RDUS parameters are not valuable in the differential diagnosis of superficial lymph node pathologies. Qualitative USG and PDUSG features, on the other hand, may be used as an alternative work-up to cytological studies in patients in whom diagnostic surgical procedures cannot be performed. Modern imaging in Langerhans cell histiocytosis A. Geoffray, K. Oudjhane, L. Lau, S. Weitzmann; Toronto, ON/CA Purpose: To review imaging features of pediatric Langerhans cell histiocytosis (LCH) with particular attention to cross-sectional imaging and aggressive cases. We reviewed retrospectively the imaging database of all the cases treated in our institution for LCH during a 5 years period (January 1998 to December 2002). There were 45 patients, 30 boys, 18 girls, with an age range of 3 weeks to 13 years. Results: 2 patients had no imaging anomalies and were excluded. Among the 43 with anomalies, 16 had a solitary bone lesion (skull 3, orbit 3, spine 4, iliac 1, long bones 5), 19 had multiple bone lesions associated with other organ involvement in 6 (lung 4, liver and spleen 2, thymus 1), 7 patients had no bone lesions (1 cervical adenopathy, 2 abdominal involvement, 2 abdominal and lung, 1 pituitary gland, 1 middle ears), 1 patient had LCH associated with neuroblastoma, and presented with lymphadenopathy, mediastinal and sacrococcygeal masses. Imaging modalities were conventional radiography in 100%, nuclear scans 95%, CT 93%, MR 76%, US 62%. Conclusion: LCH in children is characterized by a wide spectrum of organ involvement. Cross sectional imaging is useful in assessing the diagnosis and managing the most aggressive cases. Can calcaneal spur help in the evaluation of a painful heel? N. Sabir, S. Demirlenk, B. Yagci, N. Karabulut; Denizli/TR Purpose: To determine the value of presence of calcaneal spur in evaluating painful heels. Materials and Methods: 145 heels of 66 female and 11 male patients with a mean age of 45.7 ± 9.8 years and mean body mass index (BMI) of 35.0 ± 10.5 complaining of bilateral (n = 68) and unilateral (n = 9) heel pain were studied. Lateral radiographs of the 145 symptomatic and 163 asymptomatic heels were obtained to assess presence of calcaneal spur. MR imaging of the symptomatic heels was performed using 1.5 T superconductive system. The images were taken and reviewed for presence of plantar fasciitis (PF). Heel pad thickness was also measured. Results: Calcaneal spur was seen in 72 of 145 (49%) symptomatic and in 13 of 163 (7.9%) of asymptomatic heels. MR has revealed PF in 68 of 145 (46.9%) painful heels and calcaneal spur was present in 53 of the cases with PF. Calcaneal spur was significantly correlated with weight (P < 0.001), BMI (P < 0.001), age (P = 0.029), heel pain duration (P = 0.003) and PF (P < 0.0001). No correlation was seen between calcaneal spur and both height and heel fat pad. Conclusion: Although calcaneal spur is not the cause of pain, it may provide an objective assessment of the changes due to chronic repeatitive trauma to plantar fascia secondary to obesity or age. On the other hand foot radiography should be part of the initial diagnostic methods as it helps in excluding different causes of heel pain. Purpose: The positive areas in scintigraphy of sentinel lymph nodes are sometimes difficult to be anatomically identified. We have examined the usefulness of bone scintigraphy performed together with lymphoscintigraphy for identification of the anatomical positions of the positive area in lymphoscintigraphy. Materials and Methods: Sixteen patients, 12 cases of malignant melanoma and 4 cases of squamous cell carcinoma were examined by lymphoscintigraphy. Nine patients, 7 cases of malignant melanoma and 2 cases of squamous cell carcinoma, were examined by bone scintigraphy together with lymphoscintigraphy. The patients were divided into three groups. In the first group, lymphoscintigraphy was performed alone. In the second group, the patients were first injected intravenously with Tc-99mHMDP or Tc-99mMDP and then lymphoscintigraphy was performed after intradermal administration of Tc-99m sulphur colloid. Three hours after injection of Tc-99mHMDP or Tc-99mMDP, Bone scintigraphy were taken. In the third group, lymphoscintigraphy was performed 30 minutes after bone scintigraphy. Result: Anatomical identification of the positive areas in lymphoscintigraphy was difficult when used alone, whereas their identification became easier when used together with bone scintigraphy. When bone scintigraphy was performed after lymphoscintigraphy, evaluation of lesions in the bones near the original focus was sometimes not easy. However, evaluation of lymphoscintigraphy was not affected by prior performance of bone scintigraphy. Conclusion: Identification of the anatomical positions of the positive areas in lymphoscintigraphy was easier when used together with bone scintigraphy than in lymphoscintigraphy alone. In cases of the joint use, lymphoscintigraphy should be operated after bone scintigraphy. Ultrasonographic detection of iatrogenic foreign bodies in an in vitro study I.K. Rozylo-Kalinowska, L. Barczewski, E. Szczepanik, R. Lenard; Lublin/PL Purpose: Sometimes foreign bodies being parts of surgical appliances remain in soft tissues as a result of iatrogenic faults. Their presence is dectected clinically or radiologically, when the objects are radiopaque. Nevertheless, radiolucent or faintly radiopaque objects often are a diagnostic challenge as their presence is difficult to diagnose on the basis of conventional radiograms. The purpose of the study was application of ultrasonography for detection of radiolucent and faintly radiopaque foreign bodies in an in vitro model. Examples of radiolucent and poorly radiopaque foreign bodies such as plastic fragments of syringes, intravenous catheter, different cotton and gauze swabs, were embedded in containers filled with gelatine, which served as a model of soft tissues as well as played the role of a stand-off pad. The ultrasound scanning was performed by means of ATL HDI 3500 machine with a high-frequency broadband linear transducer. Results. There was determined the possibility of detection of various types of foreign bodies. There were described ultrasonographic image patterns of different objects. Image Findings: All types of used materials were well visible and hyperechoic in ultrasound image. Plastic objects caused appearance of reverberation artifacts. The swabs produced characteristic patterns of internal structure. Variations in ultrasonographic image patterns of foreign bodies studied in vitro allowed differentiation of various types of the examined materials. Conclusion: Ultrasonography may become a useful, widely available and costeffective tool in detection and localisation of foreign bodies of iatrogenic origin that otherwise remain undetected. Spectrum of MR findings of herniation pit of the femoral neck M. Ferrer, R. Dominguez, M. Romera, E. Castella, X. Merino, L. Casas; Barcelona/ES Background and Purpose: Herniation pit of the femoral neck has been considered a normal variant. This lesion is located in the superior aspect of the femoral neck, below the anterior cortex of the femur. The aim of this study was to describe the spectrum of magnetic resonance imaging (MRI) findings associated with herniation pit of the femoral neck. Material and Methods: We retrospectively reviewed the MR studies in patients with hip pain performed in our hospital over the last 10 years. A total of 12 patients presented herniation pit. The features analyzed included: type of herniation pit (unilateral/bilateral), iliofemoral ligament thickening and asymmetry, iliopsoas muscle/femoral head relationship, acetabular coverage angle, cervicodiaphisary angle, femoral anteversion angle, and associated imaging findings (synovitis). Results: In patients with hip pain and herniation pit, the following data were found: no other apparent cause of the pain (25%), iliofemoral ligament thickening (100%), decreased acetabular coverage angle (80%), altered cervicodiaphisary angle (90%). The elevated incidence of alterations in acetabular coverage and cervicodiaphisary angle in herniation pit, together with other alterations in stabilizing elements, lead us to suggest that, rather than a separate entity, herniation pit can be considered a component of the spectrum of adult hip dysplasia. B D E F A G High resolution ultrasound of the peripheral nerves of the lower limb: Technique of examination and normal US appearance X. Montet 1 , S. Bianchi 1 , C. Martinoli 2 , J. Fasel 1 ; 1 Geneva/CH, 2 Genoa/IT Objective: To present the basic normal US appearance of peripheral nerves evaluated in vitro and in vivo. To describe the examination technique, the normal US findings and the main anatomic variations of the nerves of the lower limb. Materials and Methods: US images were obtained with commercially available equipment utilizing two linear probes (5-12, 7-15 MHz). The normal US appearance of a peripheral nerve was evaluated by in vitro examination a human sciatic nerve. Sonograms were then obtained in normal volunteers and correlated with MRI and images from anatomic textbook. Results: The in vitro US appearance of the a normal peripheral nerve correlates well with the internal nerve structure. Fascicles appear as hypoechoic bundles embedded within the hyperechoic connective tissue. The normal anatomy of the sciatic, peroneal, tibial nerve is first briefly described. Then for each nerve the scanning technique is presented with emphasis on patient position, probe orientation and dynamic maneuvers. To improve the understanding of US images, correlative drawings showing the adjacent anatomic structures and diagrams showing the position of the probe are presented. High frequency transducers allow a detailed analysis of even smaller peripheral nerves. We present a practical manner to realize a US examination of the nerves of the upper extremity as well as US images of normal nerves and of their main anatomic variants. withdrawn by authors Radiologic and sonographic examinations in patients with heterotopic ossifications J. Nagy; Budapest/HU Purpose: To evaluate the diagnostic capability of radiologic and ultrasonographic examinations in patients (pts) with heterotopic ossifications (HO). During the last four years we have examined 107 pts (23 women, 83 men; age: 51 /20-90/ years) in case of the clinical suspicion of HO. Dynamic conventional radiologic and ultrasonographic (7.5 MHz linear transducer) examinations were performed. Results: In the background of HO, spinal cord injury (43 pts, 40%), brain injury (37 pts, 34%), limb damage (19 pts, 18%), orthopedic surgery (5 pts, 5%) or limb amputation (3 pts, 3%) were found. The most frequent localizations of HO were as follows: one side (53 pts) or on either of the sides of the hip (40 pts), elbow (13 pts), knee (8 pts), hip + knee (4 pts) or rare localizations (around the femoral stump) (7 pts). More than one localization was found in half of the pts. When the clinical suspicion of HO was not proved by radiology, dynamic ultrasonographic examinations were positive in each cases (17 pts, 16%). Conclusions: (1) HO can occur in more than one localization after CNS or limb injuries, (2) The most frequent localization was around one or both hip joints, (3) Sonographic examinations showed earlier positivity compared to conventional radiology, (4) Rare localizations of the HO can induce differential diagnostic problems in clinical practice. Ultrasonographic experiences of spine-related lesions in patients with back pain: Correlation with MRI W. Jin; Incheon/KR Purpose: Multiple paraspinal lesions or spine-related lesions have been overlooked on transabdominal ultrasonograhic examination. Therefore, we correlated transabdominal ultrasonographic findings with MRI findings in spine-related lesions. Materials and Methods: 50 patients were underwent transabdominal ultrasonographic examinations for routine check prior to surgery. They were 28 men and 22 women aged 17 to 70 (average, 45) years. All patients also were checked with MRI. In transabdominal ultrasonographic examination, compression of abdominal wall and inner contents were done. After this, we observed closely the contour of body, the height of body, disc height, and paraspinal lesion. Results: In 50 patients, there were 1) compression fractures or burst fractures; 23 patients, 2) spondylitis; 7 patients, 3) bone tumorous condition; 2 patients, 4) abscess formations in paraspinal muscle; 3 patients, 5) ankylosing spondylitis; 1 patient, and 6) disc herniation; 14 patients. In these patients, transabdominal ultrasonographic findings were relatively correlated with MR findings, but lesions in posterior and middle elements of spine could not be evaluated with transabdominal ultrasonographic approach. Conclusion: Despite of many limitations of transabdominal ultrasonographic examination for detection of spine and paraspinal lesion, when spine and paraspinal structures or lesion are visible on transabdominal ultrasonography, ultrasonography suggested to be a screening method in patients with back pain. In particular, ultrasonography was superior to MRI in detecting the minimal change of anterior disc, prediscal space, or anterior longitudinal ligament of spine. Creation of a radiological musculoskeletal database (DB) for statistic referrement, differential-diagnosis and didactic use (STUART project) S. Trupiani, E. Baldan, R. Stramare, C. Saccavini, L. Bacarini, G. Feltrin; Padua/IT Purpose: To create a radiological DB, with normal and pathologic cases, to be used for statistic endings, differential-diagnosis and for consultation. The DB is available to everyone who as investigation or consultation needs or else for cases submission; for this reason is necessary to follow some fixed criteria unless the case is not accepted. The submission modalities have a starting schedule that contains: patient's anagraphic data, documentation source, sequence of technical-methodological procedures used, a description of every semeiological aspect contained in every single image, Gamuts criteria-based diagnosis and final diagnosis. The cases are resumed by ACR code. The definitive diagnosis, that contain a synthesis of anatomical-clinical and diagnostic aspects about the pathology observed, is open to critical observations by everyone that is consulting the DB. Every DB consulter is able to introduce his opinion in a special window. The case report ends with a bibliographic correlation that contains the latest literature articles about the argument. The DB contents can be utilized as a cases archive for clinical research (for this aspect, very important is the ACR code), or as a support in the diagnostic report making, or as a didactical archive. Moreover the DB users can exchange their opinions, modify or add informations for every case by the web. ment was present in 15 cases (93.7%) and 4 discal involvement was present in 1 case (6.3%). 15 patients had soft tissue involvement and abscess was present in 2 patients. All cases showed vertebral and discal enhancement. 9 patients showed diffuse involvement of vertebral corpus and 5 patients showed endplate involvement. 2 cases showed both vertebral corpus and endplate involvement. Intervertebral space narrowing was present in 13 cases, height loss in vertebral body was observed in 2 cases and 16 cases showed end plate deformities. We detected epidural extension in 6 cases, posterior longitudinal ligament (PLL) elevation in 12, spinal cord compression in 9 and root compression in 2 cases. Conclusion: Spondylodiscitis is a rare complication of brucellosis and it can cause permanent neurologic deficits and spinal deformities. MRI is a very sensitive and non invasive imaging technique which must be firstly preferred for the early diagnosis of spondylodiscitis. Imaging Findings: A total of 31 aneurysms in 26 patients were evaluated. All were proved at surgery. Five small aneurysms were not depicted at 3D-CTA-SSD (three were less than 3 mm, two were less than 5 mm). But only three small aneurysms were missed in 3D-CTA-VRT (two were less than 3 mm, one was less than 5 mm). In 21 (81%) of the 26 patients, 3D-CTA-VRT gave additional informations: orientation (n = 11), defining exact neck anatomy (n = 16), incorporation of vessels into aneurysm (n = 10), lobulation (n = 10), and blebs of aneurysms (n = 8). Conclusion: 3D-CTA-VRT is superior to 3D-CTA-SSD in the detection of very small aneurysms and evaluation of complex anatomy of intracranial aneurysms. Gadolinium enhanced ultra-fast MRA: A primary diagnostic tool in the recognition and follow-up of dural sinus thrombosis S. Gaudino, T. Tartaglione, F. Molinari, V. Valentini, C. Colosimo; Rome/IT Dural sinus thromboses (DST) are not extremely rare, they still account for 5% of ictus in young adults. They need an accurate diagnosis at the onset of symptoms, and during the follow-up, to reduce the risks related to prolonged thrombolytic therapy. Digital subtraction angiography (DSA) and, in the last years, phase contrast MR angiography (PC MRA) with conventional MR sequences have become the methods of choice for DST diagnosis. Our purpose was to evaluate the usefulness of gadolinium-enhanced ultrafast MRA (GE-UF MRA), routinely employed in supra-aortic vessel evaluation, in the diagnosis and follow-up of DST. Materials and Methods: We retrospectively evaluated 12 patients with diagnosis of DST, studied using 1.5 T magnet, conventional SE, TSE and GE-UF MRA sequences. We could compare GE-UF MRA images with DSA in 3 patients and PC MRA in 5 patients. Results: In all 3 DSA controlled patients, we found a complete agreement between GE-UF MRA and DSA concerning location and extent of DST. In all 5 patients with both GE-UF and PC MRA, the overall DST diagnosis was identical, even if the diagnosis of minimal dural sinus involvement was easily and definitively assessed with UF-GE MRA, which allows a superior diagnosis confidence. Conclusions: Our preliminary experience suggests that GE-UF MRA is a very fast modality, is easily obtained and analyzed and has a superior diagnostic confidence compared to PC MRA. In our opinion GE-UF MRA should be proposed as the primary diagnostic tool in the recognition and follow-up of DST. Imaging Imaging Appearances: The images were obtained using unenhanced CT and routine MRI sequences for brain imaging (ie sagittal T1, axial T2 and coronal proton density weighted sequences). Fat suppression sequences were sometimes used for further clarification. The characteristic CT and MRI appearances of intracranial fat and the anatomical location of the lesion allow the provision of a narrow differential diagnosis using routine imaging protocols. This facilitates decisions on the need for further imaging modalities. Background: Vascular dementia represents a very heterogeneous diagnostic category. Utilizing the NINDS-AIREN criteria and a centralized imaging rater to determine eligibility for enrollment in recent large-scale clinical trials testing new treatments for vascular dementia has provided increased consistency in the diagnosis of VaD. The diagnostic criteria for probable vascular dementia include the development of dementia temporally related to stroke with neuroimaging confirmation. The criteria include a table listing brain imaging lesions associated with vascular dementia. In this study, 520 patients have been screened for the presence of cerebro-vascular disease using brain CT or MRI. Imaging Findings: The wide spectrum of neuroradiological features that are associated with VaD may result from cerebral small-vessel disease with extensive leukoencephalopathy or lacunes (basal ganglia or frontal white matter), or may be the consequence of single strategically located infarcts or multiple infarcts in large-vessel territories. It may also be the consequence of global cerebral hypoperfusion, intracerebral hemorrhage or other mechanisms such as genetically determined arteriopathies. Conclusion: Neuroimaging is required for confirmation of cerebrovascular disease in VaD and provides information about the topography and severity of vascular lesions. Neuroimaging may also assist with the differential diagnosis of dementia associated with normal pressure hydrocephalus, chronic subdural hematoma, arteriovenous malformation or tumoral diseases. Imaging spectrum of cerebral complications after cardiac surgery E. Testempassi, G. Katsou, V. Vantali, M. Kolios, D. Exarchos, D. Chondros; Athens/GR Learning Objectives: To present a systematic approach to imaging findings of cerebral complications caused by cardiac surgery. To review and understand the mechanisms and pathophysiology of cerebral involvement after cardiac surgery. Background: A wide spectrum of neurologic complications may occur after cardiac surgery, such as motor, sensory or visual disturbances, stupor or depression of consciousness. The role of imaging in differentiating a variety of conditions that may cause the above neurologic symptoms is very important. Morphology and patterns of cerebral lesions also enables an assessment of the pathophysiology and hemodynamics of brain complications after cardiac surgery. We retrospectively reviewed the brain CT images of 94 symptomatic patients, who previously had cardiac surgery performed. Imaging Findings: A variety of common and uncommon findings on CT and MR images of neurologic complications after cardiac surgery are illustrated. Acute infarctions involving a vascular territory, hemorrhagic infarctions, multiple infarctions, watershed infarctions, bilateral infarctions, braistem and cerebellar infarctions, uncal herniation, brain edema and inflammatory processes are depicted. Preoperative cerebral CT or MR images are helpful in diagnosing new lesions in patients with old infarctions, lacuna or ischemic leucoencephalopathy. The radiologist must be familiar with the imaging appearance of complications that affect the brain after cardiac surgery. Imaging findings of an ethmoidal dural arteriovenous fistula with venous drainage in the vein of Galen V.T. Skiadas, A. Prasouli, P. Mitseas, G. Kottas, S. Laxanis; Athens/GR Learning Objectives: To illustrate the MRI, MRA and angiographic findings of an ethmoidal dural arteriovenous fistula (AVF) in the anterior cranial fossa. Background: Ethmoidal AVFs are rare vascular anomalies. Only 129 cases have been presented since 1963, when they were first described by Lepoire. They can be either congenital or acquired lesions. Ethmoidal arteries are the main feeding vessels. The vast majority drain to the superior sagittal sinus and to the cavernous sinus. The presenting symptom is intracranial hemorrhage, mostly subarachnoid or intracerebral. Their propensity for hemorrhage justifies immediate surgical removal of the lesion. Imaging Findings: An MRI scan was performed demonstrating an abnormal region of signal void, suggesting a vascular anomaly involving the base of the left frontal lobe. For further evaluation, the patient underwent an MRA examination. A vascular linear lesion, probably a vein, at the base of the left frontal lobe and enlargement mainly of the left, as well as of the right ocular artery was discovered. A digital subtraction angiography (DSA) was performed and an EDAF on the left ciribriform plate supplied by bilateral ethmoidal arteries was revealed. It drained via a dilated abnormal vein to the left vein of Galen. So far, only one other case has ever been reported with venous drainage to the vein of Galen. Conclusion: Specific MRI and MRA imaging findings should arouse the suspicion of an EDAF and DSA can effectively demonstrate the nidus of the lesion, as well as the feeding and draining vessels and confirm the diagnosis. Functional Based on the hypothesis of focal cortical inhibition, low-frequency transcranial magnetic stimulation (TMS) was used, resulting in a slight reduction of hallucinations in some patients. In this case study, functional magnetic resonance imaging was employed to image blood oxygenation level dependent (BOLD) effect changes in the temporal lobes under TMS-therapy. Methods: In a curative attempt, a 30-year old schizophrenic patient (DSM-IV) with medication resistent acoustic hallucinations was treated with low-frequency TMS (fstim = 1 Hz) over a four week period. fMRI was performed in a 1.5 T clinical scanner using the standard head coil and a GE-EPI sequence. The TMSeffects were detected based on the event related BOLD-fMRI of auditory hallucination and auditory hallucinations rating scale. FMRI was performed prior to and after the TMS series to visualize possible cortical activation changes in the stimulated area. Data analyses were performed with SPM99 (http:// fil.ion.ucl.ac.uk.spm). Results: After the third week, the patient presented a reduced frequency of acoustic hallucinations of approx. 50%, while the loudness of the hallucinations remained unchanged over the 4 weeks of stimulation. fMRI demonstrated a BOLD effect activation reduction after TMS in speech related areas, which exceeded the local stimulation area. Discussion: fMRI data revealed an activation reduction in temporal and temporo-parietal areas after TMS corresponding to the clinical recovery. The combination of TMS and functional imaging is promising, allowing an insight into neuro-biological mechanisms during TMS intervention, which may help to improve treatment success. went immediate hyperbaric oxygen (HBO) therapy and the initial result was excellent. He was discharged with subtle weakness in the right lower extremity. The second woman didn't undergo HBO therapy and was discharged with left hemiparesis. Imaging Findings: MR imaging with diffusion-weighted images (DWIs) and ADC maps were performed at admission. The first man showed high signal intensities bilaterally of the perirolandic cortex and occipital cortex on T2-weighted images (T2WIs) and DWIs. These areas showed dark signal intensities on ADC maps, suggesting cytotoxic edema. The second woman showed high signal intensities bilaterally of the perirolandic cortex, bilateral globus pallidus and left occipital periventricular white matter on T2WIs and DWIs. These areas also showed dark signal intensities on ADC maps. Conclusion: MR imaging findings are similar to CO poisoning in that cytotoxic edema involves the globus pallidus bilaterally. But we experienced some different MR imaging finding to CO poisoning in that cytotoxic edema involves the perirolandic area bilaterally, which can be seen in profound perinatal asphyxia in term infants. Computed tomography angiography ( Volumic acquisition of the brain with multislice detector CT at arterial phase is analyzed systematically with 2D maximum intensity projection (MIP). In most cases, volume rendering reconstructions are also performed. All patients with negative CTA have a conventional cerebral angiography to visualize entire intracranial circulation. CTA and conventional cerebral angiography are performed by 4 senior neuroradiologists. Imaging Findings: Multislice detector CTA explores all the locations of intracranial aneurysms. CTA is a quick and reliable technique for the detection and therapy planning of intracranial aneurysms. Rarely, CTA depicts arteriovenous malformations. In some cases, hemorrhage suggests cerebral venous thrombosis that is also diagnosed on CTA. We present selected cases emphasizing the utility and the limits of the technique. Conclusion: CTA is a non invasive, reliable tool to explore patients with non traumatic intracranial hemorrhage. The use of cerebral CTA by expert neuroradiologists allows a significant reduction of the number of emergency diagnostic angiography required. Brain activations during bi-script reading in Chinese: A direct comparison of alphabetic and non-alphabetic reading using functional magnetic resonance imaging (fMRI) Y. Li 1 , X. Feng 1 , Y. Chen 2 , W. Tang 1 ; 1 Shanghai/CN, 2 Oxford/UK Learning Objectives: A direct comparison between reading alphabetic and nonalphabetic scripts was done using fMRI during bi-scripts reading of Chinese characters and its alphabetic sound symbols known as Pin Yin. Background: Six Mandarin speakers and skilled readers of Chinese participated in this study. All the subjects were right handed. Experiments were performed on GE MRI scanner at the Huashang Hospital. Sixteen slices covering the whole brain were collected with blood oxygenation level dependent (BOLD) sequence. The anatomical images were obtained in the transverse plane during the same scan session with 3D FSPGR sequence after the functional measurements. The four types of stimuli were distributed equally in two main conditions i.e. Chinese and Pinyin. In each condition, half stimuli were words and half were non-words. Data analysis was carried out using FEAT, the FMRIB Easy Analysis Tool, an extension of MEDX. Imaging Findings: The activations in the right inferior frontal gyrus, the left fusiform gyrus, the bilateral cuneus and the bilateral superior frontal gyrus were stronger for Chinese character reading than for pinyin reading. The activations in the bilateral supramarginal gyus, the bilateral superior parietal gyrus and the bilateral middle frontal gyrus, however, were stronger for pinyin reading than for Chinese character reading. Different parts of the middle temporal gyrus were also activated for reading these two scripts. The low hemispheric lateralisation for both Chinese character and pinyin reading indicate an important role for both hemispheres in reading. Conclusion: fMRI is one of the best methods of illustrating difference of brain activations during alphabetic and non-alphabetic reading. MRI of the brain in inherited neurometabolic disorders: A pictorial review S.P. Prabhu, S.A. Barnard, N. Stoodley, S.A. Renowden; Bristol/UK Learning Objectives: To illustrate typical MRI appearances of the brain of patients with inborn errors of metabolism and toxic inherited white matter disease. A simple algorithm to unravel the possible cause of imaging findings is incorporated as part of this presentation. Background: The diagnosis of a neurometabolic disease is usually suggested by clinical history and physical findings and is confirmed by appropriate special studies, which may include neuroradiological investigations. When the patient is referred with a nonspecific diagnosis, such as delayed development, the aim is to suggest the possibility of a neurometabolic disorder and initiate further evaluation including possible therapy and genetic counselling. On occasion, routine neuroradiological studies may incidentally produce results suggestive of a neurometabolic disorder. Imaging Findings: Disorders including glutaric aciduria, pyruvate dehydrogenase deficiency, Leigh's encephalopathy, maple syrup urine disease, methylmalonic aciduria, adrenoleukodystrophy, metachromatic leukodystrophy, Krabbe's leukodystrophy and Pelizaeus-Merzbacher disease are illustrated. A pattern approach based on which part of the brain is affected is used to provide an aid to the diagnosis. Conclusion: Magnetic resonance imaging plays an important role in the identification, localisation and characterisation of underlying white matter abnormalities in affected patients and is also extensively used to monitor the natural progression of such disorders and the response to therapy. Background: To compare 3D-DSA with 2D-DSA and 3D multi-detector CT angiography (CTA) with VRT in the detection and evaluation of intracranial aneurysms. Imaging Findings: A total of 101 aneurysms were evaluated. Seven very small aneurysms (diameter less than 3 mm) and two small aneurysms (less than 5 mm) that were not depicted at conventional 2D-DSA and 3D-CTA-VRT were depicted at 3D-DSA and all were proved at surgery. In 72 (90%) of the 80 patients, 3D-DSA gave additional informations: orientation (n = 26), defining exact neck anatomy (n = 60), incorporation of vessels into aneurysm (n = 30), lobulation (n = 32) and blebs of aneurysms (n = 35). Conclusion: 3D-DSA is superior to 2D-DSA and 3D CTA-VRT in the detection of very small aneurysms and evaluation of complex anatomy of intracranial aneurysms. Low Background: DWI is a useful diagnostic tool that improves our background understanding to pathology. The b-value choice has a significant repercussion on signal-to-noise ratio, DWI contrast and T2 shine-through phenomenon. We have created a straightforward animated microsoft power point presentation showing diffusion physical principles and its imaging consequences. The DWI studies from 50 normal subjects and 50 patients (including brain tumours, encephalitis, demyelinating and cerebrovascular diseases) were further analyzed. All studies were 486 B D E F A G carried out with three different b-value (1000, 2000, 3000 s/m 2 ). Exponential images and apparent diffusion coefficient (ADC) maps were subsequently computed. In normal individuals, the signal and ADC in the hemispheric white matter, basal ganglia and brain cortex were measured. Lesions' signal with different bvalues, and their contrast rate on computed maps, were subjectively compared. Imaging Findings: When we visualised some acute lesions, higher b-values improved contrast compared with lower b-values. Other lesions, like tumours, showed mixed DWI intensities and their contrast also improved with high b-value images. Exponential and ADC maps were useful for discarding T2 shine-through effects, moreover with low b-values, but contrast rate was significantly dismissed. Conclusion: High b-value DWI provides a better contrast and a reduced T2 shinethrough phenomenon but it does not display more lesions than low b-value DWI. As computed maps add useful information to that provided by DWI, it seems that the b-value choice depends on each group preferences. Utility of MR spectroscopy, diffusion and perfusion MR imaging in the evaluation of brain lesions in AIDS patients L. . Diffusion weighted imaging were performed using a diffusion gradient of 1000 sec/mm 2 applied in three axis planes. MR perfusion was performed using TR 1500 ms and TE 90 ms, following bolus infusion of intravenous contrast material, obtaining relative cerebral blood volume maps (rCBV). To determine metabolites a MR spectroscopy (MRS) was performed with single-voxel PRESS-30 sequence. We classified the brain lesions in two majors groups: one with brain lesions that cause mass effect (n = 26) and the other with infiltrating white matter lesions (n = 14). Three patients did not have any lesion. Mass effect lesions could be inflammatory/infectious diseases: toxoplasmosis (n = 9), tuberculosis (n = 5), cryptococcosis (n = 2) and neoplasic lesions: lymphoma (n = 10). As infiltrating white matter lesions, we included progressive multifocal leukoencephalopathy (n = 4), HIV encephalopathy (n = 6), CMV infection (n = 1) and HSV infection (n = 1). Brain infarct (n = 2) is an important condition in AIDS patients and is more prevalent than in the general population. The MRS, diffusion and perfusion MRI have been shown to be extremely useful in characterizing and making the correct diagnosis of brain lesions in AIDS patients. "String-knot shape" enhancement: A presenting feature of cerebral sparganosis in MRI C. Shuguang; Shanghai/CN Learning Objectives: To describe the MRI character of cerebral sparganosis. Background: The cases of cerebral sparganosis have shown a trend of increased frequency with the change of eating habits, especially eating under-cooked products of snake or frog. There is sparse literature available which illustrates nonspecific findings of cerebral sparganosis in MRI including nodular lesions, white matter degenerations or haemorrhages. MR imaging of six patients with cerebral sparganosis were reviewed retrospectively in our exhibit. Imaging Findings: All six cases of cerebral sparganosis showed a single lesion. The location of lesions were superficial with three in the parietal lobe, one in the frontal lobe, one in the temporal lobe and one in the posterior part of brain stem. Five lesions were irregular in shape and about 3 cm diameter with moderate hypointensity on T1WI and hyperintensity on T2WI. A presenting feature of the parasitic granuloma was a "string-knot shape" enhancement, which was demonstrated in 5 cases. One case showed a cystic lesion with peripheral enhancement. There was slight hyperintensity surrounding the nodular lesions which corresponded to edema. No white matter degenerations or hemorrhages were revealed which had been described by previous studies. Diagnosis of sparganosis was made on the basis of characteristic enhancement in MRI for 5 cases and one was diagnosed as parasitic infectious disease. During surgery, live larvas of sparganum were successfully removed in five cases with "string-knot shape" enhancement lesions. In the case with a cystic lesion, only fragments of worm body were obtained. Conclusion: "String-knot shape" enhancement is a characteristic MRI finding which has a high value in diagnosis of cerebral sparganosis. Cystic lesions of the brain: A pictorial essay with MR imaging S. Cakirer, M. Basak, E. Serin, I. Ince, M. Birinci; Istanbul/TR Learning Objectives: To illustrate the spectrum of intracranial cystic lesions. To clarify the underlying reasons for specific MR appearances. To define the role of additional MR sequences for differential diagnosis of cystic lesions with similar appearances. Background: Intracranial cystic lesions are common in radiological practice. The differential diagnosis of intracranial cystic lesions includes a wide spectrum of diseases and is much easier with the use of standard and advanced MR imaging techniques including diffusion and perfusion-weighted studies and MR spectroscopy. Between January 2002 and August 2003, 358 patients with intracranial cystic lesions were studied in our institute. MR imaging characteristics of the lesions, the underlying reasons for the specific MR appearances and the role of additional MR sequences for the differential diagnosis were defined following the categorization of the lesions. Imaging Findings: Intracranial cystic lesions can be categorized into five groups. They include cystic components of primary and secondary neoplasms (glioblastoma multiforme, pilocytic astrocytoma, pleomorphic xanthroastrocytoma, ependymoma, ganglioglioma, central neurocytoma, hemangioblastoma, macroadenoma, craniopharyngioma, metastases), benign developmental cysts (arachnoid cyst, colloid cyst, epidermoid cyst, dermoid cyst, pineal cyst, Rathke cleft cyst, choroid plexus cyst), post-infectious and inflammatory cysts (abscess, parasitic cysts including cystisercosis and hydatid cyst, multiple sclerosis, ADEM), post-traumatic or post-infarct cysts (porencephalic cyst, encephalomalacic cyst, leptomeningeal cyst) and normal variant cysts (enlarged tumefactive perivascular spaces, cavum septum pellucidum, cavum vergae). The underlying reasons for MR appearances of cystic lesions, role of additional sequences for their diagnosis and differential diagnoses between lesions with similar appearances have been evaluated. CTA was performed on a single-slice spiral CT scanner (HiSpeed LXi, GE) with slice thickness 1 mm, reconstruction interval 0.5 mm and pitch 1. An area from base of the skull to above the clinoid processes was covered. A non-ionic contrast medium was injected in cubital vein (370 mgI/ml, 4 mL/ s, 100 mL) and scanning started after delay of 15-20 s. Corresponding 3D image reconstructions (maximum intensity projection (MIP) and volume rendering (VR)) were produced at accompanying workstation (AW 4.0, GE). Conclusion: Intracranial aneurysms were visualized in 35 of 41 patients, but only 23 were further evaluated. Although intra-arterial DSA is still regarded as "gold standard" in diagnostic evaluation of the SAH, CTA can serve as guidance for intervention. Proton MR spectroscopy of the brain: Patterns and pitfalls in diagnosis of brain tumors C.C.T. Lim, H. Parmar, H. Yin, V.G.E. Chua; Singapore/SG Learning Objectives: To review typical spectral patterns of brain tumours and non-neoplastic lesions and to understand the potential mimics and pitfalls in using proton magnetic resonance spectroscopy (MRS). Background: MRS provides metabolic information that is independent of conventional MR imaging. MRS has been applied to distinguish brain tumors from other diseases and is available on many clinical scanners. Post-processing of single-voxel and multi-voxel studies may be presented either as metabolic spectra or parametric maps in the latter. Imaging Findings: In brain tumours, there is elevation of choline (a marker of cell membrane turnover) and decreased N-acetyl aspartate (a neuronal marker) and creatine (an energy substance). Lactate and mobile lipids are sometimes present. Conversely, non-neoplastic lesions typically do not show increased choline. Lactate is sometimes detected in ischemia, abscess and demyelination. Toxoplasmosis and tuberculomas typically show a dominant lipid peak. Bacterial breakdown products including acetate, alanine and succinate are detected in abscesses. Occasionally, increased cellular infiltrates and reactive astrogliosis may result in elevated choline levels, mimicking tumour. Conclusion: With increasing clinical application of MRS, radiologists should be familiar with common spectral patterns of brain disease as well as the potential pitfalls in interpretation. Decreased signal intensity on T2-weighted MRI in the basal ganglia in patients with white matter disorders P. Arguis, S. Capurro, J. Berenguer, T. Pujol, M. Olondo, J.M. Mercader; Barcelona/ES Learning Objectives: To describe some aspects of brain iron metabolism which can be studied by MRI. To learn how decreased signal intensity on T2-W images in the basal ganglia can be seen in several white matter disorders. Background: The iron is taken up by capillary endothelial cells in basal ganglia and then is transported axonally to projection sites where it is used in local metabolism, there the iron is stored in oligodendroglia cells. Interruption of normal axonal transportation of iron caused by white matter abnormality might lead to increased accumulation of iron at the basal ganglia since it could still be taken up but not be transported. It is generally accepted that there is a correlation between the accumulation of iron in the extrapyramidal system and the degree of hypointensity observed at this site on T2-weighted images. Imaging Findings: Low signal intensity on T2-W images were observed in the basal ganglia in 14 patients with different white matter disorders (congenital, multiple sclerosis, postradiation toxicity, ischemia, AIDS-related and tumoral). MR studies were performed with a 1.5 T scanner. Conclusion: Decreased signal intensity on T2-W images in the basal ganglia can be seen in several white matter disorders. Typical Background: Wernicke Encephalopathy (WE) is a severe neurologic disorder caused by thiamine deficiency related to malnutrition or malabsorption of B1 vitamin that occurs mainly, but not exclusively, in