Submitted Abstracts

Transcription

Submitted Abstracts

AOCR 2010
Submitted Abstracts
Contents
Oral Presentation
2010.03.20
Abdominal Radiology (AB)
Genitourinary Radiology (GU)
Others (OT)
2010.03.21
Emergency Radiology (ER)
Experimental Radiology (EX)
Interventional Radiology (IR)
Musculoskeletal Radiology (MS)
Nuclear Medicine (NM)
Pediatric Radiology (PE)
2010.03.22
Submitted
Abstracts
Computed Aids in Imaging Medicine (CA)
Chest Radiology (CH)
Head and Neck Radiology (HN)
Interventional Neuroradiology (IN)
Neuroradiology (NR)
Others (OT)
PACS & Radiology Informatics (PA)
2010.03.23
Breast Radiology (BR)
Cardiovascular Radiology (CV)
Neuroradiology (NR)
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Standing Poster
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Neuroradiology (NR)
Others (OT)
Radiation Oncology (RO)
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525
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E-Poster
Neuroradiology (NR)
Others (OT)
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Others
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461
Purpose To compare the enhancement pattern at multiphasic MDCT
between moderately-differentiated hepatocellular carcinoma (MD-HCC)
and poorly-differentiated HCC (PD-HCC).
Methods Eighty pathologically proven HCCs in 79 patients (mean age
64.2 years) who had undergone 4-phase MDCT were retrospectively
evaluated. Thirty-seven of the 80 HCCs were MD-HCC, and the other
43 HCCs were PD-HCC. CT was performed using 8- or 64-slice MDCT
scanner. Pre-contrast and 4-phase (early-arterial, late-arterial, portal
venous and equilibrium phases) contrast-enhanced images were obtained
using bolus-tracking technique. As a quantitative analysis, regions of
interest were drawn on relatively homogeneously enhanced areas of
HCCs and non-cancerous regions of liver on images of each phase. The
attenuation value of HCC and attenuation difference between HCC and
non-cancerous region in each phase and changes of attenuation values
of HCCs among the phases were compared between MD-HCC and PDHCC using Student’s t-test. As a qualitative analysis, two radiologists
visually evaluated the contrast of HCC compared with surrounding liver
parenchyma using 4-point rating system by consensus, and the contrast
of HCCs was compared between MD-HCCs and PD-HCCs using MannWhitney’s U-test.
Results The mean attenuation values of MD-HCCs on late-arterial,
portal venous and equilibrium phase (145.9, 115.1 and 91.8 HU) were
significantly higher than those of PD-HCCs (127.2, 105.9 and 86.6 HU)
(P <.01, <.04 and <.04, respectively). The attenuation differences in the
late-arterial phase (50.8 HU) for MD-HCCs were significantly greater than
that of PD-HCCs (35.6 HU) (P <.03). The changes of attenuation values
between pre-contrast and late-arterial phase of MD-HCCs (97.5 HU) were
significantly greater than those of PD-HCCs (80.5 HU) (P <.02). The visual
contrast was not significantly different between MD-HCC and PD-HCC in
any phases.
Conclusions Arterial enhancement of MD-HCCs was greater than that
of PD-HCCs. Evaluation of arterial enhancement on MDCT may enable
differentiation between moderately- and poorly-differentiated HCCs.
Keywords Liver, CT
AB066
Post-Renal Transplant Hepatocellular Carcinoma
Nai-wen Hsu¹, Yu-Fan Cheng²
¹Department of Diagnostic Radiology, QUASI-733 RSROC,
Taiwan
²Department of Diagnostic Radiology, RSROC, Taiwan
Purpose A kidney transplant is suitable surgical management for endstage renal disease patients, however, post-transplant malignancy is an
unwanted outcome. In Taiwan hepatocellular cacinoma (HCC) is a major
malignancy not only in the general population but also in the post-kidney
transplant group. Thus regular image study for post-transplant follow-up is
necessary. We would like to sort the image characters and to evaluate the
efficacy of radiological diagnostic criteria and American Joint Committee
on Cancer (AJCC) staging system in post-kidney transplant HCC.
Methods From 1988 to 2008, 15 patients with post-transplant HCC
were retrospectively reviewed from 554 hospital-based kidney transplant
recipients. The patient profiles, image studies, histopathological diagnosis,
methods of treatment and outcomes were analyzed. The AJCC radiologic
staging system was applied and validated in our study.
Results Using the AJCC staging system all 15 patients with histopathology
462
AB103
CT Demonstration of Thrombophlebitis of Hepatic Veins and
Gas in Abscess Cavity- A Characteristic of Pyogenic Liver
Abscess Caused by Klebsiella Pneumoniae?
Sudhakar Kundapur Venkatesh, Hind S Alsaif
Department of Diagnostic Imaging, National University Health
System, Singapore
Purpose A retrospective review of pyogenic liver abscesses was
performed to investigate whether Klebsiella pneumoniae liver abscess
was associated with thrombophlebitis of hepatic veins and gas in abscess
cavity.
Methods Review of 125 patients with pyogenic liver abscesses confirmed
by radiological or surgical drainage of frank pus was performed. CT scans
were reviewed for any filling defects in the hepatic veins and/or the inferior
vena cava suggesting thrombophlebitis. Other findings including gas in
abscess cavity, portal and hepatic veins and the bile ducts, numbers of
abscesses were also recorded. The cause of the abscess was established
with culture of organism from pus and/or blood. For study purpose, the
patients were grouped into Klebsiella group and non-Klebsiella group and
a comparison of incidence of thrombophlebitis, pylephlebitis and gas in
abscess cavity between the two groups was performed.
Results Klebsiella pneumoniae was the most common organism causing
liver abscess accounting for 67 cases (54%) followed by Escherichia Coli
(7 cases), Staphylococcus aureus (6 cases), Enterococcus (4 cases)
and others (10 cases). In 31 cases (25%) no organism was cultured.
Thrombophlebitis of the hepatic veins was found in 29 patients (23%) with
33% in Klebsiella group and 12% in non-Klebsiella group (p<0.05). Gas
in the abscess cavity occured in 10.5% ofKlebsiella group (7 cases) and
7% in non-Klebsiella group (4 cases) (p<0.05). Pyelephlebitis was found
in 18 patients with 9 cases (13.4%) in Klebsiella group and 9 cases in
non-Klebsiella group (15.5%) (P=0.3). Diabetes was the most common
medical condition and present in 20 patients and 10 of these associated
with Klebsiella abscess.
Conclusions Thrombophlebitis of the hepatic veins and gas in
the abscess cavity occurs significantly more common in Klebsiella
pneumoniae abscesses and CT demonstration of this finding may help in
earlier diagnosis and initiation of appropriate antibiotic therapy.
Keywords Abscess, Liver, CT, Infection
AB107
Differential CT Features of Local Tumor Recurrence in
Postoperative Patients with a History of Cholangiocarcinoma
Yoon Jin Lee¹, Joon Joo Han², Jae Young Lee², Se Hyung Kim²,
Jeong Min Lee², Byung Ihn Choi²
¹Department of Radiology, Seoul National University Hospital,
Korea
²Department of Radiology and Institute of Radiation Medicine,
Seoul National University Hospital, Korea
Purpose To identify useful CT findings for differentiating local tumor
recurrence in postoperative patients with a history of cholangiocarcinoma
Methods Among 122 patients who underwent extrahepatic bile duct
resection and hepaticojejunostomy (HJ-stomy) or choledochojejunostomy
(CJ-stomy) for extrahepatic or hilar cholangiocarcinoma from 2003 to
2005, a total of 32 patients (13 hilar local recurrence, 6 non-hlilar local
recurrence, 13 recurrence free) with follow-up CT satisfied the inclusion
criteria of this study. Two radiologists retrospectively reviewed the CT
findings in consensus regarding the presence of dilated intrahepatic bile
duct, the presence and pattern of wall thickening (even or uneven) or
wall enhancement at the HJ-stomy or CJ-stomy site, the presence of
periductal or periportal soft tissue density, attenuation of the periductal or
periportal soft tissue densities on arterial and portal venous phase images,
the presence of portal vein narrowing, and distant metastasis. Fisher’s
exact and the Mann-Whitney U tests were used for statistical analysis to
differentiate local recurrence from benign postoperative findings.
Results Periductal soft tissue densities with dilatation of intrahepatic
ducts were detected more frequently in hilar local recurrence (10 of 13,
P=0.009). Portal vein narrowing was also found more often in hilar local
recurrence malignant strictures than in benign strictures (5 of 13 versus
1 of 19, P=0.033). Uneven wall thickening at hilar anastomosis site was
observed more frequently in hilar local recurrence but not statistically
significant. Other CT findings were not statistically significant also.
Conclusions The presence of periductal soft tissue density and portal
vein narrowing may suggest local tumor recurrence in a postoperative
patient with a history of cholangiocarcinoma.
Keywords Bile Ducts
AB098
A Rare Primary Hepatic Burkitt's Lymphoma with Computed
Tomography Enhancement Pattern Mimicking Hepatocellular
Carcinoma: A Case Report and Review of Literature
Kai Lun Chen, Yeu-Sheng Tyan
Department of Medical Imaging, Chung Shan Medical University
Hospital, Taiwan
Purpose Burkitt's lymphoma is a rare disease that belongs to the
aggressive non-Hodgkin's lymphoma (NHL). On computed tomography
(CT) examination, primary hepatic lymphoma of the liver is typically
represented by hypoattenuating hypovascular lesions. A hypervascular
enhancement pattern on CT images has rarely been described in the
literature to date. Herein, we report an additional case of primary Burkitt’s
lymphoma presenting as a hypervascular hepatic mass mimicking
hepatocellualr carcinoma (HCC) clinically.
Results A 51-year-old woman visited the hospital for abdominal fullness
for 1 month. She also felt fatigue and poor appetite. Physical examination
revealed hepatomegaly and shifting dullness, but did not show any
palpable lymph node. Laboratory finding showed elevated lactate
dehydrogenase (LDH, 613 IU/L), CA-125 (1566 U/ml), CA-153 (68.6 U/ml)
and CA19-9 (136 U/ml). CEA, AFP, alanine aminotransferase, aspartate
aminotransferase levels were within normal ranges. The viral markers
were negative for HbsAg, Anti-HBs, Anti-HCV and Anti-HIV. Contrastenhanced abdominal CT showed a large heterogeneous hypervascular
liver mass with mild rim enhancement on delayed phase mimicking HCC
which occupied the right lobe of liver. However, the pathology of liver
biopsy showed Burkitt's lymphoma. The image study did not reveal any
lymphadenopathy or metastatic lesions in the abdomen. Therefore, we
diagnosed the patient as primary hepatic Burkitt's lymphoma.
Conclusions Primary hepatic lymphoma constitutes 0.4% of cases of
extranodal NHL, and only about 0.016% of all cases of NHL. Primary
hepatic Burkitt's lymphoma makes up 3% of primary hepatic lymphoma.
There are no imaging findings that are specific for the diagnosis of
primary hepatic lymphoma. Most studies have shown hypoattenuating
hypovascular lesions on CT examination. To the best of our knowledge,
such enhancement pattern with hypervascular enhancement and mild
rim enhancement on delayed phase has not been described. Therefore,
we report a unique CT enhancement pattern of primary hepatic Burkitt's
lymphoma, which mimics HCC clinically.
Keywords Liver, Lymphoma, CT
AB089
Sonographic Assessment of Abdominal Fat: A Correlation
with CT-Measured Abdominal Visceral Adipose Tissue
Jer-Shyung Huang
Department of Radiology, Division of Abdominal imaging,
Kaohsiung Veterans General Hospital, Taiwan
Purpose Visceral fat accumulation has been found to associate with
increased risk of cardiovascular disease. This study was designed to
determine the most reliable measurement in predicting abdominal visceral
adipose tissue determined by computed tomography (CT).
Methods There were 33 obese patients enrolled in a diet-control program.
We measured the body weight (BW), body mass index (BMI), waist
circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR),
thickness of subcutaneous (S) and preperitoneal (P) fat at the level of
subxyphoid (SS, PS) and umbilical (SU, PU) levels and the visceral fat
between the posterior aspect of the abdominal wall and anterior wall of
the aorta in resting (VR), end-inspiration (VI), and end-expiration (VE) in
all patients before and after the program. The results were correlated with
CT-measured intra-abdominal visceral adipose tissue at the level between
2nd to 5th lumbar spines.
Results The VR (r = 0.785, p <0.0001), VI (r = 0.666, p <0.0001), VE (r
= 0.742, p <0.0001), WHR (r = 0.642, p <0.0001), and WC (r = 0.373, p
= 0.03) were positively correlated with abdominal visceral adipose tissue
determined by CT scan, while BW, BMI, HC, subcutaneous and preperitoneal fat thickness were not.
Conclusions Sonographic assessment of the visceral fat measured
between abdominal wall and aorta in resting state has the best and most
significant correlation with CT-determined abdominal visceral adipose
tissue.
Keywords Metabolic Disorders, Efficacy Studies, Technical Aspects,
Ultrasound
AB084
Imaging of Hepatic Involvement in Hereditary Hemorrhagic
Telangiectasia
Ching-Wen Huang1, Yi-Hong Chou2, Chui-Mei Tiu2, Liang-Kuang
Chen3
1
Department of Radiology, Radiology, Taiwan
2
Department of Radiology, Veterans General Hospital, Taiwan
3
Department of Radiology, Shin-Kong Hospital, Taiwan
Purpose Hereditary hemorrhage telangiectasia (HHT) is a rare autosomal
dominant disorder characterized by repeated episodes of hemorrhage. In
this article, we would like to discuss the current diagnostic imaging tools in
assessing the hepatic involvement in HHT patients.
Methods We briefly review the genetics and mechanisms of this
hereditary disorder, and describe the findings and diagnostic criteria of
current imaging studies of this disease entity.
Results Genetic Mechanisms: Current studies by Abdalla in 2008 showed
that two types of this disease, HHT1 and HHT2, are caused by mutations
in the ENG (endoglin) and ACVRL1 genes, respectively. Reduced levels
of endoglin in HHT1 patients and ALK-1 in HHT2 patients is the underlying
cause of the disease. Ultrasonography: The study by Buonamico revealed
a higher prevalence of hepatic AVMs in HHT as compared to previous
studies. Two distinct intrahepatic signs “hypervascularization” and
“color spot” suggest small AVMs in the liver were identified. Computed
tomography: The study by Memeo M. in 2004 revealed hepatic lesions
such as shunt and vascular abnormalities in HHT patients can be
evaluated by using CT. Magnetic Resonance Imaging: The MRI study
of HHT patients by Milot L. showed hepatic abnormalities were found in
91% of HHT patient. The diameters of the hepatic artery and veins were
statistically significantly larger in patients with HHT. Nuclear Medicine:
Abnormal hepatic hemodynamics and function in HHT patients were
successfully evaluate with 99Tcm- phytate angiography and iodine-123iodoamphetamine transrectal portal scintigraphy in a case report.
Conclusions With the improved sensitivity of imaging tools, HHT patients
with hepatic involvement has increased from 8-31% to 91%. Color
Doppler Ultrasound (CDS) is a good screening tool for asymptomatic HHT
463
Standing Poster Oral Presentation
AB062
Moderately- versus Poorly-Differentiated Hepatocellular
Carcinoma; Comparison of Enhancement Pattern at
Multiphasic MDCT
Atsushi Nakamoto, Tonsok Kim, Masatoshi Hori, Hiromitsu
Onishi, Yasuhiro Nakaya, Takahiro Tsuboyama, Mitsuaki Tatsumi,
Kaname Tomoda
Department of Radiology, Osaka University Graduate School of
Medicine, Japan
confirmed HCC were enrolled as stage I (n=7), stage II (n=2), stage IIIA
(n=5) and stage IV (n=1). The 5-year survival rates are 71.4% in stage I,
50% in stage II, 20% in stage IIIA, and 0% in stage IV. The mean survival
time are listed below: 72.2 months in surgical group (n=5, stage I), 102.3
months in TAE group (n=4, stage I/II/IIIA), and 1.67 months in conservative
group (n= 6, stage I/IIIA/IV). Over half of post-kidney transplant HCC were
sized 2.5-6.0 cm in diameter and had mixed echogenicity. The positive
diagnostic rate for radiologic diagnosis criteria is 83.3%.
Conclusions The AJCC staging system and the radiological diagnostic
criteria are well-validated in post-kidney transplant HCC. Surgical
resection and TAE for early-stage HCC in kidney transplant recipients
have satisfactory outcomes. Non-cirrhotic liver in a kidney transplant
recipient makes surgical resection the treatment of choice due to better
prognosis.
Keywords Kidney, Liver, Efficacy Studies, Treatment Effects
E-Poster
Others
2010.03.20
2010.03.20
GU027
Differentiation of Renal Cell Carcinoma Subtypes
Ta-Pin Lee, Jia-Hwia Wang, Shu-Huei Shen, Cheng-Yen Chang
Department of Radiology, Taipei Veterans General Hospital,
Taiwan
Purpose We differentiated three main subtypes of renal cell carcinoma
with multislice computerized tomography (CT).
Methods We reviewed the CT images of 104 patients with renal cell
carcinoma belonging to three main subtypes of renal cell carcinoma: 92
clear cell, 5 papillary and 7 chromophobe. Triphasic CT (unenhanced,
corticomedullary and nephrogram phases) was done in all patients.
We compared patient age and sex, tumor size, degree and pattern
(homogeneous, heterogeneous and predominantly peripheral) of
enhancement, the presence or absence of calcification or cystic
degeneration (necrotic or hemorrhagic areas within the tumor) and tumorspreading patterns, including perinephric change, venous invasion and
lymphadenopathy in these 3 subtypes.
Results Clear cell renal cell carcinoma showed stronger enhancement
than the other two subtypes (p<0.05): 124±36 (mean ± SD) in the
corticomedullary phase. The sensitivity and specificity for differentiating
conventional renal carcinoma from the other subtypes were 75/% and
65% when 110 HU was used as the cutoff value in the corticomedullary
phase. The degree of enhancement was significantly different among
these 3 subtypes in the corticomedullary and excretory phases (p<0.05).
Clear cell(76%) and papillary(80%) renal cell carcinoma tended to present
with cystic degeneration as compared to chromophobe(28%) renal cell
carcinoma(p=0.0225). The chromophobe subtype showed homogeneous
enhancement in 42% of cases in comparison to 3% and 0% of clear
cell and papillary subtypes (p<0.05). Venous invasion was noted more
frequently in clear cell renal cell carcinoma(26%), whereas it was not
found in papillary and chromophobe renal cell carcinomas(p=0.1307).
Conclusions The most valuable parameter to differentiate the subtypes
of renal cell carcinoma is the degree of enhancement in corticomedullary
phase. The presence or absence of cystic degeneration and venous
invasion, and enhancement patterns can serve supplemental role in
differentiating renal cell carcinoma subtypes.
