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ER - European Radiology 25th Anniversary Session

Friday, March 3, 16:00 - 17:30 Room: Z Session Type: European Radiology 25th Anniversary Session Topics: Education, Research Digital Evaluation: Open Digital Evaluation for this Session Moderators: M. F. Reiser (Munich/DE), A. L. Baert (Kessel-Lo/BE), A. K. Dixon (Cambridge/UK) Add session to my schedule In your schedule (remove)

A-500

Introduction: 25 years of European Radiology

M. F. Reiser; Munich/DE

Learning Objectives

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Abstract

At this ECR, we celebrate the 25th anniversary of European Radiology. For this occasion, 25 articles published during the past 25 years were picked to reflect the immense progress radiology and imaging sciences have made over this period. The selection was based on number of citations and whether the work was influential for the development and changing practise of imaging and image guided interventions. Furthermore, we attempted to achieve a balance and to represent the diversity within the different subspecialties. 10 of these 25 articles are presented in this session. We invite you to join this journey through time with a perspective towards the future.

A-501

How to present research data consistently in a scientific paper

M. Laniado; Dresden/DE

Learning Objectives

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Abstract

Scientific writing is an integral part of academic radiology, and it is professionally rewarding. One of the duties of academic mentors is to motivate and help young radiologists to successfully pass the primary hurdle of knowing how to begin. As with the research project as such, thoughtful planning of the manuscript is an important step. There are many ways to begin but the writer typically drafts the methods section first, followed by the results, the discussion, and the introduction. Information given in both the introduction and the discussion may function as a clip between which data provided in materials and methods and results are embedded. The conclusions should exactly reflect what was reported in the results section. The abstract has to be written as a comprehensive but very short summary of purpose, materials and methods, results, and conclusions. It is of utmost importance that the author edits the manuscript carefully and follows the target journal's instructions to contributors. Once the manuscript has gone through peer review and revisions are requested (provisional acceptance) it is recommended to respond to the comments point by point. This will facilitate reevaluation of the manuscript by the same reviewer(s) and enhances the likelihood that the revised version will be accepted for publication. In conclusion, writing scientific articles is a form of mental exercise that has to be practised to be successful.

A-502

Cost considerations regarding an integrated CT-PET system

G. K. von Schulthess; Zurich/CH

Learning Objectives

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Abstract

Integrating two modalities into one system, like PET and CT into PET/CT has advantages and drawbacks. The advantages are: the patient gets "two examinations in one", which is time efficient (patient preparation in the scanner is half), a hybrid exam is more agreeable to the patient, and there are synergies in siting and technology. The disadvantages are mainly due to added inflexibility. Separate modalities can be used in parallel for two patients, scheduling is much more flexible and, therefore, amortization of equipment and revenue generation may become easier with separate systems. It turns out that PET/CT seems quite efficient. First, all oncologic PET (the majority) examinations require PET and CT. Second, the time gained in pre-and post-scan patient handling using PET/CT is a critical bonus. CT being so fast makes PET/CT cost-effective. Cost-effectiveness with SPECT/CT (e.g. in cardiac imaging) or in PET/MR are much more difficult to attain. In summary, when purchasing a hybrid system, one has to carefully weigh advantages and disadvantages, so as to stay on the cost-effective side.

A-503

Role of contrast-enhanced helical CT in the evaluation of acute thoracic aortic injuries after blunt chest trauma

M. Scaglione; Naples/IT

Learning Objectives

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Abstract

The purpose of this retrospective study was to determine the value of contrast-enhanced helical CT for detecting/managing acute thoracic aortic injury (ATAI). Between June 1995 and February 2000, 1419 consecutive chest CT examinations were performed in the setting of major blunt trauma. The following CT findings were considered indicative of ATAI: intimal flap; pseudoaneurysm; contour irregularity; lumen abnormality; extravasation of contrast material. On the basis of these direct findings no further diagnostic investigations were performed. Isolated mediastinal haematoma on CT scans was considered an indirect sign of ATAI. In these cases, thoracic aortography was performed even if CT indicated normal aorta. Seventy-seven patients had abnormal CT scans: among the 23 patients with direct CT signs, acute thoracic aortic injuries was confirmed at thoracotomy in 21. Two false-positive cases were observed. The 54 remaining patients had isolated mediastinal haematoma without aortic injuries at CT and corresponding negative angiograms. The 1342 patients with negative CT scans were included in the 8-month follow-up program and did not show any adverse sequela. Contrast-enhanced helical CT has a critical role in the exclusion of thoracic aortic injuries in patient with major blunt chest trauma and prevents unnecessary thoracic aortography. Direct CT signs of ATAI do not require further diagnostic investigations: isolated aortic bands or contour vessel abnormalities should be first considered as possible artefacts or related to non-traumatic aetiologies especially when mediastinal haematoma is absent. In cases of isolated mediastinal haematoma other possible sources of bleeding should be considered before directing patients to thoracic aortography.