alcoholic patients. We reviewed the risk factors as well as the usual and unusual clinico-radiological features including two cases in non-alcoholic patients (one with gastroesophageal reflux and other with pyloric stenosis secondary to biliogastric reflux). A third of patients with acute WE present with the classic clinical triad: opthalmoplegia, ataxia and confusion. Other initial manifestations are hypothermia, hypotension, coma, nutritional polyneuropathy, cardiovascular involvement. Early diagnosis is crucial because of non-specific clinical findings, a high mortality rate but a possible complete recovery with immediate thiamine replacement. Imaging Findings: Typical MR findings include symmetrical signal changes in medial thalami, tectum and periaqueductal region. In the acute stage, enhancement after contrast injection may be visible in these regions as well as in the mamillary bodies, but at chronic stages atrophy is the main finding. Atypical features described include signal changes in the cerebellum, dentate nuclei, pons, red nuclei, basal ganglia and central and precentral sulci. Massive haemorrhages are rare whereas microscopic foci are frequent. Differential diagnosis includes de/dysmyelinating disorders, infarctions and Creutzfeldt-Jakob Variant but symmetrical distribution of findings rules out most of them. Conclusion: WE is a reversible, severe disorder and a high index of suspicion is recommended to diagnose it, even in non-alcoholic patients. To determine whether functional MR imaging sequences (diffusion tensor, tractography, perfusion, spectroscopy, blood oxygenation level dependent-BOLD), can help add new information to the pre-surgery approach to brain tumors. To determine the efficiency and efficacy of these news tools in evaluating brain tumors. During the period of 6 months, MR exams of 25 patients with brain tumors (17 men, 8 women; mean age 47.5years) were performed in a 1.5 T clinical scanner (Siemens, Germany) , using MR clinical standard protocol and functional sequences (diffusion tensor imaging, perfusion, spectroscopy and BOLD sequence). All the patients had their histopathology diagnosis confirmed by brain biopsy and surgery; glioblastoma multiforme (n = 9), anaplastic astrocytoma (n = 6), low grade glioma (n = 6), gliomatosis cerebri (n = 1) and metastases (n = 3). High grade glioma and metastases had hyperperfusion, high picks of choline and low N-acetylaspartate (NAA). Low grade glioma and gliomatosis cerebri had low relative cerebral blood volume, low NAA, high choline and myoinositol. Diffusion tensor imaging showed alterations of the main tracts within and nearest the high grade tumors. Low grade tumors had main tracts dislocated but not interrupted. The white mater tract were preserved in gliomatosis cerebri. BOLD sequence identified the sensory-motor and language activating areas. MR imaging has been used to evaluate brain tumors. With new neuroimaging advanced tools, we can do this analysis in a more accurate and precise way and it takes less time than it was thought to. It is a huge contribution to the evaluation and management of patients, providing a type of diagnosis close to histopathology diagnosis. Individual approach to recanalization treatment of acute ischemic brain contrast-enhanced MRA were obtained three to five days after the insult. We retrospectively reviewed the MR findings and clinical courses of 193 patients with anterior circulation territorial infarction. Those with ICA and MCA lesions were divided into six and five groups respectively, according to the level and mechanism of the occlusion. PWI findings can be another factor in the management planning. Here, we will present representative cases of each group and discuss the management with thorough consideration of various factors, such as pattern and type of arterial occlusion, the extent of DWI/PWI mismatch, the duration of the ischemia, age of the patient, the severity of neurologic deficits, or use of other anticoagulants, etc. We believe that MR imaging is very helpful in the evaluation and management planning of patients with hyperacute stroke. The treatment should be individualized to enhance the effectiveness and safety of the various treatment modalities. Similarities and differences in functional connectivity of the prefrontal cortex: Task In episodic memory (EM), task-and item-related processes have been postulated to contribute to asymmetries in cortical involvement with the prefrontal cortex (PFC) being of particular interest. This study demonstrates task-and itemrelated differences in functional connectivity of PFC in verbal vs non-verbal EM. Methods and Materials: Twelve healthy volunteers performed visual non-verbal (line drawings of known objects) and verbal (abstract words) EM tasks undergoing O-15-butanol-PET to measure regional cerebral blood flow. Using correlation analyses, functional connectivity of item-related (verbal vs non-verbal) processes during episodic encoding and retrieval was assessed. Results: Across all tasks/items we observed strong prefrontal interactions regarding the dorsolateral (DL) and frontopolar (FP) PFC. During encoding we found bilateral but left dominant PFC interactions with any material, right DLPFC showed no interactions during the abstract word condition. During retrieval of pictures we found an increase of right FPPFC interactions and a symmetrical increase of DLPFC interactions. During retrieval of abstract words we observed an increase of left FPPFC interactions, while right DLPFC showed no interactions. Memory performance was higher for pictures vs words. Conclusion: Firstly, our results support the idea of a common bilateral PFC involvement across different stimuli and mnemonic operations. Secondly, item-related processes point to a left lateralized PFC involvement for words and a bilateral PFC involvement for pictures. These data support the "dual coding" hypothesis, introduced by Paivio (Paivio, 1971; Paivio 1991) , postulating a double (verbal and non-verbal) processing pathway for pictoral stimuli, hence a supplementary mnemonic strategy to increase memory performance. Perfusion weighted dynamic susceptibility ( Method: Fifteen patients with unilateral 70-90% carotid artery stenosis were studied with DSA and perfusion-weighted dynamic susceptibility (DSC) MRI and were compared to 15 age/sex matched controls. Regional cerebral blood volume (rCBV) and mean transit time (MTT) values were calculated in the middle cerebral artery (MCA) and borderzone (BZ) territories. All patients underwent TEA within one week from MRI and were re-examined one month after surgery. Results: There was no significant difference in rCBV and MTT values between the hemispheres in the symptomatic patients. There was a significant difference in MTT values in the borderzones between patients and controls. After TEA we found a decrease of MTT of both hemispheres in BZ territories while the remaining hemodynamic parameters persisted unchanged. The decrease in MTT values after TEA lead these values to be similar to those of normal subjects. The results of our study suggest that there is an adequate compensation of unilateral stenosis when it is less than 90%. A hemodynamic compensation mechanism between the two hemispheres, particularly for the distal border zone territories that tend to have a slower MTT with respect to the control subjects before TEA, and the restoring of MTT values in the BZ after surgery, seems to be demonstrated as well. Parkinson's disease: Pre-and post-apomorphine perfusion evaluation with dynamic susceptibility contrast (DSC) MRI F. Gaudiello, S. Marziali, A. Ludovici, E. Ferone, R. Floris, G. Simonetti; Rome/IT Purpose: Our aim was to study whether DSC-MRI perfusion method may detect an altered pattern of regional cerebral blood flow (rCBF) in Parkinson's disease (PD) patients in comparison to normal subjects and whether this altered pattern may be normalised by apomorphine. Material and Methods: Twenty subjects affected by idiopathic PD according with the Brain Bank Criteria were enrolled for this study. Nineteen normal subjects were included as controls. Ten of them performed a retest procedure. PD patients, after at least 20 days of therapy withdrawal, were submitted to perfusion DSC-MRI. Sixteen of them were retested after apomorphine injection at least 24 hours. Relative regional blood flow was evaluated by using regions of interest (ROI) of 50 pixels manually placed in different region of basal ganglia. Results: PD patients showed a significant inter-hemispheric asymmetry due to a higher perfusion in the more affected side (< 0.01), while normal subjects did not. PD exhibited an abnormal "asymmetry index" in the measured nuclei. DSC-MRI performed after subcutaneous apomorphine injection did not show any significant asymmetry in PD patients. Retest in normal subjects did not show any significant variation. Conclusion: DSC-MRI of basal ganglia confirms the asymmetry observed in PET studies of PD, suggesting this method as a promising technique in neurodegenerative diseases. B D E F A G steeper (r = 0.68, P < 0.001) comparing to WM (r = 0.49, P < 0.05) and almost negatively linear. Conclusion: Our study shows that ageing effects on metabolite concentrations are more pronounced in the GM regions of the brain. Determination of absolute metabolite concentrations, rather than use of ratios only, is essential for characterizing age-related changes in brain metabolites. Diagnosis of cerebral vascular malformations with CT angiography in patients with subarachnoid hemorrhage S. Stathopoulou 1 , C. Kokkinis 1 , N. Makris 1 , A. Petinelli 1 , K. Vassiou 2 , M. Vlychou 2 , P.J. Papadaki 1 , G.M. Zavras 1 , J.B. Fezoulidis 2 ; 1 Athens/GR, 2 Larissa/GR Purpose: To evaluate the diagnostic accuracy of spiral CT angiography in patients with subarachnoid hemorrhage due to vascular malformations. Methods and Material: One hundred and fifty-eight patients suffering from subarachnoid hemorrhage (SAH) underwent CT angiography (CTA) as well as intraarterial digital subtraction angiography (IA-DSA). CTA was performed using spiral CT with 150 mL of intravenous contrast at 4 mL/sec, after a delay of 20 sec. Slice thickness 0.8 mm and a reconstruction index of 0.5 was used. Axial slices and multi-planar reformatting (MPR), maximum intensity projection (MIP) and 3D surface shaded display (SSD) reconstructions were reviewed. IA-DSA followed in all patients. There was comparative study between two methods. Results: Twelve cases of vascular malformations were diagnosed by CTA and these comprised 9 arteriovenous malformations and 3 venous angiomas. In 10 cases, the cause of SAH was vascular malformation and in 2 cases was an incidental finding. In comparison with IA-DSA, CTA missed only a small dural arteriovenous malformation but diagnosed a small venous angioma missed by IA-DSA. These two malformations appeared without hemorrhage. Conclusion: CTA is a useful non-invasive method in detection of cerebral vascular malformations causing SAH, with similar results to IA-DSA. Even though IA-DSA offers more anatomical detail in the evaluation of supplying and draining vessels, CTA can be a useful diagnostic tool as the tridimensional aspect offers additional information in the therapeutic planning of these vascular malformations. Material and Methods: CT angiography (CTA) was performed using spiral CT with 150 mL of intravenous contrast at 4 mL/sec, after a delay of 20 sec. A slice thickness of 0.8 mm and a reconstruction index of 0.5 were used. Axial slices and multi-planar reformatting (MPR), maximum intensity projection (MIP) and surface shaded display (SSD) reconstructions were studied to evaluate aneurysm characteristics. Then the image data was analyzed using volumetric 3D rendering technique to succeed endoscoping imaging. This technique extracts CT numbers in the boundary region between the vessel wall and contrast media within the vascular lumen. Results: Forty cases of cerebral aneurysms were detected by CTA. With the technique of CT virtual angioscopy, we assured an excellent visualization of the inner contours of the vessels including the neck and the dome of the aneurysm (fly through). Also 3D morphology of the internal structure of the aneurysm was demonstrated (fly around). The size of the sac (true lumen) and the neck were exactly estimated. Blood vessels flowing into and out of aneurysms were visualized. In 9 patients with ruptured aneurysms that were operated, virtual angioscopy showed the site of rupture, wich was confirmated by operation. Conclusion: Virtual angioscopy following spiral CTA is a very useful technique supplementary to CTA in non-invasive evaluation of cerebral aneurysms and selection of the most appropriate therapeutic modality. Serial MRI in adult-onset Rasmussen's encephalitis reveals two main radiographic and clinical variants N. Danchaivijitr, R. Nicholas, T. Smith, I. Hart; Liverpool/UK Purpose: Rasmussen's encephalitis (RE) is a rare autoimmune disorder that classically affects one cerebral hemisphere. It is characterized by intractable epilepsy with progressive neurological deterioration and usually presents in childhood. Adult onset RE was believed to have a more benign clinical course and imaging features are less well described. Here, we characterize the MRI brain findings of a series of adult onset RE patients and correlate with the clinical progression. We retrospectively reviewed the serial MRI brain scans of 6 patients with pathologically confirmed adult onset RE (53 scans in total). Five patients had complete series of annual MRI studies from their onset. Clinical data including neurological signs, cognitive deficits and functional disability were recorded prospectively. Results: We recognized 2 patterns of imaging findings; 4 patients had focal increase signal on T2W in subcortical white matter of the temporal lobe. Later, these were followed by ipsilateral hemispheric atrophy. These patients had a rapidly progressive clinical course in which neurological deficits occurred within 12 months after onset. The second group (2 patients) had initial focal cortical atrophy followed later by diffuse atrophy of affected hemisphere without evidence of high signal changes. In addition, bilateral involvement and caudate atrophy were more frequent than childhood variant. Conclusion: Adult RE can be difficult to diagnose because the early MRI findings can be subtle and physicians may be unaware of the possible presentation of one hemisphere atrophy without inflammation. Pattern of initial MRI features may help to predict clinical course of the disease. Radiofrequency neurotomy for the treatment of headache associated with the third occipital nerve G.B. Marshall, C. Siwak, B. Frizzell; Calgary, AB/CA Purpose: To assess the efficacy of a fluoroscopically-guided neurotomy technique in patients with cervicogenic headache associated with the third occipital nerve. Methods: Retrospective analysis of 15 patients (12 women and 3 men) who underwent third occipital neurotomy for cervicogenic headache. These patients had failed conservative treatment and were selected based on response to facet joint injection and medial branch block. Neurotomy procedures were completed by two radiologists. A chart review of pre-and post-procedural pain levels was undertaken in addition to follow-up patient interview to determine whether they had improvement in their activities of daily living and recreation. Results: All 15 patients reported a reduction in the frequency of their headaches. Pain levels reported on a Visual Analog Scale dropped from a pre-procedural mean of 8.6/10 to a post-procedural mean of 2.5/10. The mean duration of pain relief was 9.4 months, with 9 of the 15 patients describing ongoing relief of symptoms. All 15 patients reported restoration of activities of daily living, albeit for varying lengths of time. No significant complications were encountered. This radiofrequency neurotomy technique may be a useful means of providing symptomatic relief from cervicogenic headache associated with the third occipital nerve. The study justifies proceeding to prospective evaluation of the technique. Functional magnetic resonance imaging (fMRI) study of memory functions in elderly and young healthy controls and Alzheimer's disease (AD) patients A. Urbanik, M. Binder, B. Sobiecka, J. Kozub, M. Kuniecki; Krakow/PL Purpose: The aim of the study was to assess differences in the neural correlates of nonverbal memory functions in pathological and normal ageing. Methods: Thirty-six volunteers were examined in a 1.5 T MR scanner. Three groups of twelve subjects were examined: young and elderly healthy controls, and patients with probable AD diagnosis. Subjects were required to memorize complex geometrical figures. After the scanning session, they were all asked to redraw these figures. Their performance was scored. Image data were analysed with SPM99 statistical package. Results: Both control groups copied drawings more accurately than the AD group. In all groups, the most prominent differences were seen in frontal regions and the occipital lobes, extending to the temporal. For each group this pattern was dissimilar. For the AD group moderate activation in the occipital lobe was observed, but no activation in frontal lobes. In turn, the elderly group revealed quite weak activation in occipital lobes and strong bilateral activation in the frontal lobes. Finally, in the young adults group there was very prominent activation in occipital lobes, as well as in the frontal lobes, with apparent left-hemispheric dominance. We have succeeded in revealing differential patterns of brain activation in the studied groups during nonverbal memory encoding. Our results suggest that a successful encoding requires an involvement of frontal lobes, that are probably responsible for the strategic aspects of memory functions. As was shown in the elderly control group, frontal lobes can compensate for the deteriorated visual memory which is known to decline over time. The special features of cerebral hemodynamics were studied in 52 patients with Chiari 1 malformation (CM) with the help of magnetic resonance angiography (MRA) and transcranial dopplerography (TCD). MRA data analysis (58) revealed the frequent presence of vertebrobasilar system (VBS) maldevelopment and embryonic type of circle of Willis. TCD data analysis (100) discovered vertebrobasilar insufficiency and bilateral blood flow increase in the intracranial part of the internal carotid arteries giving evidence of the compensated blood flow from the carotid system to the VBS. 21% of patients with CM and communicating hydrocephalus had TCD signs of intracranial hypertension. The most significant changes in cerebral hemodynamics were found in patients with marked pathology and older than 30 years. Conclusions: 1. Changes of cerebral hemodynamics in patients with Chiari 1 malformation are conditioned by a complex of various causes; vertebrobasilar system underdevelopment, extravasal compression of the VBS arteries, rombencephalon hernia (CM) compensated blood flow from internal carotid system to VBS and the presence of intracranial hypertension. 2. The role of vascular factors in pathogenesis of the clinical signs of Chiari 1 malformation is confirmed. Acute disorders of cerebral ischemic circulation in VBS and syncopal conditions were mainly found in patients with the 2 nd /3 rd degree Chiari malformation above 30 years of age, that correlates with the greatest changes of cerebral hemodynamics by transcranial dopplerography findings. Routine MR imaging in Parkinsonian syndromes M. Cosottini, R. Ceravolo, G. Lazzarotti, U. Bonuccelli, M. Michelassi, C. Bartolozzi; Pisa/IT Purpose: To assess the usefulness of routine MRI in the differential diagnosis of parkinsonian syndromes such as multiple system atrophy type p or c (MSA p and MSA c), supranuclear palsy (PSP), and corticobasal degeneration (CBD) from idiopathic Parkinson disease (PD). We retrospectively evaluated 142 patients with extrapyramidal signs and symptoms that had been followed for five years until a definitive clinical diagnosis. Ninety five patients had PD, 25 MSA p, 3 MSA c, 15 PSP, 4 CBD. MR examinations were obtained with 0.5 and 1.5 T equipment in 52 cases and 90 cases, respectively. Axial DP-T2 and sagittal T1-weighted images were evaluated considering the most frequently abnormal findings reported in parkinsonian syndromes. PD MR examination was supposed to be normal. Results: Using the reported radiological criteria, imaging by MRI revealed a sensitivity and specificity of 66% and 96% in PSP, 60% and 96% in MSA p, 100% and 100% in MSA c, 75% and 99% in CBD. A correct diagnosis of atypical parkinsonian syndrome was made in 70% of patients with extrapyramidal signs and symptoms. Conclusions: Several features on brain MR imaging may improve the diagnosis of atypical parkinsonian syndromes and PD in a substantial proportion of patients. Brain with done by PC MRA and the intracranial circle was evaluated with 3D TOF MRA. DSA was then performed to confirm the grading of stenosis and to depict the presence of collateral intracranial compensatory circles. Patients were divided into two groups on the basis of the presence (group 1) or absence (group 2) of a regional or hemispheric perfusion defect detectable at visual inspection of MTT map. Results: In group 1 (six patients) there was a prolonged MTT, a reduced CBF and an increased CBV in two cases. A poor depiction of MCA with MRA and a significant reduction of MBF in the MCA homolateral to ICA stenosis (103 mL/ min), as well as an angiographic impaired willisian compensation with a recruitment of vessels arising from the external carotid artery and from superficial collateral supply was detected in group1. Conclusions: PWI reveals oligemic abnormalities in only some patients with ICA stenosis. Increased MTT and reduced CBF are associated with an impaired willisian collateral supply. Probably, bolus dispersion may influence the PWI-detected oligemia in ICA stenosis. Specificity Results: Statistical differences were found between the dementias group (AD and VD) and the non-demented group (Depression and MCI). The ratio choline/ creatine (Cho/Cr), myoinositol/creatine (mI/Cr) and N-acetylaspartate/creatine (NAA/Cr) showed differences between the studied pathologies, only in PPGM, without significant differences in RTL. NAA/mI and mI/Cr distinguished between AD and the other pathologies, in PPGM, with the best area under the ROC curve for NAA/mI, showing the higher sensitivity (82%) and specificity (73%) for the diagnosis of the AD. Conclusion: 1 H MRS is a non-invasive tool for the study of CI, showing biochemical information to differentiate AD, VD, Depression and MCI. The metabolical alterations observed contribute to the differential diagnosis with a high sensitivity and specificity in pathologies with CI, in particular for the diagnosis of AD. Value of transcranial Doppler (TCD) measurements and "hyperdense middle cerebral artery" sign on CT for acute ischemic stroke prognosis Y.T. Efendiev, L.B. Khalilova; Baku/AZ Methods: CT examination was carried out on the first day of stroke for 100 patients (age range 35 to 47), who had ischemic infarcts in the middle cerebral artery (MCA) territory and repeated on the 3 rd , 7 th and 40 th days. "Hyperdense middle cerebral artery" sign reflecting active intraluminal thrombosis was found in 52 patients. The same 52 patients had TCD on the 1 st day. Results: Symmetric blood flow velocity (BFV) in both MCAs was revealed in 41% of the patients. In this group, clinical course was rather auspicious in more than 70% of patients. Infarcts area in these patents had limited, cortical (73%) and subcortical (27%) localization. No lethal outcome was noted. Asymmetric blood flow with decreased MCA BFV by more than 20% on the affected side was noted in 32% of the patients. In this group, the infarctions had cortico-subcortical localization on final CT. The clinical course was more severe and complicated than in the first group.One lethal case occurred. In 27%, TCD demonstrated signs of hyperperfusion of hemodynamics with increased of MCA BFV by more than 20%, on the affected side, combined with high peripheral resistance index. Infarcts had mainly deep basal location, and 3 lethal cases occurred. Later CT detected hemorrhagic transformation of necrotic area (5 cases, 33%). Conclusion: "Hyperdense middle cerebral artery" sign on CT is significant for early diagnosis of stroke, whereas the TCD measurements in MCA is important to predict the clinical course and possible impairment at the early stage of the disease. B D E F A G Imaging of brain parenchymal and leptomeningeal metastases from lung cancer: Significance of contrast enhancement MRI M.P.I.M. Jakimovska, T. Markoski, M. Grunevski, S. Jakimovska, S. Jovanoska; Skopje/MK Purpose: To estimate significance of iv application of paramagnetic contrast in MR imaging in diagnosis of parenchymal brain metastases, especially leptomeningeal carcinomatosis seeding from lung cancer. Next purpose is to compare sensitivity between CT and MR imaging. Material and Methods: Thirty-six patients with lung cancer were evaluated radiographicaly to determine the present of metastases in CNS. We used CT as a screening tool and MR after i.v. application of GdDTPA. Results: Our series with 36 patients included 27 or 75% with non small-cell lung cancer and 9 patients or 25% with small-cell lung cancer. Three patients (33%) of 9 with small-cell lung cancer had occult metastatic disease to the brain. Eight patients (28%) of 27 with non small-cell lung cancer had metastatic disease to the brain parenchyma. In this series, leptomeningeal metastases were not found. CT scans were performed in all 27 patients, MRI was performed in 15 cases, some with i.v. application of GdDTPA, and in 8 patients brain metastatic disease was found. Post contrast MR imaging presents leptomeningeal carcinomatosis as thin linear enhancement along the cortical surface, which follows the gyral pattern of the cortex. Conclusion: All patients with lung cancer have to be investigated for brain metastases because of a great percentage (about 30%) of occult metastatic disease. Contrast enhanced MR of the brain is a superior method compared to CT because of excellent contrast resolution, is safer and has multiplaner abilities. To demonstrate meningeal seeding, contrast enhanced MRI is the modality of choice. Evaluation of the uselfulness of high b-value diffusion-weighted MR imaging in patients with acute cerebral infarction H. Hirota 1 , E. Shimosegawa 2 , K. Takahashi 3 , M. Mineta 1 , T. Yamada 1 , W. Yamamoto 1 , K. Nagasawa 1 , H. Sato 1 , T. Aburano 1 ; 1 Asahikawa/JP, 2 Akita/JP, 3 Iowa, IA/US Purpose: We occasionally encounter cases without distinct abnormal findings on conventional diffusion-weighted MR imaging despite there being obvious clinical findings of acute cerebral infarction. Our purpose was to evaluate positive predictive value of high b-value diffusion-weighted MR imaging in subjects with acute cerebral infarction. We prospectively assessed 21 subjects with acute cerebral infarction within 12 hours from the onset. All examinations were performed with 1.5 T unit using single-shot echo planar diffusion-weighed MR imaging at three different b values of 1000, 2000 and 3000 s/mm 2 . Seven days later from the onset, we re-examined the subjects with T2 weighted image for confirming the final diagnosis. Four experienced neuroradiologists assessed each diffusionweighted images for the presence of cerebral infarction and then compared the findings of each images with those of T2 weighted images. We divided the findings of each diffusion-weighted images into five categories by location of abnormal signal intensities and calculated true positive rate in each categories. Purpose: Arterial visualization of intracranial 3D-CTA is difficult in the area of the skull base. This is due to the close proximity of the internal carotid artery and skull base and the fact that they both have almost the same CT values. Accordingly, subtraction artifacts due to misregistration are unavoidable using the conventional subtraction method. Even a slight difference of the start position in data between pre-and post-contrast CT may lead to the production of considerable artifacts. Nowadays, subtraction of two sets of volume data has become possible on a workstation. We assessed whether this technique was useful in intracranial 3D-CTA. Methods and Materials: Subtraction was performed in both phantom and patients and the accuracy was tested. Results: Precise measurement was shown to be possible in the phantom experiment. Following this, several clinical cases were applied. Conclusion: Subtraction is effective due to being almost free of misregistration. Does an interpolated high resolution matrix improve the detection of brain hyperintensities on FLAIR images in multiple sclerosis? F. Sardanelli, A. Fausto, G. Spadaccini, B. Cotticelli; Milan/IT Purpose: To test whether an interpolated high resolution matrix improves the detection of brain hyperintensities on FLAIR images in multiple sclerosis (MS). Materials and Methods: Seven MS patients (1 male, 6 females, 23-68 years old, median 36) underwent brain MR at 1.5 T using a fast-FLAIR para-axial sequence (TR/TE/TI = 8300/135/2500 ms; FoV 230 mm; 20 no-gap 5-mm slices; matrix 256 x 256; pixel size = 0.9 x 0.9 mm; time 3'36"). The sequence was repeated changing only from the standard 256 2 matrix to an interpolated 512 2 matrix with a pixel size of 0.45 x 0.45 mm. The two sequences were read on a remote console in a random blinded fashion, using a one-in-one format and free windowing, grading them as certain (C) or probable (P); for confluent plaques, only the lesions with more than half the contour detectable were counted. Wilcoxon test was used. Results: A total of 530 hyperintensities (C/P = 401/129) with 256 2 and of 550 (431/119) with 512 2 were counted. They ranged in total 9-147 (median = 72) with 256 2 and 8-178 (79) with 512 2 ; C hyperintensities 3-127 (60) and 3-160 (59); P hyperintensities 6-25 (20) and 5-29 (18), respectively. Data were similar in 6/7 patients; in the remaining patient (female, 36 years old) total hyperintensities were 147 (256 2 ) and 178 (512 2 ), with a C/P of 127/20 and 160/18, respectively. In spite of this outlier, no significant overall difference was found between 256 2 and 512 2 for total, C, and P hyperintensities (p > 0.447). Conclusion: Interpolated matrices do not significantly improve the detection of brain hyperintensities on FLAIR images in MS. A method for reducing radiation exposure in cerebral perfusion study using multi-detector row CT T. Nanjo 1 , K. Murase 1 , Y. Sugawara 2 , M. Hirata 2 , T. Mochizuki 2 ; 1 Osaka/JP, 2 Onsen-gun/JP Purpose: Radiation exposure during CT perfusion study is a serious problem. The purpose of this study was to devise a method for reducing radiation exposure in cerebral perfusion studies using multi-detector row CT. Methods and Materials: Nine patients (6 males and 3 females; mean age 68.4 years) participated in this study. Following a standard protocol for CT perfusion study, continuous (cine) scans (0.8-1.0 sec/rotation x 60 sec) consisted of four 5-mm-thick contiguous slices performed after an injection of iodinated contrast material (30-40 mL) using a multi-detector row CT scanner (Light Speed QX/I, GE). New image data were generated by thinning out the original images thus acquired. The thinned-out images were interpolated by linear or cubic interpolation. The functional images of perfusion parameters such as cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were generated from these images by applying deconvolution analysis based on singular value decomposition pixel by pixel. We calculated the correlation coefficients between the perfusion parameters obtained from original and thinned-out images for 15 regions of interest in the grey and white matter. Results: When using 10 continuous images with a scan time of 0.8-1.0 sec and the thinned-out images with a scan interval of 1.6-2.0 sec, the radiation exposure could be reduced to 56.0-58.3%, with the correlation coefficients of CBF, CBV and MTT being kept greater than 0.9. Conclusion: This method can reduce radiation exposure while keeping the accuracy of perfusion parameters equivalent to that obtained from original images. Dynamic scanning. The data acquisition conditions (analysis algorithm, analysis matrix, contrast medium injection rate, image reconstruction algorithm and exposure dose) were optimized while maintaining high quantitative analysis capabilities. Cerebral blood flow was then measured in 13 volunteers in their 20 s, 10 in their 30 s, 12 in their 40 s, 14 in their 50 s, 11 in their 60 s, and 10 in their 70 s. None of the subjects had cerebral blood flow disorders. Results: The use of optimized data acquisition conditions provided high reproducibility while permitting the exposure dose to be reduced by 50% or more. A decrease in cerebral blood flow with advancing age was confirmed in CT dynamic perfusion studies. The use of optimal data acquisition conditions allows the exposure dose to be reduced and provides high reproducibility while permitting acceptable quantitative cerebral blood flow analysis. This has made it possible to determine age-specific normal values for cerebral blood flow in dynamic CT perfusion examinations. It is expected that dynamic CT perfusion analysis will prove clinically useful for the assessment of diffuse cerebrovascular diseases and chronic-stage blood flow disorders, as well as for the diagnosis of acute-stage cerebral infarction. Diffusion weighted imaging (DWI) EPI on low field MR system (0.2 T): Comparison with 1.5 T and preliminary report on clinical use in brain ischemia P. Purpose: This study assessed the diagnostic value of low field DWI in brain stroke. The secondary goal was to compare apparent diffusion coefficient (ADC) values obtained in high and low systems. Methods: DWI were performed in 2 groups of volunteers, on 0.2 T and 1.5 T systems. DW images at b = 0 and 900 mm 2 /s were recorded. ADC values from 17 regions of interest (ROI) were compared. Forty patients with acute symptoms of CNS stroke were examined by CT and MR, 2-10 h after symptoms onset. DWI-EPI images were obtained. Follow-up MR 2 weeks later were set as a reference. Results: Statistical analysis showed significant differences of ADC values dependent on ROI location within the brain hemisphere. There was no difference between right and left hemisphere. ADC values for low and high field systems were similar. In 30 patients, ischemic lesions were found in the first examination. Follow-up confirmed 24 infarcts. Four patients out of 10 with negative DWI revealed infarction in follow-up MR. Sensitivity, specificity, and diagnostic accuracy were 87.5%, 50%, and 78%, respectively. Conclusions: Low field systems are capable of diffusion weighted imaging. For the same b value, ADC values at 0.2 T and 1.5 T are similar. In clinical practice DWI on low field MR systems can be used as a fast and reliable tool for detection of acute ischemic lesions in the brain. Advantages of a 3D multislab T2 turbo spin echo magnetic resonance (TSE MR) sequence for high resolution brain imaging B. It is feasible to scan the whole brain with T2 contrast in 1 mm³ isotropic resolution with high SNR and CNR using a multislab 3D TSE sequence. Postoperative multidetector-row CT angiography ( (2), hemimegalencephaly(2), bilateral perisylvian syndrome(2), lissencephaly(2) and focal cortical dysplasia(9). All were the subject of conventional brain MR imaging studies using the MP-RAGE (magnetization-prepared rapid gradient-echo) sequence and the resulting 3-D data sets were processed on a commercially available workstation. Abnormal gyral configurations were reviewed. Results: Abnormal gyral patterns were seen 15 of 18 patients. The configuration and orientation of affected gyri were clearly evaluated in the brain surface-rendering image. In two cases of the schizencephaly (involved the frontal lobe), there were wheel shaped broad gyral pattern of the superior, middle, and inferior frontal lobes. In two cases of the hemimegalencephaly, there were thick gyral pattern and enlarged ipsilateral brain. In two cases of the lissencephaly, the frontoparietal cortex was not delineated and showed a markedly thick and smooth gyral pattern. In two cases of the bilateral perisylvian syndrome, there were opened insular cortex and a thickened gyral pattern. In the focal cortical dysplasia, there were irregular serrated or thick and enlarged gyri. In patients with cerebral cortical dysplasia, brain surface-rendering MR imaging detects a detail gyral pattern and involvement site of abnormal gyri. It can create difficulties in the differential diagnosis and can therefore cause problems in choosing the appropriate therapy. This is especially true in cases with Alzheimer's versus Lewy-body disease ((DLB), which require different therapeutical approach. We applied 1H-MRS to assist the diagnostic process and to look for specific differences in the metabolic content of the brain tissue in these two entities. Methods: 1H-MRSwas performed using 1.5 T scanner in T1-weighted images in 3 orthogonal planes in 24 elderly subjects with consensus criteria DLB (n = 12), NINCDS-ADRDA AD (n = 12), and normal control subjects (n = 10). 