Keywords Kidney, CT
GU040
MR Assessment of Renal Lesions by Breath-Hold 3D-DIXON
Method
Akira Kawai, Hideharu Sugimoto, Shigeru Kobayashi
Department of Radiology, Jichi Medical University, Japan
Purpose Radiological detection of microscopic intracellular lipid and/
or macroscopic fat within renal lesions has been considered a reliable
sign for distinguishing renal cell carcinoma (RCC) of clear cell type and/
or angiomyolipoma (AML) from other entities. In this study, we performed
breath-hold 3D-DIXON imaging for renal lesions and evaluated its
diagnostic values.
Methods 40 patients who were suspected of renal lesions underwent
1.5-T MR study including 3D-DIXON imaging. The diagnoses were RCC
(n=11; 9 clear cell type, 1 papillary type, 1 cyst associated type), AML
(n=8), lipoma (n=1), renal pelvic carcinoma (n=3), polycystic kidney (n=3),
complicated cyst (n=5), simple cyst (n=2), post inflammatory process (n=1),
subcapsular hematoma (n=1), no lesions (n=4). Two radiologists who did
not know final diagnoses assessed independently all 3D-DIXON images in
a retrospective fashion whether the lesion had microscopic intracellular lipid
and/or macroscopic fat by using five-point scale including 0 of definitely
absent to 4 of definitely present. After assessment, data was converted
such as grades of 0, 1 and 2 as negative and grades of 3 and 4 as positive,
then diagnostic values for evaluating renal lesions that contained whether
microscopic intracellular lipid and/or macroscopic fat or not.
464
presentation had CTM or LTM. There was a significant difference (P=0.002)
in the rate of coexisting tumor when those with TM were compared with
those without TM (six of 74 vs three of 439).
Conclusions The prevalence of TM in Asian people may be higher than
previously reported, which may be due to the difference in methodology
and increase of awareness of the US finding. Although there was a
significant difference in the rate of coexisting tumor when those with TM
were compared with those without TM, the question remains whether TM
independently increases the risk of testicular malignancy.
Keywords Neoplasms-Primary, Epidemiology, Testes, Ultrasound
GU002
CT Angiography Pre-Operative Assessment in Renal Donor –
Double Read Experience in a Hong Kong Teaching Hospital
Ferdinand Chu
Department of Radiology, Queen Mary Hospital, Hong Kong,
China
GU037
Role of Ultrasound in Evaluation of Scrotal Pathologies
Nikhil V Joshi
Department of Ultrasound, Radiologist, India
Purpose CT angiography (CTA) is commonly used in pre-operative
investigation for potential live kidney donors. We plan to assess its
accuracy and document the frequency of anatomical anomalies.
Methods 17 live kidney donors had preoperative CTA in our centre
between 2001 and 2009. CTAs were subjected to two readings.
Correlation was made with operative findings.
Results Total of 17 kidneys that were subsequently harvested, the
incidences of double renal artery, early arterial branching, accessary vein
and double IVC were 4, 5, 1,and 1 respectively. These were all identified
by our second reading radiologist; while one accessory renal artery and
the accessory vein were missed in the first reading. In the 17 kidneys that
were not harvested, we found 2 double renal arteries, 3 early branching.
There was no discrepancy between the two readings. Our accuracy in
detecting renal artery anomaly was 93% (13/14) on the first reading and
raised to 100% (14/14) on the second reading. One accuracy in detecting
venous anomaly was 50% (1/2) on the first reading and 100% (2/2) on
the second reading. In the 3 cases where the surgeons operated on the
right side instead of the usual left; is probably because we found an early
branch and a double on the left. The reason for the third case remained
unknown. Out of the 34 kidneys imaged, the frequency of early branching,
multiple renal arteries, and multiple renal veins were 24.5%, 17.6% and
2.9% respectively.
Conclusions CTA especially with double reading, offers excellent
anatomical correlation with intra-operative findings in kidney donor. In our
small sample, the frequency of early branching is high compared to other
published figures, while that of multiple arteries and veins are comparable.
Keywords Anatomy, Normal Variants
GU031
Testicular Microlithiasis: Analysis of Prevalence and
Associated Testicular Cancer in Taiwanese Men
Jian-Ling Chen, Yi-Hong Chou, Jia-Hwia Wang, Chui-Mei Tiu,
Hong-Jen Chiou, Cheng-Ten Chang
Department of Radiology, School of Medicine Taipei Veterans
General Hospital, National Yang-Ming University, Taiwan
Purpose To determine the prevalence of testicular microlithiasis (TM) in
all 513 patients who were referred for scrotal ultrasonography in a period
of 7 months, and to evaluate the association between TM and cancer, with
modern, state-of-the-art equipment.
Methods This retrospective study included 513 male patients with
ultrasonography (US) in a period of 7 months. The US images and
charts of each patient were reviewed to determine the presence of TM
and relevant clinical information. Statistical analysis was performed to
determine the relationships of testicular cancer and microlithiasis.
Results The data for all 513 patients were analyzed. Their age was 0-91
years (mean, 54.32 years). There was testicular microlisthiasis in 74
patients. The overall prevalence of TM was 14.4%; 6.2% (32/513) had
classic testicular microlithiasis (CTM), and 8.2% had limited testicular
microlithiasis (LTM). The prevalence of testicular tumor in this patient
population was 1.75%. Six of 9 (6/9) patients who had testicular cancer at
Purpose The purpose of the above study is to assess the ultrasound
findings in common scrotal pathologies in day-to-day clinical practice.
Methods The above mentioned study was carried out on a PHILIPS IU-22
ultrasound machine using 17-5 and 8-4 MHZ linear transducers.
Results We analysed around thirty patients of different age groups in
whom there was a clinical suspicion of scrotal pathology. Out of the thirty
cases, about ten were having of inflammatory etiology (mostly orchitis
and epididymitis), ten cases had varicoceles, seven cases had a vascular
etiology (torsion). The remaning three were of neoplastic etiology.
Varicoceles are probably the commonest findings we encounter in patients
for a scrotal Doppler. They are usually contributory towards male infertility
and are easily correctable. Epididymitis and Orchitis are commonly seen
in young reproductive males with history of Urinary Tract Infection.The
acute inflammation is promptly picked up on the high resolution ultrasound
machines and is rapidly identified. Neoplasms of testes like seminomas
are easily identified and the patient is offered early detection and cure.
Salient Points: 1) Identify indications for scrotal ultrasound. 2) Recognize
the imaging characteristics of common scrotal pathologies like epididymitis
and orchitis.
Conclusions Ultrasound is an extremely powerful,sharp and accurate
modality for the diagnosis of scrotal diseases.Its advantage lies in being
non-invasive, bedside and providing extremely high resolution images.The
new generation, state-of-the –art machines offer extremely accurate and
quick diagnosis which helps in prompt management.
Keywords Scrotum
E-Poster
Results Diagnostic values showed sensitivity of 85% in reader 1 and 90%
in reader 2, specificity of 75% and 75%, and accuracy of 80% and 80%,
positive predictive value (PPV) of 77.3% and 78.3%, and negative predictive
value (NPV) of 83.3% and 88.2%, respectively. κ value showed 0.80.
Conclusions When assessing renal lesions that contained whether
microscopic intracellular lipid and/or macroscopic fat by breath-hold
3D-DIXON imaging on MRI, high diagnostic values in sensitivity, accuracy
and NPV with good correlation between readers were seen, although
specificity and PPV were relatively low.
Keywords Kidney, MR
Others (OT)
OT012
CT Evaluation of Hydatid Disease at Various Locations: An
Experience of 5 Years
Kishor B Taori, Amit Disawal, Nischal Kundargi
Departmen of Radiology, Government Medical College, India
Purpose Hydatid disease has characteristic imaging features on CT which
allow accurate preoperative diagnosis in most cases. However when it
occurs at unusual locations the diagnosis is often difficult, especially as
the imaging appearance varies at different sites.
Methods Prospective study for 5 years. Total no cases 95, Age
distribution from 9-71 years. CT scan machine: Multidetector CT somatom
Volume access, Siemens Medical system, Forchiem, Germany. Contrast:
Non ionic CT scanning protocol consists of plane and contrast (oral & IV2.5 ml/sec) scanning of abdomen in arterial, portal venous and delayed
phases. 5 mm collimation.
Results The liver acts as the first filter for the larvae while the lungs are
the second filter. Most hydatid cysts occur in liver (59-75%), followed in
frequency by lung (8.5-43%) and only 10-15% occur in other parts of the
body.
Conclusions HD can involve almost any part of the body. CT is a very
useful modality in detecting the characteristic features of this disease
even when it occurs at unusual sites. It is imperative for a radiologist to
be aware of the various facets of this condition for its early detection and
treatment.
Keywords Parasites, CT, Infection
Others
patients. CT, MRI, Angiography may be the modalities to further confirm
the diagnosis. Nuclear medicine may be the alternative choice to assess
the hepatic involvement.
Keywords Education
465
Purpose We analyzed imaging features in computed tomography (CT)
that could be used as predictive factors for the need of transarterial
embolization (TAE) in patients with blunt renal trauma.
Methods One hundred and three patients with blunt renal trauma who
were managed following algorithm for renal injury management were
studied. The extent of hematoma on CT was divided into 2 groups. Group
1 had a localized hematoma. Group 2 had hematoma extending to or
even cross the right margin of aorta (left renal injury) or left margin of
inferior vena cava (right renal injury), or extending downward into the
pelvis. The severity of renal injury was also classified using the criteria of
American Association for the Surgery of Trauma. Mann–Whitney U test
(continuous variables) and Fisher’s exact test (categorical variables) were
used to examine the multiple factors for predicting the need of TAE. The
sensitivity and specificity of these predictor factors were also evaluated.
Results Twenty patients received TAE and 66 patients didn’t. No patient
died of renal injury. There was statistical significance in the need of TAE
as correlated to contrast extravasation (p <0.001), the extent of hematoma
(p <0.001), pararenal hematoma (p <0.001), and the grade of renal
injury (p <0.001). But no correlation to other clinical factors was noted.
Overall, the sensitivity of present pararenal hematoma, contrast medium
extravasation, extent of hematoma, and combined the last 2 factors in
predict the need of TAE was all 100%; but the specificity were 41%, 77 %,
70%, 90%, respectively.
Conclusions The extent of hematoma in CT was a simple and sensitive
indicator for patients who need TAE, regardless of contrast extravasation.
Besides, marked increase of the specificity to indicate the need for
subsequent angiography and TAE was shown when these two factors
were combined.
Keywords Kidney, Angiography, CT, Embolization
ER003
Re-Evaluation of the Factors Affecting Management and
Outcome in Blunt Splenic Injury
Nan-Kai Wang, Wei-Ching Lin, Yung-Fang Chen, Yung-Jen Ho,
Hsein-Jar Chiang, Po-Pang Tsai, Chien-Heng Lin, Su-Tso Yang
Department of Radiology, China Medical University and Hospital,
Taiwan
Purpose We evaluate factors affecting the management and outcome of
patients with blunt splenic injury.
Methods During a 56 month period, 130 patients with blunt splenic
injury were managed follow the algorithm of blunt trauma in China
Medical University Hospital. Patients were divided into 2 groups
according the management: group 1: surgery and angiography followed
by transarterial embolization (TAE); group 2: conservation. The clinical
data, CT, angiography, outcome and complication were reviewed. Extent
of hematoma was defined as — 0: No hemoperitonium, 1+: perisplenic
blood or blood in Morrison’s pouch, 2+: presence of blood in one or
both pericolic gutters, 3+: blood in the pelvis. Statistically analysis was
performed with Fisher exact test for category factors and 2 sample
independent t-tests for continuous variable.
Results Overall 72 patients were categorized as group 1 (TAE: n=37,
surgery: n=35) and 58 patient were categorized as group 2. There are
significant differences in injury grades (p <0.001), extent of hematoma (
p<0.001), contrast medium extravasation on CT images ( p<0.001). No
significant differences regarding the demographic data and other clinical
factors.
Conclusions Contrast-enhanced CT is crucial in decision making of
466
ER005
Proximal Nonselective Angioembolization Is Effective and
Safe for Traumatic Lumbar Arterial Injuries
Sheng-Che Hung, Yon-Cheong Wong, Huan-Wu Chen, Li-Jen
Wang, Cheng-Hsien Wu
Department of Diagnostic Imaging and Intervention, ChangGung Memorial Hospital, Linkou, Taiwan
Purpose Endovascular management is becoming well recognized and
is increasingly used as the treatment of choice in the management
of traumatic lumbar arterial injuries (TLAIs). Selective embolization is
sometimes time-consuming and is not feasible when there are multiorgan
injuries or when the patient is hemodynamically unstable. We performed
proximal nonselective embolization in these urgent situations. We
conducted this retrospective study to review the outcome in patients with
TLAIs and to evaluate the efficacy of proximal nonselective embolization
Methods All patients with TLAIs who underwent angiography within a
44-month period were reviewed retrospectively. They were divided into
two groups according to the embolization method: proximal nonselective
and distal selective embolization groups. The medical records and
procedural reports of each group were reviewed to assess immediate
angiographic success, clinical success, and complications.
Results Seventeen patients with angiographically proven TLAI were
reviewed, and 14 had received immediate embolization (four distal
selective and 10 proximal nonselective embolizations). Immediate
angiographic success was seen in all patients. There was only one
possibly TLAI-related death in the proximal nonselective embolization
group. No major neurological deficits or soft tissue complications were
identified in either group.
Conclusions Proximal nonselective embolization is an effective and safe
method for immediate control of active hemorrhage from an injured lumbar
artery in hemodynamically unstable patients or in those with multiple
organ injuries.
Keywords Angiography, Outcomes Analysis, Retroperitoneum,
Embolization, Trauma, Interventional
In scores of 7 or higher, they were 15.2% and 98.2%, respectively. The
sensitivity and specificity of CT scans in patients with equivocal scores (4
to 6) for acute appendicitis was high at 78.8% and 79.7%, respectively.
Using the Chi-square test of independence, MASS Group and CT scan
findings are significantly associated with each other even at 1% level of
significance. Among patients with low MASS scores, most of them (87.0%)
have negative CT scan findings; while among those with MASS scores of
4 and above, positive CT scan finding was high at 68.4%.
Conclusions In patients presenting to the emergency department with
clinical suspicion of appendicitis, CT is most beneficial in MASS scores of
4 to 6.
Keywords Appendix
ER007
Efficacy of Interventional Treatment for Iatrogenic Arterial Injury
Shiro Onozawa¹, Hiroyuki Tajima1, Shih-Kung Chou2, Takahiko
Mine1, Tatsuo Ueda1, Ayako Shibukawa1, Shin-Ichiro Kumita1
1
Department of Radiology, Nippon Medical School, Japan
2
Department of Diagnostic Radiology, Shin-Kong Wu Ho-Su
Memorial Hospital, Taiwan
Purpose To assess the safety and efficacy of interventional treatment for
iatrogenic arterial bleedings.
Methods In our institute, we have treated 172 cases with emergency
interventions between July 2005 and March 2009. In 9 cases (male
4, female 5, mean age 66.7) of them, the causes of the arterial injury
were iatrogenic techniques (other interventional treatment 5 cases,
blood access catheter insertion 1, central venous catheter insertion 1,
surgical arteriovenous shunt 1, abdominal puncture 1). We performed
embolizations with n-butyl cyanoacrylate (NBCA) or gelatin sponge
particles. We assess the technical success (disappearance of
extravasation immediately after the embolization or embolization of target
artery) and re-bleeding and complications.
Results In all cases, we achieved technical success and clinical success.
No complication was observed. NBCA and microcoils were used for 7
patients with coagulation disorder. Gelatin sponge particles were used for
2 patients with no visualization of extravasation.
Conclusions Interventional treatment for iatrogenic arterial injury is safe
and effective.
Keywords Angiography, Embolization, Interventional
ER006
A Retrospective Study on the Use of the Modified Alvarado
Scoring System (MASS) as a Guideline in the Performance
of Computed Tomography for Suspected Acute Appendicitis
in the Emergency Department
Maria Teresa Garcia Reyes-Samson
Department of Radiology, The Medical City, Philippines
ER008
Correlation of Multiphasic CT of Traumatic Pelvic
Hemorrhage and Angioembolization
Yon-Cheong Wong, Li-Jen Wang, Cheng-Hsien Wu, Huan-Wu
Chen, Sheng-Che Hung, Cheng-Chi Huang
Department of Emergency and Critical Care Radiology, Dept.
Medical Imaging and Intervention, Chang Gung Memorial
Hospital, Chang Gung University, Taiwan
Purpose To utilize the use of the Modified Alvarado Scoring System in
determining what subgroup of patients with acute abdomen benefits most
from CT when appendicitis is considered.
Methods Patients’ records who presented with abdominal pain in the
emergency department (ED) of The Medical City (TMC) over a 15-month
period who were evaluated by ED physicians and underwent contrastenhanced whole abdominal CT to rule out appendicitis were reviewed.
Using the Modified Alvarado Scoring System (MASS) for appendicitis,
each chart was retrospectively scored. The Alvarado scores were
correlated with the CT findings, with the final diagnoses established
by means of surgical/histopathologic evaluation. Receiver Operating
Characteristics Curve analysis was done to determine the subgroup
of patients based on the Alvarado score that benefited the most from
abdominal CT scan. Likelihood ratio was used to express the usefulness
of diagnostic test. Chi-Square Test of independence was employed in
proving that MASS Group and CT scan findings are significantly related.
Results In the ROC analysis, the sensitivity and specificity for positive
CT at MASS Scores of 3 or lower were 90.9% and 62.7%, respectively.
Purpose To investigate traumatic pelvic hemorrhage on multiphasic CT
and correlate the hemorrhage with the need of angioembolization.
Methods We included 17 patients (14 men, 3 women) with a mean age
of 40.7 years (16-84 years) of blunt pelvic injuries whose multiphasic
CT study showed pelvic contrast material extravasation (CME). We
determined the extravasation as arterial CME or venous CME depending
on their first appearance on either the arterial phase or venous phase
images. Their charts were retrospective reviewed for the necessity of
angioembolization.
Results Among 17 patients of pelvic CME, 9 were arterial CME, 8
were venous CME. Of 9 arterial CME, 7 received angioembolization.
Of 8 venous CME, 2 received angioembolization. The correlation
of arterial CME with angioembolization was marginally significant,
p=0.057. Four patients died in angioembolization group. None died in
non-angioembolization group. Neither arterial CME (p=0.576) nor age
(p=0.103) was significantly correlated with mortality.
Conclusions Multiphasic CT of traumatic pelvic injury can differentiate
arterial CME from venous CME. There is a trend that arterial CME
requires angioembolization more than that of venous CME.