A-504

CT angiography of pulmonary embolism in patients with underlying respiratory disease: impact of multislice CT on image quality and negative predictive value

M. Remy-Jardin; Lille/FR

Learning Objectives

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Abstract

Our objective was to evaluate the impact of multislice CT (MSCT) on image quality and diagnostic value of spiral CT angiograms. Over an 8-month period (January 2000 to August 2000), 134 consecutive patients, including 55 patients with underlying lung disease, underwent MSCT (group 1). Image quality and diagnostic results of CT angiograms were compared with those obtained in 125 consecutive patients, including 58 patients with underlying lung disease, evaluated with thin-collimation single-slice CT (SSCT; group 2) over a similar period of time (January 1999 to August 1999). A 3-month clinical follow-up was systematically obtained in all patients who were not anticoagulated in the two groups. For a significantly longer mean z-axis coverage, the mean duration of data acquisition was significantly shorter with MSCT. The frequency of examinations devoid of motion artefacts was significantly higher in group 1 than in group 2. In the absence of significant difference in the quality of vascular enhancement, mainly coded as good or excellent, the proportion of examinations interpretable down to the subsegmental arteries was higher in group 1 (57.5%) than in group 2 (13%) (p<0.0001). The benefits of MSCT were more marked for patients with underlying respiratory disease and did not lead to a higher detection rate of peripheral pulmonary embolism. The negative predictive values of single-slice and multislice CT were 100 and 99%, respectively. Improvement in image quality on MSCT scans accounts for the improved diagnostic accuracy of CT angiography, in particular for patients with impaired respiratory function.

A-505

CT colonography: effect of experience and training on reader performance

S. Halligan; London/UK

Learning Objectives

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Abstract

The purpose of this paper was to investigate the effect of radiologist experience and increasing exposure to CT colonography on reader performance. Three radiologists of differing general experience (consultant, research fellow, trainee) independently analysed 100 CT colonographic datasets. Readers had no prior experience of CT colonography and received feedback and training after the first 50 cases from an independent experienced radiologist. Diagnostic performance and reporting times were compared for the first and second 50 datasets and compared with the results of a radiologist experienced in CT colonography. Before training only the consultant reader achieved statistical equivalence with the reference standard for detection of larger polyps. After training, detection rates ranged between 25 and 58% for larger polyps. Only the trainee significantly improved after training (P=0.007), with performance of other readers unchanged or even worse. Reporting times following training were reduced significantly for the consultant and fellow (P<0.001 and P=0.03, respectively), but increased for the trainee (P<0.001). In comparison to the consultant reader, the odds of detection of larger polyps was 0.36 (CI 0.16, 0.82) for the fellow and 0.36 (CI 0.14, 0.91) for the trainee. There is considerable variation in the ability to report CT colonography. Prior experience in gastrointestinal radiology is a distinct advantage. Competence cannot be assumed even after directed training via a database of 50 cases.

A-506

First performance evaluation of a dual-source CT (DSCT) system

T. Flohr; Forchheim/DE

Learning Objectives

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Abstract

We present the first performance evaluation of a new dual source CT (DSCT) system equipped with two x-ray tubes and two corresponding detectors that are mounted onto the rotating gantry with an angular offset of 90°. We introduce the system concept and potential benefits for ECG-controlled cardiac CT and for general radiology applications. We evaluate both temporal and spatial resolution by means of phantom scans. We present first patient scans to illustrate the performance of DSCT for ECG-gated cardiac imaging, and we demonstrate first results using a dual-energy acquisition mode. The evaluated DSCT system provides 83 ms temporal resolution independent of the patient’s heart rate for cardiac CT. In a centred z-resolution phantom, 0.4-mm cylinders can be resolved at all heart rates, owing to the z-flying focal spot technique. The scan time to cover the heart volume (12 cm) is 5-9 s, depending on the patient’s heart rate. First clinical experience shows a considerably increased robustness of the method for the imaging of patients with high heart rates. As a potential application of the dual-energy acquisition mode the automatic separation of bones and iodine filled vessels, e.g. for CT angiographic examinations, is demonstrated. Retrospect after 10 years: DSCT has been a significant step in introducing cardiac CT into clinical routine. Dual-energy CT has been reinvigorated by DSCT, resulting in some applications on their way to mainstream clinical use.