1H-MRS was performed with single-voxel (SVS) technique using STEAM sequence (TR 2000 ms, TE 20 ms). Voxel was positioned in the temporal, occipital lobe and centrum semiovale. Results: In both Alzheimer's and Lewy-body group, 1H-MRS showed changes in the metabolite pattern in all voxel locations, with the most distinct expression within temporal lobes. NAA and creatine peaks were lowered in both patients groups, comparing to the controls. In spectra of Lewy-body patients myoinosytol peak remained unchanged as opposite to the Alzheimer's where it was increased. Conclusions: 1H-MRS can be an additional, very important tool in dementia studies and differential diagnosis of this group of diseases. In DLB patients 1H-MRS is feasible but there are difficulties in scanning patients in the later stages of the illness due to tremor and the degree of brain atrophy. The activation tasks consisted of left finger movement, sensory stimulation, listening to comprehension (for sensory language area), word generation (for motor language area) and working memory. The reference function was boxcar waveform. Activation maps were thresholded at uncorrected p = 0.0001. The thresholded activation maps were placed into Talarach's space. Results: Cerebellar activation was observed in the motor, the word generation and the working memory tasks. In the hot sensory and listening comprehension tasks, there was not any visible activation in the cerebellum. Left and right posterior cerebellar (Declive) activation was observed in the left motor task. Ipsilateral cerebellar activation was more prominent than contralateral cerebellar activation during the left motor task. Left posterior cerebellar (Declive) activation was observed in the working memory task. Left posterior cerebellar (Declive) and both anterior cerebellar (Culmen) activations were noted in the word generation task. Conclusion: Cerebellar activation was observed in the afferent actions of the brain including motor, motor language and working memory tasks. There was no activation of the cerebellum in the efferent action of the brain including sensory and sensory language tasks. The cerebellum is involved in a variety of functional tasks including motor, word generation and working memory. The brain smell centres: Comparison of localisation and activation in male and female subjects using functional MR imaging (fMRI) M.D. Marchwicka-Wasiak, B. Goraj; Lodz/PL The study was conducted in order to determine and to compare the location and activation of smell brain centres in females and males brains using olfactory nerve-mediated (geraniol) and combined olfactory and trigeminal nervemediated (patchouli) stimulants. Methods: Ten normal volunteers (five women and five men), right-handed, nonsmokers, without any CNS diseases were examined to determine the activated cortex areas during stimulation by geraniol and patchouli. MR brain scans were obtained using a 1.5 T clinical scanner, with the head-neck coil. The imaging was performed in each subject using SE and EPI sequences with a blood-oxygenlevel-dependent (BOLD) effect. The individual inhaled odorized air during the 30 seconds period and alternating room air over the same period. The mean pixel intensity of activated images was substracted from the mean pixel intensity of preactivated images. Results: The olfactory system-mediated stimuli (geraniol) evoked bilateral activation of female brain smell centres compared to right hemisphere centre activation in male brains. The exposure to the olfactory and trigeminal nerve-mediated stimuli (patchouli) showed more activated regions in both sexes than to the olfactory nerve-mediated stimuli. Conclusion: fMRI proved to be a useful method to compare the location and activation of male and female brain smell centres. We compared the group of PSP patients with that of control subjects and found a highly significant difference in antero-posterior midbrain diameters (Mann-Whitney test: P < 0.005), absolute midbrain volumes (P < 0.005) and NAA/ Cr ratios (P < 0.01), as well as a significant difference in total intracranial volume-normalized midbrain volumes (P < 0.03). We also found out a significant correlation between NAA/Cr ratios and antero-posterior midbrain diameters in PSP patients (Spearman's rank correlation test: rs = 0.7619, P < 0.05). The aim of this study was to compare the diagnostic accuracy of T2 fast spin echo (T2FSE), fluid attenuated inversion recovery (FLAIR) and inversion recovery (IR), in evaluating hippocampal sclerosis and to determine a costeffective protocol for this disease process. In this prospective study, 48 patients (aged 6 months-55 years) with drug-resistant temporal lobe epilepsy (based on clinical symptomatology and electroencephalographic (EEG) registrations) were evaluated by MRI with a 1.5 Tesla unit. The protocol consists of axial T1 and PD/T2 SE, and FLAIR, T2FSE and IR in a coronal plain perpendicular to the long axis of the hippocampus. Whenever necessary, we applied T1 + Gd SE in axial and coronal planes. Films were interpreted by two experienced neuroradiologists. Sequences were statistically analyzed in pairs using Wilcoxon Sign Ranks Test. Results: There were 33 patients (68.75%) with MR and EEG findings suggestive of hippocampal sclerosis. Eight of them underwent therapeutic surgery and there was histopathologic confirmation of the diagnosis. FLAIR detected hyperintensity of the hippocampus in 31/33 (94%) and was much more sensitive than T2FSE (18/33 p = 0.002) and PD/T2 (11/33 p = 0.000). Reduced hippocampal size (28/ 33), atrophy of hippocampus (22/33) and enlarged temporal horn (24/33) were better detected with IR than T1 (9/33 p = 0.000). Conclusion: A MR protocol using thin coronal sections angled perpendicular to the hippocampus with FLAIR and IR sequences is cost-effective for mesial temporal sclerosis because it is highly sensitive, inexpensive, quick and easily applicable in most units. Reversibility of the brain white matter changes in adults with late diagnosed and treated phenylketonuria M. Gizewska, L. Cyrylowski, D. Koziarska, P. Nowacki, A. Walecka, M. Walczak; Szczecin/PL Purpose: Phenylketonuria (PKU) is an autosomal recessive disorder related to absent or reduced activity of phenylalanine hydroxylase what leads to increased plasma phenylalanine (Phe) concentration. Because screening the whole newborn population for PKU in Poland began in the late 1980s, many PKU adults have been diagnosed and treated very late. Patterns and extent of the brain white matter changes in these patients is described. In this paper, 13 late diagnosed and treated adults with PKU, including 9 males and 4 females, is presented. The mean age at diagnosis was 37.2 y (range 18 -50). Microcephaly was present in 7, seizures in 4, aggressive behavior in 3; all but one had speech difficulties, including total mutism in 7. MRI of the head was performed on 1.5 T unit with FSE and FLAIR sequences without contrast medium administration. Results: MRI of the head detected white matter changes, hyperintense on T2weighted images, in all but one patients. All but one of them had changes in parietal and/or occipital regions. The treatment with low-Phe has been introduced in 3 with improvement in all of them. The follow-up MRI were performed after mean 8.7 months, revealing decreased severity of the white matter changes in all, from mean 20 (according to Cleary's scale) on the initial MRI to 7.3 on the follow-up. Our results indicate the possibility of white matter changes reversibility in late diagnosed and treated PKU adults. Conclusion: DWI is thought to be useful in the diagnosis of CNS infections. In our experience, DWI may allow the differentiation of brain abscess from necrotic or cystic brain tumor. DWI is also a useful tool to differentiate subdural and epidural empyemas. Detection . Coronal views were performed for FLAIR imaging, and coronal and axial views for DP and T2-weighted imaging. Images were reviewed by two seniors radiologists in consensus for localisation of the signal abnormalities. Results: Lesions of the olfactory system were observed in 23 patients (82%). Signal abnormalities were localised in the temporal lobe in 15 cases (54% with 10 cases of unilateral lesions and 5 cases of bilateral lesions) and in the orbito frontal cortex in 19 cases (68% with 17 cases of bilateral lesions and 2 cases of unilateral lesions). With FLAIR, DP, and T2 weighted imaging, lesions was detected respectively in 56%, 38% and 48%. Olfactory bulb signal abnormalities were diagnosed in 19 cases (68% with 3 cases of unilateral lesions and 16 cases of bilateral lesions). For this localization, the accuracy of FLAIR, DP and T2 sequences was respectively 46%, 63%, 54%. In post-traumatic anosmia, coronal FLAIR and coronal PD imaging is required to detect respectively signal abnormalities in the parenchyma and in the olfactory bulbs. T2 weighting imaging seems to be inferior. Cerebral hydatid disease: CT and MR imaging findings Y. Bükte, S. Kemaloglu, H. Nazaroglu, A. Uyar, C. Akgül, M. Simsek; Diyarbakir/TR Purpose: Cerebral hydatid disease is very rare, representing only 2% of all cerebral space occupying lesions, even in the countries where the disease is endemic. The aim of this study was to describe the discriminative computed tomography (CT) and magnetic resonance (MR) imaging features of cerebral hydatid disease. We retrospectively reviewed the imaging findings of 18 patients with pathologically confirmed cerebral hydatid disease over a period of 13 years (1990) (1991) (1992) (1993) (1994) (1995) (1996) (1997) (1998) (1999) (2000) (2001) (2002) . Among these patients, there were 17 cases of Echinococ-B D E F A G cus granulosis and 1 case of Echinococcus multilocularis (alveolaris). They were 12 male (66.7%) and 6 female patients (33.3%), ages ranging from 7 to 50 years with an average age of 21.8 years. Results: Common CT and MR imaging findings of E. granulosis lesions were well-defined, smooth thin-walled, round or spherical, homogeneous cystic lesions with no contrast enhancement, no calcification and no surrounding edema. The lesion seen in E. multilocularis showed a well-defined multiseptated mass consisting of solid and cystic components with calcifications of solid portions. Cystic lesions with surrounding hyperintense area of perifocal edema, complete and incomplete rim of contrast enhancement were seen in two patients and were labeled as complicated and infected cysts. Conclusion: Although the cystic cerebral hydatid disease could be equally well demonstrated on CT and MR examinations, CT is superior in detecting calcification of the cyst, when present. MR is better in demonstrating cyst capsule, detecting multiplicity and defining the anatomic relationship of the lesion with the adjacent structures and helps in surgical planning. CT it may be used to identify regional differences within a patient. Qualitatively, single scan CBV maps were noisier than maps using the dynamic method. Conclusion: CBV estimates from a single contrast-enhanced scan may identify abnormal areas. However, differentiation between normal and abnormal regions is not as pronounced as when using quantitative, dynamic methods. Virtual endoscopic imaging of cerebral CT angiography (VECCTA) in selecting patients for neurosurgical intervention or endovascular treatment R. Prpic-Vuckovic, M. Rados, M. Batinica, J. Papa, M. Seronja-Kuhar; Zagreb/HR Purpose: To assess the usefulness of virtual endoscopic cerebral CT angiography data analysis in patients with aneurysm rupture before making a decision between neurosurgical intervention or endovascular treatment. Materials and Methods: During a one-year period, MSCTA was performed in 35 patients after a conventional CT proven subarachnoid hemorrhage. Images were acquired using MSCT LightSpeed Ultra, GE. Helical data acquisition followed after rapid i.v. administration of contrast material (3.5 mL/sec), with 18-23 sec delay. Data was postprocessed on GE Advantage Workstation Ultra v4.0 using reconstruction protocols MIP (maximum intensity projection), SSD (shaded surface display), VR (volume rendering) and VE (virtual endoscopy). Results: Detailed analysis of aneurysmal neck, dome, vessel of origin and surrounding vascular or bone structures was acquired by SSD, MIP or by high-accuracy VR protocol. Modified surface rendering and VE protocol were used for endoscopic mode viewing to visualize neck shape, accessibility from the parent vessel, presence of thrombotic clots or calcifications inside the aneurysm and vessel of origin, as well as to define orifices of branches arising from the dome. Conclusion: Accurate characterization of morphology of the aneurysm, especially depiction of orifices and aneurysmal neck are essential for choice between neurosurgical intervention or endovascular treatment. When endovascular treatment is an option, it is useful to know angulation between parent vessel and neck and real volume of aneurysmal dome for proper estimation of coil size and shape. VR and VE imaging of the aneurysmal sack and surrounding anatomy may provide additional useful information for endovascular treatment or neurosurgical intervention. We have demonstrated the existence of non-monoexponential diffusion in the human CSC that can be approximated by fast and slow diffusion components. Our results are within the limits of human brain and full DTI data for the rat spinal cord. The aim of this study is to review the embryology and the development of this structure. To describe the normal CT and MR appearances and to show the neuroradiological findings of pathology that can effect the craniocervical junction. Background: The craniocervical junction is an anatomical crossroads with characteristic pathologic entities, mainly malformative and traumatic in origin. We illustrate the normal anatomy of the craniocervical junction and a wide spectrum of pathological conditions involving this structure through a selection of cases from a retrospective review of the CT, MR and plain-film examinations carried out in our centre over the last five years. Imaging Findings: Normal anatomy and a wide spectrum of pathologies affecting the craniocervical junction are illustrated by CT and MR examinations. We group the findings according to etiology: Malformation, trauma, infection, inflammatory and tumor, placing emphasis on the radiological features and the differential diagnosis. Conclusion: CT depicts the bony structures of the craniocervical junction superbly while MRI shows the neurological components better, enabling excellent characterization of lesions and recognition of all potential types of disorders that need to be recognized by general as well as neuroradiologists. The spectrum of T1 hyperintensities of the sellar region F. With the introduction of high field strength it is expected to overcome the limited signal to noise ratio and subsequently decreased spatial resolution in routinely used standard field strength 1.0 -1.5 Tesla MR scanners. This would have clinical impact in the preoperative work up of patients with sellar processes. Imaging Findings: In this exhibit we present a large variety of sellar diseases using 3 Tesla MR imaging with emphasis on detection of microadenomas and visualization of anatomic structures. Furthermore, the differentiation between infiltration or just compression of the medial wall of the cavernous sinus in case of macroadenoma is illustrated. The excellent visualization of normal anatomy and tumor topography makes this technique a very valuable tool for planning neurosurgical operations. CNS manifestations following stem cell transplantation: A pictorial review D. Beckett, A. Banerjee, J. Oliff; Birmingham/UK Learning Objectives: To illustrate the spectrum of radiological manifestations in the central nervous system and head and neck following stem cell transplantation for haematological malignancy. To outline the advantages and limits of plain film radiography, cross-sectional imaging, interventional radiology and radionuclide imaging. Background: Bone marrow transplantation (BMT) is a critical therapeutic intervention for a variety of pathological conditions. The complications of BMT include chemotherapy and radiation toxicity, graft versus host disease, recurrent malignancy, infection and miscellaneous conditions. Complications of allogenic BMT manifest in a variety of clinical settings. The neurological system is commonly affected. In this presentation we will review the incidence, clinical presentation and the radiographic findings of CNS involvement following stem cell transplantation. Plain radiography, contrast material enhanced studies, sonography, CT, MRI and interventional techniques are essential in diagnosing these complications and evaluating their response to therapy. Imaging Findings: Findings may be broadly classified into either infective, cerebrovascular or treatment induced. Common infective manifestations include human herpes virus 6, invasive mucormycosis and central nervous system tuberculosis. Classical image findings of haemorrhage and infarction are seen in addition to graft versus host disease cerebrovascular angiitis. Infarcts, diffuse white matter disease and cortical atrophy are seen following total body irradiation. The imaging findings of posterior leukoencephalopathy in cyclosporin toxicity is illustrated. The spectrum of imaging findings in the central nervous system is diverse. A firm understanding of the clinical presentations and incidence in combination with typical radiological findings is essential in the successful management of this patient sub-group. B D E F A G Background: Diffusion weighted imaging has been widely used in stroke patients to detect early acute cerebral infarction and find out ischemic penumbra. However, we often unexpectedly encounter restricted diffusion on DWI of nonvascular origin mimicking hyperacute or acute infarction in clinical practice.We reviewed nonvascular diseases with restricted diffusion on DWI for past three years by retrospective selection. Imaging Findings: The characteristic findings mimicking hyperacute or acute infarction are high signal intensity and low apparent diffusion coefficient values, mainly distributed in the white matter and incompatible with arterial territory with no stenoocclusive lesion on MR angiography or conventional angiography, and are reversible. These findings may increase possibility of nonvascular diseases such as infection, inflammation (viral or bacterial encephalitis), hemorrhage, leukodystrophy, toxic (anti-cancer drugs, CO poisoning), metabolic origin and tumors. Conclusion: We present various diseases, under certain clinical settings, and systematically discuss the mechanism of restricted diffusion in a limited number of specific diseases. Background: In patients with vitamin B12 deficiency, symptoms related to the spinal cord may often help to find the diagnosis. However, in patients with atypical symptoms MRI shows typical findings often diagnostic for SCD. Beneath a general discussion, we present 2 cases of SCD in whom MRI findings were leading to the diagnosis of B12-deficiency. Patient 1 presented with tingling in her extremities. Neurologic examination showed a subacute loss of proprioception and profound loss of vibration sense. Vitamin B12 serum levels were normal. T2W-MRI showed increased signal in the posterior columns of the spinal cord. DWI showed disturbance of diffusion in the same location. Patient 2, who practiced a vegan alimentation, was admitted with incomplete paraplegia with signs of spasticity. Vibration sense and proprioception were impaired as well. MRI revealed the typical findings of severely increased signal within the posterior columns of the spinal cord. Both patients presented in very early stages of the disease. In summary, the MRI findings showed typical signal hyperintensities in T2W images in the posterior columns of the cervical and/or thoracic myelon-segments. Conclusion: Even in patients with subtle atypical symptoms, MRI with its typical findings often allows the diagnosis of SCD even in the rare case of normal levels of vitamin B12. Fiber tracking and tensor metrics in diffusion tensor MR imaging C.C.T. Lim, H. Yin, M. Xu, F. Hui; Singapore/SG Learning Objectives: To review anatomical patterns and distribution of white matter tracts in the brain and to understand the potential uses of diffusion tensor imaging (DTI), including pathological disruption and destruction of fiber tracts. Background: DTI is a new MR imaging technique that non-invasively visualizes white matter fiber tracts and may have potential to assess demyelination and other brain disorders. Using single shot echo planar imaging (TR 7000-9000/TE 90-100 ms, 3 mm section thickness, b value 800-1000 s/mm 2 in 6-54 non-collinear directions at 1.5 and 3 T) and offline post-processing of diffusion tensor metrics (fractional anisotropy, mean diffusivity and principal eigenvector) and fiber connectivity images (using fast marching tractography) could be studied. Imaging Findings: In normal patients, the fractional anisotropy (FA) maps clearly visualized white matter tracts as areas of high FA compared to gray matter. The corticospinal tracts, corpus callosum and optic radiations could be consistently identified. Abnormalities such as brain neoplasm, cerebral infarction and multiple sclerosis lesions showed decreased fractional anisotropy and elevated mean diffusivity. Principal eigenvector maps of water diffusion showed deviation in the direction of the white matter tracts surrounding benign brain neoplasms and malformations. Conclusion: Quantitative in vivo information on water diffusivity, degree of directionality and directional vector in space, that are not available on conventional MR imaging, can be measured in DTI studies. With a potential new clinical application of DTI, radiologists should be familiar with anatomy and pathology of the white matter fiber tracts. Neuroimaging of Background: Multiple gliomas are rare findings with variable incidence (2.4 to 10%). They can by classified according to: a) Time of presentation as early = synchronous (at initial diagnosis) or late = metachronous (diagnosed during the treatment); b) The imaging characteristics as multicentric (arise independently in different sites, there is absence of macroscopic connections or way of dissemination) or multifocal (they spread from primary tumor to other areas in the brain, with evidence of routes of dissemination). We reviewed documentations of 109 patients with diagnosis of glial tumor WHO grade III-IV who underwent surgery between January 2001 and December 2002. In all patients radiological and histological diagnosis was performed and 8 cases were established as multiple glioma. Imaging Fingings: Most of the patients had one bigger lesion and 2 or 3 smaller ones. The lesions were usually hyperintense on T2-weighted images and hypoor isointense on T1WI with strong postcontrast enhancement. Most of them had moderate edema. We recognized 6 multicentric and 2 multifocal gliomas, 7 were synchronous and one metachronous. Conclusion: Multiple gliomas are often radiologically reported as metastasis, sometimes as lymphomas or infectious diseases. The differential diagnosis of multiple masses in the brain is very important for therapeutic consequences and multiple glioma should considered because of suggested increasing frequency of this entity. If strong postcontrast enhancement and moderate edema around the lesions are observed, this diagnosis should be suggested. Role Background: GKS is a method of treatment allowing the delivery of a conformal radiation dose to a stereotactically defined target. The significant development of interest in the role of GKS as an alternative or adjunct to the neurosurgical management of many brain disorders, requires accurate and reliable methods of acquisition of image modalities for the stereotactic planning. Imaging and Procedures: Between December 1999 and August 2003, we treated 650 patients for a large variety of indications (metastases 26%, vascular malformations 7%, trigeminal neuralgia 14%, pituitary adenoma 3%, primary brain tumor 8%, other tumors 6%, vestibular schwannoma 19%, meningioma 18%, other functional < 1%). All patients had an MRI combined with CT in stereotactic conditions. Some patients also benefited from stereotactic DSA (n = 43) or PET (n = 57). In all cases, MR was used to delineate a target before radiosurgery. CT was always used as a control for MR distorsion. DSA was used in combination with angioMR for all arteriovenous malformations. When the tumor was ill-defined, we anticipated some limitation of target definition (infiltrative lesions, recurrence of metastases, pituitary adenomas) and also used stereotactic PET. We present a pictorial review illustrating the role of neuroimaging for appropriate targeting in GKS. These images are also critical for the evaluation of the potential risks and complications. The complementary information provided by the combination of various imaging modalities allows appropriate and accurate delineation of a target volume before stereotactic irradiation. To familiarize non-Greek radiologists with the definition of Greek eponyms and to emphasize on those terms and words that have been derived from Greek mythology. Background: Medical eponyms serve as mnemonics, add color to medical writing and are useful shorthands in medical communications. A long catalogue with the most representative Greek medical terms is listed. The exact definition and meaning of each word is explained and a short narrative of the relative myth is presented for the neuroanatomical terms which gained their name from Greek mythology. Conclusion: Accurate knowledge of the meaning of these words will help the radiologist to remember the terms and make their learning fun. Preoperative To present the potential of diffusion tensor imaging (DTI) and colored coded fractional anisotropy (FA) maps in identifying the anatomy of white matter tracts for pre-operative planning. Materials and Methods: DTI data were acquired using DW-SE-EPI sequences and a 1.5 T MR-unit, with the following parameters: TR 6000-10000, 18-28 slices, 5 mm slice thickness, 1.5 mm intersclice gap, 64 x 64 matrix and gradients encoding in 25 directions, b-1500 sec/mm 2 . Data were acquired in normal subjects and 13 patients with brain tumors, AVM's or seizure foci being considered for surgery. FA images and corresponding colored coded maps were generated. Also, FSE T2 or FLAIR images were acquired in identical locations for comparative use. Results: Major white matter tracts (intrahemispheric, interhemispheric, and brain stem) were readily visualized, including the following: superior longitudinal fasciculuus, superior fronto-occipital fasciculus, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, uncinate fasciculus, corpus callosum, cingulum, optic radiations, anterior commissure, corona radiata, internal capsule, pyramidal tracts, medial lemniscus, medial longitudinal fasciculus, cerebellar peduncles and gracile and cuneate fasciculi. The spatial relationships of these tracts and resectable lesions were analysed, with particular attention to the risk of a postoperative deficit. All results were correlated with the pre-and post-operative deficits. Conclusion: White matter anatomy can now be imaged using DTI/FA and access to pre-operative eloquent white matter mapping has great potential to improve the outcomes of neuro-surgical candidates. The future management of neuro-surgical patients will be impacted by future refinements and developments of this technique. To present a retrospective analysis of our experience in the endovascular coil trapping for ruptured vertebral artery (VA) dissecting aneurysms. Materials and Methods: We treated 9 patients who presented with acute subarachnoid hemorrhage due to rupture of a vertebral artery dissecting aneurysm. Embolization of the entire segment of the dissected site with detachable platinum coils (internal trapping) was performed in all patients. In one patient with posterior inferior cerebellar artery (PICA)-involved VA dissecting aneurysm, internal trapping of the aneurysm followed by occipital artery-PICA bypass was performed by a neurosurgeon. Results: Coil embolization was successful in all 9 patients. There were no procedure-related complications. There was no sign of infarction in the PICA territory in all patients. There was no recurrent bleeding or ischemic symptoms during the follow-up periods. Follow-up angiography showed complete occlusion of the aneurysm without recurrence in all patients. Conclusion: Endovascular coil embolization is a safe and highly effective treatment of ruptured VA dissecting aneurysms. high-grade stenoses of the carotid artery were treated with stent implantation. DW MR imaging of the brain was performed a day before and after the endovascular treatment. All patients underwent neurological examination before and after the procedure. Results: DW MR images showed a total of 12 new hyperintense lesions in 5 (31%) of the 16 procedures performed. Eight lesions were ipsilateral to the treated vessel and 4 lesions, in 2 patients, were contralateral. These patients with contralateral lesions also had new ipsilateral lesions. The lesions were located in parietal lobe (n = 5), periventricular (n = 2), occipital lobe (n = 1), frontal lobe (n = 1) and corona radiata (n = 1). All lesions measured < 5 mm in diameter. None of the patients had neurological symptoms. Results: Angiographic occlusion was complete in 84 (72%) and 30 (68%) aneurysms in groups A and B, respectively. Mean percentage of volumic occlusion in these groups was 30.9 and 29.2%, respectively. Perioperative morbidity and mortality rates were 4 and 2%, respectively in group A, and were respectively similar in group B. No significant difference between the two groups was observed. However, percentage of volumic occlusion correlated with sac-to-neck ratio smaller than 1.5 (P = 0.061) and with sac size (P = 0.002), except when 3 or more threedimensional coils per aneurysms were used (P = 0.222). The better the percentage of volumic occlusion, the better the percentage of angiographic occlusion (P = 0.004). Percentage of volumic occlusion was an independent predictor of angiographic complete occlusion (P = 0.001). WFNS grade 5 was an independent predictor of perioperative mortality (P = 0.043). The use of three-dimensional coils improved the coil-packing and angiographic and volumic occlusion of aneurysms with a neck greater than 4 mm at the time of treatment, provided the sac-to-neck ratio was 1.5 or greater and the largest number of three-dimensional coils were positioned first. Minimum apparent diffusion coefficient: A quantitative parameter for prediction of malignancy of gliomas preoperatively X. Yun; Sendai/JP Introduction: In gliomas, choline signal (Cho) correlates with total membrane metabolism, apparent diffusion coefficient (ADC) inversely with cell density, Cho*meanADC with each cell's metabolism. We examined which parameter is the most reliable in prediction of malignancy of gliomas. Methods: Twenty-three pathologically proven glioblastomas (GBM) and 22 anaplastic gliomas (AG) were retrospectively evaluated with preoperative MRI with MR spectroscopy (MRS) and DWI. Ki67 index was counted to evaluate pathological malignancy. To evaluate clinical malignancy, we selected 31 cases in which at least enhancing lesions were removed and classified into progressed and stable groups. The minimum ADC (mADC) of GBM was shown to be significantly lower than AG (P = 0.0001). The highest value of mADC in GBM was 0.964, and the lowest in AG was 0.698. Using this threshold, 31 subjects were divided into 3 groups; A: GBM with mADC < 0.698 (n = 9); B:GBM and AG with 0.698 < mADC < 0.964 (n = 15), C: AG with mADC < 0.964 (n = 7). Six cases in group A were classified as progression (4 pathologically proven recurrence, two dissemination) and all cases in group C were stable. Six cases in group B showed progres-sion (2 recurrence, 1 dissemination). Fisher test showed significance (P = 0.03). In group B, the mADC of 5 progressive GBMs was significantly lower than 3 stable GBMs (P = 0.033). The nCho and nCho*meanADC showed no difference between GBM and AG (P = 0.12, P = 0.28). Inverse correlation was found between Ki67and mADC (P = 0.0005), no correlation was found between Ki67 and nCho (P = 0.22) and meanADC*nCho (P = 0.58). The mADC suggestive of cell density was the most reliable in prediction of malignancy of gliomas preoperatively. Usefulness Methods: Forty-one cases of skull base lesions (24 meningiomas; 6 petroclival, 7 clinoidal, 4 olfactory, 2 in foramen magnum, 2 spheno-petro-clival, 1 in the planum sphenoidale, 1 in posterior pyramid and 1 in PCA; 5 acoustic schwannomas, 3 epidermoids, 2 pituitary adenomas, 2 craniopharyngiomas, 2 posterior fossa aneurysms, 1 trigeminal schwannoma, 1 dermoid and 1 juvenile angiofibroma) have been evaluated. Data was collected, fused, integrated and reconstructed by a dedicated StealthStation system for neuronavigation. CT images were acquired on axial non-overlapping slices, 1-3 mm thick; MRI images were obtained with 1.5 T device, same field of view and thickness. Results: Neuronavigation was possible in all cases and was successfully applied in pre-operative planning and during surgical procedures. We calculated some data to check the efficacy of the method, having a mean fiducial error of 0.7 mm and an accuracy value at 6 cm of depth 1.7 mm. Discussion and Conclusion: Imaging fusion for pre and intra-operative neuronavigation provided, in all cases, great advantages in the choice of the best approach, placing of bone flap, early identification of deep normal or distorted anatomic or pathologic structures and their eventual encasement or involvement by the pathologic primary process, correct definition of tumor boundaries and meningeal implant and relationship with functional areas. Neuronavigation appeared ideal for skull base meningiomas making surgical maneouvres safer, more effective and less invasive. A study of MR diffusion changes in normal appearing white matter (NAWM) of patients with relapsing remitting multiple sclerosis (MS) F. Gaudiello, S. Marziali, A. Ludovici, E. Ferone, R. Floris, G. Simonetti; Rome/IT Background and Purpose: The aim of our study was to monitor water diffusion changes over time in NAWM of patients with relapsing-remitting MS and to monitor water diffusion changes in patients with different disability status (EDSS) and with different clinical status (Poussè). Methods: We selected 18 subjects who had completed a 6 month follow-up. The MR scans were obtained at baseline, at 3 months and at 6 months. Two regions of interest (ROI) were placed in each hemisphere in the NAWM in each MR study and the apparent diffusion coefficient (ADC) value were calculated in patients and in 15 healthy controls. Results: TADC in NAWM in patients was significantly higher then in controls (controls mean tADC ± sd = 0.731 ± 0.015 mm 2 /sec x 10 -3 ; patients mean tADC ± sd = 0.7655 ± 0.108 mm 2 /sec x 10 -3 ; p < 0.01). In NAWM in patients with higher EDSS, tADC was significantly higher then in patients with lower EDSS (patients with higher EDSS: mean tADC ± sd = 0.778 ± 0.044 mm 2 /sec x 10 -3 ; patients with lower EDSS: mean tADC ± sd = 0.752 ± 0.050 mm 2 /sec x 10 -3 ; p < 0.01). TADC in NAWM in patients with Poussè was significantly higher then in patients without Poussè (patients with Poussè mean tADC ± sd = 0.786 ± 0.022 mm 2 /sec x 10 -3 ; patients without Poussè mean tADC ± sd = 0.760 ± 0.049 mm 2 /sec x 10 -3 ; p < 0.01). Purpose: Evaluation of uveal melanoma imaging characteristics in ultrasound, computed tomography and magnetic resonance imaging and correlation of those findings suggestive of melanoma. Material and Methods: Eleven patients (8 men, 6 women, age 30-75 years) with possible diagnosis of uveal melanoma were evaluated. The patients underwent ophthalmoscopic and ultrasonographic examination followed by CT and MR examination. CT imaging was performed with 3 mm axial pre-and post-contrast and coronal post-contrast sections. Axial and coronal 3 mm T1 and T2 images were obtained, followed by post-contrast T1 images in axial and coronal direction. Additional T1 fat-sat post contrast images were also obtained depending on the relative position of the melanoma in order to evaluate possible extra-orbital extension. Results: Of the melanomas, six were located in the left globe, ranging from 2 mm to15 mm in size and most commonly on the lateral wall. The tumors appeared as hyperechoic lesions on US with a reflectivity range of 50-70%, suggestive of melanoma. Retinal detachment was detected in four patients. On CT images the melanomas appeared as homogenous slightly enhancing lesions, while in two patients, the tumor was less obvious due to the retinal detachment. On MR images the tumors appeared as homogenous hyperintense lesions on T1WI in five patients. Characteristic signal void on T2WI due to melanin deposition was noted in three patients. Conclusion: Ultrasonography appears to be a valuable tool in tissue differentiation of uveal melanoma although magnetic resonance, and to a lesser degree, computed tomography are more specific in evaluating the extra-orbital extension. Purpose: Gadobenate dimeglumine (Gd-BOPTA: T1 relaxivity in blood = 9.7 mmol -1 s -1 ) was evaluated to determine whether the high relaxivity offers advantages over other agents for CNS imaging. Methods: Preliminary studies evaluated Gd-BOPTA at cumulative doses up to 0.3 mmol/kg to ascertain the optimal dose for MRI of cerebral metastases. Two Phase III controlled trials were conducted to compare Gd-BOPTA at cumulative doses up to 0.2 mmol/kg with gadodiamide (Gd-DTPA-BMA) at cumulative dose up to 0.3 mmol/kg. Two intra-individual, blinded, fully randomized comparative studies were conducted in patients with cerebral gliomas or metastases to determine differences in quantitative (tumor contrast, CNR ratios) and qualitative (lesion contrast, delineation, internal morphology, structure) enhancement parameters versus gadopentetate dimeglumine (Gd-DTPA) and gadoteric acid (Gd-DOTA) at a dose of 0.1 mmol/kg. In patients with metastases a dose of 0.1 mmol/kg Gd-BOPTA proved sufficient for most situations while a cumulative 0.2 mmol/kg dose provided additional information in certain cases. Comparative studies revealed that 0.1 mmol/ kg Gd-BOPTA offers improved performance compared to 0.1 mmol/kg Gd-DTPA-BMA and that cumulative 0.2 mmol/kg Gd-BOPTA is equivalent to cumulative 0.3 mmol/kg Gd-DTPA-BMA. The intra-individual comparative studies revealed superior qualitative enhancement performance for Gd-BOPTA compared to both Gd-DTPA and Gd-DOTA for all evaluations. The subjective assessments were confirmed by the objective measurements of signal intensity and CNR which were significantly higher for Gd-BOPTA (p < 0.01). Discussion: Gd-BOPTA is a safe and valuable contrast agent for the assessment of CNS neoplasms offering statistically significant advantages over Gd-DTPA, Gd-DOTA and Gd-DTPA-BMA for brain lesion enhancement. The In 5 cases the examinations were performed before the treatment, in 4 patients as an assessment of drug treatment. In 7 cases the efficacy of stereotactic effect (SE) was assessed on the suitable target structures. Results: A metabolism decrease (MD) in the right caudate head (CH) was noted in two patients before drug treatment. In two patients hypermetabolism was observed in the anterior cingulate (AC). Follow-up examinations revealed a MD in the AC and an metabolism increase (MI) in the right CH in these patients. In one case an MI in both dorsal thalami (DT) was observed. A MD in both DT before drug treatment was seen in two cases. A bilateral MI was noted in DT by followup examinations in these patients. In all cases of SE, it revealed a MD in suitable structures. In 3 cases, a MD was observed in AC and both the CH. In two cases, a MD was seen in the AC, in 2 a bilateral MD in the DT. Changes of glucose metabolic rate were associated with severity of clinical manifestations in all cases. This data proves participation of limbicostriatal system in forming AOD. Our results demonstrate the possibility to use 18 F-FDG PET for AOD diagnosis and estimation of treatment efficiency. B D E F A G Magneting resonance imaging in 120 patients with intractable partial seizures: A preoperative assessment A. Lefkopoulos, A. Kalogera-Fountzila, C. Kouskouras, N. Fotiadis, G. Spanos, E. Papadopoulou, A.S. Dimitriadis; Thessaloniki/GR Purpose: The aim of this study was to assess the prevalence of detected structural abnormalities in medically intractable epilepsy, especially those who are amenable to a surgical therapy, and also to evaluate the sensitivity of different dedicated MR sequences. Materials and Methods: One hundred and twenty patients (aged 6 months-64 years) with medically intractable partial seizures underwent an MRI examination in a 1.5 T unit, with T1 and PD/T2 SE in an axial plane and fluid attenuated inversion recovery (FLAIR), T2FSE and inversion recovery (IR) in a plane perpendicular to the long axis of the hippocampus. Whenever necessary, we applied T1 SE + Gd DTPA in axial and coronal planes. Results: Seventy-nine of the 120 patients had a pathological scan (65.8%). Abnormalities were hippocampal sclerosis (HS) in 30 patients (25%), cerebral tumors in 12 patients (10%), vascular malformations in 9 patients (7.5%), cortical infarcts in 8 patients (6.7%), cerebral infections in 4 patients (4.2%) and 15 patients with developmental disorders (5 cortical dysplasias, 4 pachygyrias, 2 polymicrogyrias, 3 subcortical heterotopias and 1 patient with tuberous sclerosis). All patients with cerebral tumors and eight patients with HS were operated and there was a pathologic confirmation of the diagnosis. Patients with vascular malformation underwent a therapeutic embolization. FLAIR had higher sensitivity in detecting hippocampal sclerosis and cerebral infarcts while IR was particularly useful in detecting developmental disorders. Conclusions: MR imaging, with an epilepsy dedicated protocol, plays a cardinal role in locating and characterizing anatomic epileptogenic foci in patients with refractory epilepsy and helps in defining the type of treatment. The Purpose: The aim of this study was to evaluate the possibilities of combined PET/CT imaging in detecting glioblastomas and in estimation of efficiency of their surgical treatment and radiotherapy. Materials and Methods: Seven patients (4 men, 3 women, age between 26-70 years) with biopsy-proven glioblastomas were scanned before and/or after treatment by PET/CT (Biograph, Siemens). A dose of 180 to 220 MBq fluorine-18 fluorodeoxyglucose (FDG) was administered for each PET scan with an acquisition time of 6 minutes for bed and interactive reconstruction. Acquisition time for CT was 25 seconds, bringing the total acquisition of combined PET/CT study to 15 minutes. Results: Three patients with high-grade astrocytomas demonstrated hypometabolic FDG nodules without contrast enhancement at CT scan before surgery. Two patients showed nodules with hypermetabolism of FDG (SUV 16-18) and intensive enhancement of contrast medium due to the recurrence of tumor after combined therapy. In one patient, after radiation therapy, the region of treatment had decreased uptake of FDG and increased enhancement of contrast medium at CT because of radionecrosis. Conclusion: It was confirmed that combined PET/CT study could effectively determine whether a lesion was malignant and provide evidence of tumor recurrence. The collection of prominent medullary (white matter) veins appears like a "medusa head" on MR angiographic images and gadolinium-enhanced 3D-TOF sequences; this sign is considered pathognomonic. Conclusion: MRI is of great value in the accurate identification and morphologic specification of vascular abnormalities. Traditionally, these cases required invasive diagnostic imaging. VA correct identification is very important because this anomaly is asymptomatic but the ablation can induce venous infarctions. Abdominal Imaging Findings: Gastrointestinal tract (GI), hepatobiliary system and the pancreas are involved in CF. The GI complications include obstructive (distal intestinal obstruction syndrome, intussusceptions, fibrosing colonopathy, post surgical adhesions) and non-obstructive conditions (pneumotosis intestinalis, gastroesophageal reflux, duodenitis, and rectal prolapse). Liver pathology includes steatosis, cirrhosis, and portal hypertension. The pathological mechanism of cirrhosis may be due to obstruction of the biliary ductules with thickened secretions and secondary inflammation producing fibrosis. Biliary tract abnormalities include gallstones, micro gallbladder, and sludge. Excessive loss of faecal bile acids due to pancreatic insufficiency is associated with increased lithogenicity of the bile. The pancreatic abnormalities include fat infiltration, fibrosis, atrophy and occasionally cysts and calcification. The primary problem is the plugging of the intralobular ductules by inspissated viscid mucus. Conclusion: Abdominal symptoms in patients with CF may be due to the various causes related to CF or may be due to coincidental pathology e.g. appendicitis, renal disease. The radiologist should keep an open mind and not restrict his thought process only to the conditions related to CF. Neck masses in infants and children: A pictorial review J.R.A. Turkington, A. Paterson, L.E. Sweeney, G. Thornbury; Belfast/UK Learning Objectives: This poster presents a pictorial review of pediatric neck masses and their imaging features. Particular emphasis is applied to the anatomical site of the mass to aid in differential diagnosis. Background: Infants and children with neck masses frequently present to the radiologist for further evaluation. The most common aetiologies include congenital lesions and their complications, lymphadenopathy and malignant masses. The role of the radiologist is to differentiate between these conditions using im-aging modalities such as ultrasound and colour Doppler, CT and MRI. Where appropriate, the radiologist will also stage lesions for management purposes, and aid in guiding aspiration or biopsy. Imaging Findings: The radiological appearance of congenital lesions such as thyroglossal duct cysts, branchial cleft cysts, cystic hygromas, haemangiomas, dermoid cysts and sternomastoid "tumours" are discussed. Cervical lymphadenitis and abscesses, and neoplastic masses such as neurogenic tumours, rhabdomyosarcoma, neuroblastoma and lymphoma are also described. Lastly, lesions of the thyroid and salivary glands are evaluated. It must be emphasised that the radiological findings should always be interpreted in conjunction with the patient's age, the clinical history and the findings on physical examination. Conclusion: Neck masses are common in children and a frequent cause of attendance at A&E departments. Identifying the anatomical site and radiological appearance aids the differential diagnosis. Conclusion: A typical osteoarticular lesion in a typical site can alert you to the diagnosis of SAPHO, but an unusual site or a primary presentation with no skin lesions will make diagnosis harder or there may be misdiagnosis. Children may be seen in a number of specialties, which can lead to unnecessary delays in diagnosis and possible incorrect treatments. This makes the radiologist pivotal in the diagnosis of SAPHO, although the differential diagnosis should always be considered. To demonstrate the problems which can be caused when trauma X-ray films are incorrectly marked when using the red dot system. Background: Many radiographs are returned to Accident and Emergency departments without formal radiological reports, and the red dot system, whereby radiographers attach a red dot to radiographs which they suspect to be showing a fracture, is a widely practised system, used throughout the National Health Service. It is acknowledged that whilst this system can be beneficial to Accident and Emergency departments it is not without its problems. Procedure Findings: Our poster examines the problems which can arise in children where normal variants are often highlighted as "fractures" by radiographers. Most of the common misinterpretations occur in the appendicular skeleton, e.g. normal variants of epiphyseal ossification or accessory epiphyses, especially