Keywords Pelvis
ER010
Occipital condyle fractures: Incidence and clinical follow-Up
at a Level 1 trauma centre
Dinesh Kumar Varma
Department of radiology, the alfred hospital, Australia
Purpose We proposed to ascertain the incidence, treatment and long
term outcomes of occipital condyle fractures at a Level 1 trauma centre.
Methods Blunt trauma patients who had sustained occipital condyle
fractures and were admitted over a 3 year period were identified
retrospectively via the institution’s trauma registry database. Prospective
clinical and functional follow-up was undertaken, including further
radiographic imaging.
Results There were 65 patients identified, representing 0.52% of the total
trauma population, 1.17% of seriously injured patients (Injury Severity
Score >8) and 2.54% of patients with head and/or cervical spine injuries.
Of these, 24 patients were available for follow-up at a mean of 27 months
post injury. Seven patients (29%) sustained unilateral Type III avulsion
fractures, according to the Anderson and Montesano classification, and 2
patients sustained stable bilateral occipital condyle fractures. Traumatic
brain injury was detected in 92% of patients and 42% had cervical spine
injury. No operative intervention was utilised. Halothoracic bracing was
required in 33% of cases, including 3 Type III fractures where instability
was suspected. Complete healing with anatomical alignment resulted
in 88% of cases (n=21). In the remaining three patients, fracture lines
remained visible but alignment and atlanto-occipital joints were normal.
Three patients (12.5%) had moderate to severe neckpain/disability at
follow-up, all of whom had sustained multiple injuries.
Conclusions Occipital condyle fractures most frequently occur in
conjunction with head and cervical spine injuries. Long term outcome
depended upon the existence of associated injuries, and subsequent
management, rather than fracture pathology.
Keywords Spine
ER013
Blunt Cardiac Injury in Trauma Patients with Thoracic Aortic
Injury
Rathachai Kaewlai1, Antonio Santos2, Laura L Avery3, Ashwin V
Asrani3, MarcA deMoya4, Robert A Novelline3
1
Department of Radiology, Massachusetts General Hospital,
Thailand
2
Departamento de Cirurgia Geral, Hospital Geral de Santo
Antonio, Portugal
3
Department of Radiology, Massachusetts General Hospital,
United States
4
Department of Surgery, Massachusetts General Hospital, United
States
Purpose To determine the frequency of blunt cardiac injury (BCI) in trauma
patients with thoracic aortic injury (TAI) and compare with those without TAI.
M e t h o d s A l l t r a u m a p a t i e n t s w i t h TA I w h o h a d a d m i s s i o n
electrocardiography (ECG) and serum Creatine Kinase-MB (CK-MB) from
January 1999 to May 2009 were included as a study group. Demographic
data, results of ECG, CK-MB and echocardiography were reviewed and
compared with those of a control population matched for abbreviated injury
scales (AIS) who did not have TAI (control group). BCI was diagnosed if
there was a positive ECG (nonspecific STT, ischemic change, heart block,
etc) along with either an elevated CK-MB or abnormal echocardiography
(valvular regurgitation, wall hypokinesia, pericardial effusion, etc).
Results There were 26 patients (19 men and 7 women, mean age 45.1
years, mean ISS 34.4) in the study group; 21 had evidence of BCI. Of
52 patients in the control group (38 men and 14 women, mean age 46.9
years, mean ISS 38.7), twenty had evidence of BCI based on similar
criteria. There was a significantly higher rate of BCI in trauma patients with
TAI versus those without TAI (81% versus 38%, p <0.001).
467
ER001
Predictive Factors in CT for the Need of TAE in Patients with
Blunt Renal Trauma
Wei-Ching Lin, Nan-Kai Wang, Yung-Fang Chen, Wai-Man
Cheang, Chien-Heng Lin, Jeon-Hor Chen, Yung-Jen Ho, PoPang Tsai
Department of Radiology, China Medical University and Hospital,
Taiwan
the management of blunt splenic injury. Patients with high grade splenic
injury, massive extent hematoma and contrast medium extravasation on
CT images are significant factors in predict the requirement of intervention
therapy such as TAE or surgery.
Keywords Angiography, CT, Embolization, Spleen, Trauma, Interventional
E-Poster
Others
2010.03.21
EX008
The Reason That Pulmonary Fissure Become MultiLine on Different Axial MIP Reconstruction of MDCT Was
Ascertained Through Observation of Experiment Model.
Yu Anle¹, Wu baozhong1, Yu Anlun2, Qin Jiangjun1
1
Department of Radiology, Affiliated Hospital of Hainan Medical
College, China
2
Department of Radiology, Hainan Province People's Hospital,
China
Purpose The reason that pulmonary fissure become multi-line on different
axial MIP reconstruction of MDCT was ascertained through observation of
experiment model.
Methods Three kind of papers, the thickness of which was 0.11 mm, 0.19
mm, and 0.42 mm apart, were selected, and had been cut out into different
sizes. Then, according to fissure's inclined track in lungs, they were flatly
placed from the top down to base of experiment boxes respectively. Three
boxes contained different kinds of paper had been made. Several sheets
of 0.11 mm papers in one box was rotated at 90º and inclined down to the
bottom. Scan parameter: Kv80, mA10, rotation speed 0.6 s/r, table moving
55 mm/r, pitch 1.375, rebuilding slice thickness 1.25 mm and of MIP 6.2
mm. Pulmonary window, width: 1000HU, level: -700HU, was applied.
Results One-thirds of lower part of 0.11 mm paper and of 0.19 mm one
showed multi-line shadow on image of axial MIP6.2, but the 0.42 mm one
could not show any line. The rotated papers of 0.11 mm couldn’t reveal
any line.
Conclusions It could be known from the result of the simple test that
interlobar fissure appeared multi-line shadow on different axial MIP image
was effectiveness of MIP reconstruction, its formation required proper
conditions, such as thin plane, its thickness being as thin as pleural or thin
paper(0.11-0.19 mm); the plane possessing proper density; and it should
form certain angle with anatomical planes as well as its figure should not
be distorted and deformed..
K e y w o r d s A n a t o m y, L u n g , C T, P l e u r a , I m a g e M a n i p u l a t i o n /
Reconstruction
EX009
A Combined Method of Using Doppler Ultrasound and
Venogram in Pre-Operative Mapping of Recurrent LowerLimb Varicose Veins: An Initial Experience
Hung Lit Chow¹, Hung Lit Chow 1, W.H. Luk 2, S.S. Lo 2, C.S.
Chan2
1
Department of Radiology, Kwong Wah Hospital, Hong Kong,
China
2
Department of Radiology, United Christian Hospital, Hong Kong,
China
Purpose Doppler ultrasound is the most frequently used modality for preoperative mapping for recurrent incompetent perforators. However, this
often poses a diagnostic challenge, mainly because of overlying chronic
venous ulcers and the distorted anatomy after previous operation. A pilot
method combining Doppler ultrasound followed by conventional venogram
was devised in attempt to improve detection accuracy. This study aims to
evaluate the diagnostic capability of this method.
Methods Patients referred for pre-operative mapping of recurrent
incompetent perforators were recruited into the study from 1 January
2008 to 31 December 2009. 5 patients (all male; age range 38-73;
mean 58) were recruited and there were 7 symptomatic legs. Doppler
ultrasound was initially performed only to delineate the anatomy of the
great and short saphenous veins, with skin markers given for subsequent
correlation. Conventional venogram was then performed using cine mode.
468
IR008
The Introduction of Our Experience and New Technique
Using the Start of Art Robotic Assisted Arm Angiography
System for Interventional Radiology
Peter Chu-Chun Yang, Soing Jiun Loke, Erik Jock-Hai Tan, Iam
S.Y. Wong
Interventioal Radiology Center/Department of Diagnostic
Radiology, Outram Road, Singapore General Hospital ,
Singapore
Purpose From Nov, 2008 to present, more then 400 variety cases
was performed by using our new robotic arm DSA system(Artis Zeego,
Siemens). To shall the experience of using Dyna CT function for the SIRSpheres Microspheres treatment and introduction of some new technique
regarding vascular or non-vascular Intervention procedure (iguide and
ipilot function).
Methods The robotic arm Angiography system easy to delivers more
positioning capability and offers unique flexibility of movement and Image
acquisition then traditional C-arm Angiography unit.
Results The robotic arm Angiography system easy to delivers more
positioning capability and offers unique flexibility of movement and Image
acquisition then traditional C-arm Angiography unit.
Conclusions The Dyna CT function not only to provide the satisfied
imaging information of the region of interest, also easy to applied to every
required cases. The others new techniques (iguiding & ipilot) are very
useful in our experience.
Keywords Technical Aspects
IR056
Developing Interventional Procedures, Experience Sharing
Mungun-Ulzii Khurelbaatar1, Lkhagvasuren Zundui2, Gerardin
Banoit3, Tsegeenjav Davaa4, Damdinsuren Tserendorj5
1
Department of Cardiovascular Disease, The Shastin Central
Hospital, Mongolia
2
Department of Angiographic Diagnosis and Treatment, the
Shastin Central Hospital, Mongolia
3
Department Cardiology Division, AVLOM Sante Cardio, France
4
Department of Cardiovascular Surgery, the Shastin Central
Hospital, Mongolia
5
Department of Angiographic Diagnosis and Treatment, the
Shastin Central Hospital, Mongolia
Purpose In Mongolia, the transition of diseases, from communicable to
non-communicable, started decades ago. Since then, in 1990s, causes
of mortality and morbidity have been continuously led by cardiovascular
diseases. The interventional cardiology was first introduced to Mongolia
in year 2000 by French NGO team, AVLOM SANTE Cardio. The poorlyequipped facilities and much-neglected situation were overcome by the
help of foreign medical groups and the commitment of local doctors.
During last 9 years, the interventional cardiology in Mongolia has made
noticeable progress on its interventional performance and also arrived at
its independence from the donor support.
Methods This article discusses the lessons learned and achievements
been made based on the historical analysis and comparison with similar
projects carried out by the French NGO in other countries and in France.
Historical summary of the coronary intervention development in the
country and comparative analysis of the two countries, Mongolia and
France, on the patient geography, affected vessels and interventional
procedure performance are also brought into focus.
Results This study analyzes the information of 1165 patients who have
received coronary interventional procedures from 2000 to 2009. Although
there are only 10 cases in interventional procedure in 2000, the number
increases continuously and reaches constantly over 280 procedures every
year with an average of over 100 patients receiving stent implantation
treatment each year. Compared with 93% in French institutions, the
success percentage of the procedure reaches as high as 91% in
Mongolia, however, with lower number in acute coronary cases.
Conclusions The poorly-equipped and much-neglected situation doesn’t
limit the successful development of interventional procedure in Mongolia as
there have been growing successful treatment outcomes. In addition, the
increase in the number of acute cases can further improve overall success.
Keywords Interventional
injury scale of the American Association for the Surgery of Trauma (1994
revision). Embolic agent was basically used gelatin sponge, and added
microcoils if extravasation was severe. TAE procedures were evaluated
by technical success, complications and embolic agents.
Results Hepatic injury scale were grade 3 in 8 patients, grade 4 in 3
patients and grade 5 in 3 patients respectively. Successful hemostasis
was achieved with TAE in all 14 cases. Twelve out of 14 patients
had no complications and discharged from the hospital. However, rebleeding occurred in 2 patients and they died because of uncontrollable
hemorrhage (small bowel bleeding and tracheal hemorrhage), which were
both in grade 5. They had severe injuries on hepatic vein and portal vein
compare to the rest case of grade 5. TAE was performed with gelatin
sponge, and also microcoils were used in 6 patients (grade 5 in 3 patients,
grade 4 in 1 patient, and grade 3 in 2 patients).
Conclusions TAE is an effective method for patients with severe blunt
liver trauma. However, it is difficult to achieve hemostasis by TAE alone
when the patients with grade 5 and have portal or venous injury.
Keywords Liver, Trauma, Interventional
IR002
Role of Superselective Embolization in the Management of
Acute Lower Gastrointestinal Haemorrhage
Ahmad Razali Md Ralib¹, Rozman Zakaria², Zahiah Mohamad²,
Ahmad Sobri Muda²
¹Department of Radiology, International Islamic University
Malaysia, Malaysia
²Department of Radiology, Universiti Kebangsaan Malaysia,
Malaysia
Purpose Hemorrhage as a complication of inflammation liver and
pancreatic diseases or invasive procedure/operation is uncommon but
carries a high mortality and mobility. Its ideal management remains
unclear.
Methods Between Jan, 2007 and Sep 2009, 19 cases received
angiograms with transartery embolization (TAE) of arterial hemorrhage
due to complications of inflammation liver/pancreatic diseases or invasive
procedure/operation. We retrospectively analyzed the angiographic
findings and the effectiveness of TAE.
Results There are 9 cases with pancreatic disease (post-op: 4,
pancreatitis: 5) and 10 cases with liver disease ( intrahepatic aneurysm:
6, procedure-related: 4). Angiography demonstrated pseudoaneurysms
(n=11) and extravasation (n =15). The bleeding points were at the
gastroduodenal artery (n =8), proper hepatic artery (n = 3), right hepatic
artery (n = 3), left hepatic artery (n=3), and common hepatic artery (n =4).
TAE was successful in 17 patients and hemostasis was achieved in 19
patients although 1 patient received twice TAE. All of them survived.
Conclusions TAE is a useful treatment for upper abdominal hemorrhage.
This paper presents our experience and discusses the role of TAE in its
management.
Keywords Acute, Angiography, Liver, Pancreas, Embolization, Hemorrhage
Purpose The objective of this case series is to describe the lower
gastrointestinal haemorrhage cases seen in our centre, its diagnosis and
role of superselective embolisation in the patient management.
Methods All patients who undergo superselective embolisation from
January 2008 until April 2009 in our centre were analysed. Data were
collected from the electronic medical records.
Results Five patients with mean age of 73 years old with four males were
analysed. Multidetector CT and digital substraction angiography were
positive in all patients. Superselective embolisation was performed in all
patients with platinum microcoils (n=4) and diluted histoacryl glue (n=1).
The underlying cause includes diverticular disease (n=4) and neoplasm
(n=1). Technical success was achieved in all patients (100%).
Conclusions Superselective embolisation in the treatment of lower
gastrointestinal haemorrhage is safe and effective with a very high
technical success rate.
Keywords Large Bowel, Angiography, Catheters, Hemorrhage,
Interventional
IR014
The Efficacy of Transcatheter Arterial Embolisation for
Patients with Severe Blunt Hepatic Injury
Taiki Fukuda, Yoshihisa Kodama, Yasuo Sakurai, Hirotaka Ikeda,
Kenji Murakami
Department of Radiology, Teine Keijinkai Hospital, Japan
Purpose To evaluate the efficacy of transcatheter arterial embolisation
(TAE) in patients with blunt hepatic injury.
Methods From July 2005 to March 2009, 14 patients with severe blunt
hepatic injury who performed TAE were enrolled this study. Hepatic injury
were classified into 5 grades according to CT scan findings on the basis of
IR051
Management of Arterial Hemorrhage Relative to Liver and
Pancreatic Disease, the Role of Interventional Radiology
Kang-Li Chen, Huan-Wu Chen, Yon-Cheong Wong, Li-Jen Wang,
Yung-Liang Wan, Sheng-Che Hung, Yi-Kang Ku, Chen-Ju Fu
Department of Medical Imaging and Intervention, Chang Gung
Memorial Hospital, Chang Gung University, Linkou, Taiwan
Incompetent perforators were identified by the reflux of flow from the
deep to superficial vein, with the guidance of the previous marked venous
anatomy. Findings of this combined method were then compared with the
operative results.
Results A total of 20 incompetent perforators were noted in the operation
record, 17 (85%) of them accurately identified using the combined
method. Only 3 incompetent perforators were missed, all of them in the
same patient and were located distal to the applied tourniquets at the
ankle level, which were easily diagnosed clinically. All patients had no
recurrence within a follow-up period of 6 to 9 months, and none required
follow-up scan.
Conclusions The combined method of using conventional venogram,
with anatomical correlation by Doppler ultrasound, is the first described
method that shows promising results in accurately identifying both the
number and site of incompetent perforators, thereby enabling subfascial
endoscopic surgery to be performed and sparing patients from an open
explorative surgery.
Keywords Localization, Conventional Radiography, Ultrasound, Varices,
Veins
IR005
Bronchial Artery Embolization, an Effective Procedure for
Treatment of Massive Hemoptysis in Pulmonary Tuberculosis
Kishor B Taori, Jawahar Rathod, Nischal Kundargi
Department of radiology, Government Medical College, India
Purpose Pulmonary tuberculosis is very common in developing countries
in Asia including great prevalence in Indian subcontinent. One of the
dreadful complications of pulmonary tuberculosis is massive hemoptysis.
This study is about treating patients of massive hemoptysis by bronchial
artery embolization.
Methods Bronchial artery embolization was done in 101 patients (85
male, 16 female) with massive hemoptysis between 14 to 73 years of
age (mean age 46 years) from novermber 2006 to April 2009 (2 years 6
months). Pre-procedure chest radiograph was done in each and every
case. Bronchial artery embolization was performed on the side with the
greater abnormality on the chest radiograph. Gel foam was used as
embolising agent. These were introduced through a 4F visceral hook
catheter. Pre and post-procedure angiographic films were obtained.
469
Others
Conclusions Trauma patients with TAI had a significantly higher rate of
concomitant blunt cardiac injury compared to those without TAI.
Keywords Aorta, Heart, Trauma
E-Poster
2010.03.21
Purpose To assess the normal and abnormal thickness of supraspinatus
tendon on high resolution ultrasound and to predict the changes of
tendinoses based on the thickness, and to compare and confirm the
changes of tendinoses on Magnetic resonance Imaging.
Methods Eighty patients underwent Magnetic Resonance Imaging
of shoulder at our center over a period of six months. High resolution
ultrasound was performed for all of them and the thickness of
supraspinatus tendon was measured. Ultrasound was also performed on
forty asymptomatic volunteers. Then a comparison was made between
the thickness of the supraspinatus tendon and changes of tendinoses on
the Magnetic resonance Images.
Results The thickness of the supraspinatus tendon in all the volunteers
and patients with no changes of tendinoses was 5 ± 0.4 mm. The
thickness of the supraspinatus tendon in patients of tendinoses was 6.4 ±
0.3 mm.
