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10:22 CET
EM 2 - Discovering Portuguese radiology: past, present, future
Imaging Methods Cardiac GI Tract Interventional Radiology
Saturday, March 3, 10:30 - 12:00
Room: B
Moderators: F. Caseiro Alves (Coimbra/PT), B. Hamm (Berlin/DE)

Introduction: SPRMN President address
F. Caseiro Alves; Coimbra/PT
Learning Objectives

1. To revisit the major Portuguese contribution for radiological sciences.
2. To provide a selection of present and future clinical research on imaging.
3. To explain and display the musical heritage through the Portuguese guitar.


A brief presentation of the past and present history of Portuguese Radiology will be made on behalf of SPRMN. Relevant contributions to angiography will be highlighted as well as a brief overview of the Portuguese Society and its main activities. The future will be presented by the three chosen young lecturers on topics of their research domain.

Imaging biomarkers for diffuse liver disease
M. M. França; Porto/PT
Learning Objectives

1. To understand the need for non-invasive imaging biomarkers to accurately detect and quantify hepatic steatosis, iron overload and fibrosis, in different diffuse liver diseases.
2. To review the different MR imaging techniques to evaluate and to quantify imaging biomarkers of liver steatosis, iron overload and fibrosis.
3. To discuss the role and clinical relevance of MR imaging biomarkers for the evaluation of diffuse liver diseases, in different clinical scenarios.


Fat, iron deposits and fibrosis can be found in different diffuse liver diseases. Because liver biopsy has several limitations, MR imaging biomarkers have been developed for fat and iron quantification, and to stage liver fibrosis. Quantification of proton density fat fraction (PDFF) can be accurately performed with multi-echo chemical shift-encoded (MECSE) gradient echo MR sequences, corrected for T1 relaxation, T2* decay effect, noise and fat spectral complexity. Quantification of liver iron content is needed to detect and stage iron overload, and also to monitor iron-reducing treatments. Iron MR quantification may be performed with R2/R2* relaxometry techniques. Simultaneously, quantification of hepatic fat (PDFF) and iron (R2*) can be achieved with MECSE sequences, which are advantageous in diffuse liver diseases, as fat and iron frequently coexist in the liver parenchyma. MR elastography can detect and stage significant or advanced fibrosis and cirrhosis, with high accuracy, in different diffuse liver diseases. All of these MR imaging biomarkers are increasingly being used for the non-invasive assessment of hepatic steatosis, siderosis and fibrosis for evaluating and monitoring diffuse liver diseases.

Prostate artery embolisation (PAE) for benign prostate obstruction (BPO): the paradigm shift
T. Bilhim; Lisbon/PT
Learning Objectives

1. To learn about the anatomy of male pelvic arteries relevant for selective embolisation of the prostate.
2. To understand what imaging modalities can be used for guidance inside the pelvis to find the prostate arteries.
3. To become familiar with clinical outcome and predictors of treatment response after prostate artery embolisation.


Prostate artery embolisation (PAE) has been proven to be safe and effective to relieve lower urinary tract symptoms (LUTS) related to benign prostate obstruction (BPO). Knowledge of the anatomy of the prostate arteries (PAs) is cornerstone to PAE. Pre-procedural CT-angiography (CTA) and intra-procedural cone-beam CT (CBCT) have been proven to be reliable tools to study the PAs. Identification of the PAs is generally performed under fluoroscopy. Developing alternatives are the use of fusion imaging with the pre-procedural CTA images, overlay with the intra-procedural CBCT images and the use of vessel-tracking software that automatically identifies the PAs. Up to 25% of patients may have clinical failure after PAE. Most of these patients are nonresponders, with a minority being relapsers. Thus, it is very important to define the predictors of clinical outcome to help exclude those patients less likely to respond to PAE. Predictors of better clinical outcome that have been identified include: younger age; lower baseline LUTS severity; patients under acute urinary retention; and adenomatous-dominant BPO. Bilateral PAE has been proven to be better than unilateral PAE. MR-detected ischaemia after PAE, PSA values 24 hours after PAE, prostate volume reduction and clinical outcome have been shown to be correlated. Prognostic quantification with perfusion imaging of the prostate, developing catheters and embolic agents/sizes are some of the future directions in the investigative field of PAE on the path to inclusion in the guidelines for the management of patients with symptomatic BPO.

Cardiac CT from anatomy to functional information: comprehensive CAD evaluation
H. Marques; Lisbon/PT
Learning Objectives

1. To learn and understand the different anatomic information regarding CAD derived from coronary CTA and its prognostic relevance.
2. To review different cardiac CT techniques to access functional relevance from anatomic stenosis and its clinical evidence.
3. To integrate cardiac CT derived data for a comprehensive CAD evaluation.


Coronary CTA has been a fast growing imaging technique to assess the coronary arteries non-invasively. Recently, some guidelines consider it to be the first-line test in patients with non-acute chest pain of possible cardiac origin, regardless of the pre-test probability of CAD. Intense research preceded and accompanied its evolution, from a rule-out test to an all-in-one coronary disease assessment with prognostic validation. We will follow this route and the scientific evidence behind it: from stenosis to plaque presence, segment involvement and plaque characteristics; transluminal gradient,"first-pass" perfusion CT and dual-energy "perfusion" CT; virtual fraction flow reserve (FFR);- evaluation of myocardial viability with CT. Finally, we will focus on artificial intelligence and machine learning techniques applied in this context and how they will be disruptive.

The soul of Portugal: Facts and sounds of the Portuguese guitar (part 1)
F. Caseiro Alves; Coimbra/PT

A historical perspective of the Portuguese guitar will be presented focusing on its construction and structure. Emphasis will be put on the differences between the Lisbon Guitar and the Coimbra Guitar concerning sound and purposes. The explanation will be accompanied by a live performance where players will try to show the audience the major sound differences. The session will end with a live performance of an instrumental theme for each of the two types of guitars. We hope to offer an educative and enjoyable moment of musical détente.

The soul of Portugal: Facts and sounds of the Portuguese guitar (part 2)
B. Costa; Coimbra/PT
The soul of Portugal: Facts and sounds of the Portuguese guitar (part 3)
R. Silva; Coimbra/PT
Learning Objectives


The soul of Portugal: Facts and sounds of the Portuguese guitar (part 4)
N. Botelho; Coimbra/PT
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