of the metacarpal and metatarsal bones. Other common "errors" include the pisiform, or os trigonum and accessory ossification centres for the medial and lateral malleoli. In the axial skeleton, vascular markings in the skull, facial bone sutures and end plate ossification centres for the vertebral bodies are some of the commoner areas of concern. Conclusion: Issues are raised for both Accident and Emergency departments and for Radiology departments if these "errors" are not minimised, including patient complaints of over-diagnosis and potentially unnecessary treatment and follow-up visits. The radiology of pediatric extracorporeal membrane oxygenation: Normal appearances and complications A.M. Barnacle, M.P. Hiorns; London/UK Learning Objectives: To demonstrate the normal appearances of the pediatric chest during extracorporeal membrane oxygenation (ECMO). The spectrum of radiological abnormalities arising from the complications of ECMO is illustrated, including cannula position and anticoagulation complications. Background: ECMO is a means of cardiopulmonary bypass therapy used in patients with cardiorespiratory failure who are unresponsive to conventional intensive care interventions. There is a range of indications for ECMO therapy in the pediatric population, which include congenital diaphragmatic hernia and cardiac disease. There are a number of complications associated with the use of ECMO, many of which are related to the high levels of anticoagulation required during therapy. Radiological assessment prior to the commencement of treatment and sequential imaging during therapy are mandatory, and appropriate imaging protocols are discussed. Imaging Findings: The normal radiological appearances of the chest during ECMO therapy are demonstrated, including the correct positions of both VA and VV ECMO cannulae. Several technical points are highlighted, to avoid the misinterpretation of certain radiographic appearances. The radiological manifestations of a wide range of complications are illustrated. These include intracranial haemorrhage and extra-axial collection, haemothorax, peritoneal collections and vascular complications. Inappropriate cannula positions are also reviewed. The radiologist must be familiar with both the normal and abnormal imaging appearances during ECMO therapy and should be aware of the range of potential complications. The importance of sequential imaging is highlighted and appropriate imaging protocols discussed. Acute disseminated encephalomyelitis or multiple sclerosis: What tips the balance? S. Avula, A. Ghatak, N. Wright, R. Appleton; Liverpool/UK Learning Objectives: To identify the imaging features and clinical parameters which help to distinguish between acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) in children. Background: Both ADEM and MS are disseminated inflammatory disorders affecting the central nervous system. Distinction between the two is difficult, especially at the initial presentation when the prognosis and risk of relapse is an important issue. This exhibit will highlight the salient distinguishing features stated in the literature and illustrate cases of ADEM and MS which presented over a three year period. Procedure Details: Literature review of childhood ADEM and MS was carried out and a retrospective review of cases presenting over a three year period with a subsequent diagnosis of ADEM or MS was performed. There is a considerable overlap between the imaging and clinical features of ADEM and MS. Though there are a few features that predominate in either condition, the temporal progression of the disease with presence of new lesions with or without relapse of symptoms as noted in MS, is the most important factor in distinguishing the two. MRI in assessment of fetal renal anomalies J.L. Hughes, W. Jan; London/UK Introduction: In patients with renal anomalies causing severe oligohydramnios, the lack of fluid around the fetus significantly degrades the ultrasound image, making assessment of the fetal abdomen difficult. The presence of renal anomalies has great postnatal significance and successful antenatal counselling depends on the availability of the most complete information. The advent of fast MR sequences has allowed the acquisition of high signal to noise ratio images of the fetus even in the absence of amniotic fluid. We discuss the technique of MR of the fetal renal tract. We describe the normal appearances fetal kidneys on MR and present data on illustrative cases where MR provided additional information over and above a detailed ultrasound examination. Methods: T2W single-shot Rapid Acquisition with Relaxation Enhancement (RARE) and T1W 2D Fast Low Angle Shot (FLASH) were obtained of the fetal kidneys in the three orthogonal planes. All images were acquired without fetal sedation with the mother in the supine position within 20 minutes. Comparison ultrasound and MR images are presented. Results: MRI is able to diagnose and assess a variety of renal anomalies such as renal aplasia, dysplastic renal tissue, polycystic kidney disease, congenital hydronephrosis, and ectopic renal tissue. Conclusions: Fetal MR offers further information over ultrasound examination and hence allows appropriate ante-natal counselling. Pediatric urethral anomalies A. Sharma, S. Maroo; Glasgow/UK Imaging evaluation of neonatal cystic pelvic masses V.V.T. Mascarenhas, A. Duarte, L. Lobo, J. Fonseca-Santos; Lisbon/PT Learning Objectives: To describe imaging features of cystic pelvic masses (CPM) in the newborn. To outline main differential diagnosic pitfalls. To emphasise the role of imaging evaluation in treatment and follow-up orientation. Background: Neonatal CPM are among the most common abdominal masses in the neonate and usually first suspected during fetal ultrasonography. A more precise diagnosis in the neonatal period is essential to an adequate orientation in treatment and follow-up. On this regard, imaging evaluation, particularly US and MRI as the main techniques, undertake a pivotal role. We describe diagnostic imaging features, differential diagnosis limitations and a systematic diagnostic approach to CPM among selected cases in our department. Imaging Findings: We reviewed the referred cases based on sex, location, relation to adjacent anatomic structures and morphological features. Main diagnostic entities considered were pre-sacral (sacrococcygeal teratoma and myelomeningocele) and non pre-sacral masses (genitourinary related namely hydrocolpos, ovarian cyst, bladder diverticulum; digestive tract related e.g. duplication cyst; others, particularly lymphangioma). Morphological imaging findings according to their uni-or multilocularity, simple or complex components and the presence of specific findings were considered. Ultrasound was the first and sometimes the only imaging modality performed. Selected cases were further evaluated with other imaging modalities such as conventional contrast studies (e.g. cystography) or MRI. Conclusion: Although there is a wide range of entities presenting as a CPM in the neonate, a systematic imaging approach allows a more precise diagnosis or at least a considerable narrowing of diagnostic possibilities in the majority of cases, which is essential for therapeutic orientation. Normal sonographic appearance of kidneys and adrenals in neonates and young infants: Unique distinctive features M. Vakaki, G. Pitsoulakis, H. Manoli, C. Koumanidou; Athens/GR Learning Objectives: To familiarize residents in radiology or pediatric radiology with the sonographic characteristics of neonatal and infantile kidneys and adrenals. Backround: The kidneys are the most commonly sonographically examined abdominal organs during the first months of life. The adrenals, due to their position adjacent to kidneys, are almost always clearly visualized during the renal sonogram. Their sonographic appearance is quite different from that in older children and adults and often causes misleading incorrect diagnoses. Imaging Findings: Examples of various normal sonographic findings of the kidneys and adrenals in neonates and young infants are presented and embryologically, anatomically or functionally explained. They include the hyperechogenicity of the renal cortex, the "enlarged" hypoechoic pyramids, the fetal lobulation, the inter-renicular septum, the transient neonatal renal medullary hyperechogenicity, the papillary projections in the pyelocalyceal system, the renal pyelectasis, the large and hyperemic neonatal adrenals and even more. These sonographic interpretations are often misdiagnosed as abnormal conditions, which are also provided. Conclusion: This exhibit will allow an interesting way for young radiologists and pediatric radiologists to learn the common, but also the rare sonographic appearances of neonatal and infantile kidneys and adrenals. This knowledge is essential in order to prevent misdiagnoses and needless further investigation. Background: Difficulties with blind corticosteroid injection of the subtalar joint are commonly encountered in children with JRA. Ultrasound (US) guidance can make the puncture more accurate by directly showing the needle tip within the joint. Procedure Details: Twelve consecutive patients with JIA who had clinical signs of active arthritis and intraarticular fluid or synovial proliferation in the subtalar joint detected at US received either a blinded injection (n = 7) or a US-guided (n = 5) injection with free-hand technique using high resolution (12-5 MHz) US. Patients were assessed at 24 hours, 2 months and 6 months of follow-up to compare the level of clinical response and the frequency of complications between the two treatment groups. Conclusion: Although significant improvement was documented in both groups of patients with respect to baseline, those injected under US-guidance had a lower clinical dysfunction score at 24 hrs and 2 months follow-up. No major complications were noted. Our preliminary results indicate that intraarticular corticosteroid injection of the subtalar joint in children with JIA is more accurate and successful when performed under US guidance. Background: Doppler sonography is a well-established technique to evaluate a number of pediatric abdominal conditions, but the field of diagnostic applications is now on the brink of major changes. Many contrast-specific modalities have been developed in recent years by academic researchers, ultrasound scanner manufacturers, and pharmaceutical companies. Our aim is to update the diagnostic value of conventional Doppler modalities, and to analyse potentially useful applications and indications for the more recently developed techniques. Imaging Findings: Specific entities will be used to illustrate clinical principles that can be applied to multiple clinical situations. Topics addressed include: vascular patency (arterial or venous thrombosis or stenosis, biliary atresia, liver and bowel transplantation, and surgical shunts); anomalous vessels and tubular structures (dilation of the biliary tree vs. blood vessels, pulmonary sequestration, varicocele); and evaluation of hyperemic and ischemic lesions (appendicitis, intussusception, pyelonephritis, orchitis / testicular torsion). Conclusion: B-mode sonography, as well as Doppler techniques, have a key role in pediatric diagnosis for several reasons (non-invasivity, lack of ionizing radiation, sonographic access is better than in adults, no need for anesthesia or sedation). Understanding the physical principles that govern Doppler imaging is essential for its successful clinical application. Symptomatic cases: n = 8. Mean ONSD right eye = 5.5 mm (SD = 0.7), mean ONSD left eye = 5.7 mm (SD = 0.9). A Wilcoxon Signed Ranks Test showed no significant difference between these results. Using the largest reading for each eye when well and symptomatic: mean asymptomatic ONSD = 4.8 mm (SD = 0.8, n = 8), mean symptomatic ONSD = 6 mm (SD = 0.8, n = 8). A Wilcoxon Signed Ranks Test showed a significant difference in these results (p = 0.008). Conclusion: ONSD increases in acutely raised ICP. Our results suggest that children with spina bifida and shunted hydrocephalus cannot be assumed to have ONSD within the normal range even when clinically well. In the long term we aim to compile new ONSD reference ranges for children with shunted hydrocephalus. withdrawn by authors Hyperechoic foci in the kidney: An incidental sonographic finding in neonates and infants M.A. Pourbagher, A. Pourbagher, F. Tiker, Z. Koc, E.A. Niron; Adana/TR Purpose: The purpose of this study was to determine the incidence and significance of non-shadowing hyperechoic foci in the kidney and to evaluate metabolic disturbances in these patients. In a period of 3 years abdominal ultrasonography (US) was performed as a screening procedure in 2532 neonates and infants. A followup US was performed in 50 of 76 (38 female and 38 males) patients with hyperechoic foci in the kidney approximately 2-24 months after the initial examination. All patients underwent metabolic evaluation, including serum electrolyte measurement and 24-hour urine collection. Results: Non-shadowing hyperechoic foci were detected in 76 (3%) patients (100 kidneys). The size of foci were 1-5 mm (mean 2 mm). The foci were located in the lower pole calix in 66%, upper pole calix in 4% and middle zone calix in 30% kidneys. Sixty kidneys had single, 12 had 2 and 28 had 3 or more foci. At 2-24 months follow-up the clearance for foci was 74%. Size and site of foci has no relation with foci clearance. Urinalysis showed elevated urinary calcium in 3 and hematuria in 8 patients. In 2 patients foci were passed without intervention, and uric acid was the dominant foci composition in both patients. Serum electrolyte measurement were normal in all patients. The incidence of hyperechoic foci in our study was 3%. That is usually discovered incidentally during sonography of the abdomen and generally resolve spontaneously. Follow-up of the patients is advocated with US and urinalysis. Germinal matrix morphology in antenatal ventricular dilatation K.M. Koprivsek 1 , T. Vanderheyden 2 , S. Counsell 2 , J. Allsop 2 , A. Stonebrige-Foster 2 , S. Kumar 2 , N. Fisk 2 , M.A. Rutherford 2 ; 1 Sremska Kamenica/YU, 2 London/UK Purpose: The germinal matrix (GM), a densely cellular zone lining the lateral ventricles, and give rise to the developing cortex. The MRI appearance of GM during fetal development has been well-documented, but data about GM morphology in pathological conditions is sparse. Antenatal ventricular dilation (VD) is associated with significant neurological morbidity. We used antenatal magnetic resonance imaging (MRI) to measure the GM in fetuses with and without VD. Methods: Retrospective analyses were conducted of fetal MR images acquired over a 2-year period, using fast T2 weighted sequences. In 70 fetuses (normal ventricles in 44, VD in 26 cases), we evaluated the signal characteristics and the maximum germinal matrix diameter (GMD) at three sites: the anterior and posterior ventricular horns and the caudothalamic notch (CTN). Between-group comparisons of GMD in normal and fetuses with VD were made using a Students t-test. Results: GM had the same low signal intensity regardless of GA and/or ventricular volume. None of the infants with VD had evidence of GM haemorrhage. The mean GMD in controls showed a linear decrease with brain maturation. In fetuses up to 28 weeks of GA with normal ventricles the GMD was greatest at the CTN. The similar pattern of changes in GMD was measured in VD group, where the mean GMD at the TCN were slightly, but not significantly lower then in controls (t = 1.48: p > (0.05)). Conclusion: GM diameter decreased with increasing gestational age. We did not detect any significant difference in GM morphology in the group of fetuses with antenatal VD. Contrast enhanced color Doppler ultrasonography in diagnosis of scrotal lesions in children U. Zaleska-Dorobisz, E. Czapiga, K. Moron; Wroclaw/PL Purpose: To investigate the usefulness of ultrasound with contrast agent Levovist-Schering (USCA) for the detection scrotal lesions in children. Between 2000-2002, 39 boys with scrotal masses were examinated. Mean age was 13.6 years and ranged from 1-17. Diagnostic assessment included in all cases conventional US, color Doppler and power Doopler before and after the adminstration of contrast agent keeping the same methodology in every examined patient. Focal testicular lesions (cystic and solid tumor) and extratesticular structures were documented regarding size, localization, range, vascularity and ultrasound diagnosis. In testicular tumors, the degree of tumor vascularity was subjectively graded from 0 to IV. The ultrasound diagnoses were compared to the final diagnoses based on clinical tests, surgical and histological examination. Results: 11 testicular and extratesticular tumors showed more enhancement than adjacent testicular parenchyma, seen between 15 to 60 s (mean 29 s) and 55 to 252 s (mean 83 s) after injection. The duration of enhancement was 15 to 210 s (mean 80 s). Cross sections and adjacent vessels were only seen in: teratoma, embryonal carcinoma and yolk sac tumor. Conclusions: USCA is an important and significant aid in the diagnosis of scrotal diseases, in the assessmentof of degree of vascular change and is predictive of malignancy. MR features of the preterm children with athetotic cerebral palsy K. Hayakawa, T. Kanda, Y. Yamori; Kyoto/JP Purpose: The recent development of the neonatal intensive care medicine has caused not only a dramatic decrease in the incidence of kernicterus, but also marked improvement in the survival of premature babies. Consequently, the incidence of pure athetotic cerebral palsy has decreased, whereas the incidence of spastic cerebral palsy associated with athetosis, termed mixed cerebral palsy, has increased. The purpose of this study is to evaluate the brain MR features of this condition and to assess the frequency of basal ganglia injury. The subjects consisted of 14 boys and six girls diagnosed with mixed cerebral palsy. Their gestational age range from 28 to 34 weeks (average = 29 weeks) and the birth weight ranged from 635 g to 2732 g (average = 1455 g). MR brain scans were assessed with particular attention to the basal ganglia. Imaging of pancreatic disorders in pediatric patients Y. Herrero, T. Berrocal, C. Prieto, J. Fernández, M. Parrón, R.R. Lemos; Madrid/ES Purpose: The aim of this teaching exhibit is to illustrate a wide spectrum of usual and unusual disorders involving the pancreas in children, and to evaluate the efficacy of ultrasound (US), duplex and color Doppler sonography, endoscopic retrograde cholangiopancreatography (ERCP), Computed tomography (CT) and magnetic resonance (MR) imaging in the diagnosis and management of these conditions. Methods and Materials: The imaging findings of patients with disorders involving the pancreas were reviewed from our database of pediatric pancreatic pathology. Ultrasound was performed in all cases, while CT, and MRI were performed in all tumors and whenever US and Doppler images were not conclusive. ERCP was used to study the pancreatic ducts. The embryologic and pathologic bases of the imaging findings are discussed in appropriate cases. The key findings at each imaging modality are shown and compared with the underlying pathologic features when available. Pitfalls, diagnostic difficulties and differential diagnoses are emphasized. Results: Specific topics addressed include congenital anomalies (pancreas divisum, annular pancreas, ectopic pancreas, pancreatic cysts, cystic fibrosis, Shwachman-Diamond syndrome, von Hippel-Lindau syndrome, and nesidioblastosis); acute and chronic pancreatitis; pancreatic cyst and pseudocysts; primary neoplasms (insulinoma, cystadenoma, and papillary cystic carcinoma); metastasis of Burkitt lymphoma; and miscellaneous (hemochromatosis, Cushing's disease, steroid and cytostatic therapy, and parenteral nutrition). Conclusion: Evaluation of patients with pancreatic disorders frequently requires multiple imaging modalities for diagnosis and planning surgical correction. Because many of these disorders have characteristic imaging appearances, this exhibit will help practicing radiologist to better understand and recognize pathologic processes affecting the pancreas. Imaging congenital vertebral disorders in pediatric patients M. Fernández -Velilla, T. Berrocal, A. Royo, A. Fernández, J. Gutierrez, N. Gómez-León; Madrid/ES Purpose: To illustrate a wide spectrum of usual, unusual and exceptional congenital anomalies involving the vertebrae, and to evaluate the efficacy of plain radiographs, computed tomography (CT) and magnetic resonance (MR) imaging in the management of these conditions. Methods and Materials: We retrospectively reviewed the imaging findings of patients with congenital abnormalities involving the vertebrae from our database of spinal pathology. Abnormalities were divided into isolated vertebral anomalies and anomalies associated with systemic diseases or syndromes. Plain radiographs were performed in all patients. CT or MR were performed whenever plain radiographs were inconclusive. The embryology and pathologic basis of the radiographic findings are discussed. Pitfalls, diagnostic difficulties and differential diagnoses are emphasized. Results: Specific topics addressed include anomalies in number (vertebral agenesis, sacral agenesis, omovertebral bone); anomalies in size and shape (vertebral and sacral hypoplasia, hemivertebra, occipitalization of C1, os odontoideum, lumbarization, sacralization); anomalies of fusion (blocked vertebra, Klippel-Feil abnormality, spina bifida, butterfly vertebra, coronal cleft vertebra); anomalies of alignment (spondylolisthesis, spondilolysis, scoliosis); neural arch defects (absence of the pedicle and lamina); caudal spinal anomalies with anorectal and urogenital malformations (terminal mielocystocele, caudal regression syndrome, VACTER association, OEIS complex, Currarino triad); and skeletal dysplasias (achondroplasia, thanatophoric dwarfism, chondrodysplasia punctata, spondyloepiphyseal dysplasia, and mucopolysaccharidoses). Conclusion: Evaluation of patients with vertebral abnormalities frequently requires multiple imaging modalities for diagnosis and planning treatment. Because many of these disorders have characteristic imaging appearances, this exhibit will help trainee radiologist to better understand and recognize pathologic processes affecting the vertebral spine. Defecography in chronically constipated children A.D. Yang, M.-T. Cheng, K. Lee; Changhua/TW Purpose: To evaluate the defecographic findings in children suffering from chronic constipation. Between May 1999 to August 2003, we performed a prospective study of 47 children (24 boys, 23 girls) with an age range of 3 -18 years old who fit the criteria for chronic constipation in our institution. Defecography was performed using flouroscopy with radiographs were taken during different phases of defecation; the whole study was video recorded. Results: Of the 47 children studied (42) children were found to have abnormal defecographic findings: Partial relaxation to non-relaxation of the puborectalis muscle on defecation was found in 18 patients; anterior rectocele in 16, posterior rectocele in 11, rectal intussusception in 20, mucosal prolapse in 17, rectal prolapse in 4; sigmoidoceles in 15: grade I (11), grade II (2), grade III (2). Conclusion: 1. The defecographic findings that are seen in adults could also be found in children. 2. Defecographic evaluation could be a potentially valuable and simple radiologic study which could be used in the evaluation of children suffering from chronic constipation. Evaluation of the usefulness of 3D CT reconstructions of multifragmented fractures in children M. Wozniak, E. Dybiec, P. Wieczorek; Lublin/PL Purpose: The aim of the study was the evaluation of the usefulness of 3D CT reconstructions in the imaging of post-traumatic alterations of the bones in children. The analysis was based on 39 three dimensional CT reconstructions of the fractured bones. There were cases of extensive, complex bone fractures, when evaluation based on conventional radiographs was insufficient. All examinations were performed on a Shimadzu SCT 7800TX scanner. Surface and volume rendering were employed in the processing. The results of the study show that 3D reconstructions allow very precise evaluation of post-traumatic alterations, especially in the bones of complex anatomical structures. They enable the imaging of small fracture fissures invisible on conventional radiographs and CT. In the cases of bone indentations 3D reconstructions allow very detailed evaluation of the depth of indented fragments, their displacement and rotation. Results: 797 CT examinations were performed over the nine month study period. Examinations using tube current of more than 100% greater than protocol were noted. These reduced from 37% of examinations prior to the introduction of the protocol to 16% following its introduction. Reductions were most noticeable in helical examinations of thorax, abdomen and pelvis. Conclusion: Weight related protocols reduce the tube current used and thus the radiation dose in a large percentage of paediatric CT examinations. This has proved to be an effective method of reducing dose both in this study and in previous studies. Bone sarcomas as a second malignancy in children C. Renal dysplasia and intrarenal reflux in boys with posterior urethral valves: High resolution sonographic findings M. Vakaki, G. Pitsoulakis, H. Manoli, C. Koumanidou; Athens/GR Purpose: Voiding cystourethrography (VCUG) is considered the gold standard for the diagnosis of the posterior urethral valves (PUV) and the accompanying vesicoureteral reflux (VUR) in boys. However, its contribution to the characterization of intrarenal pathology, which is considered to be of great prognostic value, is minimal. It is only with recently introduced high resolution ultrasonographic equipment that details of disturbed renal architecture can be visualized. Materials and Methods: 12 infant boys with PUV, aged 1 day to 7 months were examined sonographically with 5-8 MHz convex and 5-12 MHz linear transducers. The presence of PUV was confirmed with VCUG in all cases. Results: Apart from the classic sonographic findings of PUV, which were also demonstrated, findings specific to the kidney included: a) bilaterally increased renal parenchymal echogenicity and loss of corticomedullary differentiation (12/ 12), which with b) small cortical cysts (8/12) imply renal dysplastic lesions, c) increased medullary echogenicity, cupping of dilated calyces, which is attributed to intrarenal reflux (3/12), d) hypoechoic lines pointing towards rounded calyces, corresponding to the pelvotubular backflow of urine (2/12), e) small subcapsular urinomas (2/12), f) urinoma and urine ascites (1/12) and g) intrarenal abscesses (1/12) and fungal balls in the collecting system (2/12), due to post-surgical candidiasis of the urinary tract. Conclusion: Ultrasonography with high-resolution transducers is able to visualize underlying renal pathology and to image the parenchymal architecture, contributing not only to the diagnosis but also to the definition of the prognosis in boys with PUV. Meningiomas within the vertebral column are even rarer. We present the imaging characteristics of 7 meningiomas (5 intracranial and 2 intracanal) in 4 girls and 3 boys, aged 3.5-14 years (mean age 8.6 years). These meningiomas were diagnosed during 10 year period (1992) (1993) (1994) (1995) (1996) (1997) (1998) (1999) (2000) (2001) (2002) (2003) . None of the studied children had previously been treated with radiotherapy. Both children with vertebral meningioma suffered from neurofibromatosis. The imaging studies included brain CT (5/7) and MR of the brain (5/7) and vertebral column (2/7) before and after intravenous administration of Gd-DTPA. The histologic examination after the surgical tumor resection showed meningioma of the transitional type in 6 children and co-existing malignant elements in the 7 th child. Following tumor resection, 6 children were free of symptoms and no other treatment was required. In contrast, the patient with the meningioma with malignant elements was treated with chemotherapy and radiotherapy, after subtotal tumor resection. Conclusion: Imaging of meningiomas (intracranial and intracanal) provides essential information for surgical planning, demonstrating the extraparenchymal nature of the neoplasm, its location, its dimensions, possible calcifications, as well as its effects on adjacent anatomic structures. Rare hepatic vascular anomalies in pediatric patients Z. Harkanyi, G. Balazs, G. Tasnadi; Budapest/HU Purpose: To present a selection of rare cases of hepatic vascular anomalies in pediatric patients. US, helical CT and MR were used in the diagnosis and in the follow-up of these lesions. Various venous anomalies were detected including intrahepatic arterio-portal and porto-hepatic shunts. A case of porto-caval shunt was also identified. The most frequent anomaly was portal cavernoma due to portal vein thrombosis. One case of caval web has been followed up for 15 years. Another case of Budd-Chiari syndrome has been followed up for two years. Several cases of hepatic and portal vein anatomic variations are also documented. 2D and color Doppler US was used as the first line examination in the diagnosis and follow-up different congenital hepatic vascular anomalies. Helical CT, CTA and, more recently, MRA has been used for further analysis of these lesions. Conclusions: US is still the first method for the evaluation of the pediatric liver and the hepatic vessels. Color Doppler is the modality of choice for functional evaluation of the vascular anomalies and is also useful in the follow-up of the patients. Contrast-enhanced MRA and CTA is helpful in selected cases to demonstrate the extent of the lesions and other associated anomalies, such as development of systemic collaterals. Acute [1992] [1993] [1994] [1995] [1996] [1997] [1998] [1999] [2000] [2001] [2002] [2003] , 24 (n = 24) children with septic sacroiliitis and/or acute osteomyelitis of the pelvic bones were imaged by our Radiology Department. Other laboratory tests were already performed and in 15 (15/24) young patients, material from needle aspiration had been sent for cytological examination. The imaging initial approach included plain film study and triple-phase 99 Tc radiophosphate scan. In addition, 19 (19/24) patients underwent MRI examination and 12 (12/24) children had CT. The laboratory results confirmed the diagnosis of osteomyelitis and/or that of septic sacroiliitis. The retrospective study of the imaging examination results indicated the superiority of scintigraphy and of MRI in the diagnosis of these entities. Plain film radiographic signs of disease were observed only in 5 patients (5/24) though the bone scintiscan was positive in all 24 patients (24/24). The CT examination was positive in 10 young patients (10/12) while MRI's sensitivity was 100% (19/19). At the end of therapy all patients recovered completely. Conclusion: A bone scan is warranted in every case of clinically suspected osteomyelitis and/or septic sacroiliitis in which the radiographs are unrevealing. However, MRI is a useful adjunct in the evaluation of the bone edema, the detection and localization of abscess and in the demonstration of the soft tissue extent of the infectious process. The Results: HRCT showed that 16/51 of the cases had bronchiectasis, with cystic fibrosis as the underlying cause in 5 cases. 2 cases had bronchiolitis obliterans and 2 cases had Macleod's syndrome. 2 cases with aspiration pneumonia had gastroesophageal reflux, and a intrabrochial foreign body was detected in one case. One case had bronchopulmonary dysplasia, and 2 had TB lymphadenitis compressing bronchi. Chest radiography revealed findings of bronchiectasis only in 5 of the 16 cases. Hyperaeration was detected in the chest radiographs of only 3 cases out of 18, whose HRCT revealed air trapping. HRCT showed peribronchial thickening in 18 cases, however, chest radiography showed the same finding in 5 patients. HRCT made it possible to observe linear densities caused by linear atelectasis / scars in 12 cases. HRCT showed the underlying pathology and consequent pulmonary lesions in 22 out of 51 cases, and linear densities in 12. Conclusion: HRCT has a significant role in detecting the underlying abnormalities and consequent lesions in children with recurrent pulmonary infections. Compared to chest radiography, HRCT gives much more information. Analysis of Doppler signals: Application for detection of fetal movements A. Kribeche, S. Benderbous, M. Berson, D. Kouame, L. Pourcelot; Tours/FR The objective is to develop and validate a new Doppler ultrasound system allowing the imaging of fetal movements in real time. We describe the prototype of new ultra-sound sensors and present the results obtained in pregnant women. The apparatus enabling us to acquire the signals coming from fetal activity consists of 12 ultrasonic sensors, a Doppler module and a computer provided with a chart of acquisition of the signals. After suitable recording and signal processing, Fetal Heart Rhythm (FHR) and the Fetal Breathing Movements (FBM) are extracted. Study of the Doppler signals after fast Fourier Transform enables us to characterize the fetal movements in term of the amplitude, displacement and frequency. Estimate of displacement is obtained by calculating the phase of the signal resulting from the analytical filtering of the Doppler signal and to separate the direction from the Doppler signals. Results: Twenty recordings were carried out on four women in their last quarter of pregnancy. During the last quarter of pregnancy, the FHR is approximately 130 Beats.min -1 . however, the FHR that we detected is about 134 Beats.min -1 . We are thus in the presence of the fetal heart rhythm. Conclusion: This is the first time that parameters giving the fetal movements are extracted. As a first approach, the FFT gives satisfactory results. Assesment of skeletal age with hand and wrist sonography: Could a standardised method replace radiography? S. Megremis, G. Cavallo, M. Michalakou, E. Kehagias, N. Segkos, E. Agianniotakis, E. Sfakianaki; Iraklion/GR Purpose: To investigate the capability of hand and wrist sonography in skeletal age assessment, and to propose a technique that could be commonly used. Materials and Methods: Forty-two children, aged 0 months to 16 years, underwent a left hand radiograph for skeletal evaluation. They were also sonographically examined on the same hand, with focus on distal epiphyses of radius and ulna, carpal ossification centers, adductor sesamoid bones of metacarpophalangeal joint of the wrist and the cartilage of the third's finger distal phalange. Scanning and measurements were obtained in both transverse and longitudinal planes, and the images were digitally recorded for further evaluation. Results: All areas of interest were identified both in the left hand radiograph as well as in the sonographic examination, for each individual. Furthermore by dorsal and palmar scanning of the carpal ossification centers, accurate mapping and measurements were feasible. Gaining experience, and developing a common procedure, we were able to progressively minimize most technical difficulties. Conclusion: Hand and wrist sonography promises an accurate, safe and cost effective assessment of skeletal age. Detailed knowledge of hand and wrist anatomy, and familiarization with a standardized method, as the one we propose, in acquiring and interpreting images is indispensable. In addition, the designation of sonographic charts for the evaluation of skeletal age could be possible in the future. The role of hepatobiliary scintigraphy in the differential diagnosis of neonatal hepatitis, intrahepatic cholestasis, and biliary atresia E. Palócz, T. Györke, K. Bártfai, L. Balogh, L. Szönyi, I. Máttyus, É. Kis, T. Verebély, E.K. Makó; Budapest/HU Purpose: Biliary atresia (BA), intrahepatic cholestasis (IHC) and neonatal hepatitis (NH) are the main causes of neonatal direct hyperbilirubinaemia (NDH). The distinction of BA needing early surgical intervention from NH and IHC syndromes is essential, but difficult. The impact of hepatobiliary scintigraphy (HSC) in the differential diagnosis of NDH was evaluated. Methods and Materials: 28 HSCs of 25 patients (age: 10 days-6 months) with NDH were included in our retrospective study of a five years period. After administration of 1.85 MBq/kg (min.: 9 MBq) 99mTc-BrIDA serial abdominal images were performed up to 24 hours. The scintigraphic diagnoses (SD) of BA, IHC, NH and indeterminate (IND) were defined based on visual scoring of liver uptake, intrahepatic radiopharmaceutical transport and bowel activity. SDs were compared with clinical diagnoses (CD), which were based on laboratory, histological or operative findings and/or clinical follow-up. Results: The CDs were: 12 BA, 9 IHC, and 7 NH. The SDs were: 10 BA, 5 IHC, 7 NH, 6 IND were correct in 14 and false in 8 cases, while the CD in the 6 IND cases was BA. Regarding the shortage of bowel activity as a basis for SD of BA the sensitivity and specificity of HSC in the diagnosis of biliary atresia were 100 and 75% respectively. Conclusion: Our results suggest that hepatobiliary scintigraphy is a useful tool in distinguishing BA requiring urgent surgical intervention from other kinds of pathologic conditions causing NDH, but that it is unreliable in further narrowing of the differential diagnosis. Various radiologic findings of Wilms' tumor Y.-W. Kim 1 , W. Kim 2 , I.-O. Kim 2 , K. Yeon 2 ; 1 Busan/KR, 2 Seoul/KR Purpose: Wilms' tumor is the most common pediatric renal mass. Although it usually manifests as a solid intrarenal mass with a pseudocapsule and distortion of the renal parenchyma and collecting system, some atypical radiologic findings may produce diagnostic confusion. The purpose of our exhibit is to illustrate various radiologic findings of Wilms' tumor. We retrospectively reviewed radiologic findings of 60 cases, which were pathologically proven from 1996 to 2001 (the age of patients; between 2 months and 9 years). Results: This exhibit includes: 1) typical intrarenal Wilms' tumor (n = 19), 2) Wilms' tumor with vascular invasion (n = 7; renal vein 4, IVC 4, right atrium 3), 3) Wilms' tumor with perirenal extension (n = 11; psoas & LN 1, perirenal hematoma 6, subcapsular hematoma 2), 4) Wilms' tumor with extension into the urinary tract (n = 6; renal pelvis 4, ureter & bladder 2), 5) Wilms' tumor with metastasis (n = 6; lung 4, bone 1, pleura 2, mediastinum 1, scrotum 1), 6) bilateral Wilms' tumor (n = 4), 7) Wilms' tumor in a Horseshoe kidney (n = 1), 8) Atypical Wilms' tumor (teratoid Wilms'; n = 1, cystic Wilms'; n = 3, extrarenal Wilms'; n = 1, intrapelvic Wilms'; n = 1). The knowledge of these various radiologic findings of Wilms' tumor can be helpful in the diagnosis and management of the tumor. Extracorporeal shock wave lithotripsy monotherapy for pediatric urinary tract calculi Z. Siric, A. Slavkovic, M. Radovanovic, M. Mrvic; Nis/YU Purpose: To show the safety and efficacy of extracorporeal shock wave lithotripsy (ESWL) for the urolithiasis in the pediatric age group and to evaluate the complications encountered after the treatment. Material and Methods: 84 children (age range 8 months to 14 years) with 183 stones underwent ESWL. KUB were taken on the day after treatment. If stonefree status was achieved, the patient was followed with ultrasonography and urinalysis every six months. If fragments < 4 mm were present, follow-up was repeated every 3 months. Results: Stone size ranged from 0.5 to 2.5 cm. 64 kidneys, 27 ureters and 3 bladers underwent 165 ESWL sessions. Retreatment was required in 43% patients. The mean number of sessions per child was 1.9. Mean fluoroscopy time per session was 0.79 min. The overall success rate was 90%, but the stone -free status was achieved in 62% of children. The composition of the stones were struvite and calcium oxalate in the majority of the patients. Auxiliary procedures (JJ stents) were used in 27% children. Transient hematuria, ecchymoses and colic P P P P Pedia edia edia edia ediatric tric tric tric tric were the complications encountered after treatment in 31% of children. Perirenal haematoma was identified in one patient. 22 (26%) children developed obstruction and 11 required nephrostomy. Conclusions: ESWL is non-invasive procedure suitable for stones in all locations in the pediatric patients. It may be the first-line treatment for all pediatric urinary tract calculi, although the long-term effects of lithotripsy on the kidney are unknown. Imaging to Meckel's diverticulum (n:9), small bowel tumour (n:2), duplication enteric cyst (n:1), postoperative (n:6) and bowel wall hemorrhage (as in Henoch-Schonlein purpura (n:5). The enema failed to reduce the intussusception in all cases. All children underwent definitive surgery rather than inappropriate treatment by attempted radiological reduction. Conclusion: Abdominal sonography is the most efficient examination for the diagnosis of intestinal intussusception. Various pathological lead points in intussusception can now be defined by ultrasound. Secondary intussusception treatment is surgical. Diagnostic value of diffusion weighted MR imaging in pediatric cerebral neurological diseases Y. Oksuzler, H. Cakmakci, S. Kurul, M. Oksuzler, E. Dirik; Izmir/TR Purpose: To detect the diagnostic value of diffusion weighted (DW) magnetic resonance (MR) imaging in different diseases involving the cerebral white and gray matter and to compare the diffusion properties with age matched normal children. Conventional and DW MR imaging was performed in 18 children with neurologic disorders, and 25 normal control subjects. Neurological disorders included neurodegenerative brain diseases (n: 6), anoxic encephalopathy (n:4), acute disseminated encephalomyelitis (ADEM) (n:3), encephalitis (n:1), subacute sclerosing panencephalitis (SSPE)(n:4). Apparent diffusion coefficients (ADC) were measured from the brain lesions and 12 normal appearing white and gray matter areas in study group. 