Conclusions There is a significant co-relation between the thicknesses
of supraspinatus tendon as measured on high resolution ultrasound
and changes of tendinoses. Therefore the thickness of supraspinatus
tendon as measured on high resolution ultrasound is a reliable indicator
of tendinoses even if changes of tendinoses are not demonstrable on the
ultrasound
Keywords Joints, Comparative Studies, Tendons, Ultrasound
MS021
The Role of High Resolution Ultrasound in the Calcific
Tendonitis of the Rotator Cuff in Resorptive Status
Chien-Hung Lin¹, Hong-Jen Chiou², Hailun Chao³
¹Department of Radiology, Chi-Mei Medical Center, Taiwan
²Department of Radiology, Taipei Veterans Hospital, Taiwan
³Department of Health Care Administration, Chunghwa University
of Medical Technology, Taiwan
Purpose Calcified tendonitis of the rotator cuff has been an inflammatory
process around the calcific deposits within the tendon due to unknown
etiology. It has been a major cause of the shoulder pain or limitation of the
range of motion of the shoulder joint. In this study, we wanted to compare
the difference of the morphology of non-arch-shaped calcification of the
calcific tendonitis and correlate with their symptoms after several months
or years later.
Methods From 2003 to 2009, about 160 patients were diagnosed as nonarch shaped calcified tendonitis without receiving any treatment. They
were called and ased to follow up the condition of their painful symptoms
and the morphology of the calcified plaques. The painful sensation of the
patients was graded into painless (0), mild (1-4), moderate (4-8), and
470
MS027
Femoral Retroversion Mimicking Gluteal Muscular
Contracture
Chiang Chia-Ling, Kuen-Huang Chen
Department of Radiology, Veterans General Hospital Kaohsiung,
Taiwan
Purpose Gluteal muscular contracture is well-known secondary to multiple
gluteal injections in susceptible patients. It is not uncommon in East Asia.
Diagnosis is mainly clinically based on positive physical examination
that patient can not squat with both knees close together. Since gluteal
muscular contracture is one of the criteria of exemption from military
service in Taiwan, MR studies are requested to confirm the diagnosis.
Negative MR findings can be contributed to well-trained malingerers. Our
experience, however, discloses the possibility of femoral retroversion,
which can mimic gluteal muscular contracture in clinical aspects.
Methods Over sixty cases of MRI were performed to detect gluteal
muscular fibrosis during 2003 to 2009. Femoral torsion study with CT
scan was arranged right after MRI if gluteal muscular contracture was not
demonstrated.
Results Among the cases with normal MR appearance of the gluteus
muscles, there were eight young individuals demonstrating femoral
retroversion on CT torsion studies. Repeat physical examination still
presented abnormalities mimicking gluteal muscular contracture.
Conclusions The clinical manifestations of femoral retroversion may
mimic that of gluteal muscular contracture. Additional study of femoral
torsion, either with CT or MRI, can make the appropriate diagnosis instead
of mistaking the patients for malingerers.
Keywords MR, Congenital, Hip
MS033
Avulsion Fracture of the Anterior Cruciate Ligament:
Different Frequency of Associated Injuries between Adults
and Children on MR Imaging
Seon-Kwan Juhng1, Eugene Kang1, Se-Jeong Jeon1, Sung-Hoon
Park1, Kang-Deuk Kim2, Sang-Gook Song3, Sang-Yong Lee4
1
Department of Radiology, Wonkwang University, School of
Medicine & Hospital, Korea
2
Department of Radiology, Kunsan Medial Center, Korea
3
Department of Radiology, Chunnam National University
Hospital, Korea
4
Department of Radiology, Chunbuk National University Hospital,
Korea
Purpose To compare the magnetic resonance (MR) imaging findings of
the associated injuries with ACL avulsion fracture in children patients with
immature skeletal system and adult patients with mature skeletal system.
Methods MR images obtained in 48 patients aged 5–58 years who
previously proved to have anterior tibial spine fracture on plain AP
radiographs. Two reviewers evaluated the type of fracture of anterior tibial
spine (modified Meyers and McKeeve classification) and the associated
injuries (joint effusions, medial and lateral meniscal injuries, ligamentous
injuries, fractures, bruises and other injuries) of two groups
Results There were eight and one type-I fractures, six and five type-II
fractures, twenty-one and six type-III fractures and one and no type-IV
fracture in adult and children(p=.5204). There were various associated
injuries; twenty-four and eight joint effusions of grade III (p=1.0) , nine
and one lipohemarthroses (p=.4139), nineteen and one meniscal injuries
(p=.0696), thirty-six and six ligamentous injuries (p=.3193), seventeen and
no fractures of other bones (p=.0101), ninety-four and twelve contusions
of bones (p=.0092), and seventeen and no other injuries in adults and
children.
Conclusions Among many associated injuries with the avulsion fracture
of the anterior cruciate ligamnet, the frequency of fractures, bone bruises
and meniscal injuries in adults are significantly higher than in children.
Therefore, in adults with the avulsion fracture of ACL, MR imaging of the
knee might be necessary to evaluate the associated injuries.
Key words Knee, Ligaments, MR, Tendons, Trauma
MS036
Diagnostic Accuracy of Acute versus Chronic Meniscal
Tears of the Knee with MR Imaging
Wing P Chan, Ying-Jiun Lin, Min-Szu Yao
Department of Radiology, Taipei Medical University-Wan Fang
Hospital, Taipei, Taiwan
Purpose To evaluate the performance of MR imaging in the diagnosis of
acute versus chronic tears of the menisci of the knee.
Methods MR imaging obtained from 63 patients imaged within 6 weeks
(acute) and more than 6 weeks (chronic) of injury who had underwent
arthroscopy were reviewed prospectively and retrospectively for meniscal
tears. All arthroscopy was performed by one senior orthopedic surgeon.
Prospective reading was interpreted by one experienced musculoskeletal
radiologist. The same radiologist read all images randomly in retrospect,
who knew that there was an incorrect diagnosis in prospective evaluation
but did not know the correct diagnosis.
Results For acute meniscal tears (n=31 patients), the prospective
diagnostic sensitivity, specificity, accuracy, positive predictive value and
negative predictive value were as follows: medial meniscus, 89% (lateral,
50%), 64% (84%), 71% (71%), 50% (67%), and 93% (73%); for chronic
tears (n=32) were: medial, 90% (lateral, 72%), 77% (93%), 81% (81%),
64% (93%), and 94% (72%). In retrospect, for acute tears there were:
medial, 89% (lateral, 58%), 64% (95%), 71% (81%), 50% (88%), and 93%
(78%); for chronic tears were: medial, 90% (lateral, 89%), 91% (93%),
91% (91%), 82% (94%), and 95% (87%). In acute injury of medial (lateral)
menisci, 63% (67%) false-positive tears were associated with adjacent
contusion with bone marrow edema, versus none for all false-positive
chronic tears had bone bruise. Most false negatives were peripheral tears.
Conclusions In acute injury, MR imaging has relatively low sensitivity
for detecting lateral meniscal tears due to missed peripheral tears. Most
false-positive errors occurred in prospective reading also occurred in
retrospective evaluation.
Key words Joints, Knee, MR, Trauma
MS047
The Diagnostic Effect of Axial Loading MR Imaging in
Patients with Clinical Symptoms of Spinal Stenosis
Chao-Jung Wei, Cheng-Yen Chang
Departments of Radiology, Taipei Veterans General Hospital,
Taiwan
Purpose To investigate the size of the thecal sac in either psoas musclerelaxed position or in axially loaded position and to evaluate the impact
of the MR imaging of lumbar spine on axially loading upon the clinical
treatment planning and to follow up the treatment outcome.
Methods We recruited 5 normal volunteers as a normal control group. We
also applied axial loading during MR imaging examination for 68 patients
with signs and symptoms of spinal stenosis, including low back pain and
sciatica after the informed consents for MR imaging. Routine lumbar
spine MR imaging plus axial and sagittal T1- and T2-weighted imaging
after axial loading of 50% of body weight according to manufacturer’s
instruction. Dura sac cross area at each lumbar spine disc levels were
measured before and after axial loading. Finally, the treatment outcome
was followed up on the basis of pain relief on a visual analog scale (VAS).
Results We have identified 40 patients with spinal stenosis (DCSA < 100
mm2) and 5 patients with prominent lateral herniation of nucleus pulposus.
30 subjects were identified to have positive result after axial loading on
lumbar spine. The orthopedic surgeons felt that the decision for surgical
intervention was affected by the results of lumbar axial loading studies
in 5 patients, who had demonstrated average 50% (38~68%) reduction
of DCSA. These patients underwent surgical treatment with satisfactorily
pain relief (pain VAS 8.3 to 3.0). In contrast, 12 patients with spinal
stenosis and DCSA reduction after axial loading at least one disc level but
without operation did not have much pain relief and experienced same
pain pattern on medical treatment.
Conclusions Spine MR under axial compression maneuver may be
helpful to evaluate patients presenting with discordant conventional spine
MR findings with clinical manifestations.
Keywords MR, Outcomes Analysis, Spine
MS052
Research on Dynamic MR-DWI in a Rabbit Fracture with
Denervation Model at Healing Stage and Its Correlation with
Expression of the OPG
Shinong Pan1, Jun Yang2, Ze Zhang1, Qi Li1, Qi Yong Guo1
1
Department of Radiology, the Shengjing Hospital of China
Medical University, China
2
Department of Orthopaedic Surgery, the Shengjing Hospital of
China Medical University, China
Purpose To evaluate the values of dynamic MR-DWI in a rabbit fracture
with denervation model at healing stage and its correlation with expression
of the OPG.
Methods 24 adult healthy rabbits (1500±20 g )were divided into 3
groups randomly: Group A (control group, n=8) ; Group B (Fracture
group without denervation, n=8) : right distal Femur fracture produced by
compressed machine (DLY-90) with 950±50N; Group C (Fracture group
with denervation, n=8): sciatic nerve cut in right side through surgical
operation after right distal Femur fracture with same method as Group
B. 3.0T MR-DWI (Philips Achive B=0,500 s/mm2 ) were performed on
Group A , B and C in post-operation (immediately, 7 days, 14 days, 21
days).The morphological changes were confirmed by histopathology, and
immunohistochemical method (SP) were taken for the assessment of
osteoprotegerin (OPG) with optical density (OD).
Results (1) ADC value in Group A was 1.1873±0.4053 , ADC values in
Group B repectively were 0.9494±0.2848, 1.4150±0.8813, 1.5444±0.3272,
1.6392±0.3029 in post-operation immediately, 7 days, 14 days, 21 days;
ADC values in Group C repectively were 0.6010±0.1299, 0.8439±0.2962,
1.0166±0.3057, 1.2439±0.2341 in post-operation immediately, 7 days, 14
days, 21 days. (2) OPG value in Group A was 0.1144±0.2055, OPG values
in Group B repectively were 0.1734±0.025, 0.1586±0.018, 0.1443±0.019,
0.1375±0.012 in post-operation immediately, 7 days, 14 days, 21 days;
OPG values in Group C repectively were 0.1432±0.024, 0.1285±0.017,
0.1265±0.013, 0.1294±0.012 in post-operation immediately, 7 days, 14
days, 21 days; (3) Microscopy in Group C showed larger fabric osteotylus
and little fine woven bone formation than that in Group B.
Conclusions Dynamic MR-DWI could noninvasively and effectively
reflected the delayed healing feature in rabbit fracture with denervation,
which is corresponding to expression of the OPG
Keywords MR, Experimental Investigations
MS008
Anterior Shoulder Instability: Role of Low Field Magnetic
Resonance Arthrography in Evaluation of Anteroinferior
Labroligamentous Injuries
471
MS055
Assessment of Thickness of Supraspinatus Tendon on
High Resolution Ultrasound, as a Predictor of TendinosesComparison with Magnetic Resonance Imaging
Palle Lalitha
General, Focus Diagnostics, India
severe (8-10). The morphology of the calcified tendonitis of the rotator
cuffs was also divided into arch shaped, fragmented, nodular and cystic
types We also used the color duplex to help examine the vascularity of the
calcified plaques of the rotator cuff.
Results In our study, some patients have dramatic decreased of
the calcified plaques due to the process of resorption and excellent
improvement of the clinical symptoms and signs, but some patients did
not change a lot.
Conclusions When people have acute symptoms of shoulder pain,
they usually search for a treatment to relieve their pain. There are many
therapeutic choices, including conservative medical treatment, fine needle
aspiration or lavage, extracorporeal shock wave treatment. In our study,
there is a significant relationship between the clinical improvement of the
patients and the change of the calcification morphology. By performing this
study, we hoped to development a more appropriate alternative way, rather
than the more invasive modalities of fine needle aspiration or surgery.
Keywords Shoulder, Skull
E-Poster
Results Embolization was performed in 100 of 101 patients. Bronchial
arteries (n=76); as well as nonbronchial arteries like intercostal arteries
(n=98), internal mammary (n=36); lateral thoracic (n=25); costocervical
trunk (n=3) and thyrocervical trunk (n=3) responsible for haemoptysis
were selectively embolized. The average number of arteries embolized per
patient was 2.7.Out of the 100 patients immediate control of hemoptysis
was achieved in 98 patients within a period of 24-48 hours with a
procedure success rate of 98%. 12 patients had rehaemoptysis within 30
days with re-bleed rate of 12%. Out of these 12 patients, 8 patients were
re-embolized and remaining 4 patients were managed conservatively.
Conclusions Bronchial artery embolization is an effective procedure for
treatment of massive hemoptysis in pulmonary tuberculosis.
Keywords Angiography, Cost-effectiveness, Embolization, Hemorrhage,
Infection, Interventional
Others
2010.03.21
MS012
Role of Radiographs in the Evaluation of Dwarfism Due to
the Skeletal Dysplasia
Amit Disawal, Kishor Taori, Nischal Kundargi, Virendra Patil
Department of Radiology, Government Medical College, India
Purpose Dwarfism is arbitrarily defined as adult height less than 4 feet 10
inches or in childrens height below 2 SD of mean. Skeletal dysplasias are
common and important culprits for dwarfism. To illustrate that, radiography
is a simple, most cost effective & key investigation to evaluate a patient
with dwarfism due to skeletal dysplasia.
Methods We studied a group of patient with dwarfism attending to our
hospital since last 10 years. Detailed Radiographic skeletal survey was
performed in patients suspected to have skeletal dysplasia. Along with
Radiographs appropriate biochemical & hormonal investigations are done
to rule out hormonal and other causes of dwarfism and genetic evaluation
when ever necessary to identify those with skeleton dysplasia as primary
cause of dwarfism.
Results Dwarfism due to skeletal dysplasia are classified into
proportionate and disproportionate, depending on relative differences
in stunting of body parts. Dwarfism is mutifactorial but most common
causes are constitutional delay in growth and achondroplasia world
wide. We came across achondroplasia (n=7), osteogenesis imperfecta
(n = 5), camptomelic dysplasia (n = 2), thanatophoric dysplasia (n
= 2), arthrogryposis (n = 2), ellis van creveld syndrome (n=2), short
rib polydactyly syndrome type 4 beemer langer syndrome (n=1),
achondrogenesis (n=1) and etc during the study.
Conclusions Even in this advanced era of Diagnostic imaging,
Radiography still remains the mainstay of investigation in evaluation of
dwarfism due to skeletal dysplasia.
Keywords Dysplasias
MS061
Radial Tear of Meniscus near Its Posterior Root: An
Important and Easily Overlooked Tear
Hung Lit Chow1, Bill Lo2, Kai-Hsiung Ko3
1
China
2
Department of Radiology, Princess of Margaret Hospital, Hong
Kong, China
3
Department of Radiology, Tri-Service General Hospital, Taiwan
Purpose To determine the prevalence of those diagnosed and overlooked
472
NM004
Whole-Body Integrated FDG-PET/CT vs. Standard Radiologic
Examination: Postsurgical Recurrence Assessment in NonSmall Cell Lung Cancer Patients
Yumiko Onishi, Yoshiharu Ohno, Hisanobu Koyama, Munenobu
Nogami, Daisuke Takenaka, Kazuro Sugimura, Setsu Sakamoto,
Sugimura Kazuro
Department of Radiology, Kobe University Graduate School of
Medicine, Japan
Purpose To prospectively compare the diagnostic capability of
postsurgical recurrence among qualitatively assessed FDG-PET/CT
without and with SUV assessment and standard radiologic method in nonsmall cell lung cancer (NSCLC) patients.
Methods 121consecutive postoperative NSCLC patients (80 males,
41 females; mean age, 71years) pathologically diagnosed as complete
resection were prospectively underwent PET/CT and standard radiologic
method. Final diagnosis of each patient was based on postoperative
radiologic examination and/ or pathological examinations. On comparison
of capability for qualitative assessment between two methods, the
probability of postsurgical recurrence on each method was assessed on
a per site basis by using 5-point visual scoring system. Then, diagnostic
capabilities of intra-and extra-thoracic recurrences on both methods were
compared by using ROC analyses. To improve diagnostic capability of
PET/CT by using quantitative information, SUVs of qualitatively assessed
positive lesions of intra- and extra-thoracic recurrence were assessed by
ROI measurements, and feasible threshold value of each recurrence was
determined by ROC-based positive test. Finally, sensitivity, specificity and
accuracy about each recurrence were compared among PET/CT without
and with SUV assessment and standard method by means of McNemar’s
test.
Results Although area under the curve (Az) of qualitatively assessed
PET/CT had no significant difference with that of standard method about
extra-thoracic recurrence, Az of PET/CT (Az=0.91) was significantly higher
than that of standard method (Az=0.75, p<0.05). When adapted 2.6 as
feasible threshold value of SUV and evaluated intra-thoracic recurrence,
accuracy of qualitatively assessed FDG-PET/CT with SUV assessment
was significantly higher than that of quantitatively assessed PET/CT
without SUV assessment and standard method (p<0.05).
Conclusions Qualitatively assessed PET/CT with SUV assessment is
more accurate method than qualitatively assessed PET/CT without SUV
assessment and standard radiologic method for postsurgical recurrence
assessment in NSCLC patients.
Keywords Lung, Screening, Staging, Surgery
NM010
Diagnostic Accuracy of F-18 FDG PET/CT for Detecting Early
Gastric Cancer: A Comparison with Abdominal CT
Deuk Lin Choi¹, Dong Erk Goo1, Seong Sook Hong1, Jung Hoon
Kim1, Yun Woo Chang1, Jeong Hwa Hwang1, Yong Bae Kim2
1
Department of Radiology, Soonchunhyang University Hospital,
Korea
2
Department of Preventive Medicine, Soonchunhyang University
Medical College, Korea
Purpose To compare the diagnostic accuracy of PET/CT with abdominal
CT for the preoperative detection of EGC by using histopathology as the
reference standard.
Methods Fifty-five patients (33 men and 22 women: mean age
56.4 years) proven of EGC were correlated with endoscopic and
histopathologic results. Preoperative PET/CT and abdominal CT were
reviewed retrospectively for primary tumors. Any increased F-18 FDG
uptake exceeding adjacent normal gastric wall was considered positive for
the primary tumor.