A-507

Gd-EOB-DTPA-enhanced magnetic resonance images of hepatocellular carcinoma: correlation with histological grading and portal blood flow

T. Murakami1, Y. Imai2; 1 Osaka/JP 2 Ikeda City/JP

Learning Objectives

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Abstract

The objective of this study is to retrospectively investigate enhancement patterns of hepatocellular carcinoma (HCC) and dysplastic nodule (DN) in the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine (Gd-EOB-DTPA)-enhanced MRI in relation to histological grading and portal blood flow. Sixty-nine consecutive patients with 83 histologically proven HCCs and DNs were studied. To assess Gd-EOB-DTPA uptake, we calculated the EOB enhancement ratio, which is the ratio of the relative intensity of tumorous lesion to surrounding non-tumorous area on hepatobiliary phase images (post-contrast EOB ratio) to that on unenhanced images (pre-contrast EOB ratio). Portal blood flow was evaluated by CT during arterial portography. Post-contrast EOB ratios significantly decreased as the degree of differentiation declined in DNs (1.00 ± 0.14) and well, moderately and poorly differentiated HCCs (0.79 ± 0.19, 0.60 ± 0.27, 0.49 ± 0.10, respectively). Gd-EOB-DTPA uptake, assessed by EOB enhancement ratios, deceased slightly in DNs and still more in HCCs, while there was no statistical difference in the decrease between different histological grades of HCC. Reductions in portal blood flow were observed less frequently than decreases in Gd-EOB-DTPA uptake in DNs and well-differentiated HCCs. Reduced Gd-EOB-DTPA uptake might be an early event of hepatocarcinogenesis, preceding portal blood flow reduction. The hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI may help estimate histological grading, although difficulties exist in differentiating HCCs from DNs.

A-508

ESUR prostate MR guidelines 2012

J. O. Barentsz; Nijmegen/NL

Learning Objectives

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Abstract

The aim was to develop clinical guidelines for multi-parametric MRI of the prostate by a group of prostate MRI experts from the European Society of Urogenital Radiology (ESUR), based on the literature evidence and consensus expert opinion. True evidence-based guidelines could not be formulated, but a compromise, reflected by “minimal” and “optimal” requirements has been made. The scope of these ESUR guidelines is to promulgate high-quality MRI in acquisition and evaluation with the correct indications for prostate cancer across the whole of Europe and eventually outside Europe. The guidelines for the optimal technique and three protocols for “detection”, “staging” and “node and bone” are presented. The use of endorectal coil vs. pelvic phased array coil and 1.5 vs. 3 T is discussed. Clinical indications and a PI-RADS classification for structured reporting are presented.

A-509

Nephrogenic systemic fibrosis and gadolinium-based contrast media: updated ESUR Contrast Medium Safety Committee guidelines

H. Thomsen; Aalborg/DK

Learning Objectives

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Abstract

The purpose of the session is to update the guidelines of the Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) on nephrogenic systemic fibrosis and gadolinium-based contrast media. Topics reviewed include the history, clinical features and prevalence of nephrogenic systemic fibrosis and the current understanding of its pathophysiology. The risk factors for NSF are discussed and prophylactic measures are recommended. The stability of the different gadolinium-based contrast media and the potential long-term effects of gadolinium in the body have also been reviewed.

A-510

Iterative reconstruction techniques for computed tomography Part 1: Technical principles

M. J. Willemink; Utrecht/NL

Learning Objectives

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Abstract

The objectives are to explain the technical principles of and differences between commercially available iterative reconstruction (IR) algorithms for computed tomography (CT) in non-mathematical terms for radiologists and clinicians. Technical details of the different proprietary IR techniques were distilled from available scientific articles and manufacturers' white papers and were verified by the manufacturers. Clinical results were obtained from a literature search spanning January 2006 to January 2012, including only original research papers concerning IR for CT. IR for CT iteratively reduces noise and artefacts in either image space or raw data, or both. Reported dose reductions ranged from 23% to 76% compared to locally used default filtered back-projection (FBP) settings, with similar noise, artefacts, subjective, and objective image quality. IR has the potential to allow reducing the radiation dose while preserving image quality. Disadvantages of IR include blotchy image appearance and longer computational time. Future studies need to address differences between IR algorithms for clinical low-dose CT.

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