12 normal appearing areas were also measured in the control group. Results: ADC values obtained from the normal subjects were similar to values described in the literature. ADC values of study groups were significantly different from the control subjects. ADC values for the neurodegenerative disease group, anoxic encephalopathy group, ADEM group, encephalitis, SSPE group, were respectively between 0.33 x 10-3-2.1 x 10-3 cm 2 /s, 0.10 x 10-3-2.03 x 10-3 cm 2 /s, 0.55 x 10-3-0.93 x 10-3 cm 2 /s, 1.02 x 10-3-1.58 x 10-3, 1.07 x 10-3-1.46 x 10-3 cm 2 /s. Conclusion: Although this study is limited due to population size and disease heterogeneity DW MRI provides useful and complementary information regarding the degree of involvement in different pediatric neurological disorders. Clinical presentation and MRI findings in non-accidental trauma in children under two years of age P.C. Sundgren 1 , M. Petrou 1 , J. Jennings 1 , J. Ksar 1 , J. Smythe 1 , B. Foerster 2 , P. Maly 1 , P. Eldevik 1 ; 1 Ann Arbor, MI/US, 2 Lund/SE Purpose: To describe the clinical presentation and illustrate the MRI findings in suspected non-accidental brain trauma in children under two years of age. We reviewed the hospital charts and the MR reports of 15 patients examined due to clinical suspicion of non-accidental brain trauma. We noted the clinical presentation and the MRI findings in each case. Both the radiological diagnoses and the final diagnoses were extracted and compared, and the impact of the MRI examination on the clinical course of the patient was evaluated. Results: Subdural hematoma was the most common finding seen in 13 of the 15 patients, petechial hemorrhages and brain edema was other common findings in these patients. Discussion/Conclusion: Non-accidental brain trauma is not uncommon and in most cases CT of the brain is the method of evaluation. MRI is only performed in a limited number of cases, for example, when dating the abnormalities is crucial, and to evaluate for additional findings of axonal shearing injury. Examples of this will be illustrated. Congenital hip dysplasia: MRI after reduction of the femoral head E. Svedström; Turku/FI Purpose: In the treatment of developmental dysplasia of the hip, maintenance of the correct position of the reduced femoral head is very important. Many modalities such as conventional X-ray images, tomography, CT and US have been used in the evaluation of the femoral head position after reduction. These techniques either use ionizating radiation or require an experienced examiner. They might even be subject to technical limitations or sometimes be inaccurate. This poster describes the use of MRI in the assessment of femoral head position after closed or open reduction. MRI studies with an open-configured 0.23 T MR-imager were performed on four children. Some of these children (0-8 months of age) were studied multiple times during the follow-up. No sedation was used. Coronal and axial sequences were used. Position of the femoral head, appearance of the limbus and formation of the pseudoacetabulum were noted. Results: All MRI studies were successfully performed without any sedation. The plaster did not reduce image quality in any of the studied hips. In four still-dislocated hips MRI showed correct diagnosis. In two of these hips an inverted limbus could correctly demonstrated. Conclusions: Accurate diagnosis is very important after reduction of the femoral head. These children commonly require multiple imaging studies during followup. Therefore, MRI and US, which do not use ionizating radiation, are the preferred modalities. After reduction, MRI findings are easily reproduced and are accurate. Even other findings like inverted limbus in interposition and formation of pseudoacetabulum can be demonstrated. 516 B D E F A G Practical experience with the application of the "Digital addendum of the European protocol for quality assurance in mammography" H. Bosmans 1 , F. Rogge 1 , A.-K. Carton 1 , K. Young 2 , R. van Engen 3 , M. Thijssen 3 , G. Marchal 1 ; 1 Leuven/BE, 2 Guildford/UK, 3 Nijmegen/NL Learning Objectives: To teach different aspects of the digital addendum (DA) to the European protocol for quality control in mammography: • The purpose of the tests as described in the document. • The test methods. • The applicability of the test methods and the discussion of the first measurement results. Background: Digital mammography is a new imaging modality for mammographic applications. In order to assure sufficiently high quality standards, new test protocols had to be developed. A group of European medical physicists has cooperated under the coordination of the European Breast Cancer network and Euref. The first publication is expected for October 2003. The (pre-released) version (Aug. 2003), work in progress, has been evaluated on different full field digital mammography (FFDM) systems and is the basis of the present teaching session. Procedure Details: Following systems were included: Senographe 2000D (GE), Senoscan (Fischer), 5000MA (Fuji), AC3 (Fuji), Embrace CR (Agfa) and Embrace DR (Agfa). The tests as described in the protocol included direct performance tests, contrast detail analysis, patient dose measurements and physical measurements such as MTF and DQE. For these last measurements, acceptable and achievable levels have not yet been defined. The help of a service engineer was necessary in most systems to get access to raw data. The tests as proposed in the protocol could then be performed. Contrast detail analysis is the most critical part and should be automated to reduce interobserver variability. Patient doses were comparable or lower than doses in conventional mammography. The acquisition of MTF and DQE requires a further standardization of the method. The Digital Addendum in its current phase was applicable to all systems tested so far. Practical experience is growing and will add to the applicability and value of the document. Anisotropic resolution in helical cone-beam CT reconstruction D. Heuscher 1 , S. Utrup 1 , F. Noo 2 ; 1 Highland Heights, OH/US, 2 Salt Lake City, UT/US Learning Objectives: To describe how the different aspects of helical cone-beam reconstruction affect spatial resolution in all three dimensions. To demonstrate that depending on the radial and angular position of a voxel, this resolution can be anisotropic. To describe appropriate filtering and interpolation steps that can be taken to reduce these effects. Background: A number of methods have been described recently that provide either exact or near-exact reconstructions of helical cone-beam scan data. In this exhibit, we will describe key aspects of the implementation of these reconstruction algorithms that affect spatial resolution. We will show how the anisotropy of in-plane resolution can be related to the corresponding effect in single-slice 2D reconstructions. Alternative filtering and interpolation steps will be suggested. Procedure Details: FWHM slice-sensitivity profile and in-plane resolution measurements were performed on helical reconstructions of a phantom consisting of seventeen 0.25 mm diameter spherical beads located at 0, 100, and 200 mm radii. The scans used an MX8000-IDT 16 x .75 mm detector configuration with a 1.25 pitch factor. Single-slice 2D reconstructions were performed on the same phantom using both fan and parallel convolution-backprojection algorithms to produce comparative in-plane measurements. Alternative hi-order interpolation and voxel-dependent filters were investigated to produce nearly isotropic resolution. Conclusion: Significant spatial variation in resolution can be observed in exact or near-exact helical cone-beam reconstructions. A more uniform and isotropic result can be achieved by using hi-order interpolation to produce parallel projection data along with longitudinal voxel-dependent filtering. Comparison In PET/CT studies IV contrast agents increased the SUV of the mediastinum to 2.5 (0.5) and the liver to 2.8 (0.6). These increases in SUV were coincident with changes in CT density from 30 HU to 156 HU (mediastinum) and from 52 HU to 97 HU (liver). SUV values in the colon wall seem unaffected by positive oral contrast compared to PET: 1.5 (0.4) vs 1.3 (0.2). Conclusions: Physiologic SUV from PET/CT appear somewhat higher than SUV from standard PET when the CT is acquired with standard volumes of IV contrast media. Adventures in non medical radiography A.A. Alhajeri, D. McKenna, B. Tuohy, C. Roche, P. McCarthy; Galway/IE Learning Objectives: To demonstrate the non-radiological use of familiar imaging modalities and show how far we have come since the first X-rays of Mrs. Roentgen's hand. Background: Today, X-rays technology has a wide application and is presently in use in fields as diverse as engineering, art, forensic pathology and security. Procedure Details: Through a pictorial review we show how X-rays have a role in non-medical applications. We demonstrate how law enforcement agencies have adapted X-ray technology to screen luggage at airports, sometimes even using CT. Furthermore newer technology in use in Europe has been developed, termed "Back scatter", which makes possible the detection of illegal immigrants and contraband material concealed within trucks. The characterisation of the bony skeleton with the aid of X-rays is not only helpful in identification but sometimes can also indicate to the forensic pathologist the mode of death. Industrial engineers are able to evaluate the integrity of a structure with the aid of X-rays. Examples include the examination of airplane engines and pipes for hairline fractures, unidentifiable to the unaided eye. In the art world, X-rays have been used to detect forgeries and even to create original art works. Conclusions: This poster reaffirms the benefits of different imaging modalities showing how technology developed for medical imaging has been adapted for use in non-medical areas. Radiation-induced temporary hair loss after cerebral perfusion studies with multi-detector CT Y. Imanishi, A. Fukui, H. Niimi, S. Nakaji, K. Nozaki, Y. Furuya, M. Uzura, S. Hashizume, Y. Nakajima; Kawasaki/JP Learning Objectives: Learning presence of complications by a cumulative or multiplier effect of radiation exposure from multiple diagnostic techniques. Background: As various imaging technologies become increasingly advanced, they make it possible to get various kinds of information and large amount of imaging data. In some imaging technologies, the radiation dose increases with the ability to obtain better images or more detailed information. Imaging Findings: We encountered 3 cases of temporary bandage-shaped hair loss, which was caused by perfusion studies of the head by multi-detector computed tomography (MDCT) for evaluation of blood flow in the brain. In all of the 3, digital subtraction angiography of the head was performed within a period of the CT perfusion studies. This suggested the possibility that radiation exposure from angiography performed in serial examinations, combined with the perfusion studies Effectiveness of a new dual-energy subtraction system using CsI:Tl amorphous silicon flat-panel technology H. Tagashira, N. Bandai, M. Yoshimoto, Y. Yasuhara; Ehime/JP Learning Objectives: To describe the theory of the new dual-energy subtraction system. To demonstrate the system with chest radiology cases. Background: Lung cancer is the current leading cause of cancer death and continues to be increasing. Chest radiography has been shown to have relatively low sensitivity and specificity for the detection of the pulmonary nodules. This new dual-energy subtraction system allows the fast (200 millisecond) acquisition of two, high and low voltage images and provides soft tissue and bone structure image of the chest with relatively low dose. Procedure Details: The radiologists' performance for reporting chest radiographs was evaluated by use of receiver operating characteristic (ROC) analysis. The performance of radiologists was improved significantly when the dual-energy subtraction image was used (P < 0.01). Conclusion: Diagnostic accuracy will be improved by using this dual-energy subtraction system. Longitudinal filters for uniform cone-beam resolution D. Heuscher, S. Utrup; Highland Heights, OH/US Purpose: This presentation demonstrates the non-uniform longitudinal resolution inherent in today's cone-beam reconstructions and how, through the appropriate use of longitudinal filtering, improvements in image quality can be achieved. Simulations and scans for acquisition geometries of 16 or more detector rows were evaluated. A circular half-scan (HS) and a helical scan (pitch factor 1.25) were performed on an MX8000IDT using a 16x.75 mm detector configuration. A phantom consisting of 17 steel beads was used to measure longitudinal resolution at 8 angles and 3 radii. Simulations were performed using the same phantom geometry, including a 32x.75 mm helical scan. A voxel-dependent filter was used to achieve uniform longitudinal resolution and compared to projectionbased filtering. Both real and simulated thorax phantoms were used to evaluate the effects on image quality. Results: Resolution measurements demonstrate an angular variation in longitudinal resolution for large-pitch helical and circular HS cone-beam scans. The FWHM SSP measurements varied by over 15% and 25% at 100 and 200 mm radii respectively. Reconstructions with projection-based filters did not reduce this variation. Similar results were observed for helical scans with the larger cone angle (32 x .75 mm detectors), wherein the resolution pattern varied at half the frequency along the longitudinal direction. Applying voxel-dependent longitudinal filtration achieved uniform resolution, demonstrating improved image quality in both real and simulated scans. Conclusion: There is an inherent non-uniformity of longitudinal resolution for cone-beam scans, particularly for large-pitch helical and circular half-scans. Uniform resolution can be achieved using voxel-dependent filters. Potential of phase contrast in X-ray imaging P. Monnin 1 , R. Meuli 1 , J. Hoszowska 2 , J.-F. Valley 1 , F.R. Verdun 1 ; 1 Lausanne/CH, 2 Grenoble/FR Purpose: One of the limitations of conventional radiology is that small or weakly absorbing structures cannot be detected on images. Coherent properties of an X-ray beam produce phase contrast images where a change of the refraction index of tissues translates into an edge enhancement phenomena on the images that allows the detection of weakly contrasted structures. This study shows the feasibility of implementing the in-line holography principle with an aim to imaging very small structures. Material and Methods: Phase-contrast images were obtained using synchrotron radiations at ESRF (Grenoble, France). Images of 20 to 100 micrometer nylon wires, immersed in different media, were recorded with a CCD camera (1.8 micrometers pixel size) in different imaging conditions. Images were compared with the results obtained by means of Fresnel diffraction theory. The coherent X-ray beam and the defocusing distance between the structures to be imaged and the detector produced phase contrast images of the wires. The comparison of the recorded images with the predicted image formation from the Fresnel diffraction theory revealed the performance of this technique in terms of sensitivity, geometrical and energy requirements. Images of a biological sample (i.e. pork kidney, cam's) were also produced where very fine low contrast structures, unnoticed in pure absorption contrast, appeared. The potential of the technique in neo-vascular process imaging will also be discussed. The potential of in-line holography techniques to improve image contrast of biological tissues has been demonstrated. Experimental The aim of the present study was to evaluate Y3Al5O12:Ce (YAG:Ce) phosphor for radiographic and mammographic imaging. YAG:Ce, which has never been previously used in diagnostic radiology, emits green light with very short decay time (70 ns). It is expected to match the spectral sensitivities of most photodetectors. Radiographic test screens of various coating thickness (13-166 mg/cm 2 ) were prepared in laboratory employing YAG:Ce phosphor in powder form with 8.0 µm median grain size. Luminescence emission efficiency (emitted light over X-ray exposure) and light emission spectrum were experimentally evaluated as a function of X-ray tube voltage employing both tungsten and molybdenum target X-ray tubes. In addition, the spectral compatibility of YAG:Ce emission spectrum with orthochromatic films, photocathodes, CCD arrays and amorphous silicon photodiodes, used in both conventional and digital radiography, was determined. Results were compared with other phosphor materials (Gd2-O-2S:Tb, CsI:Tl) currently employed in medical imaging. Results: Maximum YAG:Ce emission efficiency was observed for 107 mg/cm 2 screen at 40-50 kV using tungsten target X-ray tube. Emission spectra peaked at 553 nm. The spectral compatibility with amorphous silicon photodiodes (0.937) and CCDs (0.951) was found to be very high, better than the corresponding compatibility of CsI:Tl, as mostly used in digital radiography detectors currently. Conclusion: Considering the YAG:Ce performance, its short emission decay time and its spectral compatibility with amorphous silicon detectors and CCDs, this phosphor material is appropriate for use with digital radiography detectors. B D E F A G Reduction of eddy current artifacts in echo planar diffusion tensor imaging with a stimulated echo preparation G. Steidle, F. Schick; Tübingen/DE Purpose: Diffusion-tensor-imaging (DTI) using SE-EPI in tissue with short T2 values, such as kidney or skeletal muscle, suffers from a poor SNR for higher bvalues. Using a stimulated-echo diffusion preparation, sufficiently high b-values can be obtained by increasing the mixing time (TM) rather than TE. A diffusionweighted stimulated-echo EPI sequence is proposed which minimizes the influence of eddy currents (EC) without any increase in the minimum TE or acquisition time. Methods and Materials: Assuming a monoexponential decay for the EC with time constant λ, gradient pulses can be implemented within the TM interval such that eddy current effects proportional to exp (-λ x t) will vanish. In-vivo DTI measurements were performed in human calf musculature on a 1.5 T Siemens Sonata unit. Measurement parameters were TE = 37 ms, TM = 100 ms, TR = 4000 ms, b = 0 resp. 500 s/mm 2 , Matrix 64 x 64, FOV 200 mm, NEX = 4, slice thickness 8 mm. Diffusion weighting was applied in six directions in order to calculate the diffusion tensor. Results: Diffusion images were acquired with and without EC correction. Images without EC correction showed obvious scaling and shearing distorsions whereas in images obtained with EC correction no significant distorsions were observed. Conclusion: Diffusion-weighted MR imaging using EPI is very sensitive to image distorsions caused by eddy currents. Inserting additional gradient waveforms in a stimulated-echo EPI sequence drastically reduces these artifacts and allows a calculation of the diffusion tensor in various tissues with low T2/T1 ratios without significant misregistration. RF-induced artifacts due to aneurysm clips in MRT at 3.0 T U.A. Lauer, H. Graf, F. Schick, C.D. Claussen; Tübingen/DE Purpose: Metallic implants such as aneurysm clips may cause enlarged artifacts at higher magnetic field strengths, not only due to susceptibility effects. Aneurysm clips made of Ti-alloy were investigated with special respect to MR-imaging results and possible RF-induced artifacts. Materials and Methods: 10 aneurysm clips were measured in Gd-DTPA doped water at 1.5 T and 3.0 T with adapted SE-sequences. Additionally, two models made of copper were investigated at 3.0 T. To separate RF induced effects, the transmitter voltage was bisected stepwise to verify the RF-induced deviation of the local flip angle near to the implant. This was also done with 3D-TSE sequences. Results: In comparison to 1.5 T, more pronounced hyperintense zones were found at 3.0 T. They were independent of the exchange of phase-and frequency-encoding direction (swap) and became more pronounced at reduced transmitter voltage. Comparative investigation of two Cu-models and one selected Ti clip at reduced transmitter voltage revealed RF induced effects depending on inductive and capacitive structures of the clip. Conclusion: Metallic implants have to be considered carefully at 3.0 T due to the electrical conductivity. RF-induced artifacts can appear not only for longish objects but also on smaller devices. In the case of aneurysm clips, a slight RFinduced effect could be detected. Potential patient endangering due to a local enhancement of the secific absorption rate (SAR) can be estimated as negligible. Optimum is currently recommended as a consistent image display function. However, while the CIELAB function is still in use in Europe, comparative evaluation of these two functions for optimum display function has not yet been reported. The purpose of the present study was to identify which of GSDF and CIELAB is the optimum display function for thoracic CT imaging by means of visual contrast analysis (VCI), i.e. the ratio of luminance contrast to CT value contrast. Methods and Materials: Monochromatic 1M LCD monitor and photometer of luminance calibration tool kit (Data Ray Corp, Westminster, USA) were used. The luminance contrast of this monitor was measured by a photometer displaying GSDF and CIELAB. Luminance change and digital driving level (DDL) that corresponded to CT value (HU) were tabulated. CT value was represented by window setting of thoracic CT imaging, i.e. for mediastinum (ww:150~350, wl:30) and lung (ww:1400~2000, wl:-500) using GSDF and CIELAB. The ratio of luminance contrast to CT value contrast was calculated as visual contrast index (VCI). The VCI of GSDF and CIELAB was evaluated using t-test. Result: Using t-test, VIC of CIELAB was significantly higher than that of GSDF in window setting of thoracic CT imaging (p < 0.01). Based on visual contrast index analysis, CIELAB was more useful than GSDF as a monitor display function of thoracic CT imaging. We suggest that CIELAB is the optimum monitor display function of thoracic CT imaging because it intrinsically has excellent luminance contrast characteristics. Follow-up of patients subjected to high skin radiation dose as a consequence of repeated interventional cardiology procedures R. Padovani, G. Bernardi, E. Quai, M. Signor, H. Toh; Udine/IT Purpose: As part of a quality assurance program, to retrospectively evaluate cumulative skin dose (CSD) received by patients subjected to repeated interventional coronary procedures and to detect radiation induced skin injuries in patients who have received the highest dose. Materials and Methods: From April 1998 to February 2002, 5039 cardiac procedures, coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) have been performed on 3332 patients. Mean DAP was 78.6 Gycm 2 . Patients with a cumulative dose-area product (DAP) higher than 300 Gycm 2 have been extracted. They were 78 patients (2.3%), 17 female and 61 male, mean age 71 years, who underwent a mean number of 4.5 procedures resulting in a mean cumulative DAP of 335 Gycm 2 and a maximum value of 995 Gycm 2 . From DAP, CSD has been estimated adopting 4.3 and 8.7 10 -3 cm -1 as conversion factors for CA and PTCA, respectively. Clinical follow-up has been performed adopting the LENT-SOMA methodology and scale. Results: The highest CSD estimated was 6.7 Gy and only 25 patients (32%) exceed a skin dose of 3 Gy. No skin injuries were detected at clinical follow-up. These results allow to estimate a frequency for skin injuries of less than 3.10 -4 in patients undergoing repeated cardiac procedures. The results of this study implies that the frequency of skin injuries may be very low when a quality assurance programme, including regular patient dose monitoring, periodic evaluation of procedure protocol, quality control of equipment and operator training, is established. Ultrasound Purpose: Ultrasound is the most frequently used diagnostic imaging modality. The main problem of ultrasound, however, is interobserver variability. The intention of the development of ultrasound computer tomography was to increase the reliability of ultrasound imaging and to supply standardized images similar to other cross section imaging procedures. Methods and Materials: Instead of a manually-controlled linear transducer array, we used ultrasound computer tomography (USCT) to image a volume directly. A few thousand ultrasound transducers were arranged in a cylindrical array around a tank containing the object to be examined coupled by water. Every single transducer was small enough to emit an almost spherical sound wave. While one transducer was transmitting all other transducers worked as receivers simultaneously. Afterwards a different transducer emitted the next pulse. For volume reconstruction each transmitted, scattered and reflected signal was used. In an experimental set-up a phantom containing nylon filaments, straws, and a cadaveric forearm were investigated. Results: Nylon filaments with a diameter of 0.1 mm were visualized. The skin and soft tissue of the cadaveric forearm were clearly detectable but the bone structures could not be delineated sufficiently. USCT supplied reproducible image sequences. Conclusion: USCT promises to supply standardized high quality three-dimensional images without ultrasound shadowing artifacts and without interobserver variability. Furthermore, the tissue is not deformed, in principle offering multimodal image fusion with other cross section imaging modalities. Prior to clinical set up extended development especially of large transducer element tubes and improvement of software is necessary. Multicentre assessment of a complexity index for PTCA procedure A. Peterzol 1 , E. Quai 1 , R. Padovani 1 , G. Bernardi 1 , J. Kotre 2 , A. Dowling 3 ; 1 Udine/IT, 2 Newcastle/UK, 3 Dublin/IE Purpose: Multicentre assessment of a procedure-severity-based complexity index (CI) for the introduction of reference levels (RLs) in percutaneous transluminal coronary angioplasties (PTCA) as a function of procedure complexity. Materials and Methods: 204, 75 and 104 PTCAs performed at three different centres were investigated. Multiple linear stepwise regression analysis, including clinical, anatomic, and technical factors, was performed in order to obtain fluoroscopy time (FT) predictors. Based on the regression coefficients of the emerging model a scoring system was defined, and a CI was obtained by adding up the single scores for each individual procedure. Since a good correlation (r = 0.41; p < 0.001) was found between the dose-area product (DAP) and the resulting CI, the latter was used to classify dose values into three groups. CI groups were determined by means of an ANOVA test: different sets of groups were explored until the matrix of pairwise comparison probabilities reached a minimum value (p < 0.001). The resulting DAP and FT third quartiles corresponding to each CI group are suggested as preliminary RLs in PTCA as a function of procedure complexity. Results: PTCA preliminary RLs: (i) for DAP values: 54, 76 and 127 Gycm 2 , and (ii) for FT: 12, 20 and 27 min, respectively for the three CI groups: low, medium and high complex procedures. The possibility to introduce RLs as a function of procedure complexity, as confirmed by this multicentre study, can improve the process of patient dose optimisation in interventional cardiology. Investigation of the radiation detection properties of Lu2SiO5:Ce and Gd2O2S scintillators for applications in medical imaging D. Nikolopoulos, P. Liaparinos, D. Margetis, D. Linardatos, P. Mellisaropoulos, K. Kourkoutas, G. Panayiotakis, D. Cavouras, I. Kandarakis; Athens/GR Purpose: The aim of this study was to use Monte Marlo techniques to examine the detection efficiency of three Ce-doped fast emitting scintillators, YAP (YAlO3: Ce), LSO (Lu2SiO5:Ce) and GOS (Gd2O2S:Pr, Ce, F) when used with photon energies and coating thicknesses employed in medical imaging. A general Monte Carlo code has been generated for tracking photons in the energy range covering all medical imaging applications (diagnostic radiology, nuclear medicine). Simulated scintillator materials were selected to be in blocks and arrays of dimensions equal to those usually employed in medical imaging. The results for the YAP scintillator, showed that the fraction of the incident photon energy which was totally absorbed decreases very rapidly for energies higher than 80 keV (e.g. from 65% at 100 keV to 10% at 511 keV for 0.01 mm coating thickness). LSO was better than YAP, its absorption efficiency being significantly higher (p < 0.001) at 20-25 keV (mammography), 60-100 keV (X-ray imaging), 140 keV (gamma ray imaging) and at 511 keV (positron imaging). GOS was also found to exhibit significant detection efficiency in the whole energy range examined (e.g. from 100% at 10 keV to 98% at 100 keV for 0.01 mm coating thickness), however its applications are limited due to its longer decay time. Conclusion: LSO was found to be of adequate efficiency for most imaging applications, while YAP could be considered most suitable for X-ray mammography applications. Analyses of physiological kinetic functions in dynamic chest radiography by the use of time series spectroscopy Y. Tsuchiya 1 , Y. Kodera 2 , M. Tsuchiya 1 , A. Fukui 1 , S. Itou 1 , Y. Machida 2 ; 1 Shizuoka/JP, 2 Nagoya/JP Purpose: The purpose of this study was to distinguish between movement of diaphragm and heart wall, and to evaluate the kinetic function of these structures in dynamic chest radiography with computer aided diagnoses. We obtained a dynamic chest radiograph of one healthy volunteer during respiration to assess the distinction between structures and another radiograph of a patient during a left ventriculogram to evaluate heartbeat calculation using an image intensifier system. We performed FFT and band pass filter processing to obtain an intensity curve of the spectrum of dynamic chest radiography and detected the "change-point" of the phase by using characteristic analysis. Fifty-five kinds of band pass filters were used to compare "detection rate of change-point", "matching rate of heartbeat" and "heartbeat error". Results: Movement of diaphragm and heart wall could be extracted selectively by the use of an extreme low pass filter (0.0~0.03 cycle/mm) and middle frequency pass filter (1.4~2.2 cycle/mm). We obtained 100% of matching rate, when detection rate was 100% with these two kinds of filters. There was correlation significantly between them (r = 0.779, p < 0.05). Improvement of detection rate decreased heartbeat error. But there was no significant difference between them by the non-repeated measures ANOVA (p = 1.061). Conclusion: Our method was effective in analysing the dynamic chest radiograph in order to evaluate precise kinetic function, when suitable filters were used. Therefore it is expected to apply for computer-aided diagnoses. Reduction of ionising radiation exposure in patients as a consequence of new imaging technology for medical diagnostics of the spine: A retrospective study covering 20 years in a Norwegian referral hospital A. Nyquist 1 , H. Olerud 2 , B. Bjørnarå 1 , L. Borgen 1 , T. Gudmundsen 1 ; 1 Drammen/NO, 2 Oslo/NO Purpose: To examine possible changes in ionising radiation doses to patients (collective effective dose) undergoing diagnostic imaging procedures for spinal problems over the last 20 years in view of the shift in modalities from conventional X-ray examination and myelography to computed tomography (CT) and later on to magnetic resonance imaging (MRI). Retrospective study of all patient files for the period from 1983 to 2002. The main modality groups for each of the three parts of the spine (cervical, thoracal, lumbar) were: Conventional radiographs, myelography, CT, and MRI. For each type of examination the mean effective radiation dose were obtained from the Norwegian Radiation Protection Authority (NRPA) as published in 1997. The number of conventional X-ray examinations performed was nearly unchanged. Use of myelography reduced by 50%, 100%, and 95% for the cervical, thoracal and lumbar regions, respectively. CT usage increased steadily, remained nearly unchanged, and was reduced by nearly 90% for the cervical, thoracal, and lumbar regions, respectively. The annual collective effective dose from examinations the spine was reduced by 48% in our hospital from 6.1 manSv in 1983 to 3.2 manSv in 2002. The shift in modalities from conventional X-ray and myelography to CT and MRI resulted in a significant reduction in patient exposure to ionising radiation. The results may be explained by our intended policy to select MRI insted of CT whenever possible, and is an overture to the discussion of the further development and structure of diagnostic imaging in general, and for the spine in particular. Dose evaluation for clinical proton beam with standard dosimetry 01 H. Ohtani 1 , T. Hiraoka 2 , H. Saitoh 1 , T. Irifune 1 , T. Katoh 1 ; 1 Tokyo/JP, 2 Chiba/JP Purpose: The standard dosimetry was revised on August 2002 in Japan; it had calling standard dosimetry of absorbed dose in external beam radiotherapy (standard dosimetry 01). The purpose of standard dosimetry 01 are the establishment of traceability for dose of radiotherapy and quality assurance / quality control, according as we measure the dose of high-energy radiation using the standardized international method. We explained the dosimetry of absorbed dose with the standard dosimetry 01 for proton beams and the depth dose was measured with the reference ionization chamber and the parallel plate ionization chamber. The maximum energy of the proton beam used in this study was 70 MeV. Electric separation induced radicals were calibrated for squarer field of 3×3 cm 2 with some ionization chambers. The absorbed dose to water calibration factor is obtained by the reference ionization chamber calibrated 60 Co gamma rays. The remainder range in water calibrated the beam quality conversion factor for proton beam. Using these coefficients, the absorbed dose was calibrated. The absorbed dose used the parallel plate ionization chamber was relatively decided by the results for the reference ionization chamber. Conclusion: The absorbed dose for proton beam was calibrated at each depth. Dosimetry in water was recommended on the standard dosimetry 01. However, it is difficult that we have the waterproof dosimeter. We suggested that the method and problem for proton dosimetry using the standard dosimetry 01. 520 B D E F A G Kinetic analysis of the temporomandibular joint with computer-aided detection system N. Bandai 1 , S. Sanada 2 , K. Ueki 2 , S. Funabasama 2 , S. Tsuduki 3 , Y. Otani 2 , T. Matsui 2 ; 1 Onsen-gun/JP, 2 Kanazawa/JP, 3 Otsu/JP Purpose: The purpose of this study was to develop a method of kinetic radiography and a computer-aided detection (CAD) system for quantitative evaluation of the temporomandibular joint (TMJ). Methods and Materials: Dynamic images of the TMJ were obtained from one healthy volunteer by digital fluoroscopy in the lateral view on the right and left sides. The accumulated image subtraction technique extracted the condyle in each image. A sequential similarity detection algorithm (SSDA) was employed to trace the movement path and the velocity of the condyle. Results: There were no significant differences between by manual and computer analysis. The shape of the path of the right condyle was smoother than that of the left condyle. The size of the maximum vertical and horizontal movements of the condyle were 4.6 ± 0.1 mm and 15.0 ± 0.2 mm, respectively. The velocity of the movement of the condyle was higher in the area close to the articular eminence than in any other area during the opening and closing of the mouth. Conclusion: Our CAD system will contribute to the kinetic analysis of the TMJ for screening, follow-up study, and informed consent, providing speed, quantitation, and cost-effectiveness. Assessment of fetal dose in X-ray examinations of pregnant patients A.J. Servomaa 1 , A. Kettunen 2 ; 1 Helsinki/FI, 2 Oulu/FI Purpose: When a pregnant woman undergoes examination of the lower abdomen or pelvic area, the fetus is directly irradiated. Determination of the absorbed dose to the fetus is therefore of interest as a basis for risk estimates. In Finland, the practice with regard to both estimation of the dose to the fetus and recording of the examination in patient records varies considerably. The fetal dose calculated by means of various dose calculation methods are compared and the results presented. Methods and Materials: Using the "FetDose" and "PCXMC" programs, the normalized fetal dose was calculated for abdominal and pelvic examinations of various radiation qualities, ESD and conceptus depths. The doses obtained were compared against those reported in the literature. The calculated NUDs (normalized uterus doses) obtained for various parameters by means of various calculation methods agree, with reasonable accuracy. The NUD occurring in a pelvic AP examination (80 kV, 3 mmAl filtration, FSD 80 cm) is about 0.40 for a gestational age of 0-7 weeks and for a fetal depth of 8 cm. The dose to the ovaries differs slightly from the dose occurring to the uterus during the same examination. Detailed data about the NUDs in various common radiography examinations are presented. The results of calculations obtained with different programs show the same NUD with reasonable accuracy. Normalized fetal doses and radiation risks corresponding to the European ESD recommendations in conventional radiography examinations may help the radiological staff to assess the significance of the exposure to the fetus. withdrawn by authors Quality advances via noise reduction in laser imaging T.R. Lindquist; Oakdale, MN/US Purpose: Noise sources in medical imaging and printing can limit diagnostic accuracy but are often not assessed quantitatively. A method is described for objectively quantifying noise by means of a film digitizer and analysis software. A second method, based on human perception of simulated nodules on films with varying amounts of noise, is also described. In the first method, a film digitizer scans a print of a constant gray level image. The scanned digital image file is then processed by software that: (1) extracts and averages density data from narrow horizontal and vertical strips, and (2) performs one-dimensional Fast Fourier Transform (FFT) processing to yield a Noise Power Spectrum (NPS) for each horizontal or vertical strip. In the second method, a computer program is used to synthesize a test image with very low contrast dots ("nodules") superimposed on a gradually changing background. In timed experiments, prints of these images are placed on a light box, and an observer is asked to mark the locations where the dots are believed to be present, after which the true and false positives are counted. Results: Prints were made on a variety of medical imagers, using film with a variety of quality levels. Prints made with the latest laser imager and film yielded lower measured noise and higher perception scores than prints made with prior technology. Conclusion: Measurable progress has been made in reducing the noise level of medical imaging printers. This is further demonstrated by improved perception of subtle details. Estimation of maximum skin dose and average lung dose in coronary angiography procedures A. Karambatsakidou, P. Tornvall, N. Saleh, P.