Results Among 55 patients, 35 patients (63.6%) were positive on PET/
CT, while 6 patients (10.9%) were positive on abdominal CT. PET/CT and
CT was concordant in 4 cases (7.3%). 18 patients were negative on PET/
CT and CT. The sensitivity of PET/CT was 63.6% compared to 10.9% for
CT. Values for well-differentiated and moderately differentiated versus
poorly differentiated adenocarcinoma and signet ring cell carcinoma
were 2.94±0.92 versus 2.72±0.51 (P=0.612)for the primary lesion (SUV:
2.73±0.64)
Conclusions F-18 FDG PET/CT was more sensitive than abdominal CT
for the detection of preoperative EGC.
Keywords Comparative Studies, CT, Radionuclide Studies, Stomach
NM003
Tumor-Necrosis Model for Estimating Radiation Doses
from Yttrium-90 Microspheres in Treating Liver Tumor with
Necrosis
Ching-Sheng Liu1, Ko-Han Lin2, Rheun-Chuan Lee1, Hsiou-Shan
Tseng1, Ling-Wei Wang3, Ping-I Huang3, Syh-Jen Wang2, RenShyan Liu2
1
Taiwan
2
Department of Nuclear Medicine, Taiepi Veterans General
Hospital, Taiwan
3
Department of Cancer Therapy Center, Taipei Veterans General
Hospital, Taiwan
Purpose The objectives of this work were to calculate the absorbed
fraction of emitted energy from Yttrium-90 (90Y) microspheres treatment
of liver tumor with necrosis and dose correction in clinical application.
Absorbed fraction and their variations were analyzed for the dependences
on adopted methods, mean energy or complete beta spectrum, and
necrosis-tumor geometry.
Methods The tumor-necrosis model was proposed for calculation of
absorbed fraction of emitted energy from 90Y microspheres distributed
over the spherical shell region. Two approaches, i.e. the semi-analytic
method and the stochastic method, were adopted. In the semi-analytic
method, the range-energy relation and the sampling of electron paths
were applied to calculation the energy deposition within the target region
under the straight-ahead and continuous slowing down assumption
(CSDA). In the stochastic method, the Monte Carlo Penelope code was
used to verify the results from the semi-analytic method.
Results The absorbed fraction of one cm thickness of shell tumor from
90Y microspheres distribution by CSDA with complete beta spectrum
were 0.832 ± 0.001, 0.833 ± 0.001 for smaller (RT = 5 cm) and larger (RT
= 10 cm) tumor, irrespectively. It was shown that the absorbed fraction
was mainly dependent on the thickness of tumor-necrosis configuration,
rather than tumor-necrosis sizes. The thinner the tumor shell is, the
less absorbed fraction is because the energetic beta particles are more
probably escape from the target region for the thinner tumor regions.
As to the comparison between both approaches, the differences will be
diminished to be insignificant (<1%) while the thickness of the tumor shell
becomes thicker (>2 cm).
Conclusions The tumor-necrosis model was developed for dosimetry
calculation of 90Y microspheres treatment of hepatic tumor with central
necrosis. With this model, it provides important information of absorbed
fraction applicable on clinical 90Y microspheres treatment.
Keywords Liver, Dosimetry, Radiation Therapy/Oncology, Radionuclide
Therapy, Embolization, Interventional
NM005
Evaluating Yttrium-90 Microsphere Treatment Response of
Liver Metastases: PERCIST versus RECIST
Ko-Han Lin¹, Ren-Shyen Liu1, Shyh-Jen Wang1, Rheun-Chuan
Lee2, Yum-Kung Chu1
1
Department of Nuclear Medicine, Taipei Veteran General
Hospital, Taiwan
2
Department of Radiology, Taipei Veteran General Hospital,
Taiwan
Purpose The PERCIST (PET evaluation response in solid tumors) is a
newly-proposed method to evaluate the metabolic response of tumors to
anti-cancer therapy. The purpose of this study was to evaluate response
of liver metastases to Yttrium-90 microsphere treatment and compare
between RECIST measured by CT and PERCIST by FDG-PET.
Methods 21 patients with unresectable liver metastases underwent lobar,
sequential, or whole liver treatment with Y-90 SIRT. Baseline CT and
FDG-PET/CT were performed within 1 week before SIRT. The followup imaging was performed between 6-8 weeks after SIRT. Response
evaluation was determined using RECIST for CT and PERCIST for FDGPET. For PERCIST criteria, the standard uptake value was corrected with
lean body mass (SUL). Target tumor size should be greater than 2 cm for
accurate measurement, unless smaller lesions of significant uptake for
assessment. Each baseline tumor SUL peak must greater than 2X bloodpool activity ± 2 SDs in the mediastinum.
Results Treatment response was classified as complete response (CR),
partial response (PR), and stable disease (SD). Response determined by
RECIST: 5 PR and 16 SD; by PERCIST: 2 CR, 9 PR, and 10 SD. Among
5 PR in RECIST, 2 were re-classified as CR in PERCIST. And 16 SD in
RECIST, 6 were determined as PR in PERCIST.
Conclusions The PERCIST, which represents reduction of tumor
metabolic activity, could assess the treatment response to Y-90 SIRT
earlier than the RECIST.
Keywords Liver, Metastases, Radiation Therapy/Oncology, Treatment
Effects
NM013
Diagnostic Value of SPECT vs SPECT/CT in Femoral
Avascular Necrosis
Andrea Wai San Au-Yeung, Wing Hang Luk, Michael
Kwok WaiYang, James Chi Sang Chan
Department of Radiology, United Christian Hospital, Hong Kong,
China
Purpose Accurate diagnosis of femoral AVN relies on a combination of
clinical evaluation, radiological and scintigraphical assessment. Magnetic
resonance imaging (MRI) remains the most sensitive imaging tool but in
cases where it is contraindicated, radionuclide bone scan with SPECT
and/or CT are valid alternatives. In this study, we evaluated whether
SPECT/CT is superior to SPECT alone in the diagnosis of femoral AVN.
473
Purpose To evaluate accuracy of low field magnetic resonance
arthrography (MRA) in diagnosis and classification of anteroinferior
labroligamentous injuries in anterior shoulder instability.
Methods A prospective comparative study was conducted at a tertiary
care centre. Sixteen patients with history of anterior shoulder dislocation
underwent MR arthrography on a low field MRI (0.35 T). MR arthrograms
were analyzed for presence and type (Bankart, anterior labral periosteal
sleeve avulsion [ALPSA], Perthes and glenolabral articular disruption
[GLAD]) of labroligamentous injury. Results were compared with
arthroscopic and surgical findings.
Results On arthroscopy, 15 patients had anteroinferior labroligamentous
injuries (12 Bankart, 1 ALPSA, 1 Perthes, 1 GLAD) and 1 patient was
normal. On MRA, 14 patients had anteroinferior labroligamentous lesions
(12 Bankart, 1 ALPSA and 1 GLAD) and 1 patient was normal. When
compared with arthroscopy, MRA had 1 false negative result (93 %
sensitivity) and one true negative result (100% specificity). One Perthes
lesion was falsely labeled as Bankart lesion on MRA.
Conclusions Low field MRA is sensitive and specific for evaluation of
anteroinferior labroligamentous injuries in anterior shoulder instability.
Keywords Arthrography, MR, Shoulder
radial tear near the posterior root of both medial and lateral meniscus as
depicted on MR images, and to further investigate the associated findings.
Methods MR images of the knee of 190 patients from 1 January 2008
through 31 June 2009 were retrospectively reviewed for the presence of
radial tear of the meniscus near its posterior root. The demographic data,
location, type of tear, and other secondary findings were recorded.
Results A total of 160 MR knee studies were reviewed and 14 radial
tears (8.8%) close to the posterior roots were identified, accounting for
24% of total tears (14/58). Among these, more than half of the cases
(57%) were overlooked. In all 14 cases, the ipsilateral posterior roots were
clearly visualized while 5 (36%) of them was either partially or fully torn.
All tears also demonstrated abnormalities in the ipsilateral posterior horn,
either abnormal signal or morphological changes. Associated meniscal
extrusion was present in 6 cases (43%) and 5 patients (36%) had another
synchronous meniscal tear. There were 6 patients (43%) with associated
bony abnormality and 4 of them located at the root ligament arising point.
Associated ligamentous injury was seen in 5 studies (36%) and all of them
had torn anterior cruciate ligament.
Conclusions Radial tear of meniscus near the posterior root is an
important tear which can be easily overlooked. Because the condition is
amenable to repair that can prevent further mechanical damage to the
joint, thorough examination of the region should be ensured in every
MR studies. Useful secondary findings to alert reading radiologist for the
condition include abnormal signal or morphology of the ipsilateral posterior
horn, meniscal extrusion and bony abnormality at the anchor site of the
root ligament.
Keywords Knee, Anatomy, MR
E-Poster
Dr. Abhijit D Pawar, Hariqbal Singh
Department of Radiology, Sknmedical College, Pune, India
Others
2010.03.21
Purpose To review benign hypervascular hepatic nodules (BHHN)
encountered in the childhood cancer survivors with an emphasis on its
natural course
Methods 11 patients (F: 8, M: 3, mean age 9 years) who have BHHN
detected on surveillance CT after treatment of malignant solid tumor are
enrolled for this study. We designated a hepatic nodule which met the
following criteria as BHHN:1) homogenously enhancing nodular lesion
on postcontrast CT without evidence of tumor recurrence or secondary
malignancy during at least one year follow-up period, or 2) any hepatic
nodule showing a typical imaging finding of focal nodular hyperplasia.
Lesion number, size, CT appearance and US echo-pattern were
evaluated. The changes during follow-up were also assessed. Clinical risk
factors were also investigated.
Results Time interval between initial diagnosis of the malignancy and
occurrence of BHHN was 3 to 8 years with a median delay of 5.3 years.
Total 16 lesions were detected and have been followed-up over a median
period of 2.5 years (range 1 - 4.5 years). Number of lesions was five
(n=1), two (n=1) and one (n= 9). The size of the lesion was 0.6 -3.3 cm
(median 1.4 cm ). All lesions showed high attenuation on postcontrast
CT with some demonstrating the change of the degree of enhancement
at sequential CT. At US, most lesions were hypervascular isoechoic
nodules. During follow-up, change in number of the lesions was present in
4 patients; increase in 3, decrease in 1. Change in size of the lesion was
noted in 9 nodules;increase in 5, decrease in 4. Risk factors were noted
as follows; high dose of alkylating agents (all),venoocclusive disease (n=6),
liver radiotherapy (n=8).
Conclusions BHHNs of the childhood cancer survivors shows a variable
natural course. Although it is unclear what they are, they are likely to be a
kind of late complication of chemotherapy and/or radiotherapy.
Keywords Liver, CT, Ultrasound
PE013
Acute Respiratory Distress Syndrome in Children: The Early
474
Purpose To The acute respiratory distress syndrome (ARDS)is a lifethreatening complication of various types of lung injury. In Childhood, the
entity is a major cause of morbidity, death, and cost in intensive care unit
(ICU). Therefore, finding the presentations of chest film in children with
ARDS earlier would be helpful in treatment in time so as to reduce the
mortality in ICU. This study was done to evaluate the early findings of
chest radiography of ARDS in children.
Methods 100 cases who met the clinical diagnostic criteria established
by AECC in 1994 were included in the study. Among them, there were 60
boys and 40 girls, aged from 29days to 14 years (mean aged 4.58 years
). The causes of ARDS in the group were pneumonia (58 cases), sepsis
(13 cases), toxin (6 cases), trauma (5 cases), inspiration of foreign body
(2 cases) and unknown entities (16 cases). Retrospectively, the earliest
chest film of each patients was reviewed by two experienced pediatric
radiologists independently. Furthermore, the patients were divided into
two groups, pulmonary ARDS (ARDSp) and extrapulmonary ARDS
(ARDSex), according to the causes of the disease. The findings of chest
radiographies in each group were compared by Chi-square (SPSS13.0).
Results The most common early finding of chest x-ray film in our study
was infiltration (85%). The other findings included ground glass sign
(58%), emphysema (40%), reticular-nodular sign (39%), pulmonary
edema (30%), plural effusion (27%) and lobular septum thicken (16%) in
turn. Additionally, as result of statistical analysis, there were significant
differences between ARDSp and ARDSex in pulmonary edema, reticularnodular sign, ground glass sign and plural effusion, p value was 0.026,
0.037, 0.04, and 0.013 respectively.
Conclusions The common early appearances of chest radiography
of children with ARDS were infiltration, ground glass sign. Different
causations would result in different findings on chest films.
Keywords Lung
PE019
An Overview of the Radiological Features of Metatropic
Dysplasia and Spondylometaphyseal Dysplasia, Kozlowski
Type: Presentation of a Series of 28 Patients
Ok-Hwa Kim 1, Gen Nishimura 2, Tae-Joon Cho 3, In-Ho Choi 3,
Hae-Ryong Song4, Hirofumi Ohashi5, Jin Dai6, Shiro Ikegawa7,
Andrea Superti-Furga8
1
Department of Radiology, Ajou University Hospital, Korea
2
Department of Radiology, Tokyo metropolitan Kiyose Children's
hospital, Japan
3
Department of Orthopedic Surgery, Seoul National University
Children's Hospital, Korea
4
Department of Orthopedic Surgery, Korea University Guro
hospital, Korea
5
Division of Medical Genetics, Saitama Children's Medical
Center, Japan
6
Center for Diagnosis and Treatment for Joint Disease, Nanjing
University Drum Tower 5Hospital, Japan
7
Laboratory for Bone and Joint Diseases, Center for Genomic
Medicine, RIKEN, Japan
8
Center for Pediatrics and Adolescent Medicine, University of
Freiburg, Germany
Purpose Recently, mutations in TRPV4, which encodes a calcium
permeable ion channel, have been shown to cause a spectrum of
skeletal dysplasias including brachyolmia, metatropic dysplasia (MD),
and spondylometaphyseal dysplasia, Kozlowski type (SMDK). Of these,
MD and SMDK share the similar radiographic alterations of the spine,
pelvis and long bones. This presentation is provided to further define the
radiological spectrum of manifestations of these dysplasias.
Methods A multi-institutional cases review was performed on 26 patients,
ranging in age from newborn to 18 years and 2 adults, the mothers of
affected children. We reviewed the clinical data and skeletal survey
focused on radiographs of the spine, pelvis, long bones, and hands/feet.
Results Of 28 patients, 15 diagnosed with MD, 8 were SMDK and
5 were intermediate type. The main radiological features for MD
included wafer-thin or diamond-shaped platyspondyly in newborn and
childhood. The pelvis showed flared iliac wings, flat acetabula and
supraacetabular notches in combination. The femur showed dumbbellshaped metaphyseal widening. Other manifestations included dysplastic
epiphyses, metaphyseal irregularities, and brachydactyly with delayed
carpal ossifications. The radiological hallmarks of SMDK included a
variable degree of platyspondyly with elongated width of the vertebral
bodies that appeared as overfaced pedicles. The metaphyses of the long
bones were wide but not the shape of dumbbell seen in MD. Metaphyseal
irregularities were prominent at the proximal and distal femora; however,
the epiphyses of the long bone were almost normal. Delayed carpal ages
without brachydactyly were noted. Mutations for TRPV4 were detected in
all patients.
Conclusions Although there were some crossover of the radiological
features between MD and SMDK, the characteristic pelvis, dumbbellshaped femora, epiphyseal dysplasia and brachydactyly were important
features, differentiating MD from SMDK.
Keywords Congenital, Dysplasias, Genetic Defects
established.
Methods A total of 534 normal children with left hand roentgenograms
which include 270 training data sets and 264 testing data sets were
utilized and were diagnosed by a senior pediatrician. An algorithm was
developed to decrease the complexity of TW3 method denominated
Grouped-TW algorithm (GTA) which analyzes the growth curve of radius,
ulna and short bones (RUS). If the growth curve of a bone in RUS is
a linear development, the bone was a good candidate for estimation
the bone age. Next, according to the characteristic of RUS growth
curve in each age bracket, those bones with good linear development
can be classified into three groups. The new score of each group was
calculated by linear regression and fuzzy logic as TW3-like score table.
Finally, the assessment accuracy between the result of the study and the
pediatrician’s assessment were calculated by correlation coefficient.
Results The correlation coefficients between the result of the
pediatrician’s assessment and GTA have reached at about 97% accuracy
rate. GTA efficiently curtail the complexity of TW method; besides, the
accuracy of GTA for assessment of skeletal maturation is nearly the same
as the result of the pediatrician and TW determination.
Conclusions GTA algorithm was developed to reduce the complexity of
the TW3 method which utilize the data-mining technique combined with
linear regression and fuzzy and help pediatricians to assess the bone age.
Keywords Computer Applications, Digital Radiography
PE025
Neonatal Cranial Ultrasound Images through Posterior
Fontanelle ; Objective Analysis of the Oblique Sonographic
Scans Using MRI and Reconstruction Program
Sang Young Ho, Young Seok Lee, Dong Soo Yoo
Department of Diagnostic Radiology, Dankook Univ. Hospital,
Korea
Purpose To evaluate the anatomy of neonatal brain ultrasound images
objectively through posterior fontanelle, authors reconstructed several
oblique magnetic resonance images corresponding with the oblique
ultrasound images using MRI and multiplanar reconstruction programs.
E-Poster
PE005
Benign Hypervacular Hepatic Nodules in the Childhood
Cancer Survivors: A Retrospective Study in 11 Children with
an Emphasis on Its Natural Course
Soyong Yoo, Ji Hye Kim, Mi Hee Lee
Department of Radiology, Samsung Medical Center, Korea
Findings of Chest Radiography
Xinyu Yuan, Yang Yang
Department of Radiology, Capital Institute of Pediatrics, China
Methods MRI 3D-SPGR axial scans of the brain were performed for
one neonate and then we obtained reconstructed MR images on parallel
with the direction of sonographic oblique scanning plane. We made the
anatomic models of neonatal cranial ultrasound images using axial MRI
as the standard reference on same screen.
Results We created an anatomic atlas, with the representative seven
oblique coronal and four oblique sagittal scans & plates that corresponded
to the neonatal brain ultrasound images through posterior fontanelle.
Conclusions This objective manner of anatomic research using MRI and
multiplanar reconstruction program for creating the ultrasound oblique
brain images of neonate through posterior fontanelle, will be very helpful
for evaluating the sonographic anatomy and detecting abnormalities of the
basal ganglia, thalamus and posterior part of the brain.
Keywords Anatomy, Brain/Brain Stem, Ultrasound
PE026
A Revised-TW Method for Diminution the TW3 Procedure
Based on Data Mining and Fuzzy Logic
Chi-Wen Hsieh1, Tzu-Chiang Liu2, Tai-Lang Jong2, Chui-Mei Tiu3
1
Department of Radiology, National Chiayi University, Taiwan
2
Department of Electric Engineering, National Tsing-Hwa
University, Taiwan
3
Taiwan
Others
Methods This retrospective study evaluated all patients who underwent
SPECT/CT during the period 1-11-08 to 31-07-09 for possible femoral
AVN for which MRI was contraindicated. The SPECT and SPECT/CT
images were reviewed separately by two radiologists of different level of
experience (trainee – 3 years, specialist – 10 years) in a double-blinded
manner. The likelihood of AVN for each symptomatic hip was graded
according to level of confidence: highly unlikely, probably negative,
equivocal, probably positive and highly likely. Clinical outcome was
considered as the gold standard. The sensitivity (SN), specificity (SP),
positive predictive value (PPV), negative predictive value (NPV) and
accuracy for SPECT and SPECT/CT by each radiologist was obtained
and compared against the gold standard. The corresponding receiveroperating-characteristic (ROC) and area under the curve (AUC) were
used to evaluate the diagnostic power of SPECT vs SPECT/CT.
Results Total of 22 patients and 24 symptomatic hips were analyzed.
Seven hips (29%) were confirmed to have AVN. The AUCs obtained from
ROC for trainee radiologist for SPECT vs SPECT/CT were 0.828 and
0.916 respectively. Although there was marginal improvement, the results
were not statistical significance (p >0.05). Similarly, the AUC for specialist
radiologist increased from 0.916 to 0.941 with CT correlation but results
were also not statistically significant (p >0.05).
Conclusions We therefore conclude that SPECT/CT conferred no
statistically significant improvement on the diagnostic accuracy of AVN as
compared to SPECT alone.
Keywords Ischemia/Infarction, Long Bones, Radionuclide Studies
2010.03.21
Purpose Bone age assessment (BAA) is extensively used to examine
children's growth by pediatricians. One of most famous ways to evaluate
BA is Tanner-Whitehouse (TW) method. Unfortunately, the method is
time-consuming to determine the skeletal maturity in clinical. Therefore,
to improve the efficiency and complexity of TW3 method, a new method
which simplifies the procedure and reduces the complexity of TW3 was
475
Purpose To analyze frequency and degree of intrahepatic periportal
enhancement on hepatobiliary phase images of Gd-EOB-DTPA (EOB)
enhanced MR images in patients with various hepatobiliary diseases.
Methods Successive 991 patients who performed EOB enhanced
MRI were subjected to this study. Periportal enhancement was defined
as enhancement which took the form of a periportal ring or tram-line,
surrounding the intrahepatic portal veins, on hepatobiliary phase images
of EOB enhanced MRI. Periportal enhancement was categorized into four
grades; severe, moderate, mild, and negative. The frequency and degree
of periportal enhancement were evaluated among the groups of patients
with various hepatobiliary diseases.
Results Periportal enhancement was observed in 23 of 768 hepatobiliary
disease cases (3.0%). No periportal enhancement was observed in 223
normal livers. The incidence and grades of periportal enhancement among
various hepatobiliary diseases are as follows; liver cirrhosis 18/506 (3.6%;
severe 1, moderate 5, mild 12), chronic hepatitis 2/187 (1.1%; severe
0, moderate 0, mild 2), primary biliary cirrhosis 2/15 (13.3%; severe 1,
moderate 1, mild 0), idiopathic portal hypertension 1/3 (33.3%; severe
0, moderate 1, mild 0). The incidence of periportal enhancement was
significantly higher in cirrhosis and PBC compared to chronic hepatitis and
normal liver (p<0.05). 15/23 of the cases had liver biopsy, however, region
to region correlation was not possible because of small specimens.
Keywords Liver, MR
AB083
Detection of Hepatic Lesions on 1.5-T MR system:
Comparison of Combined T2 Weighted Imaging and
Respiratory-Triggered Diffusion Weighted Imaging
Nyoung-Keun Lee¹, Hyeon Je Cho¹, Myeong-Jin Kim², Eun-Mi
Kim¹, Hae Yung Park¹, Byung Hoon Lee¹, Yong-Hoon Kim¹
¹Department of Radiology, Ilsan Paik Hospital, Inje University
School of Medicine, 2240, Daehwa-dong, Ilsanseo-gu, Goyangsi, Korea
²Department of Radiology, Yonsei University Health System 250
Seongsanno (134 Sinchon-dong), Seodaemun-gu, Korea
Purpose To compare combined moderately and heavily T2-weighted
imaging and respiratory-triggered diffusion weighted imaging in the
detection of hepatic lesions
Methods 74 patients (mean 58.8year, M:F = 43:31) with 101 lesions (48
cysts, 0.2-5.6 cm: 53 non-cystic lesions, 0.3-8.2 cm) underwent liver MR
imaging using moderately T2-weighted imaging, heavily T2-weighted
imaging and respiratory-triggered diffusion weighted imaging at a single
examination. Two radiologists retrospectively reviewed two image sets
in random order with a time interval of 2 weeks: T2 set (moderately and
heavily T2-weighted imaging) and diffusion set (B50, B400, B800 diffusion
weighted images and ADC map). Sensitivity and positive predictable value
were calculated for each cystic and non-cystic lesions and diagnostic
accuracy was measured by area under curve (Az) obtained from receiver
476
AB086
Comparison of Free-Breathing and Respiratory-Triggered
Diffusion-Weighted MR Imaging for the Detection of Focal
Hepatic Lesions on 1.5-T MR system
Hyeon Je Cho1, Hea-Young Park2, Nyoung-Keun Lee1, Yong
Hoon Kim1
1
Department of Radiology, Inje University Ilsan-Paik Hospital,
Korea
2
Department of 2240 Daehwa-Dong, Ilsan-Gu, Goyang,
Gyeonggi, Inje University Ilsan-Paik Hospital, Korea
Purpose To compare free-breathing and respiratory-triggered diffusionweighted MR imaging on 1.5-T MR system for the detection of focal
hepatic lesions.
Methods 47 patients (mean 57.9 year; male/female ratio 0.88) underwent
hepatic MR imaging on 1.5-T MR system using both free-breathing
and respiratory-triggered diffusion-weighted MR imaging at a single
examination. Two radiologists retrospectively reviewed respiratorytriggered and free-breathing sets (B50, B400, B800 diffusion images and
ADC map) in random order with a time interval of 2 weeks. Liver SNR and
lesion-to-liver CNR of ADC map were calculated measuring ROI.
Results The lesion sensitivities were increased in respiratorytriggered diffusion-weighted MR imaging [reviewer1:reviewer2, 47/62
(75.81%):45/62 (72.58%)] than free-breathing diffusion-weighted MR
imaging [44/62 (70.97%):41/62 (66.13%)], especially for smaller than 1
cm hepatic lesions: [24/30 (80%):21/30 (70%)] for respiratory-triggered
images and [17/30 (56.7%):15/30 (50%)] for free-breathing images.
Liver SNR of respiratory-triggered ADC map (87.6±41.4) was statistically
different from free-breathing ADC map (38.8±13.6) (p value <0.01).
Lesion-to-liver CNR of respiratory-triggered ADC map (41.2±62.5) was
higher than free-breathing ADC map (24.8±36.8) (p value <0.01).
Conclusions Respiratory-triggered diffusion-weighted MR imaging was
better than free-breathing diffusion-weighted MR imaging on 1.5-T MR
system.
Keywords Liver, MR
AB094
Dynamic Contrast-Enhanced Magnetic Resonance Imaging
with Hepatocyte-Specific Contrast Agent in the Evaluation
of Liver Fibrosis in Patients with Chronic Hepatitis
Bang-Bin Chen¹, Tiffany Ting-Fang Shih², Chao-Yu Hsu², ChihWei Yu², Shwu-Yuan Wei²
¹Department of Medical Imaging and Radiology, National Taiwan
University Hospital, Yunlin Branch, Taiwan
²Department of Medical Imaging and Radiology, National Taiwan
University, Medical College and Hospital, Taiwan
Purpose To develop a non-invasive method for evaluation of liver fibrosis
by using comprehensive dynamic contrast-enhanced MR imaging (DCEMRI) using Gd-EOB-DTPA, with histologic analysis as reference standard.
Methods DCE-MRI with Gd-EOB-DTPA was performed in 79 subjects
(healthy group, 21 subjects, 14 male, 7 female, mean age, 39.1 years;
hepatitis group, 41male, 17 female, mean age, 42.4 years). These 79
subjects were assigned into three different fibrotic stages according to
Metavir score: stage 0 (F0, n=30), stage 1(F1 and F2, n=34), stage 2(F3
and F4, n=16).The following perfusion parameters were measured with a
dual-input single-compartment (Van Beers) model: absolute arterial blood
flow (Fa), absolute portal venous blood flow (Fp), absolute total liver blood
flow (Ft) (Ft = Fa + Fp), arterial fraction (ART), distribution volume (DV),
and mean transit time (MTT) of Gd-EOB-DTPA. Another curve analysis
model was used to obtain curve parameters: Peak, Slope, AUC (area
under curve), FWHM (full width at half maximum) and MT (mean time).
Student t test was first used to compare perfusion parameters between
healthy and hepatitis groups. The AVONA and the nonparametric KruskalWallis test were used to compare perfusion parameters between three
fibrotic groups.
Results There was an increase in Fa and ART at both 60 seconds and
100 seconds, and a decrease in DV, AUC, FWHM and MT at 100 seconds
in hepatitis group compared with healthy group. When these parameters
of two models were compared between three fibrotic groups, there was a
significant decrease in slope and AUC in stage 2 compared with stage 0.
The ROC area in differentiating mild and severe fibrosis is 0.68 for slope
and 0.66 for AUC respectively.
Conclusions Gd-EOB-DTPA is a feasible and noninvasive imaging
modality in which multiple perfusion parameters can be measured and
potentially used as biomarkers of liver fibrosis.
Keywords Liver, MR, Cirrhosis, Contrast Agents
AB041
Comparison of MR Elastography and Diffusion Weighted MR
Imaging for Non-Invasive Detection of Liver Fibrosis
Sudhakar Kundapur Venkatesh¹, Lynette Li San Teo¹, Bertrand
Wei Leng Ang¹, Richard L Ehman², Hind S Alsaif¹
¹Department of Diagnostic Radiology, National University Health
System, Singapore
²Department of Diagnostic Radiology, Mayo Clinic, United States
Purpose Comparative evaluation of MR Elastography (MRE) and
Diffusion Weighted Imaging (DWI) for the detection of liver fibrosis.
Methods MRE and DWI were performed in 12 normal healthy volunteers
and in 25 patients (chronic liver disease-19 and liver tumour-5). DWI
was performed before the gadolinium enhanced sequences and MRE
was performed at the end of the routine liver MRI study protocol. DWI
was performed with a free breathing technique (TR/TE 5000-6000/91
ms, matrix 160 x 160, 5 mm thickness, b=0,500). The apparent diffusion
coefficient (ADC) maps were generated on workstation. MRE was
performed with modified phase-contrast gradient-echo sequences with
TR/TE=100/27 ms, matrix 96 x 256, 4 x 10 mm slices, interslice gap 5
mm. The software automatically generated stiffness maps or elastograms
for each slice of MRE. Regions of interest (ROI) were drawn on the
elastograms and ADC maps excluding large vessels, liver edges, and
artifacts and every attempt was made to match the ROIs on ADC maps
and elastograms wherever possible. Mean stiffness values in kilopascals
(kPa) and mean ADC values (10-3 mm2/s) were derived for each subject.
Receiver Operating Curve (ROC) analysis was performed to determine
the area under curve (AUC) for accuracies of both MRE and ADC for
detection of liver fibrosis.
Results ROC analysis showed that AUC/sensitivity/specificity for
MRE (cut off, >2.48 kPa) and DWI (cut off, <121.63 x 10-3 mm2/s) were
0.99/95.6%/93.3% and 0.84/78.3%/86.7% respectively for the detection
of liver fibrosis. The accuracy of MRE was significantly better than DWI
(p=0.035). MRE also performed significantly better than DWI for detection
of clinically significant fibrosis (METAVIR >F2) also (AUC, 0.97 (95% CI,
0.88, 100) vs. 0.79 (95% CI, 0.63, 0.90), P=0.005).
Conclusions MRE is more accurate than DWI for detection of liver fibrosis.
Keywords Liver, MR, Cirrhosis
AB104
Clinical Utility of MR Elastography for Evaluation of Liver
Fibrosis in Patients Who Refuse or Have Contraindications
to Liver Biopsy- Initial Experience
Sudhakar Kundapur Venkatesh¹, Hind S Alsaif¹, Seng Gee Lim²,
Vincent Wai Kuan Lai²
¹Department of Diagnostic Imaging, National University Health
System, Singapore
²Department of Gastroenterology and Hepatology, National
University Health System, Singapore
Purpose To describe initial experience of use of MR Elastography (MRE)
for evaluation of liver fibrosis in patients who refuse or have contraindications for liver biopsy.
Methods Twenty-two patients underwent MRE of liver for suspected
liver fibrosis (n=16, Group A) or for confirmation of liver fibrosis/cirrhosis
in patients who were already on treatment (n=6, Group B). Liver biopsy
was not performed in these patients as 20 patients refused biopsy,
one patient had bleeding diathesis and one patient had allergy to local
anesthesia. The risk factor for chronic liver disease was hepatitis B (n=21)
and non-alcoholic fatty liver disease (n=1). MRE was performed on a
1.5T MR scanner using a special Liver MRE sequence with four axial
sections of 10mm thickness through the largest cross-section of the liver.
Mean stiffness value was calculated by placing regions of interest on
automatically generated stiffness maps excluding liver edges and major
vessels. Stiffness values more than 2.93kPa was reported as abnormal.
Clinical follow up of patients was done to see if MRE was useful for further
management of these patients.
Results In Group A, eight patients with normal liver stiffness and three
patients with mildly elevated stiffness (<3.5kPa) but low serum viral DNA
levels did not receive any treatment whereas five patients with elevated
liver stiffness and high viral DNA levels received anti-viral treatment. In
Group B, MRE confirmed fibrosis in four patients and antiviral treatment
was continued. Liver stiffness was normal in two patients. Antiviral therapy
was stopped in one patient who had no detectable serum viral DNA levels
whereas in another patient treatment was continued as there was high
serum viral DNA levels.
Conclusions MRE is a useful non-invasive alternative to percutaneous
liver biopsy for detection of liver fibrosis or confirmation of cirrhosis and
provides clinicians useful information for management of patients with
chronic liver diseases.
Keywords Liver, MR, Cirrhosis
AB044
MR Elastography and Fibro-C Index for Quantification of
Liver Fibrosis: Comparison with METAVIR Score-Preliminary
Results
Sudhakar Kundapur Venkatesh1, Shuoyu Xu2, Dean Tai3, Aileen
Wee4
1
Department of Diagnostic Radiology, National University Health
System, Singapore
2
Department of Institute of Bioengineering and Nanotechnology,
Nanyang Technological University, Singapore
3
Department of Institute of Bioengineering and Nanotechnology,
SBIC A-STAR, Singapore
4
Department of Pathology, National University Health System,
Singapore
Purpose To present preliminary findings of comparison of MR
Elastography (MRE) and Fibro-C, index for quantification of liver fibrosis.
Methods Five patients who underwent MRE of the liver and liver biopsy
for suspected liver fibrosis were studied. The time interval between MRE
of liver and liver biopsy was less than 4 weeks. MRE was performed
with four 10mm axial slices through liver with a modified phase contrast
gradient echo sequence. The software automatically generated the
elastograms (stiffness maps). An experienced reader placed regions of
interest on the stiffness maps for all four slices and a mean liver stiffness
value in kilopascals (kPa) obtained. The liver biopsy samples were
processed for histology using standard technique and an experienced liver
pathologist performed METAVIR score for fibrosis. On the same biopsy
477
AB040
Intrahepatic Periportal Enhancement on Hepatobiliary Phase
Images of Gd-EOB-DTPA Enhanced MRI: Imaging Findings
and the Prevalence in Various Hepatobiliary Diseases
Satoshi Kobayashi1, Osamu Matsui2, Toshifumi Gabata2, Wataru
Koda3, Tetsuya Minami4, Yasuji Ryu1, Kazuto Kozaka1, Rieko
Shinmura1
1
Department of Radiology, Kanazawa Univ. School of Medicine,
Japan
2
System, Singapore, Singapore
3
Department of Gastroenterology and Hepatology, National
University Health System, Singapore, Singapore
4
Department of Pathology, National University Health System,
Singapore, Singapore
operating characteristic (ROC) curve analysis
Results The overall per-lesion sensitivities were increased in respiratorytriggered diffusion-weighted MR imaging [reviewer1:reviewer2,
81/101 (80.2%):82/101 (81.2%)] than T2 weighted imaging [60/101
(59.4%):73/101 (72.3%)] with statistical difference in a reviewer (p
value 0.0018). Although the sensitivities for cystic lesions were similar
in two reviewers, the sensitivities for non-cystic lesions were higher in
respiratory-triggered diffusion-weighted MR imaging [45/53 (84.9%):42/53
(79.2%)] than T2 weighted imaging [27/53 (50.9%):37/53 (69.8%)]. Perperson sensitivities and positive predictive values were similar in two
reviewers (95.7%:91.3%, 0.957:0.913). Diagnostic accuracies measuring
Az values were not statistically different between two sets.
Conclusions Respiratory-triggered diffusion weighted imaging was better
in the detection of focal hepatic lesions, especially for non-cystic lesions
Keywords Liver, Metastases, MR, Neoplasms-Primary, Cysts, Imaging
Sequences
E-Poster
Others
2010.03.22
Purpose To evaluate the capabilities of multisection computed
tomography (CT) and magnetic resonance imaging in assessing the
likelihood of invasiveness of intraductal papillary mucinous neoplasm
(IPMN) of the pancreas
Methods The institutional review board approved this research and waived
informed consent from the patients. Two radiologists retrospectively
evaluated CT images and MRI of 46 consecutive surgically resected
tumors (6 adenomas, 17 borderline lesions, 4 noninvasive carcinomas,
and 19 invasive carcinomas) in patients who underwent multiphase
contrast material–enhanced CT, MRCP and dynamic MRI study. The
findings were statistically analyzed by using univariate and multivariate
analyses, with the optimal cutoff levels of each continuous parameter
determined by generating receiver operating characteristic curves.
Results The following findings showed significant differences among
the three groups: maximum diameter of the main pancreatic duct (MPD),
size (length of major axis) of the largest mural nodule in the MPD or in
any associated cystic lesion, protrusion of the MPD into the ampulla
of Vater, and bile duct dilatation. An MPD diameter of 6 mm or larger,
a mural nodule of 3 mm or larger, and an abnormal attenuating area
were independently predictive of malignancy. A mural nodule of 3 mm or
larger in the MPD and an abnormal attenuating area were independently
predictive of parenchymal invasion.
Conclusions Multisection CT and MRI are useful for distinguishing benign
from malignant lesion in patients with IPMN.