-O. Löfberg, A. Fransson; Stockholm/SE Purpose: A comparison of phantom and patient based techniques to estimate the maximum skin dose (MESD) and average lung dose from coronary angiography procedure is described. Conversion factors for the dose to the skin and lung, normalized to the dose-area-product (DAP), have previously been obtained from measurements using an Alderson phantom. In this study, measurements on patients using slow radiographic film and diodes were used in combination with the software WinODS to evaluate the impact of different operators, and of variations in patient size, on these factors. The transmission ion chamber integrated into the angiographic unit was used to measure DAP. The conversion factor for MESD from the phantom simulation was reported as 3.8 mSv/Gycm 2 . The corresponding value for measurements on patients in this study was 3.7 ± 0.7 mSv/Gycm 2 (1 SD; 18 patients). No significant difference in conversion factor between the operators was found. The lung dose varied with the body mass index (BMI). In slightly overweight patients (BMI: 27-30), the lung dose was about 16% lower than in normal sized patients (BMI:19-26) for the same DAP-value, while for overweight patients (BMI > 30) this difference increased to 24%. Conclusion: Measurements on phantoms and on patients yield similar conversion factors for MESD in coronary angiography procedures. The BMI-value seems to be a robust indicator of the variation in dose to internal organs from such procedures. With film/diode measurements, the differences in techniques (geometry; projections) between operators can be easily verified, and as such be integrated into the training of new angiography operators. Radiation doses in a newly installed flat-panel digital system in interventional cardiology department V. Tsapaki, S. Kottou, N. Kollaros, P. Dafnomili, V. Neofotistou; Athens/GR Purpose:The purpose of the study was to investigate the radiation doses of the newly installed flat-panel fluoroscopy (FPF) system in an Interventional Cardiology (IC) department and to examine possible methods of technique optimization regarding the new digital system. Materials and Methods: Fifty coronary angiographies (CAs) and 50 percutaneous transluminal coronary angioplasties (PTCAs) were investigated. Patient data were: sex, age, weight, height, Dose Area Product (DAP), fluoroscopy time (T) and total number of frames (F). Further more, dose rates in all fluoroscopic and cine modes were measured. Image quality was assessed using a dedicated test tool. Results: Median values of DAP, T and F were: 27.7 Gycm 2 , 4.1 min and 876 in CA and 51.1 Gycm 2 , 12.7 min, 1184 in PTCA. Our results are comparable with those found in the recent literature. Regarding the technical characteristics of the digital system, the high contrast resolution (HCR) is not affected by fluoroscopic mode, whereas low contrast resolution (LCR) is slightly decreased in the lowest mode. The results of the study concerning the FPF system lead to the conclusion that the lowest fluoroscopic mode and the lowest frame rate should be used routinely for dose optimization and that the new digital technology has comparable radiation dose to the conventional technology. Purpose: An earlier study using the MTE scanner enabled us to register in vivo wave-like activity of the skin electrical landscape (SEL), which is supposedly macroscopic manifestation of intercellular communication. The present study of the chaotic SEL activity was done to try to find out distinctive dynamic features between melanoma and adjacent tissues. Methods and Materials: MTE is a new functional, non-invasive digital imaging modality, which enables dynamic visualization of the skin and underlying tissues in terms of spectral electroimpedance and electropotential parameters, with high spatial and temporal resolution (~ 0.5 mm). Non-thermal mm-EMF (4 min) and weak MF (< 0.001 T) were used as test influences. Initial and induced SEL dynamics have been graphically and statistically analyzed. Specifically, the throughimage-sequence analysis resulted in detailed dispersion maps of the scan-area. The SELs of (i) healthy and allergic subjects, and (ii) those with cutaneous melanoma were investigated. Results: Primary melanoma manifested not only as a sharp electro-abnormality, but also as a distinctly stable/hyposensitive zone (sigma = 0.0 -1.0%) in all measurement parameters.This hyposensitive zone(s) was surrounded by islet areas of marked hypersensitivity (sigma is up to 50%). Dispersion range of the more distant environment had intermediate values. In cases of allergy, strongly pronounced dependence of the mm-EMF response upon time of investigation was observed at the same subject, i.e.: from sharply marked reactions at the stage of sensitization to practically indistinguishable ones during remission. In healthy subjects, in most cases, significant trigger reversible changes of histograms were registered in response to both tests. Intracranial elastance analysis using MRI in normal-pressure hydrocephalus T. Miyati 1 , M. Mase 2 , M. Onoguchi 1 , H. Kasai 2 , M. Hara 2 , K. Yamada 2 , Y. Shibamoto 2 , S. Matsunaga 1 , T. Kasuga 1 ; 1 Kanazawa/JP, 2 Nagoya/JP Purpose: In order to assess the state and dynamics of the intracranial system in normal-pressure hydrocephalus (NPH), intracranial elastance (ICE) was measured with magnetic resonance imaging (MRI). The ICE index, which is the ratio of pressure to volume change, was obtained with Alperin's method; intracranial volume and pressure changes during the cardiac cycle were calculated from the net transcranial blood and cerebrospinal fluid (CSF) flow measured with phase-contrast (PC) cine MRI. ICE indices were determined in patients (n = 13) with NPH, brain atrophy or asymptomatic ventricular dilation (VD), and in healthy volunteers (control group; n = 11). Concurrently, a time constant of the integral of the CSF response function, which represents the intracranial mechanical property was determined with PC cine MRI. The changes in ICE indices were also analyzed after intravenous injection of acetazolamide. These values were then compared with the volume-pressure response (VPR) during the shunt operations. Results: The ICE index in the NPH group was significantly higher than in the control or VD group, but no difference was found between the control and VD groups. The ICE index increased in all groups after an acetazolamide injection because of an increase in cerebral blood volume. There were significant correlations between the ICE index and the time constant. A positive correlation was noted between the ICE index and the VPR. Conclusion: ICE analysis measured by PC cine MRI makes it possible to noninvasively obtain a detailed assessment of intracranial state and dynamics in the NPH and to assist in diagnosis of the NPH. Quantification of magnetization transfer by sampling the transient signal using MT-prepared single-shot EPI G. Helms 1 , G.E. Hagberg 2 , C.D. Claussen 1 , F. Schick 1 ; 1 Tübingen/DE, 2 Rome/IT Purpose: Using trains of MT-pulse and EPI readout, the transition to steady state can be measured with higher accuracy than the steady state. A novel quantification method based on sampling transitions at different repetition periods (PR) is introduced. Gaussian MT-pulses of 6.4 ms duration and flip angle of 720 degrees were repetitively applied at 1 kHz offset at PR = 8, 16, 26, 100, 200 ms. An axial slice through the centrum semiovale of the brain was measured by single-shot SE-EPI (50 ms TE, 5 mm thickness, 20 cm FOV, 64 x 64 matrix). In brain tissue, the signal dependence was described by analogy to progressive partial saturation, where the direct saturation is increased by PR-dependent MTcontribution proportional to macromolecular content and differential saturation. Macromolecular content, kinetic and relaxation parameters and the saturation were estimated by a global non-linear least-square fit of the signal equation for ROIs in cortical grey matter (GM) and central white matter (WM). Results: The macromolecular content was (15.6 ± 0.6)% in WM and (9.5 ± 0.6)% in GM, the apparent relaxation rates (0.92 ± 0.2) 1/s and (0.70 ± 0.05) 1/s. The apparent transfer rates were (30.1 ± 0.7) 1/s and (23.4 ± 2.8) 1/s. Macromolecular saturation of a single MT-pulse was (38.2 ± 0.1)% in WM and (40.0 ± 3.2) in GM; the direct effect on water less than 1%. Signal correction for CSF contributions was necessary. Conclusion: Quantitative MT-mapping of the whole brain may become feasible in vivo at higher field strengths by means of permutation of the slice order. 522 B D E F A G The concept of radiography in health sciences: A concept analysis S. Sorppanen 1 , A. Servomaa 2 ; 1 Oulu/FI, 2 Helsinki/FI Learning Objectives: To clarify the content and uses of the concept of radiography in health sciences and to compare it to the concept of radiography in physics and technology. Background: In the field of radiography, theoretical research related to concepts has so far being rare. Nevertheless, the concept development is an important part in constructing theories and clarifying the identity of a discipline. In Finland, the discipline of radiography started in 1999 at the University of Oulu, and since then it has offered radiographers academic education in their own field. For being able to build its own knowledge base and theories to be used in developing the profession and education of radiographer, and for being able to stand for its position as an independent academic discipline, the young discipline of radiography needs systematic conceptual clarification and development. Procedure Details: The concept of radiography was analysed using so-called evolutionary method of concept analysis (presented by Rodgers). The contents and uses of the concept were studied by determining the concept's characteristics and by observing these characteristics in the cross-disciplinary comparison. The data consisted of literature and Internet pages, and were analysed using deductive-inductive content analysis. Conclusion: The concept of "radiography" in health sciences can be determined as "dual, dynamic, social and situation-related expertise of radiographers in the use of radiation, which is based on a versatile synthesis". It seems to be wide and complex in nature, and radiographer-centered. The content and the use of the concept varies according to the discipline. Measurement of distribution of horizontal dose amount to chest X-ray by Gafchromic film K. Nishikiori 1 , M. Miyazawa 2 , A. Otonashi 3 ; 1 Habikino/JP, 2 Itabashiku/JP, 3 Suita/JP Learning Objectives: To illustrate horizontal dose distributions of human diagnostic level in the chest phantom by Gafchromic film and glass dosimeters. To point out the characteristics of horizontal dose distributions by materials in ten shots and in fluoroscopy. Background: In general, we use an ionization chamber dosimeter or TLD to measure dose distribution of diagnostic level. However TLD can not indicate horizontal and consecutive dose distributions, because it has only scattered dose data. Consequently, we used Gafchromic film to obtain a horizontal consecutive dose distribution of human diagnostic level. Imaging Findings: 1. First, we placed a Gafchromic film and glass dosimeters in the specific place of the chest phantom. Then we irradiated the chest phantom with diagnostic level X-rays. The dose distribution which was acquired by the film and glass dosimeters was then analyzed. 2. Next, we examined the result of fluoroscopy. 3. The results of the first method were compared with the result of the fluoroscopy and the difference between the distributions in 1 (Gafchromic film and glass dosimeters) and 2 (fluoroscopy) examined. The characteristic dose distributions of the incidence dose in diagnostic level were confirmed by both horizontal dose distributions. 1. Horizontal dose distribution which was specific and consecutive data could be obtained from the Gafchromic film. 2. Horizontal dose distribution which was specific and scattered data could be acquired by glass dosimeters. We obtained almost the same as results in fluoroscopy. Horizontal dose distribution of fluoroscopy showed a sharp reduction on the subcutaneous tissue of the chest phantom. Barium enemas: Are radiographers up to it? P. Vora, A. Chapman; Leeds/UK Aim: To determine the types and rates of complications encountered by radiographers when performing double contrast barium enemas. A similar complication rate to those encountered by radiologists will reassure those who have adopted this new skill mix and encourage its further development whereas an increase in complications may point to areas where radiographer training needs to be improved. Materials and Methods: 741 questionnaires were posted to radiographers who had in the last 5 years attended one of the biannual Leeds barium enema training courses. Results: Of 741 questionnaires posted 407 (54.9%) were returned completed. Approximately, 348,433 barium enema examinations had been performed. 59 radiographers reported 87 complications, including 13 intraperitoneal and 11 extraperitoneal perforations. There were five deaths (mortality rate -1 in 69,687). The five deaths included two of the twenty-four (10%) perforations, two of the forty-five (5%) cardiac events and one CVA that occurred during an examination. Conclusions: Radiographers have been regularly performing DCBEs for almost a decade. The mortality rate for radiographer performed double contrast barium enemas is similar to that reported for radiologists. A slightly higher than expected rate of perforation is noted in this study and so this is an area where radiographer training should be targeted. The level and incidence of the fear in patients subjected to radiological examinations E. Czekajska-Chehab, M. Makara-Studzinska, A. Koczynasz, I. Nowak, A. Drop; Lublin/PL Purpose: Analysis of incidence and intensity of fear in patients subjected to diagnostic procedures. Methods: An anonymous survey concerning the occurrence and level of fear connected with radiological examinations was conducted among 320 individuals: 170 patients attending for various contrast examinations and 150 women before mammography, using the questionnaire prepared by the authors. The level of fear was evaluated according to the adopted scale in relation to the obtainable maximum values. Results: 252 out of 320 individuals (79%) reported their fears before planned radiological examinations. The frequency of fear was extremely high for mammography (98%) and lower for contrast procedures (61%). The strongest fear was associated with the uncertainty of diagnosis and length of waiting for results (86-94%). The fears of patients before contrast examinations were mostly related to results and harmful effects of radiation. The fears concerning allergic reactions were reported by almost a half of patients before CT, urography and barium enema. In patients before contrast procedures the highest fear level was related to the uncertainty of results (77-86%). The lower level (45%) was associated only with urography. The fears about the examination itself, allergic reactions or harmful effects of radiation showed similar intensity (52-79%), irrespective of the kind of examination. Conclusions: Fears before radiological examinations are common and concern over a half of patients subjected to contrast procedures and almost all of those before mammography. The most common causes of fear include: uncertainty about diagnosis, exposure to harmful effects of radiation and length of waiting for results. Audit of adequacy of inpatient CT requests: Implications and consequences W. Chooi, P. Heath, M.J. Bull; Sheffield/UK Purpose: Vetting of CT requests ensure that the examination is justified in accordance to local guidelines and also allow the radiologist to select the most appropriate CT protocol. However the provision of poor clinical information severely limits this step. This audit aims to determine the prevalence of inadequate clinical details in CT request forms and also identify trends that result in poor referring technique. Methods and Materials: For a two week period all inpatient electronically generated CT request were prospectively monitored. Outpatient & out-of-hour requests were excluded. Results: Out of a total of 126 requests, 102 were successfully audited (81%). The types of examinations included CT head 63 (62%), abdomen 19 (19%), thorax 13 (13%), abdomen and thorax 2 (2%), and musculoskeletal 2 (2%). Problems were encountered with 39 requests (38%). The most common problem encountered was that of inadequate or misleading information (n = 20). Others issues included better alternative examination (n = 2), undisclosed renal impairment (n = 4), failed examinations due to agitated patients (n = 2), ward cancellations (n = 4), requests without contact details (n = 7), and wrong ward details (n = 5). As a result 20 of these requests were not performed. The majority of these requests are completed by junior doctors. Conclusion: Vetting of CT requests is an essential first step towards a successful CT examination. The provision of inadequate clinical information is prevalent and junior doctors require closer supervision when completing CT requests. to determinate whether use of high iodine concentration contrast medium offers more complete information. Diagnosis and follow-up of aortic dissection with multislice computed tomography Y. Herrero, M. Martí, J. Echeveste, M. Fernández-Velilla, G. Garzón, N. Gómez-León; Madrid/ES Purpose: To assess the utility of multislice computed tomography (MSCT) in the diagnosis and follow-up of aortic dissection. Materials and Methods: Seventy-one patients referred to rule out aortic dissection underwent MSCT following a standardised protocol. The volume of interest was the entire aortoiliac system, 120 mL of non-ionic iodinated contrast were administered at a flow rate of 3 mL/sec. A collimation of 3 mm, table speed of 16 mm per rotation, pitch of 4 and reconstruction interval of 2 mm were used. Multiplanar (MPR) and three-dimensional reconstructions (external rendering) were obtained in a workstation (Vitrea 2; Vital Images Plymouth, Minn). Aortic dissection was diagnosed when an intimal flap separating the true and false lumen was observed. Patients diagnosed with aortic dissection underwent an endovascular repair (stentgraft placement). Follow-up CT examinations after endovascular repair were acquired with the same MSCT protocol, after performing a basal nonenhaced study. Complete closure of the entry site, and both stent-graft and visceral arterial branches patency were considered as adequate stent-graft function signs. Results: Nine of the 71 patients were diagnosed with aortic dissection (six acute and three chronic dissections), two of which involved the ascending aorta and seven the descending thoracic aorta. Follow-up demonstrated in all cases a residual abdominal aortic dissection with progressive decrease in size of the false lumen. Conclusion: MSCT determined the exact anatomy of the dissection flap, the location of the entry and reentry sites, and the major branch vessels that were supplied by the true lumen. Endovascular stent-graft placement for treatment of thoracic aortic aneurysms M. Fernández -Velilla, G. Garzón, I. Acitores, F. Ibáñez, L. Riera; Madrid/ES Learning Objectives: To assess the safety and efficacy of endovascular stentgraft placement for repairing descending thoracic aortic aneurysms in high-risk patients. To analyse the major associated complications. To show our experience in the management of these patients over a six-year period. Background: By helping patients avoid open surgery, endovascular aneurysm repair minimises the perioperative derangement of pulmonary, renal, cardiac, and gastrointestinal function. The greatest potential benefit is in high-risk patients who have large aneurysms and who are poorly suited to any of the current alternatives. Procedure Details: Endovascular aneurysm repair was performed in 39 highrisk patients who could not undergo conventional repair. The feasibility of endovascular treatment and the prosthesis' size was determined based on preoperative spiral CT and intraoperative angiography findings. Stent-grafts were surgically inserted through exposed femoral arteries with fluoroscopic guidance. The anaesthetic technique was either epidural or general. Endovascular grafts were constructed with Gianturco stents and polytetrafluoruroethylene (PTFE) graft. Stent-grafts were placed in 12 disecting, 21 atherosclerotic, five traumatic, and one post-coarctation descending thoracic aortic aneurysm. 68% of them were chronic. We analysed the results obtained in both stable patients, in which an elective treatment was performed of sacular, fusiform, traumatic and chronic dissection aneurysms, and in emergency patients (intramural bruise, penetrating ulcer, and aortic dissection). Conclusion: Endovascular treatment of thoracic aortic aneurysms offers considerable benefits. Long-term follow-up is needed to ascertain the durability of the procedure especially in dissecting aneurysms. An interdisciplinary and experienced team is needed to manage endovascular and surgical treatment. Radiologic appearances of thoracic outlet syndrome: Evaluated by PAT optimized 3D contrast enhanced MR angiography and intraarterial DSA Ö. Özsarlak, O. D'Archambeau, F. Delrue, P.M. Parizel; Antwerp/BE Learning Objectives: Thoracic outlet syndrome: PAT optimized contrast enhanced (CE) MRA and intraarterial digital subtraction angiography. Background: Seventeen patients clinically suspected of having a vascular thoracic outlet syndrome were retrospectively reviewed. The patient population consists of 10 women, and 7 men with an age range between 14 and 65. In eight patients, CE-MRA was performed in 1.5 T MR system. GRE Flash 3D MR angiography with CARE Bolus technique was used with a PAT acceleration factor of two. The remaining nine patients were examined by intraarterial, and intravenous DSA of the upper extremity. All examinations, including MRA were performed both in neutral and in Adson positions with abduction of arms. Imaging Findings: None of the patients showed abnormality during neutral position. Examinations repeated during Adson position revealed 22 subclavian artery lesions in 17 patients: 8 occlusions, 8 high-grade stenoses, and 6 mild-grade stenoses. In 8 patients, the lesion was located on the left side, in 2 patients on the right side, and remaining 7 patients' lesions were bilateral. Conclusion: A review of the functional anatomy, clinical symptoms, CE-MRA and DSA findings are presented with illustrative cases. The advantages of PAToptimized CE-MRA are highlighted. MRI evaluation of patients with peripheral vascular malformations G. Calabrese, G. Falda, G. Lucchini, A. Cazzulani; Garbagnate Milanese/IT Learning Objectives: To define a MRI protocol to study patients with angiodysplasia in order to evaluate soft tissues and bone involvement and to demontrate the appearance of the vascular malformations. Background: Imaging studies must show all the abnormal vessels and provide information on the degree of surrounding tissue involvement. In this exibit we describe the MRI findings in 15 patients with angiodysplasia of the lower or upper limbs. Procedure Details: T1 weighted FSE sequences and T2 weighted FE sequences in the sagital and coronal planes were acquired. A sagital T2 FSE sequence B D E F A G with 16 echos and fat-saturation was used to demonstrate vessels with slow flow. DSA and DSV were performed to proceed to embolization or operation. T1 images gave good morphological demonstration of muscle involvement. On T2 FE images the presence of small vessels within the subcutaneous fat or within the bones was easily shown. Images acquired with the 16 echos T2 sequence were processed with the M.I.P. function to show the abnormal vessels; this sequence was especially useful in the venous malformations and in some cases the draining veins were also identified. Conclusion: MRI is the technique of choice to demonstrate the anatomic extent of the lesions and their relationship to the adjacent soft tissues. Even if MRA is improving from the technical point of view, still it remains quite complex and time consuming. In our protocol a simple T2 sequence showed to be a good method to demonstrate abnormal vessel with slow flow. Occlusion Background: Thrombosis of the IVC and its tributaries is most commonly associated with malignancy, resulting from direct invasion by carcinoma of the kidney, liver or adrenal gland. Thrombosis of the IVC secondary to benign causes is less common. Predisposing factors include pregnancy, connective tissues disorders and coagulation abnormalities. Recognition of caval thrombosis on ultrasound may be difficult. However, depiction of the IVC on both contrast-enhanced computerised tomography and MRI is more accurate. Although non-contrast MRI is useful for demonstrating IVC occlusion, contrast-enhanced MR venography offers the opportunity for rapid evaluation in a single breath-hold. Imaging Findings: The normal appearance of the IVC as demonstrated by MRI is illustrated, along with examples of IVC occlusion associated with both benign and malignant pathology. Simple rules for differentiating bland versus tumour thrombus are presented and illustrated. A method for optimising the timing of data acquisition for CE-MRA is presented. The merits of "indirect" versus "direct" IVC MR venography are also discussed. Finally, artefacts that may mimic IVC thrombus are described. Conclusion: MRI/MRA accurately evaluates the IVC. The multiplanar imaging capabilities, lack of ionising radiation, coupled with the added benefit gained from the use of intravenous gadolinium based contrast agents in MRA, makes MRI the modality of choice in evaluating patients with suspected IVC occlusion. The swollen leg: The various etiology and its CT venography findings W. Jun, W. Lee, J. Chung, J. Park; Seoul/KR Learning Objectives: To illustrate the various causes of swollen legs. To recognize the characteristic imaging findings of various causes of swollen legs. To evaluate the accuracy of CT venography in the differential diagnosis of the etiology in patients with swollen legs. Background: The swollen leg is a common clinical problem that complicates many medial and surgical disorders. Clinical applications of computed tomography (CT) venography have increased with the improved technology of multidetector CT systems. CT venography showed the diagnosis of DVT and other soft tissue disease in patients with swollen leg. For the past two years, CT angiography of lower limbs was performed in 180 patient (age 19-92 years) with swollen legs. The various causes and imaging findings of swollen legs are described and illustrated. Imaging Findings: The characteristic imaging findings of acute deep vein thrombosis (DVT) are a definite intraluminal filling defect, venous distension and muscle compartment enlargement. Findings of chronic DVT are small, thick-walled, poorly enhancing veins and presence of collaterals. Findings of lymphedema are skin thickening, subcutaneous tissue thickening, fat infiltration: lines parallel to skin and perpendicular to skin. Findings of cellulitis including necrotizing fasciitis, are fascial thickening, fat infiltration, focal fluid collection, soft -tissue gas and muscle involvement. Conclusion: CT venography showed promise for the diagnosis of DVT and other soft tissue disease in patients with swollen legs. CT venography is the modality of choice when clinical and other imaging findings are indeterminate. The aorta revisited: Spectrum of findings on helical CT A.J. Madureira, J.P. Jesus, J. Loureiro, I. Ramos; Porto/PT Learning Objectives: To review the imaging findings of the anatomical variants and disease processes that may affect the aorta from the aortic valve to the bifurcation. To describe the pitfalls that may be encountered. Background: Helical CT is a frequently used method in the evaluation of diseases affecting the aorta. It provides invaluable information in the assessment of acute aortic syndromes and is often employed in diagnosis and follow-up of dissection, aneurysm and bypass surgery. Procedure Details: The imaging findings of the diseases that may affect the aorta are presented based on the experience of our tertiary care hospital and level 1 trauma center. The anatomical variations of the aortic arch vessels, acute aortic syndromes, aneurysmal disease and aortic bypass surgery are discussed and illustrated thoroughly. Conclusion: Helical CT is a firstline imaging method in the evaluation of aortic disease due to it's widespread availability, good spatial resolution and speed. Learning Objectives: To illustrate the MR findings that differentiate severe carotid artery stenosis with a tiny residual distal lumen from patients with total carotid artery occlusion. Background: Due to the small but substantial stroke risk in patients undergoing digital subtraction angiography, contrast enhanced magnetic resonance angiography (M.R.A.) has become the standard for evaluation of carotid occlusive disease in many centres. M.R.A. is highly accurate in differentiating significant stenosis (70%-99%) that requires carotid endarterectomy, from insignificant (< 70%) disease. M.R.A. is also highly accurate in differentiating severe stenosis from occlusion. However, demonstration of a string sign depends on careful interrogation of the source images as the residual patent lumen may not be visualised on standard maximum intensity projections. Given the clinical importance of differentiating between these two groups, we present and contrast the imaging findings of patients with significant carotid stenosis and those with total carotid artery occlusion. Imaging Findings: We describe the varied findings in both patients with total carotid artery occlusion and those with severe stenosis. We present a simple algorithm for rapid evaluation of patients referred for differentiation of severe stenosis from occlusion. Background: Anomalies of IVC and renal veins occur with a prevalence of 0.07% to 8.7%, and are easily identified on CT, frequently incidentally. If unidentified, they can be misinterpreted as pathology (adenomegaly, retroperitoneal masses, normal venous structures and/or collaterals during acquired obstruction) or can lead to morbidity during radiologic and surgical procedures (positioning IVC filters, varicocoele sclerotherapy, renal venous sampling, shunt placement for portal hypertension, liver or kidney transplantation, IVC ligation for thromboembolic disease, abdominal aortic aneurysm repair). We describe the CT findings in 48 cases of anomalies of the IVC and the LRV. Imaging Findings: 20 female and 28 male patients, aged 20-76 years, were studied. We found 4 anomalies of the suprarenal segment (interrupted IVC with azygos continuation), 26 anomalies of the renal segment (18 circumaortic LRV, 8 retroarotic LRV), and 18 anomalies of the infrarrenal segment (1 retrocaval ureter, 6 transposition of the IVC, and 11 duplications of the IVC). One patient with agenesis of the IVC with azygos continuation had profound venous thrombosis, and another had bronchiectasis. In any other case the anomaly was responsible for the patient's symptoms. Results: Mean size of the ascending aorta in these patients at initial presentation was 7.4 cm (range 5.0 to 12.5 cm). Dissection of the ascending aorta occurred in 50%. Median size of ascending aorta at time of dissection was 5.6 cm. All patients underwent surgery for their aneurysms. The postoperative mortality was 6.3%. We have compared the two groups of Marfan's syndrome patients whom had dissections: with an aortic-root diameter from 7.0 to 12.0 cm (70%) and with an aortic-root diameter from 5.0 to 7.0 cm (30%). There is correlation between the aortic-root diameter and the probability of aortic dissection. Analysis to isolate risk factors for dissection revealed that size larger than 6.0 cm increased the probability by 40%. The incidence of dissection increased with aneurysm size and the radiological criteria for surgical intervention in Marfan's syndrome are aneurysm diameter of 5.0 cm. Maximal information about size and dissection of aneurysms in Marfan's syndrome patients are obtained from analysis of angiography data. An evaluation of internal carotid artery and cerebral blood flow volume using color duplex sonography in patients with vertebral artery hypoplasia M. Acar, B. Degirmenci, A. Yucel, R. Albayrak; Afyon/TR Purpose: Vertebral artery hypoplasia (VAH) may be defined as VA flow volume below ~ 30 to 40 mL/min using color duplex sonography. The aim of this study was to evaluate the effect of VA hypoplasia on internal carotid artery (ICA) flow volume and cerebral blood flow (CBF) volume. Materials and Methods: In this study, 17 patients with VA hypoplasia and 20 control subjects with normal VA flow volume were enrolled. The patients and control subjects were 50-75 years of age. The ICA and VA flow volumes were determined by using color duplex sonography. Cerebral blood flow volume was calculated as sum of flow volumes in the ICA and VA of both sides. The ICA and CBF volumes of patients with VA hypoplasia were compared with control group flow volumes. Results: In VA hypoplasia and control group, there were no significant differences between ICA flow volumes of right and left sides (222 ± 70 versus 260 ± 87 mL/ min; p = 0.16 on the right side, 211 ± 117 versus 236 ± 73 mL/min; p = 0.45 on the left side) or sum of flow volumes of both ICA (434 ± 144 versus 495 ± 127 mL/ min; p = 0.18). However CBF volume tended to be lower in patients with VA hypoplasia than control group. Conclusion: Evaluation of CBF using color duplex sonography is noninvasive and easily applicable to all patients and provides valuable diagnostic data. To the best of our knowledge, this is the first study demonstrating lower SBFV and normal ICA flow volume in patients with VA hypoplasia. The floating layer: A new sonographic sign of ruptured abdominal aortic aneurysm A. Nunziata 1 , O. Catalano 2 , M. Mattace Raso 2 , F. Sandomenico 2 , A. Siani 2 ; 1 Naples/IT, 2 Pozzuoli/IT Purpose: In patients with ruptured abdominal aortic aneurysm we have occasionally seen a floating layer, similar to the intimal flap recognizable in patients with aortic dissection but slightly thicker. We reviewed our series to assess the overall prevalence, specificity and diagnostic significance of this finding. Materials and Methods: In a 6 year period (from January 1997 to December 2002) we have evaluated with US, 388 consecutive patients with abdominal aortic aneurysm (larger axial diameter of the aorta > 30 mm). Twenty-nine aneurysms were proven to be ruptured (sonographic and/or CT diagnosis) and were surgically confirmed. The remaining 359 patients were not symptomatic and were proven to have a non-ruptured aneurysm at follow-up. Results: A floating membrane was found in 8 out of 29 patients with ruptured aneurysm (28%) and in none of the subjects with non-ruptured aneurysm. The image appeared as a thick layer floating within the aneurysm lumen, clearly detached from a more or less eccentrically placed luminal thrombosis (present in all 8 cases), with a paradoxical movement unrelated to overall vessel pulsation. The floating layer is an uncommon but specific sonographic sign of abdominal aortic aneurysm rupture. Recognizing this findings should lead to prompt surgical treatment, without need for further imaging (contrast-enhanced CT). Color duplex measurement of cerebral blood flow volume in patients with polycystic ovary syndrome M. Acar, A.S. Cevrioglu, B. Degirmenci, A. Yucel, R. Albayrak, M. Yilmzer; Afyon/TR Purpose: Polycystic ovary syndrome (PCOS), one of the commonest endocrinopathies in the human, is known to be associated with risk factors for cerebrovascular disease. We want to determined whether there is a change in cerebral blood flow volume in PCOS. We reported 30 women with PCOS and 20 healthy women with similar body mass index (BMI). Both groups of women were aged 16 to 35 years. We detected internal carotid (ICA) and vertebral artery (VA) flow volume using color duplex sonography. Cerebral blood flow (CBF) volume was determined as the sum of flow volumes of internal carotid and vertebral arteries of both sides. Results: There were no significant differences between patients with PCOS and control group in CBF volume or the bilateral sum of flow volumes in the ICA and VA. But bilateral mean velocity of VA was significantly lower in patients with PCOS compared to control group. Correlation between age of patients and mean velocity of VA and ICA were assessed with Pearson correlation analysis. In control group, mean velocity of VA and ICA was inversely correlated with age (r = 0.61, p = 0.005 versus r = 0.59, p = 0.006). However no correlation was found for patients with PCOS. Conclusion: This is the first study demonstrating normal CBF volume using duplex sonography in PCOS. It is known that the increased risk factors for cerebrovascular disease does not increase stroke mortality in PCOS. Normal CBF volume and absence of decrease in VA and ICA mean velocity by aging may be protective mechanisms. Thoracic aortic calcification in the elderly G.S. Karlsdottir, T. Aspelund, S. Sigurdsson, G. Eiriksdottir, L. Launer, T. Harris, V. Gudnason, R. Detrano; Kopavogur/IS Purpose: Though demographic associates of coronary and abdominal aortic calcification in elderly persons are known, similar information about the thoracic aorta is not available. We developed a protocol for scanning the thoracic aorta from the aortic bulb to the descending aorta at the level of the cardiac apex. Methods and Materials: Computed tomographic images were acquired with a Siemens Sensation 4 scanner, using sequential mode and prospective ECG gating. The CT images were processed using calcium scoring software for coronary arteries, which is modified in order to label areas and quantify calcium in the thoracic aorta. The thoracic aorta is divided into three segments: arch, ascending, and descending. These segments are labeled and calcium within them quantified and results expressed in Agatston scores. Results: Agatston scores were acquired from 676 individuals (263 men, 413 women) with an age range of 66-92 (mean 75) years. There was a 34% increase (95%CI: 22%-45%) in the total Agatston score for every 5 years of age for men, and 49% (95%CI: 40%-58%) for women. There was no significant difference between men and women in the age group 66-70 and, men in the age group 85+ had significantly lower scores than women. Conclusion: A robust method for quantifying calcium in the thoracic aorta has been established. Age and gender distributions of thoracic aortic calcification in the elderly show strong age dependance for both genders but significantly stronger for women than for men. B D E F A G Materials and Methods: CT scans of fourty patients (mean age 70 years, 18 female: previous aortic repair (n = 13), atherosclerosis (n = 10), trauma (n = 8), other (n = 9)) with aortic or supraaortic emergency were reviewed for aortic rupture (AR), aortic or supraaortic fistula (AF), covered aortic perforation (CAP) with transection (AT), dissection (AD), or ruptured ulcer (RAU), and rapid aortic aneurysm expansion (RAAE). Morphological findings were correlated by DSA, surgery or post-mortem. Results: There were 10 AR, 8 AF (4 tracheobronchial, 3 oesophageal, 1 duodenal), 17 CAP (4 AT, 7 AD, 6 RAU) and 5 RAAE. CTA was diagnostic in all cases except five AF: four were diagnosed by DSA, one at post-mortem. In 34 cases, CTA correctly determined the decision of patient management. One separate vertebral artery origin was missed. Two patients died before surgery. 36 patients underwent emergency repair (22 surgical, 14 endovascular); two were observed. Five thoracic AF were treated by endovascular repair, two by surgery, one infradiaphragmatic AF by surgery. Conclusion: CTA is valuable for diagnosing aortic and supraaortic emergencies and determining their treatment. However, in suspected AF complementation by DSA is usually required. Low Materials and Methods: Seventy-five patients with peripheral arterial disease, divided into three groups of 25, underwent MDCTA. MDCTA scanning protocol was: collimation 4 x 2.5 mm, thickness 3 mm, gantry rotation time 0.5 s, kV 120, delay time 28 s. The only variable among the three groups was mAs, respectively 130, 100 and 80, with a resultant CTDIw of 13.2, 10 and 7.9 mGy. All patients underwent DSA within 72 hours from CTA. The volume of contrast medium (0.7 gI/ kg of iomeprol 400 mgI/mL), injected at 3.8 mL/s, was flushed with 40 mL of saline. 