Keywords Pancreas
AB064
Evaluation of Rejection and Vascular Complications in
Pancreas Transplantation with Multidetector Computed
Tomography
Jian-Ling Chen1, Rheun-Chuan Lee2, Jen-Huey Chiang1, HsiouShan Tseng2, Yi-You Chiou1, Cheng-Yen Chang1
1
National Yang-Ming University, Taiwan
2
Taiwan
Purpose To evaluate transplant-related complication, define the
pancreatic enhancement of pancreas allograft at triple-phase CT and
compare it with that of those with acute or chronic rejection.
Methods Triple-phase CT scans of 17 patients were obtained and
478
AB105
The Dynamic Enhancing Pattern of Autoimmune Pancreatitis
Hsiao-Ping Chou
Department of Radiology, Radiology Society Republic of China,
Taiwan
Purpose To evaluate the enhancing pattern of autoimmune pancreatitis
(AIP) and associated extrapancreatic lesions.
Methods An electronic database of 289 patients with a diagnosis of
chronic pancreatitis and/or with autoimmune disease from January 2002
to June 2009 was retrospective evaluated. After excluding the pancreatic
cancer and alcoholic-related pancreatitis, there are 15 patients with AIP
included according to the Asian criteria. We measured the HU in arterial
phase and delay phase according to CT scan and the ratio of arterial
phase divided pre-contrast scan and that of delay phase divided precontrast scan according to MR for different portions, including pancreatic
head, body, tail, peripancreatic rim and extrapancreatic lesions, such as
retroperitoneal fibrosis or renal nodules, in diffuse type AIP. In focal type
AIP, we measured the enhancing pattern of focal lesions and spared
parenchyma. SPSS 17.0 was used for statistical analysis and P<0.05 was
considered significant.
Results Significant delayed enhancement of pancreatic head (CT mean
HU=86.4 v.s. 106.13; p=0.007, MR p=0.006), body (HU=85 v.s. 98.5;
p=0.007, MR p=0.048), tail (HU=80 v.s. 100.13; p=0.059, MR p=0.046)
and peripancreatic rim (HU=28.3 v.s. 39; p=0.03, MR p=0.049), also
in extrapancreatic lesions (HU=75v.s.104.3; p=0.047) were depicted
in diffuse type AIP and all of them had difference more than 10 HU in
CT images. However, in focal type AIP, there is no significant delayed
enhancement (p>0.05). Two focal type cases with head lesions show
delayed enhancement in both lesion site and normal parenchyma, while
in the one with body lesion of focal AIP, lack of delayed enhancement
perhaps due to long term (more than10 years past history of pancreatitis)
and chronic relapsing disease entity.
Conclusions Delayed enhancement was found in diffuse type, as well as
in the peripancreatic rim and extrapancreatic lesions, which is helpful for
early diagnosis of AIP. However, no significant delayed enhancement in
the focal type.
Keywords MR, Pancreas, CT, Retroperitoneum
AB074
Peripancreatic Lymphatic Invasion by Pancreatic Body/Tail
Cancer: Evaluation with Multi-Detector Raw CT
Shunro Matsumoto, Hiromu Mori, Michiaki Sai, Maki Kiyonaga,
Yasunari Yamada
Department of Radiology, Oita University Faculty of Medicine,
Japan
Purpose In pancreatic body/tail carcinoma, “peripancreatic thick-strand
appearance”, which radiates from primary lesion and is associated with
increased CT attenuation of surrounding fat tissues, is frequently seen.
This finding is supposed to reflect carcinoma invasion to the peripancreatic
lymphatics. The purpose of this study is to clarify its radiological and
clinical significance.
Methods We retrospectively evaluated the contrast-enhanced MDCT
images of nine patients with pancreatic body/tail carcinoma who
underwent surgical operation and was pathologically correlated.
Carcinomas located in or extended to pancreatic head were excluded
from this study because CT evaluation of this finding was difficult. As
control groups, normal subjects (n=20) having no abdominal symptom or
previous surgical history, and patients with autoimmune pancreatitis (n=9)
were chosen. All CT examinations were performed by contrast-enhanced
MDCT (16 or 32 detectors) using imaging reconstruction every 1 mm with
a multiplanar reformation technique.
Results The “peripancreatic thick-strands appearance” was detected
in 7 (78%).of 9 patients with pancreatic body/tail carcinoma. Carcinoma
invasion to the extrapancreatic fat tissue was pathologically confirmed
in 8 (89%) of 9 patients. Two pathological findings corresponded to
the “peripancreatic thick-strands appearance” on MDCT; one was
carcinoma invasion via vessels, mainly lymphatic vessels, and fibrous
band along lymphatic invasion, and the other was fibrosis around
carcinoma invasion to extrapancreatic fat tissue. There was difference
of development of fibrosis between these two findings, but these were
coexisted more or less. In control groups, there was no “peripancreatic
thick-strands appearance” in the peripancreatic areas, although thin, fine
linear structures around tail of pancreas were identified in autoimmune
pancreatitis.
Conclusions The “peripancreatic thick-strands appearance” in pancreatic
body/tail carcinoma reflects mainly the lymphatic carcinoma spread and
fibrosis with carcinoma invasion. This finding is important to decide the
preoperative staging, and to judge the necessity for chemotherapy.
Keywords Pancreas, CT
AB036
Abdominal Lymphoma: What Radiologists Need to Know
You Sung Kim, Seung Eun Jung, Sung Eun Rha, Soon Nam Oh,
Yu Ri Shin, Jae Young Byun
Department of Radiology, Seoul St. Mary's Hospital, The Catholic
University of Korea, Korea
Purpose To discuss what radiologists should know about abdominal
lymphoma for diagnosis, proper advice about treatment, and treatment
response.
Methods Between January 2007 and December 2009, 155 patients
with pathologically confirmed lymphoma with abdominal manifestations
were included in this study. Two experienced radiologists retrospectively
assessed the initial and follow up CT and PET-CT. The image findings
were correlated with pathologic examinations.
Results Typical findings of abdominal lymphoma are multiple enlarged
lymph nodes, hepatosplenomegaly, or bowel wall thickening. Most of
the cases showed the usual manifestations of abdominal lymphoma, but
unusual manifestations were found in some cases. Several cases showed
solid organ involvement rather than bowel wall thickening. Three cases
of abdominal lymphoma were combined with another primary cancer,
such as paraganglioma, hepatocellular carcinoma, and cervix cancer.
Some cases showed remaining mass on CT and increased FDG uptake
on PET CT after finishing the treatment were confirmed to the fibrosis
pathologically.
Conclusions Lymphoma has various manifestations and radiologist must
have knowledge about its findings, treatment, and treatment response
evaluation to be a proper guide for diagnosis and treatment.
Keywords Lymphoma
AB090
Abdominal Tuberculosis; Current Role and Imaging Findings
of MDCT
Hye Seon Shin, Young Hwan Lee, Eugene Kang
Department of Radiology, Wonkwang University Hospital, Korea
Purpose 1. To illustrate usual and unusual CT findings of abdominal
tuberculosis. 2. To discuss the various imaging features that can
differentiate from non-tuberculous diseases.
Methods We reviewed 103 cases of abdominal CT images that comfirmed
with tuberculosis involving various abdominal organs. We used 4 channel
and 64 channel multidetector CT scanner and in selective cases among
them, 3D reconstruction was performed. We will illustrate the various CT
findings of abdominal Tbc involving solid abdominal organs ( such as
liver, pancreas, spleen, kidney and adrenal gland), gastrointestinal tract,
genitourinary tract, peritoneum and its reflections, and lymphatic systems.
Results The most common involved organ of abdomen from tuberculosis
is gastrointestinal tract. Ileoceal area is the common site. The imaging
findings of solid organ Tbc were mimic malignant tumors. For example
Hepatic tuberculosis was manifested as a large solid mass that mimic
malignant hepatic tumor, Multiple splenic nodules were mimic metastasis.
Peritoneal tuberculosis had a various imaging features, according to
their types such as wet, dry and mixed types. Lmphadenitis is frequently
combined but not always associated.
Conclusions MDCT imaging is essential for detect the various adominal
involvement of tuberculosis and helpful to differentiate from other nontuberculous diseases that mimic abdominal Tbc.
Keywords CT, Infection
AB055
CT Imaging Features of Phlebosclerotic Colitis: Correlation
of Calcification of the Mesenteric Vein with the Modalities of
Treatment in 10 Cases
Chun-Han Liao¹, Wu-Chung Shen¹, Wei-Ching Lin², Yung-Jen
Ho², Jeon-Hor Chen², Yu-Fen Chiu¹, Shen-Wu Chung³
¹Department of Radiology, China Medical University Hospital
Taichung Taiwan, RSROC, Taiwan
²Department of Radiology, China Medical University Hospital
Taichung Taiwan; Department of Biomedical Imaging and
Radiological Science, China Medical University Taichung Taiwan,
RSROC, Taiwan
³Department of Radiology, RSROC, Taiwan
Purpose Phlebosclerotic colitis (PC) is a rare form of colitis caused by
phlebosclerosis of the mesenteric vein. This study aimed to analyze its
CT imaging features using a new scoring system and to correlate with the
modalities of treatment.
Methods Ten PC patients diagnosed in CT were analyzed. The extent
and severity of the mesenteric venous calcifications was evaluated using
a scoring system. When the mesenteric venous calcifications limited in
straight vein of colon, the score was 1; when calcification extended to the
paracolic marginal vein, the score was 2; when calcification extended to
the main branch of mesenteric vein, the score was 3; when the proximal
end of the main branch was involved, the score was 4. The score of
mesenteric venous calcification in every branch was summed in each
patient to represent the overall distribution and severity of their mesenteric
calcifications. Two samples independent t-test was used to analyze the
relationship between the modalities of treatment and the distribution of
mesenteric venous calcifications in CT.
Results Eight patients presented with symptoms of abdominal pain,
fullness, diarrhea and vomiting showing colonic wall thickening with
pericolic fat stranding which indicating active ischemic colitis. Two patients
remained asymptomatic. The proximal colon was mostly affected in
all patients. Extension of calcification to distal colon occurred in three
patients. Three patients received operation and five patients merely
received conservative treatment. Two patients didn’t receive treatment
because they were asymptomatic. The sum of calcification score
approached significantly higher value in patients who needed surgical
treatment than those who did not (15±3.6 vs. 8.88±2.03, P = 0.05).
Conclusions The CT images of PC showed variable degree of mesenteric
calcification. The preliminary results in 10 patients showed our proposed
calcification score can potentially be used as a sensitive indicator for
evaluation of the need of surgery.
479
AB079
Intraductal Papillary Mucinous Neoplasm of the Pancreas:
Determination of the Likelihood of Malignancy with
Multisection CT and Magnetic Resonance Imaging
Ming Yi Hsu, Jeng-Hwei Tseng, Kuang-Tse Pan, Sung-Yu Chu,
Chien-Fu Hung, Ren-Fu Shie, Yuan-Chang Liu, Chi-Lai Kea
Memorial Hospital at Linkou, Taiwan
reviewed. Six of them had biopsy-proven episodes of acute or chronic
rejection. The mean CT attenuation value of the pancreatic parenchyma
in patients with rejection was compared with that in patients with normal
pancreas allografts.
Results Transplant-related complications include rejection, intestinal
obstruction, hemorrhage or hematoma, pancreatic leakage and venous
thrombosis or narrowing. Four patients showed venous thrombosis, and
one of them showing concomitant atrophic change of the graft eventually
had graft failure, another one showing concomitant acute rejection also
had graft failure. Six patients had biopsy proved acute or chronic rejection.
In the venous phase, the mean CT attenuation value of the pancreatic
parenchyma in patients with graft rejection was slightly lower than that
in patients with a normal pancreas graft (graft rejection, 101 HU; normal
graft, 109.6 HU, p >0.05) though may not show statistic significance.
Three of them eventually had graft failure and one had re-transplantation.
Conclusions Rejection is a common post-transplant complication and the
grafts may have a trend to enhance less than normal grafts do. Venous
thrombosis diagnosed on images may be a benign process if there is no
other concomitant finding such as rejection or graft atrophy.
Keywords Complications, Pancreas, Transplantation
E-Poster
sample, quantification of the amount of collagen with Fibro-C index was
performed with Gaussian mixture model segmentation method. The total
aggregated collagen amount was reported as the quantification index.
We present preliminary results here in the abstract and more subjects are
being recruited for this comparative study.
Results At histology, there was one case each of F0 to F4 fibrosis stage
(METAVIR). The mean aggregated collagen amount (Fibro-C index) in
the study group was 0.45 (range, 0.007 to 0.09). The mean liver stiffness
value in the study group was 3.96kPa (range, 2.5 to 7.5kPa). There was
good correlation between the stiffness values and Fibro-C index (R2= 0.80)
and excellent correlation between Fibro-C index and METAVIR score
(R2=0.92).
Conclusions Preliminary findings show that there is positive correlation
between Fibro-C index and MRE stiffness values. Future studies with
larger number of patients are required to validate our preliminary findings.
Keywords Liver, MR, Cirrhosis, Pathology
Others
2010.03.22
Purpose To evaluate the tumor response after Imatinib treatment for
Gastrointestinal Stromal Tumor by Choi criteria as compared with
Response Evaluation Criteria in Solid Tumors (RECIST).
Methods From January 2004 to November 2008, 212 patients were
diagnosed as GI tract or extra GI tract GIST histologically by surgical
resection or biopsy. 72 cases were treated with Imatinib because of
metastasis, unresectable spreading or recurrence. We retrospectively
evaluate the CT image and using both Choi criteria and RECIST criteria.
Results Seventy two patients received Imatinib therapy, average 63.1
years old. 56 patients received operation for primary lesion resection.
11 of them excluded due to loss of follow up, combined malignancy and
death in other cause. In included cases, stomach is the primary site
in 38%, following by small intestine in 33%. Liver is the most common
metastatic site (59%). In 61 cases, complete response, partial response,
stable disease and progression disease rate are 10%, 39%, 18% and
33% in RECIST criteria and 10%, 54%, 13%, and 23% in Choi criteria.
Choi criteria had better correlation with time of tumor response in nonresponder groups than RECIST criteria (p=0.02).
Conclusions Choi Criteria is a better indicator of tumor response after
Imatinib therapy. These criteria should be evaluated by radiologists
experienced in assessing the response to Imatinib in GISTs with
awareness of their limitations.
Keywords Neoplasms-Primary, CT, Small Bowel, Stomach, Treatment
Effects
AB095
Brunner’s Gland Hamartoma of the Duodenum—CT and
Other Imaging Manifestations
Cheng-Hui Yang, Yi-You Chiou, Jen-Huey Chiang, Shyh-Hau
Tsay, Yi-Hong Chou, Cheng-Yen Chang
Taiwan
Purpose Brunner’s gland hamartoma is a rare duodenal benign tumor.
The upper gastrointestinal panendoscopy (UGI-PES) and endoscopic
ultrasonography (EUS) may not establish the diagnosis before biopsy or
surgery. The aim of this study is to characterize the computed tomography
(CT) imaging findings in the patients with Brunner’s gland hamartoma.
Methods From 2000 to 2009, 19 patients (10 male & 9 female, mean age:
63.4, range 41 to 83 years old) with Brunner’s gland hamartoma of the
dundeum were proved at our hospital (Taipei Veterans General Hospital).
13 patients underwent CT scan before & after intravenous (IV) contrast
medium injection. All patients received surgical resection or endoscopical
biopsy. CT manifestations and other imaging studies including UGI-PES &
EUS were reviewed and correlated with pathological findings.
Results The clinical presentation was either incidental finding (15/19) or
with symptoms including nausea/vomiting (3/19), epigastralgia (3/19) and
abdominal fullness (1/19). The tumor location was at the first (15/19) or
the second portion (4/19) of the duodenum, while none of them was at the
third/fourth portion. The tumor size was classified larger than 2cm (4/13),
1-2 cm (4/13), and smaller than 1cm (5/13). The CT findings included welldefined soft tissue nodule (13/13), no calcification, hemorrhage or necrosis
(13/13), and no adjacent tissue invasion (13/13). The CT findings in the
4 patients with tumor size larger than 2cm included: cystic degeneration
(2/4), heterogenous enhancement (3/4), and delayed enhancement in
dynamic CT study (2/2). Homogenous enhancement was found in all the
lesions smaller than 2cm in size (9/9).
Conclusions CT plays an important role in the diagnosis of Brunner’s
gland hamartoma. If a well-defined soft tissue mass larger than 2cm with
480
AB109
Crohn's Disease: Diagnostic Role of Multidetector CT
Hesham Ali Badawi
Department of Radiology department medical research institute,
Consultant Radiologist, Egypt
Purpose The purpose of this study was to evaluate the accuracy of
multidetector-CT in initial diagnosis and estimation of Crohn's disease and
to estimate the severity and complications of the disease along the small
and large bowel.
Methods This study included thirty five patients with clinically suspected
or established Crohn's disease. All patients underwent thorough
clinical examination, complete laboratory investigation and radiological
examinations included pelvi abdominal MDCT, and Barium studies to
evaluate the extent, activity and extra intestinal complications of Crohn's
disease. MDCT and endoscopies were performed within 1 week of clinical
diagnosis on consecutive days before commencement of medical therapy.
Specific CT findings were used to assess the presence or absence of
Crohn's disease; these findings were then compared with the reference
standard which included: Endoscopic findings (n = 32), biopsy (n= 7),
operative findings (n= 3) and clinical data.
Results Positive bowel involvements with Crohn's disease were noted
in 91.42% of our patients Negative CT findings for Crohn's disease were
noted in 8.57% of the patients included in this study.CT manifestations
of Crohn's disease were included active, fibrostenotic, perforating and
fistulising lesions ,Intra abdominal complications included; multiple
pockets of intra abdominal abscesses , Psoas abscess in one patient and
right iliac fossa inflammatory masses,fistulising sigmoid Crohn's lesion
into uterus.
Conclusions MDCT is a reliable, accurate imaging modality for the
evaluation of Crohn's disease. The ability to directly demonstrate the
bowel wall, adjacent abdominal organs, mesentery and retroperitoneum
makes CT superior to barium studies in diagnosing the complications of
Crohn's disease.
Keywords Large Bowel, CT, Fistula, Inflammation
AB114
Patient Outcomes Following CT for Suspected Acute
Appendicitis over a One-Year Period: A Single Institution
Experience
Mark Tan¹, Huang John², Harsh Sadana²
¹Department of Diagnostic Radiolgoy, MBBS, FRCR, M.MED,
Singapore
²Department of Diagnostic Radiology, Singapore General
Hospital, Singapore
Purpose To evaluate outcomes of patients who presented with abdominal
pain and underwent CT to exclude appendicitis
Methods Retrospective analysis of all patients over a 1 year period who
underwent CT to evaluate abdominal pain with the intention to exclude
acute appendicitis. Electronic records were reviewed.