3D real time interaction approach on a dedicated workstation was performed in all cases, with different reconstructions algorithms. Image quality and degree of stenosis were independently evaluated by 2 blinded readers. Results: Regarding image quality no significant difference was found among three protocols. Slight artefacts related to beam hardening were present in the pelvis with the lower mAs protocol without impairment of diagnostic quality. Interobserver agreement was substantial to almost perfect in all cases. The sensitivity, specificity and accuracy resulted of 96, 93 and 94%, independent of the mAs value. Conclusions: Low-dose MDCTA provides qualitatively acceptable images. It also appears accurate in the assessment of patients with peripheral arterial disease providing results comparable to higher dose protocols. Image noise on native lowest dose protocol can be reduced or eliminated by thickening MIP or MPR images. Diseases had lymphadema, 26 (5.5%) had superficial venous thrombosis, 6 (1.3%) had popliteal vein or artery aneurysm. Nine (1.9%) limbs had pseudoaneurysms (8 femoral and 1 located at the tibial-peroneal trunk), 4 (0.8%) had AVF (3 detected to be femoral and 1at the level of the external iliac artery). Four (0.8%) had either abscess, or enlarged lymph nodes in the groin, compressing the veins, and 6 (1.3%) had some kind of musculoskeletal problem (muscular tear). Conclusion: Complete venous evaluation with duplex imaging can be very helpful in the determination of the underlying cause of leg swelling. DVT is the commonest. Sonographic assessment of intima-media thickness (IMT) and plaque morphology of the carotid system: A comparative study A.A. Kotis 1 , P. Brestas 2 , L. Guindaglia 1 , G. Chatzakis 1 , K. Papanastasiou 1 ; 1 Rhodes/GR, 2 Athens/GR Purpose: To investigate the potential association of increase in IMT with carotid artery disease extension, plaque morphology and formation of carotid bifurcation stenosis. Materials and Methods: 250 patients 140 females and 110 males referred for color duplex ultrasound were included. Risk factors for cerebrovascular disease were recorded. Measurements of common carotid (CCA) IMT adjacent to the bulb and carotid bifurcation plaque characterization and classification were realized. Coefficients of variation and k-statistics were used for assessment of variability in IMT measurements and plaque characterization respectively. Controversy cases underwent SHU 508A contrast agent injection. Results: Significantly higher IMT values were measured a) in men than in women (p < 0.05) b) on the left side compared with the right (p < 0.01). Mean IMT measurements showed positive linear relationship with age. We identified plaques in 205 of 280 carotid bulbs and stenosis (> 50%) in 60 of them. Echogenic US plaque appearance (121/280) predominated in comparison with echolucent (84/ 280) and relationship of lumen stenosis with the presence of echolucent plaques (p < 0.05) was found. Multiple regression model revealed significantly higher IMT values in patients with plaques at any side (p = 0.019), with more evident difference in those with stenosis (p < 0.001). The magnitude of plaques correlated significantly with IMT. There was no relationship between plaque echogenity and IMT (p > 0.05). We realize the existence of correlation between increase in IMT in CCA and extent of carotid bifurcation atherosclerotic disease. Color doppler ultrasonography is accurate and reproducible for assessment of IMT and detection of carotid plaque morphology and evolution. To emphasize the role of MR angiography in the evaluation of renovascular disease, and to discuss the performances, advantages and limitations of different MR angiography techniques. Materials and Methods: More than 200 MR angiograms of renal arteries were reviewed for the presence of any anatomic variations, the number of renal arteries, the presence of renal artery stenosis, occlusion, or other arterial diseases together with the limitations, artifacts and pitfalls of the technique. More than 100 examinations were performed after applying parallel acquisition technique with acceleration factors up to 4, using a 12-channel phased array body coil. Influence of PAT on slice thickness, image matrix, total examination time, and image quality are discussed. Results: Phase contrast acquisitions are extremely helpful in evaluating flow patterns in the renal arteries, and offer unique information about the flow velocity patterns. PAT using SENSE reconstruction algorithm leads faster 3D MRA acquisitions. This results in, not only shortening the examination time, but also shortening the breath-hold time, and providing better image quality due to decreased motion artifacts. PAT-optimized 3D contrast enhanced MR angiography is unique among noninvasive imaging modalities in that it offers a comprehensive 3D evaluation of renal anatomy, and renal vascular territories in a very short acquisition time. The main challenge in the evaluation of renovascular hypertension is the detection of hemodynamically significant renal artery stenosis. A combination of different techniques (phase contrast and contrast-enhanced MRA) yields the best results, comprising both morphologic and functional information. Possibilities Results: Pathologic changes in the visceral arteries were revealed in 31 cases, including 14 findings with various grades of stenosis of the coeliac trunk, 11with stenosis of the SMA, 6 -occlusion of the splanchnic arteries. Causes of visceral ischemia were: atherosclerosis (the main cause), found in 23 patients, aorto-arteriitis -in 2, coarctation of abdominal aorta -in 1, extravasal compression-in 5. High correlation between conventional angiography and ce-MRA was determined in 28 patients. The functional phase-contrast MRA was done in 18 patients with stenoses of small and middle degree; it gave an opportunity to acquire information on flow parameters and to elaborate the grade of stenotic changes. The ce-MRA with pc-MRA gives a chance to determine the grade of stenosis with high accuracy, visualize colateral vessels, to get information on flow parameters in damaged splanchnic arteries. B D E F A G Imaging Findings: All degrees of local vascular damage were seen. Various imaging modalities may be employed in characterising such lesions, including CT, MRI and conventional angiography and venography. An addict may injure any vessel during injection and the superficially placed femoral vessels are particularly susceptible to damage. Septic vascular complication is common. Arterial injury resulting in haematoma formation, arterial dissection and thrombosis, arteriovenous fistula and mycotic aneurysm formation is shown. A case of torrential haemorrhage from a ruptured pseudo-aneurysm treated with coil embolisation is demonstrated. Deleterious effects secondary to the injected substance, including distal ischaemia and tissue necrosis, are demonstrated. Venous thrombosis is common and can be shown by multiple imaging modalities. Infected venous pseudo-aneurysms with secondary septic embolisation may occur. Conclusion: It is important for radiologists to become familiar with the appearance of vascular complications occurring in the setting of injection drug use. Early imaging to define disease extent and possible complication is important in this difficult patient group. Carotid intima-media thickness ( The aim of the study was to investigate the probable association of atherosclerotic disease with endothelial cell adhesion molecule ICAM-1, VCAM-1 and E-selectin levels. Carotid IMT was measured by high resolution ultrasonography of the common carotid arteries in 45 predialysis patients with ESRD, 83 patients on chronic haemodialysis (HD) and 35 controls. Compared with controls, ESRD and HD patients had increased IMT (p < 0.01 and p < 0.01 respectively), as well as serum ICAM-1 (p < 0.0001 and p < 0.0001 respectively) and VCAM-1 (p < 0.0001 and p < 0.0001 respectively) levels. IMT was correlated with age in controls, ESRD and HD patients (p = 0.002, p = 0.001 and p = 0.0001 respectively). No correlation was found between IMT and other cardiovascular (CV) risk factors such as gender, lipid levels, mean arterial blood pressure, Ca x P products or HD duration in HD patients. In univariate analyses, IMT was correlated with history of CV events, logCRP and ICAM-1 both in ESRD (p = 0.01, p = 0.04 and p = 0.03 respectively) and HD patients (p = 0.04, p = 0.02 and p = 0.003 respectively). Moreover, compared with patients with normal IMT, ESRD and HD patients with increased IMT (> 0.82 mm) had increased ICAM-1 (p = 0.03 and p = 0.003 respectively). Multivariate analyses showed that ICAM-1 was a strong independent correlate of IMT values both in ESRD and HD patients (p = 0.03 and p = 0.004 respectively). VCAM-1 and E-selectin levels failed to be a significant contributor to IMT. In conclusion, chronic uraemia is associated with advanced atherosclerosis. In patients with ESRD, both on conservative treatment and on HD, ICAM-1 levels are potentially a useful surrogate marker of the extent of atherosclerosis. Evaluation of tumor microvessels using monochromatic X-ray after administration of angiogenesis inhibitor T. Yamashita, S. Imai, N. Maehara, A. Yamamoto, M. Kobatake, Y. Kajihara; Kurashiki/JP Purpose: To quantitatively evaluate changes in tumor microvessels using synchrotron radiation in vivo after FR-118487 administration as an angiogenesis inhibitor. The FR-118487 agent (using propylene glycol as a solvent) was continuously infused subcutaneously to 30 rabbits with VX2 carcinoma implantation at auricles. The rabbits were divided into six groups: Control-3 and Control-7 received only propylene glycol for three or seven days, FR-1-3 and FR-1-7 received 1 mg/day/kg of FR-118487 for three or seven days, FR-3-3 and FR-3-7 received 3 mg/day/kg for three or seven days. Microangiograms using a synchrotron radiation system were obtained to evaluate the tumor microvessels and tumor size. Results: Compared to Control-3 group, FR-x-3 groups showed no significant tumor size difference (FR: diameter = 4.03 ± 0.59 mm, volume = 38.38 ± 8.48 mm 3 , Control-3: 5.07 ± 0.57 mm, 55.40 ± 8.41 mm 3 ), but microangiologically fewer vessels were observed. FR-x-7 groups presented significant difference (FR: diameter = 5.37 ± 0.45 mm, volume = 68.02 ± 14.40 mm 3 , Control-7: 9.91 ± 0.56 mm, 512.66 ± 71.14 mm 3 ), and many irregular vessels, findings similar to Control-3. There was no significant difference in tumor size and microangiographic findings between FR-1-x and FR-3-x. Conclusion: Our study demonstrates the application of new technique to examine antiangiogenic effects in vivo. The growth of the VX2 carcinoma were sup-pressed remarkably in the FR-7-day-groups, and the microangiographic findings were similar to those of Control-3. The synchrotron radiation microangiogram is a useful tool to evaluate antiangiogenic agent. Early atherosclerotic changes in HIV positive patients treated with protease inhibitors M. Cristofaro, N. Petrosillo, L. Rovighi, C. Bibbolino; Rome/IT Purpose: Antiretroviral therapies with protease inhibitors (PI) produce derangement of lipid metabolism with possible occurrence of early atherosclerotic changes. Aim of this study is to evaluate onset of early atherosclerotic changes of epiaortic vessels in HIV positive patients, treated with PI. Purpose: Hematoporphyrin (HP) accumulates in arteriosclerosis selectively and shows specific fluorescence spectrum change in accordance with the stages of the sclerosis, and this fact is under discussion as to its availability to diagnosis and therapy. We paid our attention to the fact that HP accumulates in the interface of swollen collagen type IV and lipid. We assumed such a model of atheroma, and we examined the possibility of a photodynamic therapy for arteriosclerosis using collagen type IV and phosphatidyl choline liposome. Material and Method: We added HP to collagen type IV, then the liposome containing cholesterol to the mixture, and examined the agglutination state of the protein-lipid complex. Afterwards, we irradiated that complex with LED pulse of 680nm for one hour, and examined scattered spectroscopy, interference spectroscopy using 680nm semiconductor laser and high sensitivity CCD in order to observe the HP and the agglutination state of complex, and, then, analyzed the alteration of protein-lipid complex in terms of Fourier analysis. Result: HP gave influence to the various state of assembly of protein-lipid complex. In addition, protein-lipid integration state was changed by the irradiation of light pulse and the change of scattered light that signifies the state of dispersion was observed. Conclusion: This study suggested that the molecule composition of the proteinlipid complex in the plaque was changed by the irradiation of light pulse after the addition of HP, and that the photo stimulation could contribute to the decomposition of the cumulated lipid and the stabilization of plaque. Depiction of arterial branches in the abdomen using multidetector-row CT N. Terayama 1 , O. Matsui 1 , K. Ueda 2 , T. Kobayashi 1 Contrast medium (300 mgI) was administered intravenously at a rate of 3 mL/sec. Parameters of data acquisition were as follows: a slice thickness of 0.625 mm, reconstruction intervals of 0.4 mm, a pitch of 1.375, and FOV of 35 cm. Axial images were transferred to Advantage Workstation 4.0 (GE Medical Systems) and multi-projection volume reconstruction (MPVR) images were obtained. If the origin of each arterial branch and the route until the target organ was depicted, we regarded that the branch was visible. Results: Coeliac, superior and inferior mesenteric, renal, intercostal, lumbar, right and left hepatic, and anterior and posterior pancreaticoduodenal arteries were visible in all cases. Cystic, right gastric and dorsal pancreatic arteries were visible in 20 cases (95%), in 18 cases (82%) and in 17 cases (77%), respectively Testicular arteries were visible in 4 cases (44%), and in 4 cases (44%), respectively. Conclusion: Reformation images of MDCT can visualize thin arterial branches in the abdomen experimental lung injury prior to the CT examinations. In addition, segmental and subsegmental pulmonary embolism was artificially induced in four healthy pigs. Scanning was performed using a 16-slice MSCT protocol Using contour finding and adaptive thresholding, both plain and enhanced CT volumes were separated into lung parenchyma, vascular structures and airways. The high contrast information was used to locally match and align sub-volumes. The matched parenchymal volumes were low pass filtered, subtracted and normalized to the enhancement level in a major vessel. Results: Scanning was successfully performed during a total ~15 s scanning time in all pigs. Post-processing was technically feasible, even in underlying experimental lung injury. In PE, filling defects corresponded to areas of decreased enhancement. Conclusion: It is expected that this imaging technique will increase the sensitivity and specificity of MSCT Determination of arterial input function for measurement of brain perfusion index with Tc-99m compounds using a solid-state gamma camera Y. Uenishi, K. Murase, M. Nagayoshi, M. Kawamata, M. Takasawa, N. Oku, A. Takahashi, J. Hatazawa; Osaka/JP Purpose: Cerebral blood flow (CBF) can be non-invasively quantified using the brain perfusion index (BPI) determined from radionuclide angiography (RA). For measurement of BPI, accurate determination of arterial input function (AIF) is necessary. We have developed a method for the automatic extraction of AIF using fuzzy clustering and a solid-state gamma camera (Digirad). Methods and Materials: RA was performed using Tc-99m HMPAO for 120 sec with a Digirad placed on the heart and a 4-head SPECT (SPECT2000H). For comparison, the data were also acquired using a conventional gamma camera (RC-2600I). The AIFs were obtained using fuzzy clustering (AIF a ) and manual drawing of a region of interest (ROI) (AIF m ) from the region of aortic arch. The ROIs were also drawn over the left and right cerebral hemispheres. The BPI values were calculated using spectral analysis (BPI a : BPI obtained using AIF a , BPI m : BPI using AIF m ). The deadtimes of Digirad and RC-2600I were measured using the reference source method. Results: The mean and SD of BPI m became larger with increasing ROI size, while the BPI a was almost constant regardless of ROI size. The SD of BPI a was smaller than that of BPI m . The deadtime of Digirad (0.92 ± 0.63 µsec) was much less than that of RC-2600I (5.00 ± 0.95 µsec). Furthermore, the deadtime of Digirad was almost constant regardless of the volume of phantoms, while that of RC-2600I increased with increasing volume. The proposed method appears promising for calculation of the BPI, because it allows automatic and objective determination of AIF. Spectroscopic imaging of radiation-induced effects in the brain after brachytherapy G. Bajzik 1 , J. Julow 2 , I. Repa 1 ; 1 Kaposvar/HU, 2 Budapest/HU Purpose: The effect of brachytherapy, characterized by rapid dose fall off from the radiation source, is different compared to external radiation. We used proton MR spectroscopic imaging to investigate brain tissue response to brachytherapy. Methods and Materials: Twenty glioma patients treated with surgery and/or brachytherapy were studied with MR imaging (T2 weighted images and post contrast T1 weighted images) and 2D proton MR spectroscopy (TR: 1500 ms, TE: 135 ms, voxel size 3.3 cm 3 ). Brachytherapy resulted in central necrotic zone, surrounded by an enhancing rim (demarcation zone) and an outer edematous zone on MR images. In each patient sample, spectra of the three zones and the normal appearing white matter were analyzed. Results: In demarcation zone, choline/creatine (Cho/Crea) ratio (2.9 ± 1.33 vs. 1.04 ± 0.23, p = 0.004, two-tailed unpaired Student's test) and choline/N-acetylaspartate (Cho/NAA) ratio (1.43 ± 0.53 vs. 0.74 ± 0.28, p = 0.003) was increased compared to normal white matter. In edematous zone Cho/Crea ratio was increased (1.31 ± 0.33 vs. 1.04 ± 0.23, p = 0.007), Cho/NAA ratio was not different (0.9 ± 0.39 vs. 0.74 ± 0.28, p = 0.21) compared to normal white matter. In demarcation zone we found elevated Cho/Crea ratio (2.9 ± 1.33 vs 1.31 ± 0.33, p = 0.03) and Cho/NAA ratio (1.43 ± 0.53 vs 0.9 ± 0.39, p = 0.006) compared to edematous zone. In the central necrotic zone we could only detect lipid and/or lactate peaks. Conclusions: MR spectroscopy demonstrates significant spectral differences in the brain following brachytherapy. Tumor recurrence can be suspected in cases where focal choline accumulation is detected. Does CT-perfusion imaging based on parametric deconvolution permit prediction of infarct volume in acute stroke? G. Bohner 1 , A. Förschler 2 , C. Zimmer 2 , R. Klingebiel 1 ; 1 Berlin/DE, 2 Leipzig/DE Objectives: Suitability of quantitative CT-perfusion (CTP) imaging for assessing the early as well as final infarct volume in acute stroke patients. Material and Methods: Twenty-two patients with acute cerebral ischemia underwent CTP on admission. Parameter maps of cerebral blood perfusion (CBP), cerebral blood volume (CBV) and mean transit time (MTT) were generated using a parametric deconvolution algorithm. Additional diffusion weighted imaging (DWI) was performed in seven cases. Volume of diffusion abnormality was compared with the infarct volumes as assessed by two blinded neuroradiologists for each of the perfusion maps. In addition, final infarct volumes were determined on the basis of follow-up studies. Results: Mean volumes of ischemia as assessed by CBP, CBV and MTT were 38.5, 15.9 and 41.3 mL respectively. Amongst the patients in whom DWI was performed, six showed perfusions deficits in all perfusion images. In one patient, who had no DWI abnormality, perfusion deficits only were found on CBP and MTT images. Mean volume of DWI changes was 25.1 mL. The most significant correlation was found between the extent of CBV reduction and DWI infarct volume (r = 0.899, P < 0.01). Mean final infarct volume was 27.7 mL for all patients. CBV reduction showed the best correlation (r = 0.838, P < 0.01) with final infarct volume. Conclusion: Our findings suggest that CBV maps based on the CTP technique applied in this study permit prediction of infarct volume in early stroke, so CTP would deliver information about the ischemic penumbra. Hepatic encephalopathy in alcoholic and non-alcoholic subjects: Correlation of magnetization transfer ratio, apparent diffusion coefficient and critical flicker frequency M. Cohnen, G. Kircheis, H.-J. Wittsack, F. Miese, F. Wenserski, A. Saleh, D. Häussinger, U. Moedder; Düsseldorf/DE Purpose: To correlate quantitative changes of water content in brain parenchyma using magnetization transfer imaging (MTI) with different stages of hepatic encephalopathy (HE). Materials and Methods: Forty-three patients with hepatic encephalopathy and 15 age-matched control subjects underwent MR imaging (1.5 T Vision, Siemens) including MTI, MR-spectroscopy (MRS) and diffusion weighted imaging (DWI). Liver cirrhosis was due to alcohol in 26 patients whereas non-alcoholic disease was found in 17. Patients underwent assessment of critical flicker frequency (CFF) as test for HE with a frequency under 39 Hz considered pathologic. Magnetiza-tion transfer ratios (MTR) and apparent diffusion coefficient (ADC) values were determined in basal ganglia, posterior white matter and pons using ROI-measurements. Single-voxel MRS was performed using a STEAM sequence (TE = 20 ms, TR = 1.5 s) assessing basal ganglia and posterior white matter. Results: MRS showed typical findings with decreased myo-Inositol combined with increased glutamine/glutamate with increasing degree of HE indicated by a reduced CFF. Compared to controls, MTR showed a significant decrease both in the basal ganglia as well as in the posterior white matter. In alcoholic subjects, this was independent from the degree of HE, whereas in posthepatitic cirrhosis a correlation was found. A non-significant increase in ADC was noted with a decrease of CFF in both groups. Conclusion: The results may indicate an increase of free protons in the brain parenchyma of patients with HE possibly supporting the hypothesis of a lowgrade cerebral edema. The differences between alcoholic and non-alcoholic subjects may hint at a general brain damage due to alcohol independent of hepatic failure. Assessment of cerebral blood flow values obtained from dynamic perfusion computed tomography: A comparison with positron emission tomography H. Yokote, K. Nakayama, T. Okamura, N. Tsuyuguchi, K. Kitamura, N. Ozawa, S. Minamikawa, T. Tashiro, Y. Inoue; Osaka/JP Purpose: Among imaging modalities measuring regional cerebral blood flow (CBF), dynamic perfusion computed tomography (CT) studies are easy to perform and readily available without specialized equipment. However, quantitative studies comparing perfusion CT with positron emission tomography (PET) have been few. We assessed the correlation of CBF values obtained from perfusion CT and PET. Methods and Materials: Eleven patients with various cerebrovascular diseases underwent perfusion CT and PET. The perfusion CT studies were performed with a four-channel multi-detector row CT scanner. Four contiguous 8-mm CT sections were cine-scanned during a 36 mL bolus of intravenous contrast medium at a rate of 4 mL/s, with a total acquisition time of 50 s. CBF maps were obtained from perfusion CT data by central volume principle and deconvolution method. On CBF maps of both perfusion CT and PET, multiple regions of interest (ROI) were drawn independently, including frontal, temporal, parieto-occipital territories, caudate nucleus, thalamus and white matter in both hemispheres. ROIs were visually matched by agreement of three radiologists. Mean CBF values of multiple ROIs with both CT and PET were compared through linear regression analysis. Results: Correlation coefficients for individual analysis ranged from 0.657 to 0.833, overall 0.553. Linear regression analysis showed moderate correlation between perfusion CT and PET values (slope = 0.668, intercept = 21.958). Conclusions: Our study has shown moderate correlation of CBF values between perfusion CT and PET. Despite the various alterations of cerebral blood flow in our cases, perfusion CT studies were validated to be an easy-to-perform imaging technique to assess CBF values. Ageing of the cerebrum: Assesment with quantitative proton MR spectroscopy J. Ostojic, R. Semnic, D. Kozic, D. Bogdanovic, M. Prvulovic; Sremska Kamenica/YU Introduction: Aging is recognized to originate from a diversity of mechanisms that blur the limits between normal and pathologic processes. The purpose of this study was to determine the early effect of normal aging on the regional distribution of brain metabolite concentrations, including N-acetylaspartate (NAA), choline (Cho) and creatine (Cr). Methods: Seventy nine volunteers, ages 16 to 75 years, were examined by localized single-voxel proton MR spectroscopy at 1.5 T using PRESS 135 sequence.Voxels 2 x 2 x 2 cm were placed in the middle white matter (WM) of the centrum semiovale in the left hemisphere and in the occipital gray matter (GM) of posterior parietal lobes. The ratio of NAA/Cho were calculated, as well as absolute concentrations of NAA, Cr and Cho.Quantification was performed using method of external standard. Results: Absolute concentrations (mM/kg) of Cho increased with age both in WM (r = 0.42, P < 0.05) and in GM (r = 0.57, P < 0.05). Cr concentrations were much higher in GM than in WM and significantly higher in the old than young subjets (r = 0.41, P < 0.05). The change of WM Cr with age failed to meet P < 0.05 criteria. NAA concentration was higher in GM than in WM and did not differ between young and old subjects. The age dependency of GM NAA/Cho ratio was Technical inadequacies of plain films in an emergency department B. Rajashanker, F. Jabeen, R.W. Whitehouse; Manchester/UK Purpose: 1. To assess the diagnostic quality of radiographs performed in the emergency department in a major referral hospital. 2. To determine the type and number of inadequacy encountered most often. Materials and Methods: Two specialist registrars (Trainees) in radiology, reviewed 800 plain films performed in a busy emergency department. Films were examined for inadequacies, which impair the diagnostic quality of the examination. Despite artefacts or exposure problems, if a reasonable diagnostic conclusion could be made, the film was considered to be adequate. If a film was found to be inadequate, clinical details (that could have contributed to the poor quality) were looked at, and taken into consideration. Artefacts obscuring the area of interest, inadequate collimation, incomplete examinations and improper exposure factors were considered as inadequate. The number and the type of inadequacy, the type of examination were noted. Results: 1. The study showed that about 9% of the total films performed were inadequate. There are no national figures we could find to compare our results with to evaluate the performances on our emergency department. 2. The type of inadequacy encountered most often was the presence of jewellery obscuring the area of interest (27%), followed by artefacts caused by clothing (10%). Chest radiograph was the most frequently encountered inadequate examinations (55%). Conclusion: National guidelines regarding target quality radiographs that need to be achieved in institutions need to be published. The inadequacies were pointed out for better performance in future. Drug courier pays a high price for easy money B. Szabó, Z. Mocsári, S.O. Farkas, P. Magyar, Á. Takács, K. Karlinger, E.K. Makó; Budapest/HU Purpose: The aim of this study is to show the most common methods for examining drug couriers and their results. Method: Native abdomen CT scans and native abdomen X-rays and US examination were performed on probably positive patients. In the year 2003 until now we examined 19 patients. Four positive cases were found. One of them after the CT examination died in the hospital, because leakage of a capsule. Conclusion: Swallowers before traveling swallow 2-3 cm long, 1 cm diameter capsules, which they hope to retrieve after traveling. Stuffers insert drug filled corpus alienums into the rectum or vagina. The danger of this type of drug smuggling is the braking or bursting of the capsules, leading to potential fatal drug overdose. Steps to European Union from Europe: Reforms of education of Hungarian radiographers A. Maléta, Z. Mocsári, S.O. Farkas, Á. Mester, K. Karlinger, E.K. Makó; Budapest/HU Purpose: The aim of this presentation is to show a short summary of the education of Hungarian radiographers currently and in the future. Method: Assessment based on the Bologna contract new education system with the cooperation between the Society of Hungarian Radiographers and Hungarian Ministry of Education according to the European directives. Results: The base of the Modular Education system is already laid down. The construction and edition of the new scientific books and the preparation of the teachers and professors has already commenced. Conclusion: Since the Hungarian educational system of radiographers has a history of nearly ninety years we need to use the lessonst of the past into the new system. Since the result of the reforms requires a long time, well-organized feedback mechanisms is needed to ensure the effectiveness of the reforms. Origin of military radiology: First use of X-rays in Ottoman Empire A. Tunaci, N. Yildirim, Y.I. Ulman, E. Yekeler, H. Genchellac, M. Tunaci, G. Acunas; Istanbul/TR X-ray usage as a diagnostic device was realized in Turkey first time at the Military Medical School in 1896 by Esad Feyzi, who was an intern and physics assistant. This new invention attracted attention so much that Dr. Salih and Rifat Osman also joined him and they started to work in a small unit, where they practiced radiographic examination.The following year, Yildiz Portable Military Hospital was reserved for wounded patients from the battlefield of the Ottoman-Greek War. This mobile hospital, which was activated in 1892, was exported from Germany and comprised Duquer system pavilions that were reassembled within 10 hours. They took away the X-ray equipment from the Military Medical School to Yildiz and began to produce images of bullet and shrapnel pieces from the patients sent from the battlefield. Kuttner and Nasse from German Red Cross came to Istanbul in 1897. They were surprised to see that this new invention was already being used there. On the Greek side English physicians used two X-ray devices that were transferred from England to Pire Harbour on May 1897. Therefore the Ottoman-Greek war took its place in medical literature as the first war that radiographic images were taken, first by the Turkish and soon after by German and English physicians. References stated that English physicians took X-ray images of wounded Greek soldiers and there is no record about Greek physicians taking part in this work. Turkish physicians continued to work on radiographic images during the war which they had started shortly after the discovery of X-rays. To demonstrate how to perform a numeric flow simulation in patient-specific vessels based on isotropic CTdatasets. To illustrate the possibilities of this promising tool on clinical cases. Background: CFD was introduced recently to investigate the behaviour of blood flow. Different studies determined CFD as a valuable method to demonstrate the flow and pressure. Most studies use simplified standard models for the simulations. This exhibit explains methodological aspects of CFD and how numeric flow simulations are performed in patient-specific vessels based on high-resoloution CT datasets. Possible applications of CFD in the cardiovascular field are discussed. Procedure Details: Isotropic CT-angiography data are used to segment the vessels. After generation of a surface mesh using the marching cube algorithm, the model is transferred into a volume mesh and the different entities and walls were defined. Specific parameters as velocity at the inlet boundary, flow parameters, and material specific parameters have to be assigned in a next step.The simulation itself provides detailed information about flow-behaviour and pressure. This helps to identify possible zones for development of artherosclerosis or, especially in aneurysms, locations for a possible rupture. Furthermore, blood flow can be quantified and e.g. effects of stent-graft implantations or the benefit of a coronary bypass can be demonstrated. Conclusion: CFD in combination with patient-specific patient-data is a promising method to visualise flow-effects. In the near future CFD will also gain increased importance for pre-interventional planning of vascular procedures. Background: Evaluation of the central veins is easily achieved with contrastenhanced MR angiography. "Indirect" CE-MRV, a technique where the veins are evaluated during the "venous" phase has been largely replaced by "direct" CE-MRV, a technique whereby dilute contrast agent is injected into the upper extremity veins and imaging is performed during the first-pass. Imaging Findings: In order to overcome T2*-induced susceptibility-effect commercial strength contrast-agent is diluted with saline. In our institution we use a 6% solution (3 cc of contrast agent in 50 cc saline). 1-3 cc of contrast is injected over the duration of the breath-hold scan (TR/TE/Flip 5 msec/2 msec/40 deg, Matrix 512 x 200, FOV 400-450 mm x 360 -450 mm. 32-60 slices, 4 mm interpolated to 2 mm). Mask subtraction of a pre-contrast scan is performed. The spectrum of findings in normal and diseased veins is illustrated. Examples of thrombosis, stenosis and occlusion of the central veins will be illustrated. Common pit-falls and artefacts will also be emphasised. Conclusion: "Direct" CE-MRV is an effective modality for evaluating the central veins. A simple robust method is presented, along with examples of the appearance in normal and pathological states. Multidetector row CT angiography of the lower extremities for the assessment of traumatic vascular injury E.E. Williamson, J.C. Hellinger, A. Napoli, G.D. Rubin, D. Fleischmann; Stanford, CA/US Learning Objectives: 1. To describe the CT angiographic (CTA) technique used in the evaluation of traumatic lower extremity (LE) vascular injury. 2. To illustrate the spectrum of vascular and nonvascular pathology found during LE-CTA in the setting of trauma. Background: Digital subtraction angiography (DSA) has long been considered the imaging standard for traumatic vascular injury. CTA is a more readily available, noninvasive imaging alternative which is less expensive, less resource intensive and can be used to assess bone and soft tissue injuries without the need for additional imaging tests. In this exhibit we highlight our experience with CTA in 27 trauma patients.Procedure Details: All examinations were acquired using 8 or 16-channel multidetector-row CT (MDCT). Contrast media was administered at 4-5 cc/sec using bolus-tracking technique. Thin section images were obtained from one vascular segment above the level of trauma through to the foot with collimation of 1.25 and pitch of 1.35-1.5. Table feed and gantry rotation speed were adjusted to optimize scan duration to match the peripheral delivery of IV contrast. All studies were reformatted in 3-dimensions using volume rendering, maximum intensity projection and curved planar reformation techniques. Conclusion: The spectrum of direct vascular injuries included large and small vessel occlusions, pseudoaneursyms, active extravasation, and vasospasm. Nonvascular pathology with indirect effects on the vascular system included complex fractures, open soft tissue wounds, hematomas, and joint effusions. CT angiography of the extremities is a promising technique in the evaluation of traumatic LE arterial injury with the ability to assess nonvascular injuries without the need for additional studies. There is a wide range of imaging techniques available for MRV evaluation of the central chest veins, including conventional non-contrast time of flight imaging and contrast enhanced methods such as the newer VESPA (venous enhanced subtracted peak arterial) sequences. Imaging Findings: Examples of common central venous pathologies will be illustrated from our database of over 120 patients, who underwent MR at 1.5 T using various sequences including non contrast time-of-flight, and post gadolinium true FISP, T1-weighted VIBE and 3D FLASH sequences. Typical scan parameters included matrix 512 x 200, FOV 400-450 x 360-450 mm, 32-60 slices, 4 mm interpolated to 2 mm. Common pathologies demonstrated included thrombo-embolic disease, central venous obstruction due to local tumour extension, congenital and acquired venous stenoses, AV fistulas and infected venous pseudo-aneurysms. Conclusion: MRV is a robust, highly accurate and non-invasive technique for assessment of central venous pathology. Accuracy of automated centerline approximation algorithms for lower extremity vessels in a CTA phantom A. La Cruz 1 , M. Straka 1 , A. Köchl 1 , M. Šrámek 1 , E. Gröller 1 , D. Fleischmann 2 ; 1 Vienna/AT, 2 Stanford, CA/US Purpose: The accurate determination of the central vessel axis is a prerequisite for automated visualization (curved planar reformation) and quantitation. The purpose of this work was to assess the accuracy of different algorithms for automated centerline detection in a phantom simulating the peripheral arterial tree. Materials and Methods: Six algorithms were used to determine the centerline of a synthetic peripheral arterial vessel (aorto-to-pedal arteries, diameter 18-0.6 mm) dataset (256 x 256 x 768, voxel size 0.5 x 0.5 x 0.5 mm). They are ray-casting/ thresholding (RCT), ray-casting/maximum gradient (RCMG), block matching (BM), fitting to ellipse (FE), center of gravity (CoG), and Randomized Hough transform (RHT). Gaussian noise with a sigma: 0, 5 and 10 was used to observe the accuracy of the method under noise influence. The accuracy of automatic centerline determination was quantified by measuring the error-distance between the derived centerlines, and the known centerline course of the synthetic dataset. Results: BM demonstrated unacceptable performance in large vessels (> 5 mm) when the shift used was less than 3 voxels. RCMG demonstrated a greater error (mean of the error 4.73 mm) in large diameter (> 15 mm) vessels than in small diameter (< 15 mm) vessels (mean of the error 0.64 mm). Because RHT and FE use Canny edge detector preprocessing, both are sensitive to noise. CoG and RCT keep the mean of the error-distance significantly smaller (0.7 mm and 0.9 mm respectively) than all other algorithms. Conclusion: CoG and RCT algorithms provide the most efficient centerline approximation over a wide range of vessel diameters. Detection of the Adamkiewicz artery by subtraction magnetic resonance angiography H. Hyodoh, R. Shirase, H. Akiba, M. Tamakawa, K. Hyodoh, K. Aratani, N. Kawaharada, K. Morishita, M. Hareyama; Sapporo/JP Purpose: To assess the ability of magnetic resonance angiography (MRA) to depict the Adamkiewicz artery. Materials and Methods: Fifty-one patients with thoracoabdominal disease underwent MRA of the bypass graft region. Subtraction maximum intensity projection (MIP) images and cine-mode displays were produced to identify the Adamkiewicz artery, its side of origin and branching level, and the drainage vein. For statistical analysis, signal intensity ratio (SNR) and contrast noise ratio (CNR) were also calculated. Results: In 46 (90.2%) of the 51 patients, at least one Adamkiewicz artery was seen to arise from an intercostal artery. Two Adamkiewicz arteries were identified in 9 (19.6%) of the 46 patients. Spinal drainage veins were visualized in 41 (80.4%) of the 51 patients, a single drainage vein in 30 of the 41 (58.8% of the total patient group) and two drainage veins in the remaining 11 (21.6% of the total patient group). In 19 of the 46 patients, both the Adamkiewicz artery and the drainage vein were detected during the early phase. Conclusion: Subtraction MRA depicts the Adamkiewicz artery in a high percentage of patients. 16-row multislice computed tomography of pulmonary veins: Assessment before and after cryothermal energy ablation R. Maksimovic 1 , F. Cademartiri 2 , M. Scholten 2 , L. Jordaens 2 , P.M.T. Pattynama 2 ; 1 Belgrade/YU, 2 Rotterdam/NL Purpose: Electrical isolation of the pulmonary veins (PVs) with radiofrequency ablation in treatment of patients with paroxysmal atrial fibrillation is associated with PV stenosis. Cryothermal ablation (CA) is a new promising method in treatment of these patients. Although initial experience of CA showed no associated PV stenosis, results at follow-up have not been reported. The aim of the study was to assess PVs for the presence of stenosis three months after CA by contrast enhanced angiography on 16-row detectors multislice computed tomography (MSCT). Materials and Methods: Twenty four patients (mean age 52.6 ± 7.6 years, 15 males) with symptomatic atrial fibrillation underwent CA in 46 PVs. All patients underwent complete clinical work-up, electrophysiological study, ultrasonography and MSCT angiography before CA. MSCT pulmonary angiography was performed three months after the procedure to evaluate ostium and the proximal 10 mm of all PVs. Results: Dimensions of the treated PVs remained unchanged: the coronal ostial diameter was 19.1 ± 2.4 preprocedural vs. 18.6 ± 2.4 mm at follow-up, p < 0.05, ratio of coronal and axial diameter 1.2 ± 0.2 vs. 1.2 ± 0.1, p < 0.05, respectively and the coronal diameter of the proximal 10 mm from the ostium 17.1 ± 2.5 mm vs. 16.5 ± 2.2 mm, p < 0.05, respectively. Conclusions: CA of PVs in atrial fibrillation has not been associated with stenosis at the orifice and proximal 10 mm of the PVs after three months follow-up. MSCT pulmonary venography is a reliable, noninvasive method for assessment of PVs in a three-dimensional manner prior to ablative treatment and during the follow-up period. Magnetic resonance venography without contrast media for patients with lower extremity varicose veins J. Koizumi 1 , M. Wada 2 , T. Horie 1 , E. Kimura 1 , I. Muro 1 , K. Myojin 1 , T. Niibori 2 , Y. Imai 1 ; 1 Isehara/JP, 2 Wako/JP Purpose: To compare three different sequences of magnetic resonance (MR) venography without contrast media for patients with varicose veins below the knee. Materials and Methods: For 23 patients with lower extremity varicose veins, MR-venography using time-of-flight (TOF), fat suppressed T2-weighted turbo spin echo (TSE) and balanced turbo field echo (bTFE) were compared.The original images on 1.5 Tesla Gyroscan (Philips) were transferred to a workstation (M900 Quadra, ZIOSOFT Inc.) and 3D images were reconstructed using maximum intensity projection (MIP), multiplaner reformation (MPR), and volume rendering (VR) techniques. For analysis, the veins were divided into superficial, deep venous systems, perforating and varicose veins, and were evaluated using three points scale by a radiologist and a surgeon.Results: Superficial, deep venous systems and perforating veins were best visualized on bTFE (p < .05), while varicose veins were equally visualized on TSE and bTFE. TOF provided poor visibility except in popliteal veins. Coexisting arterial system seen on bTFE could be discriminated from the deep venous system especially on axial reconstructed images. The varicose veins connected with the superficial venous systems and perforating veins on the surface of the muscle were easily recognized on VR only using bTFE. Conclusions: MR-venography using bTFE displays the best images of the whole venous system in patients with varicose veins below the knee. Magnetic resonance angiography in potential live renal donors: A joint radiological and surgical audit A. Mizzi, G. Roditi, M. Subramaniam; Glasgow/UK Purpose: To assess the impact of joint surgical and radiological audit on the accuracy of MRA reports in the evaluation of potential live renal donors. Materials and Methods: We analysed the case records of live renal donors who underwent gadolinium enhanced MRA as part of pre-operative evaluation to assess renal vasculature between August 1999 and July 2002. In cases of discrepancy between MRA reports and surgical findings, studies were retrieved to the MRI workstation and subjected to detailed joint clinical and radiological review. Scan quality was assessed and sources of discrepancy were identified. Results: There were 45 donors, 23 men and 22 women. Reported MRA findings were fully confirmed at surgery in 38 of 45 cases. These scans were not analysed further. In 7 donors, the findings at surgery were discrepant with the radiological reports. There were 4 cases of "missed" early branches and 3 cases of "missed" accessory arteries. In the first year of audit there were 4 discrepant cases out of 18 (22%), all of which were radiological reporting errors. The number of discrepant cases in the second year dropped to 2 out of 19 cases (11%). Neither of these was a radiological reporting error. There was one "missed" early renal artery branch in the third year of audit, which was visualised on MRA review. Conclusion: The accuracy of preoperative MRA in potential live renal donors is high. Radiological reporting of MRA examinations is improved through careful clinical feedback, audit and interdisciplinary co-operation. 3D contrast-enhanced MR portography to scan the entire volume of upper abdomen with maximal spatial resolution using parallel acquisition techniques: Preliminary experience D. Horák, M. Herman, J. Bucil, J. Klein, J. Nekula; Olomouc/CZ Purpose: To assess the feasibility and to evaluate the benefit of a 3D contrastenhanced (CE) MR portography (MRP) covering the entire volume of upper abdomen with maximal spatial resolution using GRAPPA (GeneRalized Autocalibrating Partially Parallel Acqusitions). Materials and Methods: 12 patients were examined before or after surgical creation of porto-systemic shunt. T1-weighted 3D angiographic sequence with 3D centric reordering optimized using a GRAPPA factor of 2 was performed at a 1.5 T scanner (Siemens Symphony Maestro Class) in three phases after administration of 30-40 mL of 0.5-molar or 15 mL of 1-molar gadolinium-DTPA followed by 20 mL saline solution into the canula in antecubital vein. Anatomical postcontrast T1-weighted 3D spoiled GRE with Fat Saturation was added. Parameters of HiRes 3D-CE-MRA sequence: in-plane resolution = 1.5 x 0.9 mm, number of partitions = 80, slice = 2.5 mm, partial-Fourier = 6/8, FOV = 400, TR/ TE/FA = 3.55/1.28/25, TA = 27 sec. Results: Large evaluated volume HiRes MRP sequence is suitable for detailed postprocessing (subvolume MIPs) in any plane, imaging borderline vessels like recanalized umbilical vein or retroperitoneal collaterals, usually best seen in portal phase. Robust protocol can be very easily adapted for uncooperative patients covering the same evaluated volume. Functional information (flow direction) can be added with Phase Contrast MRA flow quantification sequence. Conclusion: Our preliminary results show that the application of GRAPPA allows to capture the whole portal vascular system without missing any important collateral with high spatial resolution in cooperative patients and with sufficient spatial resolution in non-cooperative ones. It's possible to image the flow in surgically placed porto-systemic shunts. Gadobenate dimeglumine (MultiHance®) in contrast-enhanced MR angiography M. Kirchin 1 , R. La Ferla 1 , M. Daprà 1 , G. Pirovano 2 , A. Spinazzi 2 ; 1 Milan/IT, 2 Princeton, NJ/US Purpose: Gadobenate dimeglumine (Gd-BOPTA) has high T1 relaxivity in blood (r1 = 9.7°mM-1 s -1 ) compared to other gadolinium agents. This review is aimed at defining the usefulness of Gd-BOPTA for CE-MRA. Methods: Preliminary intraindividual, crossover studies were conducted in healthy volunteers to compare Gd-BOPTA and Gd-DTPA at the same dose and injection rate for MRA of the abdominal aorta and run-off vasculature. Subsequently, Phase II multicenter trials were performed in the renal/abdominal arteries (n = 94 patients), the pelvic arteries (n = 136 patients) and the carotid arteries (n = 163 patients) to establish the optimum dose of Gd-BOPTA for CE-MRA. Standard unenhanced and contrast-enhanced sequences were employed and images were evaluated by independent, off-site blinded radiologists on the basis of segmental and overall diagnostic quality scores per patient and dose. The crossover studies demonstrated significantly greater signal intensity enhancement after Gd-BOPTA compared to Gd-DTPA both in the abdominal aorta and run-off vasculature. The Phase II studies revealed dose-related trends for the contrast-enhanced images in each territory and good correlation between readers. The greatest increase in diagnostic quality from unenhanced MRA to CE-MRA occurred at 0.1 mmol/kg BW while a higher dose of 0.2 mmol/kg BW provided little or no additional benefit. CE-MRA led to an increased number of patients with lesions detected and increased reviewer confidence for lesion characterization. Conclusions: CE-MRA with Gd-BOPTA is more efficacious than unenhanced MRA and appears superior to CE-MRA with conventional gadolinium chelates. The optimum dose for CE-MRA of vascular disease is indicated to be 0.1 mmol/ kg BW. Influence of CT scanner and observer on volume measurement: Five glass phantoms filled with diluted contrast material underwent one single-detector row CT (SDCT) and two multi-detector row CT (MDCT) examinations. For each CT scanner the clinical protocol for CT angiography of the abdominal aorta was used. In a first step the resulting 15 volumes were measured using a special software with automatic outline detection without need of manual segmentation and thus without intra-and interobserver variability to evaluate differences between the CT scanners. In a second step the volumes were measured by three observers using a standard software for manual outline detection to assess inter-and intraobserver variability. Results: There was no statistically significant difference between the CT scanners with the corresponding standard protocols (p = 0.27). Inter-and intraobserver variability was 7.2 and 2.6 mL and lead to significant difference in volume measurement between the observers (p = 0.002). Conclusion: Volume measurement does not seem to be influenced by the used CT scanner. The interobserver variability is significant, but slight. Consequently, changes of the volume of abdominal aortic aneurysms in follow-up CT angiography after endovascular repair can be considered as true change and not as scanner related. 16-slice multi-detector CT angiography in the assessment of stenoocclusive disease of the carotid artery bifurcation and vertebral artery origin S. Lee, H. Roh, H. Byun; Seoul/KR Purpose: To determine the accuracy of 16-slice multi-detector CT angiography (16-MDCTA) in the assessment of steno-occlusive disease of the carotid artery bifurcation and vertebral artery origin. Materials and Methods: In 24 patients, 48 carotid arteries and 48 vertebral arteries were evaluated with 16-MDCTA and conventional digital subtraction angi-ography (DSA). Standardized 16-MDCTA acquired from the circle of Willis to the aortic arch. 16-MDCTA data were displayed with maximum intensity projection (MIP) for carotid and vertebral arteries and with volume rendering (VR) for carotid artery. The percent diameter stenoses of the carotid artery bifurcation and vertebral artery origin were measured separately on MIP, and/or VR CT images and DSA. The carotid stenosis was graded as no, mild (< 30%), moderate (30-70%), severe (> 70%), and occlusion with NASCET criteria. The vertebral artery stenosis was also assessed with the same five-grade scale. The results of 16-MDCTA were correlated with the gold standard of DSA. Results: All carotid and vertebral arteries were assessable on MIP and/or VR CT images. Correlation between stenosis measured with 16-MDCTA and that measured with DSA were good (Pearson correlation: on carotid MIP images, c = 0.983, < 0.001; on carotid VR images, c = 0.992, < 0.001; on vertebral origin MIP images, c = 0.984, < 0.001). The aggrement rate of stenosis grading between 16-MDCTA and DSA was also high (91.7% on carotid MIP; 93.8% on carotid VR images; 91.7% on vertebral origin MIP images). Conclusion: 16-MDCTA has a high accuracy for the evaluation of carotid and vertebral artery stenosis and provides multiplanar information preoperatively. Does high iodine concentration contrast agent improve arterial enhancement in MDCT angiography of the run off vessels? Comparison of three different iodine concentration contrast agents F. Venditti, C. Catalano, M. Francone, F. Fraioli, A. Napoli, V. Votta, R. Passariello; Rome/IT Purpose: To evaluate whether a high iodine concentration contrast agent may determine a greater arterial contrast enhancement in the visualization of aortoiliac and peripheral vessels. Materials and Methods: Sixty-six patients, randomly divided into two groups, A and B, were studied with a multi detector-row CT (MDCT) scanner. Both groups were divided in three subgroups (A1 = 300, A2 = 350 and A3 = 400 mgI/mL; B1 = 300, B2 = 350 and B3 = 400 mgI/mL) in which different iodine concentrations were injected. In group A variable flow rates were used. In group B the flow rate was kept constant at 3.5 mL/s. Quantitative and qualitative analyses were performed at predefined fixed vascular segments. Results: In both groups a greater density value was achieved using the high concentration contrast agent, in particular at the level of the superficial femoral artery for subgroup A3 and at the level of the popliteal artery in subgroup B3. For all vascular segments the best enhancement was visualized for group B3. No statistical significant differences were achieved between the two different groups in the visualization of sub-popliteal vessels. Conclusion: Our study demonstrates that the use of a high iodine concentration contrast agent increases arterial enhancement of the peripheral arterial tree using MDCT scanner. Multidetector CT angiography in arterial occlusive disease of the lower extremities: A step forward in vascular diagnostic procedures? M. Maggi, S. Alborino, E. Paci; Ancona/IT Purpose: Multidetector computer tomography (MDCT) angiography is a new available technique for studying arterial disease of the lower limbs. In this study we report our experience with MDCT angiography in evaluating atherosclerotic lesions of peripheral arteries. Materials and Methods: 60 patients (36/24 male/female, age 63 ± 10, 45 in 2 and 15 in 3 Rutherford category) were investigated by MDCT between April 2002 and March 2003, 30 patients underwent digital subtraction angiography (DSA) of the lower extremities within 20 days from MDCT angiography. We used a 4-8 channels GE Medical System CT-scanner, 18 needle-cannula, flow rate 4 mL/ sec, 150 mL iodinated contrast medium 300/350 mgI/ml, bolus tracking program (SMART PREP). MIP and Volume Rendering reformations were used. DSA and MDCT angiograms were blindly evaluated by two vascular radiologists according to the following parameters: stenosis (lumen reduction 50-99%), occlusion (> 99%), absence of lesion (< 50%) in 1140 arterial segments, 19 for each patient. Therapeutical implications of MDCT angiography were also evaluated. Results: Concordance between MDCT angiography and DSA was 92.3% in detecting and 96.9% in excluding lesions, 66.7% in defining stenosis and 85.5% for occlusions. In 21/30 patients percutaneous approach was modified according to CT images. Conclusions: MDCT angiography could be considered as the first step in diagnostic procedures of peripheral arterial disease and could also modify therapeutical strategy and vascular radiologist's performance. Further studies are needed Value of long-term routine ultrasound assessment of hemodialysis fistulae in comparison with clinical parameters A. Wojciechowski, M. Golebiowski, M. Grzeszczyk, W. Kania; Warsaw/PL Purpose: The aim of the study was to correlate the results of clinical and ultrasonographic long term follow-up of hemodialysis fistulae. The utility of routine ultrasound examination was discussed. Materials and Methods: 86 patients underwent Doppler ultrasound evaluation of dialysis fistulae. Patients were randomly assigned for evaluation. In addition routine tests for blood cell count, hematocrit, Kt/V, URR and blood pressure in the venous line were available in all patients. All patients had native fistulae. A single unit (ATL ULTRAMARK 9 HDI) was used for ultrasound examinations. Results: Results of laboratory and clinical parameters were abnormal in almost 50% of patients. Low levels of hematocrit (< 30%) were observed in 47.7%, albumin (< 4.0 g/l) in 36.6%, elevated pressure in venous line (> 140 mmHg) in 22.1%. Abnormal Kt/V (< 1.0) and URR (< 60%) in 32.6 and 36.6% respectively. US revealed: pseudoanerysms in 5.8% of patients, hematomas adjacent to the fistula 10.5%, arterial steal syndrome in 11.6%, stenosis in 25.6% and mural thrombi in 40.7%. In 8.1% of patients brachial artery blood flow was less than 300 mL/min and in 7% of cases dialysis fistula flow was greater than 2100 mL/min. Conclusion: Only 11.6% patients had no abnormal either clinical, morphological nor flow parameters. 44.2% of patients had abnormal clinical and US morphological parameters. Colour Doppler ultrasound is more sensitive than clinical or laboratory methods in detection of hemodialysis fistula dysfunction. It is strongly recommended to start regular ultrasound examinations of all dialysed patients. Material and Methods: 50 patients with Brescia-cimino-shunts were examined by independent examiners with i. a. DSA and vascular ultrasound. All patients had a shunt-volume of less than 400 mL/min., an angiographical stenosis of the anastomosis of at least 50% or changes of the venous portion of the shunt were examined. Studies were performed with the aid of a multifrequency ultrasound probe (5-10 MHz, Logic 700, 9, GE) using B-mode, color coded Duplex (CCD) and B-flow, first of all in the brightness modification. Results: In the group of anastomotic stenosis measurements of intrastenotic diameter gave for i. a. DSA values of (average: 2.33 mm), for B-mode (average: 2.56 mm), for CCD (average: 2.88 mm), for brightness mode of B-flow (average: 2.27 mm) and for B-flow with B-mode information values of (average: 2.37 mm). The best agreement with DSA was achieved by brightness mode of B-flow. While in B-flow in cases of anastomotic lesion or venous stenotic lesions, hypoechogenic vessel wall alterations were detected, they were not seen in B-mode in any case and not reliably in CCD due to blooming artifacts. In cases of venous aneurysm and vascular elongation a flow detection free of artifacts was only demonstrated by B-flow. Conclusion: Ultrasound B-flow detects anastomotic stenosis of hemodialysis fistula better than other ultrasound modes. The visualization of hypoechogenic vessel wall alterations and the degree of stenosis is also better appreciated by this mode. Ultrasonographic assessment of internal mammary artery in the screening of radiotherapy induced coronary artery disease N. Tuncbilek 1 , O.O. Okten 1 , H.M. Karakas 2 ; 1 Edirne/TR, 2 Malatya/TR Purpose: Radiotherapeutically treated breast carcinoma patients are prone to the development of iatrogenic fibrosis and plaque formation in coronary vasculature. In this group of patients, early changes in the diameter and the flow characteristics of internal mammary artery, hypothesised as the surrogate markers of the coronary artery disease, were ultrasonographically (USG) investigated. The study group was consisted of 33 breast cancer patients with ages between 23 and 77 (mean age 47.3 yrs) and 15 age-matched control subjects. All patients were radiotherapeutically treated 6 to 24 month ago. Internal mammary arteries were ultrasonographically investigated with 7.5 MHz linear transducer in longitudinal planes. Diameters of the arteries were measured in M-mode; resistivity indices (RI), pulsatility indices (PI), peak systolic and end diastolic values were measured with color Doppler USG. Mean values of the above mentioned parameters were statistically compared among patient and subject groups. Results: Mean diameter of the internal mammary arteries were found to be 19.02 mm in patients and 36.57 mm in control subjects. There was a statistically significant difference between two groups regarding the stated parameter (p < 0.001). In contrary, the difference of RI, PI, peak systolic and end diastolic values were not statistically significant in two groups studied. Conclusion: Shortly after radiotherapy the diameter of the internal mammary artery significantly decreases but its flow spectrum does not change. Ultrasonographically performed simple diametric measurements may be used as rapid and noninvasive screening tests to predict the development of coronary artery disease. Assessment and follow-up of endovascular repair of aortic aneurysm with multislice computed tomography M. Fernández -Velilla, M. Martí, Y. Herrero, J. Echeveste, G. Garzón, N. Gómez-León; Madrid/ES Purpose: To evaluate the usefulness of multislice computed tomography (MSCT) after placement of endovascular stent-grafts for treatment of aortic aneurysms. Matrials and Methods: Seventy-six patients underwent MSCT angiography following treatment of thoracic or abdominal aortoiliac aneurysm with endoluminal stent-grafts. MSCT was performed from the supracoeliac aorta to the femoral artery bifurcation in patients with aneurysm affecting the abdominal aorta (n = 70), and from the thoracic inlet to the femoral bifurcation in patients with thoracic aneurysm (n = 6). The standardized protocol consisted of a nonenhanced CT (3 mm collimation, pitch of 4, reconstruction interval of 2 mm, table speed of 16 mm per rotation and a single-breath-hold acquisition), followed by a contrast-enhanced CT. All images were postprocessed in a workstation (Vitrea 2; Vital Images, Plymouth, Minn). The image postprocessing included multiplanar reformats, MIP, shaded-surface display, and volume rendering. The studies were assessed for stenosis, thrombosis, perigraft leakage, migration, angulation of graft, and enlarging sac size without visible endoleak (endotension). Follow-up CT was performed prior to discharge and at six and twelve months after intervention. Results: After stent-graft placement in the 76 patients, CT demonstrated graft permeability in 76 (100%), perigraft leaks in 17 (22%), angulation of the graft in 9 (12%) and endotension in 2 (2.6%). Conclusion: MSCT was able to study the entire aorta with a maximal and homogeneus opacification. The MSCT technique allowed fast scanning, great anatomic coverage during a single breath hold, few motion artefacts, and high spatial resolution in the longitudinal plane, improving the diagnostic accuracy of the examinations. Evaluation of vertebral artery using color duplex sonography: Comparison of vertebral artery velocity and flow volume measurements for diagnosis of vertebrobasilar insufficiency M. Acar, B. Degirmenci, A. Yucel, R. Albayrak; Afyon/TR Purpose: The aim of this study was to compare the measurements of vertebral artery (VA) flow velocity and flow volume for diagnosis of vertebrobasilar insufficiency. Matrials and Methods: We examined 96 patients referred for evaluation of vertebrobasilar insufficiency. Net VA flow volume and mean systolic flow velocity were determined by using color duplex sonography. We grouped the patients into three: group 1 consisted of patients with severely damped VA flow volume (< 120 mL/min), group 2 moderately damped (120-200 mL/min) and group 3, normal (> 200 mL/min). The mean systolic flow velocities in each group were compared by one-way ANOVA. Results: Damped VA flow volume was determined in 56 of 96 patients, of these patients 18 had severely damped, 38 had moderately damped, 40 had normal VA flow volume. Mean VA systolic flow velocities of group 1, 2 and 3 were 32 ± 12, 42 ± 10 and 46 ± 8 cm/sec, respectively. Mean VA systolic flow velocity in group 1 was significantly lower than that of group 2 (p = 0.001). However there were no significant differences between VA systolic flow velocities in group 2 and group 3 (p = 0.2). Conclusion: According to our findings, measurement of VA velocity is enough for diagnosis of vertebrobasilar insufficiency in patients with severely damped VA flow volume but may not always be helpful in differentiation of moderately damped flow volume from normal. Therefore we conclude that for the diagnosis of vertebrobasilar insufficiency, measurement of volume in addition to velocity is necessary in detection of moderately damped VA flow volumes. Rotational angiography of femoropopliteal arteries after percutaneous transluminal angioplasty (PTA): Preliminary results F. Pozzi-Mucelli, M. Belgrano, G. Tona, R. Pozzi-Mucelli; Trieste/IT Purpose: To report our experience in rotational angiography (RA) after PTA of the femoropopliteal arteries and to compare this modality to standard anteroposterior (AP) projection. Materials and Methods: Forty patients underwent PTA of the femoropopliteal arteries in the last 12 months. Twentysix were stenoses (lenght: 1-5 cm) and 14 occlusions (lenght: 3-10). In all cases PTA was successful and the result was checked with AP projection and with an RA acquisition. The procedure were performed on the Philips Integris Allura System providing the RA tool. Results: RA after PTA was successful in all cases. In 42% of cases there was no difference between the static AP projection and RA, whereas in 47% the static acquisition, compared to RA, underestimated the degree of residual stenosis by 10-30%. In about 40% of these cases a disagreement on the presence and extent of subintimal flaps between static and rotational acquisition was identified. In another 11% of cases there was substantial agreement on the residual stenosis but not on the PTA-induced dissection which was always better identified on RA. Conclusions: RA allowed optimal evaluation of all cases improving the information on the conventional technique based on one or two projections. In our experience this information modified our therapeutic approach leading to repeated balloon angioplasty or stenting in 46% of cases. All the diagnosis were confirmed by digital angiography or surgical treatment. In the first group (endoluminal repair), the complications were: a) periprosthetic hematoma (n = 2); b) neointinal hyperplasia (n = 2); c) partial stent-graft thrombosis (n = 4); d) total stent-graft thrombosis of an iliac branch (n = 7); e) endoleak type II (n = 4); f) endoleak type III (n = 4), separation of the stents' components (n = 1). In the second group (surgical repair) we observed: a) periprosthetic infections (n = 3); b) supraprosthetic aneurysm (n = 1); c) pseudoaneurysm (n = 2); d) aortoenteric fistula (n = 2). Conclusion: CTA is accurate, fast and minimally invasive imaging method in the evaluation of complications after abdominal aortic aneurism repair. Interobserver agreement in the CT evaluation of carotid artery stenosis P.M. Carrascosa 1 , F. Meli 1 , C. Capuñay 1 , T. Sampere 1 , E. Martin Lopez 1 , D. Smith 2 , S. Chandra 2 , J. Carrascosa 1 ; 1 Buenos Aires/AR, 2 Cleveland, OH/US Objective: To determine the usefulness of CT angiography (CTA) in the detection and quantification of carotid stenosis in comparison with DA. Materials and Methods: Thirty-eight carotid arteries were evaluated in 19 patients with transient ischemic attacks. CTAs were performed with a Helical CT Scanner (PQ 5000; Picker). Images were evaluated by two radiologists, who were blinded to the percentage of stenosis determined by DA. The stenosis were considered positive if they were ≥ 70%. Different methods of stenosis quantification (NASCET(N), ESCT (E) and area quantification (A)) were performed on the same vessel to determine the sensitivity and specificity of each one in comparison with DA. Interobserver variability of the three methods was evaluated. Statistical Analysis: kappa coefficient was performed to determine the interobserver variability. Results: Observer 1: Sensitivity: N: 94%, E: 77% and A: 94% and specificity: 91%, 87.5% and 87.5% for each method, respectively. Observer 2 = Sensitivity: N: 77%, E: 77% and A: 74% and specificity: 91%, 87.5% and 95% for each method, respectively. Kappa: 0.83, 0792 and 0.78 for N, E and A respectively. Conclusion: CTA showed high S and Sp in the carotid stenosis quantification, specially with the NASCET method. Emergency multislice CT angiography (MSCTA) in patients with suspected aortic dissection R. Stern Padovan, M. Lusic, B. Oberman, K. Potocki; Zagreb/HR Purpose: The purpose of the study was to evaluate positive MSCT-angiography findings in patients with spontaneus-nontraumatic aortic dissection. MSCTA is a noninvasive, time-saving radiological procedure for patients with aortic dissection because they need prompt and accurate diagnosis and treatment. Aortic dissection is defined as a separation of the inner aortic wall layers. It is divided by Stanford classification into type A that involves the ascendent aorta and type B involves distal to the origin of the left subclavian artery. Materials and Methods: MSCTA was performed in 42 patients (14 (33.5%) female and 28 (66.7%) male age 18 -81) with clinically suspected aortic dissection over a period of 14 months on Lightspeed Ultra 8 Slices, GE. Slice thickness was 2.5 mm with 50% overlap of reformatted images. We injected 100-120 mL of nonionic contrast material at a flow rate of 4 mL/sec with Smart Prep feature. MIP and MPR were usually used. Results: Aortic dissection was found in 29 (67.4%) patients. 21 (72.4%) had acute aortic dissection and 8 (27.6%) chronic type. Acute aortic dissection Stanford type A was found in 13 (62%) and type B in 8 (38%). In 13 patients we did not find aortic dissection but other CT findings could explain the symptoms: AA, rupture of AA, mesenteric ischemia, pericardial effusion. Conclusion: MSCTA is noninvasive, rapid and relatively comfortable radiological procedure for patients with suspected acute aortic dissection in cardiovascular emergency. This technique enables correct and detailed diagnostic information and obviates catheter aortography. Diagnosis of aortic and supraaortic emergency with CT angiography: How does aortic morphology influence the choice of treatment? C. Engelke 1 , K. Marten 1 , A. Chavan 2 , J.F. Reidy 3 , A.-M. Belli 3 , E.J. Rummeny 1 ; 1 Munich/DE, 2 Hannover/DE, 3 London/UK Objective: CT angiography (CTA) is the imaging method of choice for diagnosis of aortic and supraaortic emergency. In this retrospective evaluation of patients with aortic or supraaortic emergency undergoing intial CTA at four european centres diagnosis and determination of treatment are reviewed. The assessment of diagnostic value of Vmax, Vmin, PI, RI measurements in the diagnosis of coeliac trunk stenosis before and after Levovist injection -ROC curves analysis A. Drelich-Zbroja, T. Jargiello, W. Krzyzanowski, P. Kurczab, M. Szczerbo-Trojanowska; Lublin/PL Purpose: To assess the diagnostic value of Vmax, Vmin, PI, RI measurements in the diagnosis of coeliac trunk stenosis before and after Levovist injection. In 100 patients Doppler examination of coeliac trunk before and after Levovist injection was performed measuring Vmax, Vmin, PI, RI. In conventional Doppler 23 and after Levovist administration 29 stenoses were diagnosed. Number of diagnosed stenoses in relation to number of normal coeliac trunks was representative enough to perform the statistical analysis using ROC curves. Results: 1. The areas under curves (AUCs) for Vmax, Vmin, PI, RI, before and after Levovist. 1a. Before Levovist: AUCVmax = 0.947*, AUCVmin = 0.860*, AUCPI = 0.537 NS , AUCRI = 0.509 NS . 2a. After Levovist: AUCVmax = 0.984*, AUCVmin = 0.918*, AUCPI = 0.551 NS , AUCRI = 0.546 NS . *p < 0.05 when compared with AUC = 0.5; NS-not significant when compared with AUC = 0.5 2. The comparison of AUCs for Vmax and Vmin before and after Levovist. AUCVmax after Levovist -AUCVmax before Levovist = 0.037 NS , AUCVmin after Levovist -AUCVmin before Levovist = 0.058 NS , AUCVmax before Levovist -AUCVmin before Levovist = 0.087*, AUCVmax after Levovist -AUCVmin after Levovist = 0.066*. *p < 0.05; NS-difference not significant Conclusions: Only Vmax and Vmin are useful in the diagnosis of coeliac trunk stenosis. The diagnostic value of Vmax is significantly higher than diagnostic value of Vmin. The use of Levovist has no an effect on diagnostic value of Vmax and Vmin. The effect of body mass index on the ultrasonographic measurements of the portal venous system N. Tuncbilek 1 , O.O. Okten 1 , S. Guldiken 1 , H.M. Karakas 2 ; 1 Edirne/TR, 2 Malatya/TR Purpose: The effect of body mass index (BMI) on portal venous diameter and pulsatility index was investigated. The study group consisted of 29 obese and 12 control subjects with normal BMI. Inferior vena cava (VCI) and portal vein (PV) diameters and their pulsatility indices (PI) were prospectively evaluated with 3.5 Mhz convex transducer. Diametric measurements were employed in M-mode imaging. The difference between obese and normal subjects regarding above mentioned parameters and their correlations with PI are investigated. Results: BMI varies between 16.8 and 22.2 kg/m 2 in control, and between 28.3 and 44.5 kg/m 2 in obese subjects. In control subjects, mean PI is 0.65 for PV and 0.75 for VCI. In obese patients, these values are 0.49 and 0.65, respectively. PI for PV significantly differs between two groups (p < 0.01) whereas vascular diameters for VCI and PV, and PI for VCI are not statistically different. In both groups there is a negative correlation between PI and BMI (for control subjects: r = -0.415, p < 0.01; for obese subjects r = -0.519, p < 0.01). Conclusion: PI of the portal venous system is regarded as the surrogate marker of right cardiac function. However factors such as inspiratory and expiratory intraabdominal pressure changes are known to affect this parameter. When considering PI as a marker of right cardiac function, attention must be paid to the relation of PI and BMI, proved by this study to be one of these factors. Significance of patent pyloric branch in hepatic arterial infusion chemotherapy S. Yoshioka, Y. Yasuhara, T. Murakami, S. Kumano, T. Mochizuki; Ehime/JP Purpose: To investigate the clinical significance of the patent pyloric branches after right gastric artery (RGA) embolization for arterial infusion chemotherapy. Materials and Methods: Sixty-six patients who received catheter placement in the hepatic artery for arterial infusion chemotherapy were retrospectively recruited from the pool of clinical records between 1998 and 2003. Two interventional radiologists reviewed the digital subtraction angiographies (DSAs) and clinical records of these patients. They assessed the following items by consensus: 1) location of the RGA, 2) frequency of the patent pyloric branchs after coil embolizaton of the RGA, 3) outcome of arterial infusion chemotherapy through the catheter. Results: The location of the RGA could be determined in 58 patients. RGA-coil embolization was performed in 36 patients. In 7 patients, fine pyloric branchs were patent after embolization. They were too fine to be embolized by the catheter technique. In 2 of these 7 patients, the catheter was successfully placed to avoid the drug infusion into the pyloric branch. The clinical outcome of the other 5 patients were as follows: One patient received the arterial infusion chemotherapy without any complication. One patient experienced transient abdominal pain in the course of arterial infusion chemotherapy. Two patients received replacement of the catheter because of abdominal complication. The last patient received surgical ligation of the RGA because of reopening of the RGA. Conclusion: The frequency of abdominal complication in arterial infusion chemotherapy was not negligible in the cases with patent pyloric branchs after RGA embolization. Erdheim-Chester disease: Imaging features C. Graef, E. Dion, P. Cluzel, R. Renard-Penna, J. Haroche, B. Wechsler, C. Beigelman-Aubry, P.A. Grenier; Paris/FR Learning Objectives: To be familiar with the radiologic features of Erdheim-Chester disease, a rare form of non-Langerhans cell histiocytosis of unknown etiology. Background: The disease is characterized by tissue infiltration with lipid-laden foamy histiocytes, polymorphic granuloma of inflammatory cells and collagen fibrosis. The patients have a mosaic of infiltrative involvement of various organs. Bone involvement is almost always present but often clinically asymptomatic. The prognosis depends on the severity of cardiovascular, renal or cerebral involvement. Imaging features of 10 histologically proven cases were reviewed. Imaging Features: Radiological bone involvement was present in all cases, characterized by bilateral and symmetrical spongy bone densification, cortical thickening and periostosis of long bones from the metaphysis to the diaphysis associated with scintigraphic tracer uptake. Renal and perirenal involvement seen on CT scans consisted of bilateral and symmetrical perirenal tissue infiltration (hairy kidney) (n = 6), extended to the adrenal fossae, the renal sinuses, and the proximal ureters. Cardiovascular involvement consisted in 1) thoracic and abdominal circumferential periaortic tissue infiltration (coated aorta) with extension to the coronary, supraaortic and pulmonary arteries, and abdominal branches, 2) stenosis of renal or mesenteric arteries (n = 3), 3) involvement of pericardium (n = 2) and myocardial mass (n = 1). Tissue infiltration involved pituitary in one case and orbits in another one. Conclusion: A diagnosis of Erdheim-Chester disease should be considered in patients who demonstrate bilateral and symmetric densification of the long bones with increased uptake on scintigraphy in association with perirenal fat infiltration and/or a periaortic fibrosis. Human NK-92 cells were labeled with Ferumoxides and Ferucarbotran using simple incubation, lipofection and electroporation techniques. Incubation times were varied from 2-24 hours and added contrast agent concentrations were varied from 100-300 microgram Fe/1000000 cells. Pellets of labeled cells and non-labeled controls were evaluated by MR imaging. The cellular iron oxide uptake was proven by prussian blue stains and spectrometry as a standard of reference. In addition, cell viability was tested with the Trypan Blue exclusion test. Differences between labeled cells and non-labeled controls were tested for significance using the t-test. Results: NK-92 cells could be labeled with Ferucarbotran and Ferumoxides by lipofection and electroporation, but not simple incubation. Lipofection had to be performed for 24 h, but resulted in only minor, not significant impairment of cell viablility (88-92%) compared to controls (96-98%), while electroporation caused cell labeling within seconds, but reduced the viablility of the cells significantly (61-74%), thereby necessitating additional cell culture time for cell recovery. The intracellular iron oxide uptake was proven histologically and quantified by spectrometry. Ferucarbotran and Ferumoxides-labeled cells could be depicted by a significant signal decline on T2*weighted MR images. Conclusion: Human NK-92 cells can be labeled with Ferucarbotran and Ferumoxides by lipofection and electroporation. Optimized labeling techniques allow a subsequent cell depiction with a standard 1.5 T MR scanner. Which temporal frame rate is necessary in quantitative dynamic ³He-MRI? C. Heussel 1 , A. Dahmen 1 , F. Lehmann 1 , M. Salerno 2 , K.K. Gast 1 , H.-U. Kauczor 1 , J.P.I. Mugler 2 , E.E. de Lange 2 , W. Schreiber 1 ; 1 Mainz/DE, 2 Charlottesville, VA/US Purpose: Dynamic ³He-MRI permits regional analysis of distribution ventilatory kinetics. Dedicated post-processing offers image-based lung function parameters. Sliding window reconstruction of interleaved-spiral acquisitions provides high temporal rates, but do functional parameter values depend on the temporal frame rate? Methods and Material: Single-slice coronal dynamic ³He-MRI was acquired continuously for 15 s during free respiration. Image reconstruction was performed using sliding window technique with 3.4 ms data sampling-time (repetition-time 10 ms). Post-processing was performed using a self-written software with linear motion correction for calculation of: Rise Time (TR, interval of lung-signal from 10% to 90% of peak signal), delay-90 time (TD90, interval of trachea-signal 50% and lung-signal 90%), amplitude (peak lung-signal), and peak flow (PF, maximum signal slope). Analysis was done for 6 ROIs using a temporal resolution of 20 ms, 120 ms, and 240 ms (2 nd , 12 th , and 24 th image). This study included 4 exemplary patients (Asbestosis, 2 x Asthma, COPD) so far. Results: Post-processing of the data-sets lasted 30 to 120 mins at an actual PC (2.4 GHz P4, 2 GB RAM). TR ranged from 418 to 1707 ms (median 859 ms), TD90 ranged from 228 to 1427 ms (median 753 ms), amplitude ranged from 13 to 557 a.u. (median 130 a.u.), PF ranged from 12 to 710 a.u. (median 207 a.u.). No relevant difference was detected in the evaluation of different temporal frame rates for all patients or within an individual patient. Conclusion: Since these preliminary data suggest a limited effect of high temporal frame rates, improvement of spatial rather than temporal resolution might be the emphasis in the future. To determine the compensatory mechanisms involved in recovery of motor function following resection of the supplementary motor area (SMA) and their relation to the clinical characteristics of recovery. Subjects and Methods: Thirteen patients referred for surgery of low-grade gliomas located in the SMA were compared to nine healthy controls using fMRI before and after surgery during self-paced movements of both hands, successively. Activation within regions of interest (ROIs) (primary sensorimotor cortex (SMC), premotor cortex (PMC), SMA) were compared and tested for correlation with anatomical characteristics of the tumor and resection, and clinical data. Interaction analysis between ROIs was performed using partial correlation. Results: Tumor growth induced preoperative underactivity in the adjacent SMA and overactivity in the opposite SMA. Postoperative recovery was associated with recruitment of the lateral premotor cortex in the healthy hemisphere. In the affected hemisphere, pre-and postoperative correlations between SMA, PMC and SMC were decreased. In the healthy hemisphere, postoperative correlations between PMC and SMA or SMC were increased. Shortened onset and duration of recovery was associated with preoperative changes in SMA activation. Conclusions: These findings suggest that tumors induced a dysfunction in activation and connectivity of the ipsilateral SMA, which was partially compensated by a recruitment of the SMA in the healthy hemisphere. This preoperative remodeling of SMA activity did not prevent the occurrence of the postoperative deficit but was associated with shortened recovery. SMA resection was compensated by the recruitment of an ipsilateral premotor circuitry. The use of internet filters to build a radiology education and teaching resource P. Davison, J. Revell, M.R. Rees; Bristol/UK Purpose: To develop a resource for radiology undergraduate and postgraduate education from a series of research projects dealing with internet filter aided search. Supported by a research and education grant from the EAR. Materials and Methods: Two independent research projects into internet search were examined for their application to radiology education and these methods were compared to conventional image search protocols. This experience was translated into constructive advice for undergraduate students undertaking special study modules in radiology. The two internet filters developed were designed to improve accuracy of text search and to improve the search results from image search enquiries in radiology and medical subjects. A second iteration of the image search filter was developed to produce a web crawler that selected images from previously carried out text searches. The text and image based filters were tested with other search engines over a preset number of criteria. Results: Both the text based search facility and the image based facility showed advantages when compared to conventional search methods. The image search facility was successful in handling medical searches compared to common search engines and the web-crawler was efficient at producing a large number of images from selected sites. These methods were used to develop medical students skills in the use of the internet and has been used in the construction of radiology image based special study projects. Conclusion: Web based filter programmes and education in search techniques can result in improving the efficiency of internet based material for radiology education. Single breath-hold subtraction: Novel approach to diagnosing pulmonary embolism by multi-slice CT (work-in-progress) J.E. Wildberger 1 , A.H. Mahnken 1 , H. Ditt 2 , M.U. Niethammer 2 , E. Spüntrup 1 , E. Klotz 2 , R.W. Günther 1 ; 1 Aachen/DE, 2 Forchheim/DE Purpose: In the work-up of pulmonary embolism (PE), CT allows for direct visualization of emboli. In addition, perfusion defects permit direct assessment of the extent of PE, using color-coded lung densitometry. This new image processing technique has been deployed for a 4-slice multi-slice CT (MSCT) system. For further improvement, a subtraction technique within a single breath-hold will be mandatory. Materials and Methods: Three healthy pigs underwent lung lavage to induce C-960 Assessment of the angioarchitecture and hemodynamic characteristics of cerebral AVMs by contrast enhanced static and non enhanced dynamic MR angiography M. Essig; Heidelberg/DE Purpose: The aim was to improve the definition of the angioarchitectural components of the AVM based on a dynamic MRA (dMRA) and a high resolution 3D multi-bolus and multi-phasic contrast-enhanced MRA (CE-MRA). Both techniques will be compared with 3D-TOF-MRA and transfemoral high resolution plain film angiography performed for treatment planning. Materials and Methods: DMRA will be performed by tracking a blood bolus through a vessel structure using the spin labeling technique STAR (Signal Targeting with Alternating Radiofrequency Sequences). Time-resolved CE-MRA will be acquired with an ultrashort 3D fast low-angle shot (FLASH) sequence (TR/TE 2.3/0.9 msec) using asymmetric k-space sampling in readout, phase-encoding, and partition directions. Results: All used sequences were successful in the assessment of patients' cerebral AVMs. The integration of acquired images into the treatment planning protocol was possible for all modalities. The different AVM compartments, feeding arteries, AVM nidus, and draining veins were detected easily and best on the dMRA. The method also allowed to hemodynamically assess the malformations: small AVMs generally showed shorter shunt times, however, a short shunt-time was associated with a higher risk of bleeding. CE-MRA also proved to be superior than TOF-MRA in the assessment of the angioarchitecture, however, the time resolution of the dynamic varient was too slow to achieve a substantial hemodynamic characterisation. Discussion: DMRA and CE-MRA are better suited than TOF-MRA to assess AVM angioarchitecture. The differentiation of different compartments of the malformation and the hemodynamic assessment is best seen with dMRA. Diagnostic investigations in relation to determination of paramagnetic centres and free radicals in the model of testicular tumor metastases M. Kekelidze, F. Todua; Tbilisi/GE Purpose: To assess the possible connections between diagnostic imaging (spiral CT, MRI) of retroperitoneal metastases of testicular tumor and the detection of paramagnetic centres and free radicals in the resected lymph node tissue after retroperitoneal lymph node dissection (RPLND). Materials and Methods: 23 patients with stage I morphologically confirmed nonseminomatous testicular tumors were subjected to RPLND. Diagnostic imaging included abdominal spiral CT with IV contrast and MRI. Specific tumor markers (AFP, CGT) were detected. Highly sensitive (10 10 -10 11 spin/gas) electron paramagnetic resonance (EPR) of 46 resected lymph node tissue was performed to detect the presence of paramagnetic centres and free radicals (Fe 2+ , Mn 2+ , N0) signals. CT or MRI scans were judged as positive or negative for Rp metastases on the basis of size, contrast enhancement criteria and compared with morphological and EPR data. Results: In 14 patients estimated as N0 on CT and MRI the increased signals of free radicals were revealed in 2 tissues. Among 9 patients (N1) with 18 resected lymph node tissue, 5 showed low signals of Fe 2+ Mn 2+ N0 and 13 material (morphologically confirmed as metastatic) high signals of free radicals, while the increased presence of paramagnetic centers were not detected in these tissues. Spiral CT and conventional MRI fail to detect micrometastases in 3 cases. There exists real correlation (p < 0.02) between the increased signals of free radicals (Fe 2+ , Mn 2+ , N0) and low stage metastatic lesions of Rp lymph nodes, which can reflect the connection between particular molecular events and malignant degeneration. Diagnostic accuracy of Gadolinium-enhanced MR-angiography vs. contrastenhanced helical CT in the diagnosis of pulmonary embolism in the presence of lung infiltrate: An animal study T. Franquet, S.E. Kalloger, A. Oikonomou, S.L. MacDonald, E.M. Baile, R.J. Mayo; Barcelona/ES Purpose: To compare gadolinium-enhanced MR angiography with contrast-enhanced spiral CT for the detection of small pulmonary emboli in pigs with and without pneumonia. Materials and Methods: Ten female juvenile pigs were anaesthetized, intubated and ventilated. Sub-segmental sized pulmonary emboli were introduced by injecting 4.5 mm methacrylate beads into the external jugular vein. Lung infiltrates were simulated by intra-bronchial injection of human plasma. Animals were imaged in the supine position at suspended inspiration with 15 cm H20 PEEP. Contrast media was injected via brachial vein. Dual gradient (TwinSpeed) 1.5 T MR images were acquired using 3 dimensional spoiled gradient-echo time of flight sequence; TR 4.8 msec, TE 1.2 msec, 45* flip angle, 6 mm section thickness, 32 cm FOV, 256 x 160 matrix, one average. Two MRA sets, pulmonary arterial and venous, were acquired in 39 seconds. Contrast enhancement was provided by 20 mL of Gd dimeglumine followed by 20 mL of normal saline, injected at 2 mL/sec. Non-contrast and contrast enhanced CT images were obtained using an 8 track spiral CT; 1.25 mm detector aperture, 90 mL contrast at 3 mL/sec. Subtraction perfusion images were calculated by subtracting contrast enhanced from non-contrast CT images. After imaging the pig was euthanized and a methacrylate cast of the pulmonary vasculature was obtained and used as a "goldstandard". CTA, CTA with subtraction perfusion images and MR images were independently interpreted by two observers in a blinded fashion. Results: No significant difference (p > 0.05) was seen between CTA, CTA with subtraction perfusion images and MR for mean sensitivity (86%, 88% and 68%) or mean specificity (94%, 94% and 73%), respectively. No significant difference (p > 0.05) was seen in sensitivity or specificity between pigs with and without infiltrates. A prospective power analysis based upon this preliminary data indicates that the addition of two more readers (N = 4) would yield significant differences (p£0.05) between CTA and CTA with subtraction perfusion images compared to MRA for sensitivity and specificity. Conclusion: Preliminary results indicate that CTA and CTA with subtraction perfusion images provide improved detection of sub-segmental sized PE in comparison to Gadolinium-enhanced MRA.