Results The age range of the patients was 16 to 88 years old, with
a mean age of 48.7. There were 52 males and 115 females. Patients
were divided into 3 groups based on the CT scan findings: Positive,
indeterminate or negative for acute appendicitis. 27% of the studies were
positive, 62% were negative and 11% were indeterminate. Of those with
a positive CT, 36 underwent surgery and 33 had appendicitis confirmed.
2 had an alternative diagnosis at surgery. There was 1 false positive.
Overall mortality during the study period was 1%. In those with a positive
CT, there was only 1 death, all other patients being well after appropriate
treatment. In those with a negative CT, there were no deaths during the
study period. 56% were given an alternate diagnosis. Negative laparatomy
rate was only 8%, similar to other studies and favourable to negative
laparatomy rates of about 15 to 20% for acute appendicitis without preoperative imaging.
Conclusions CT may be useful as part of standard of care in the
management of suspected acute appendicitis.
Keywords Appendix, CT, Inflammation
CA003
Computed Tomographic Evaluation of Thyroid Gland and
Correlation with Thyroid Function Tests
Sumeet Bhargava, Rajesh Gothi
Department of Radiodiagnosis, Medical Council of India, India
Purpose *To evaluate the CT density of the thyroid gland. *To provisionally
diagnose subclinical hypothyroidism in patients coming for CT scan of the
neck and chest done for some other problem.
Methods 30 Controls: known euthyroids with thyroid function tests.
30 Cases: known hypothyroid patients with increased TSH (thyroid
stimulating hormone). 60 Random: patients whom the gland appears
abnormal from the data gained from the controls and cases, provisionally
diagnosed with subclinical hypothyroidism and thyroid function tests
further carried out. Statistical analysis was done.
Results 1. The CT value of the normal thyroid gland ranges from 75 150 HU in euthyroids. 2. The CT value of hypothyroids ranges from 35-60
HU. 3. Confirmation of the already known fact that there is no difference
in the density patterns between males and females and does not seem
to be affected by advancing age. Hence the density measurement can be
applied to general population.
Conclusions The density of the thyroid gland in euthyroids ranges from
75-150 HU and the gland appears hyperdense as compared with the
surrounding muscles due to its iodine content. The density is reduces in
patients of hypothyroidism and the CT vaslue in these patients ranges
from 35-60 HU. This is evident even on eyeballing and the gland becomes
almost isodense to the surrounding muscles. Though CT can not be used
as a primary screening modality for thyroid disorders, however knowing
this fact can benefit patients who come for CT scan of the neck and chest
for some other problem and are suffering from a well known entity called
Subclinical Hypothyroidism. These patients can then be advised further
work up with Thyroid Function Tests.
Keywords Thyroid
CA004
Computer-Aided Diagnosis Scheme for Detection of
Intracranial Unruptured Aneurysms in MR Angiograph
Yoshikazu Uchiyama 1, Takeshi Hara 2, Hiroshi Fujita 2, Toru
Iwama3, Hiroaki Hoshi4, Yasutomi Kinosada1
1
Department of Biomedical Informatics, Graduate School of
Medicine, Gifu University, Japan
2
Department of Intelligent Image Information, Graduate School of
3
Department of Neurosurgery, Graduate School pf Medicine, Gifu
University, Japan
4
Department of Radiology, Graduate School of Medicine, Gifu
University, Japan
Purpose The detection of unruptured aneurysms in MR angiography
is important task because aneurysm rupture is the main cause of
subarachnoid hemorrhage. However, their accurate detection is often
difficult because of the overlapping between the aneurysm and the
adjacent vessels on MIP image. The purpose of this study is to develop
CAD schemes for the detection of unruptured aneurysms.
Methods Our CAD schemes consist of two components: (1) to provide
location of aneurysm candidates on MIP images and/or volume rendering
images, and (2) to provide SelMIP images as a new type of MIP image
with interested vessel regions only by manually selecting a desired
cerebral artery from a list. For the detection of aneurysms, the vessel
regions were segmented using gray-level thresholding and region growing
technique. The gradient concentration (GC) filter was applied for the
enhancement of aneurysms. The initial candidates were identified in
the GC image with a gray-level thresholding. For the elimination of false
positives (FPs), we determined shape features and anatomical location
features. Finally, rule-based schemes and a quadratic discriminant
analysis were employed for distinguishing between aneurysms and FPs.
For making SelMIP image, the reference image was used as a reference
for the locations of eight arteries. The eight cerebral arteries were prelabeled in the reference image. The segmented vessel regions in an
image were shifted to align with the reference image by using the image
registration technique. Recognition of each of the cerebral arteries was
based on the Euclidian distance measured between a labeled artery in the
reference image and the segmented vessel pixels in the image.
Results Our method was applied to 100 cases. The result indicated that
sensitivity for detection of aneurysms was 90% with 1.52 FPs per patient.
Conclusions Our CAD schemes would be useful in assisting the
radiologists in the detection of unruptured aneurysms.
Keywords Aneurysms, MR, Neural Networks, Computer Applications
CA009
A Computer-Aided Diagnosis of Brain SPECT Imaging Using
3D Haar Wavelets
Tang-Kai Yin¹, Nan-Tsing Chiu²
¹Department of Computer Science and Information Engineering,
National University of Kaohsiung
²Department of Nuclear Medicine, National Cheng Kung
University Hospital, Taiwan
Purpose Brain SPECT volumes are three-dimensional matrices of more
than one hundred thousand voxels. In this research, we show that 3D
Haar wavelets can be used to extract differentiating variables from these
voxels. Specifically, we conducted experiments on two groups of SPECT
volumes: Alzheimer’s patients and normal controls.
Methods Each SPECT volume is preprocessed by SPM99 (http://www.
fil.ion.ucl.ac.uk/spm/). Spatial normalization and spatial smoothing are
applied first. Then a grid sampling of spacing 6 voxels is used to get
16*16*16 variables. These variables are further transformed by the 3D
Haar wavelet transform to obtain 4680 wavelet coefficients. A greedy
algorithm is designed to select the five most significant coefficients in
classification between the two groups. Since the wavelet coefficients
are approximately of multivariate normal distributions, the quadratic
discriminant function is the optimal classifier. From the training data, the
plug-in quadratic discriminant function is applied.
Results There are 107 brain technetium-99m hexamethylpropylene amine
oxime (99m-Tc-HMPAO) SPECT volumes. Fifty-eight of them are from
the patients of Alzheimer's disease, and the other forty-nine volumes are
from normal controls. These volumes were from the National Cheng Kung
University Hospital, Tainan, Taiwan. When the threshold is set to be zero,
sensitivity is 0.912, specificity is 0.927, and accuracy is 0.920.
Conclusions The differentiating variables for SPECT volumes can be
extracted from 3D Haar wavelets. Since the values of the voxels are
approximately multivariate normal distributions, the plug-in quadratic
discriminant function is an effective classifier. Experiments show the
effectiveness of the proposed approach.
Keywords Brain/Brain Stem, Computer Applications, Screening
CH041
Computed Tomography Guided Biopsy of Pulmoanry
Ground Glass Opacity Lesion
Mei-Han Wu¹, Chun-Ku Chen1, Ming-Sheng Chern2, Ming-Huei
Sheu1, Cheng-Yen Chang1
1
Department of Radiology, Taipei Veterans GeneraL Hospital,
Taiwan
2
Department of Radiology, Enoyway Health Maintenance Center,
Taiwan
Purpose To evaluate the feasibility and sensitivity of percutaneous CT-
481
AB069
Image Evaluation for Gastrointestinal Stromal Tumor after
Imatinib Therapy: Choi Criteria and RECIST Criteria
Yueh-hsun Lu
Taiwan
cystic degeneration and delayed heterogenous enhancement is found at
the duodenum, especially at the first or second portion, Brunner’s gland
hamartoma should be listed in the differential diagnoses.
Keywords Neoplasms-Primary, CT, Duodenum
E-Poster
Keywords Mesentery, CT, Surgery, Veins, Inflammation
Others
2010.03.22
Purpose This study aimed to evaluate the use of multi-detector
tomography (MDCT) characteristics to differentiate the smear-positive
active PTB from other pulmonary infection at the emergency room.
Methods One hundred and eight –three (183) patients with pulmonary
infection at emergency room were divided into the smear-positive active
PTB (N=84) group {group1} and non-AFB positive pulmonary infection
(n=99) group {group2}. Multi-planar MDCT images by a 64-MDCT scanner
were analyzed with retrospective evaluation for CT morphology, number
and segmental distribution of the lesions.
Results By univariate analysis, MDCT findings of ground-glass opacity,
consolidation, bronchial wall thickening, clusters of nodules (galaxy sign),
para-tracheal adenopathy, inter-lobular septal thickening, cavitation, halo
sign, feeding vessel sign, reverse halo sign, and cystic change were
significantly more frequent in the group 1. In contrast, calcification, fibrosis,
and emphysema change were more frequent in the group 2.On the
multivariate analysis, consolidation in apex segment, posterior segment
of right upper lobe or apical-posterior segment of left upper lobe,superior
segment of right lower lower lobe or left lower lobe, cavitation and galaxy
nodules were independently significant predictive of group1.In contrast,
centri-lobule nodules was independently predictive of group2 . Using the
five independent variables that were associated with the risk of group1,
we created a group1 prediction score to help distinguish between group1
and group2. On the ROC curve analysis, the area under the curve is 0.957±
0.021 for our prediction model. With the ideal cut-off point score of 1, the
sensitivity, specificity, and positive predictive value were 97.9%, 78.8%,
and 82.0%, respectively.
Conclusions The smear-positive active PTB prediction model may help
clinicians decide if a patient with pending sputum smears results should
first be placed in isolation and empiric anti-tuberculous therapy started at
emergency room.
Keywords Lung, CT
CH033
Lung Cancer Detection Using Low Dose Computed
Tomography in Health Maintenance Center
Ming-Sheng Chern1, San-Ming Lai2, See-Yin Chiou3, Wei-Hsing
Lee2, Cheng-Yu Cheng2, Edward TA Ling1
1
Department of Diagnostic Imaging/ School of Medicine, West
Garden Hospital/ Yang-Ming University
2
Department of Diagnostic Imaging, Westgarden Hospital,
482
Medical Sciences, Kumamoto University, Japan
2
Department of Diagnostic Radiology, Kumamoto Central
Hospital, Japan
Purpose To evaluate lung cancer detection rate and stage I incidence by
low dose CT (LDCT) in non-referral routine check up.
Methods From March 2005 to March 2009, LDCTs were performed
in 4281 person. (2564 in men, mean age 49.9 years; 1617 in women,
mean age 50.8 years). Three referred cases of lung cancer and 1 breast
metastatic cancer were excluded. Twenty-eight cases of non-referral
primary lung cancer including 13 males (mean age 62.77 ± 11.30 years,
range 40~88 years) and 15 females (mean age 58.6 ± 13.23 years, range
34~83 years) were enrolled. All patients were proved by operation (19/28),
CT-guided or bronchoscopic biopsy (8/28) and sputum cytology (1/28).
Results The non-referral lung cancer detection rate was 0.65 % (28/4281);
0.51 % (13/2564) in men and 0.93 % (15/1617) in women. Mean tumor
size was 24.53 mm (range, 5.9 mm ~ 76.5 mm; median, 15.95 mm). The
tumor cell types were as following: adenocarcinoma (n= 23, including
4 BAC), SCC (n= 2), poorly differentiated carcinoma (n= 1), SCLC (n=
1) and NSCLC (n= 1). The incidence of stage I in totally detected lung
cancers was 57.1% (16/28), 7 cases (87.5%) in small tumor size group
(≤10 mm, n=8), 8 cases (61.5%) in mediate size group (>10 mm, <30 mm,
n=13) and 1 case (14.3 %) in mass size group (≥30 mm, n=7).
Conclusions The non-referral lung cancer detection rate is 0.65 % and
stage I incidence is 57.1% in our center. The smaller the tumor size, the
lower the tumor staging. Using LDCT for screening is able to early detection
of small lung cancer less than 10 mm, which is difficult detection by
conventional chest X-ray, and provides early stage. The high incidence of
female lung cancer in our center is unclear and needs further investigation.
Keywords Lung, CT, Staging
Purpose The purpose of this study was to evaluate the usefulness of
diffusion-weighted imaging (DWI) with measurement of the apparent
diffusion coefficient (ADC) for differentiating between malignant and
benign solid mediastinal tumors.
Methods This prospective study included 49 consecutive patients (27
men, 22 women ranging in age from 24–79 years, mean 56 years) with
histologically confirmed solid mediastinal tumors. They were 26 malignant(invasive thymoma, n=9; thymic cancer, n=8; lymphoma, n=7; malignant
fibrous histiocytoma, n=1; seminoma, n=1) and 23 benign tumors
(noninvasive thymoma, n=16; schwannoma, n=3; mature cystic teratoma,
n=2; thyroid adenoma, n=2). We classified the invasive thymomas as
malignant based on their clinical characteristics. DWI was on a 1.5T-MRI
scanner (Achieva, Philips) with a b-factor of 0 and 1000 s/mm 2 by
respiratory-triggered single-shot echo-planar imaging. We generated ADC
maps, measured the ADC values in all mediastinal tumors, and compared
these values between malignant- and benign tumors. We also compared
the ADC values among noninvasive thymomas, invasive thymomas, and
thymic cancers.
Results The mean ADC value was 1.04 ± 0.20 x 10-3 and 1.75 ± 0.55
x 10-3 mm2/sec for malignant- and benign tumors, respectively; it was
significantly lower in malignant- than benign tumors (p<0.01). The mean
ADC value was 1.58 ± 0.39 x 10-3, 1.11 ± 0.21 x 10-3, and 1.02 ± 0.20 x
10-3 mm2/sec for noninvasive- and invasive thymoma, and thymic cancer,
respectively; the ADC value of noninvasive thymoma was significantly
higher than of invasive thymoma and thymic cancer (p<0.01). There was
no statistically significant difference in the mean ADC value between
invasive thymoma and thymic cancer (p= 0.82).
Conclusions The ADC value was useful for differentiating between
malignant and benign mediastinal tumors. Invasive thymoma and thymic
cancer exhibited lower ADC values than noninvasive thymoma.
Keywords Mediastinum, MR
CH007
Diverse Presentation of Primary Anterior Mediastinal Tumor:
7 Years Experience
Jae Kyo Lee1, Rak Chae Son2, Jin-Hwan Kim3
1
Department of Radiology, Korea
2
Department of Diagnostic Radiology, Residency, Korea
3
Department of Diagnostic Radiology, Member, Korea
Purpose Primary tumors in anterior mediastinum account for half of all
mediastinal masses. They also represent a wide diversity of disease state.
The purpose of our study was to describe diverse presentation of anterior
mediastinal tumors for our 7 years experience.
Methods During last 7 years (July, 2002 ~ June, 2009), 94 consecutive
patients were represented anterior mediastinal mass including thymic
hyperplasia and metastasis. We retrospectively reviewed CT scans of
79 patients (48 men, 31 women) with pathologically confirmed primary
anterior mediastinal tumors (surgical resection, n=59; biopsy, n=20).
Results Total mean age was 42 (years), and mean diameter on axial
scan was 6.3 (cm). The patients included 47 (59%) cases of thymoma (7
cases of invasive thymoma, 1 case of thymic carcinoma), 15 (19%) cases
of germ cell tumor (teratoma, n=10; yolk sac tumor, n=2; seminoma,
n=2, mixed germ cell tumor, n=1), 11 (14%) cases of primary mediastinal
lymphoma, 3 (4%) cases of neuroendocrine tumor (all of small cell lung
cancer) and 3 (4%) cases of others (each account of angiosarcoma,
synovial sarcoma, and leukemia).
Conclusions The most common primary anterior mediastinal tumors
were thymoma, lymphoma, and teratoma. But, various kinds of tumors
maybe occur in anterior mediastinum.
Keywords Mediastinum
CH001
D i f f u s i o n - We i g h t e d I m a g i n g f o r D i a g n o s i n g S o l i d
Mediastinal Tumors: Assessment with Apparent Diffusion
Coefficient Measurements
Seitaro Oda¹, Kazuo Awai1, Kazuhiro Katahira2, Shoji Morishita2,
Yasuyuki Yamashita1, Yasuyuki Yamashita1
1
Department of Diagnostic Radiology, Graduate School of
CH002
The Impact of CT Pulmonary Angiogram in Management
of Patients with Suspected Pulmonary Embolism. A
Retrospective Study in an Acute Hospital in Hong Kong.
Kai Yan Kwok, Sherman Sheung Ming Lo, Wing Chong Wai, Kin
Sun Tse, Tsz Kan Tsang, Ting Lok Kwan
Department of Radiology and Imaging, Queen Elizabeth
Hospital, Hong Kong, China
Purpose Computed tomography pulmonary angiogram (CTPA) is the
most important diagnostic investigation in the workup of patients with
suspected pulmonary embolism (PE). The purpose of this retrospective
study is to assess the impact of CTPA in clinical management of patients
with suspected PE.
Methods Clinical data of all patients with CTPA performed to confirm
or exclude PE between 1st January 2008 and 31st December 2008 in
Queen Elizabeth Hospital, Hong Kong, were reviewed by five radiologists.
If a patient was already diagnosed to have PE, subsequent CTPA during
the same admission was excluded. The clinical diagnosis and treatment
of each patient before and after CTPA were reviewed. The changes in
clinical diagnosis and treatment were analysed.
Results Total 119 patients were included in this study and 18 patients
(15.1%) were found to have PE. CTPA changed anticoagulation
management in 20 patients (16.8%). Among these, 12 patients started
anticoagulation after CTPA while 8 patients stopped anticoagulation
after CTPA. In addition, 14 patients (11.8%) had other important findings
which were unexpected by clinicians and directly affected the treatment.
Totally, 28.6% of the CTPA performed had significant impact on patient
management.
Conclusions CTPA is the principle diagnostic investigation for patients
with suspected PE. It not only has significant impact on anticoagulation
treatment but also detects other significant findings that change patient
management.
Keywords Lung, CT, Embolism/Thrombosis
CH004
Pulmonary Cryptococcosis: Comparison of Clinical and
Radiographic Characteristics in Immunocompetent and
Immunocompromised Patients
Wei-Chou Chang¹, Hsian-He Hsu 1, Wen-Chiung Lin 1, WannCherng Perng2, Ching Tzao3, Shih-Chun Lee3
1
2
Department of Internal Medicine, Tri-Service General Hospital,
Taiwan
3
Department of Surgery, Tri-Service General Hospital, Taiwan
Purpose We compared the clinical characteristics and imaging findings
between immunocompetent and immunocompromised patients in whom
pulmonary cryptococcosis had been diagnosed to define the role of serum
cryptococcal antigen (sCRAG) and radiographs during a follow-up period
of up to 1 year.
Methods The clinical records, chest radiographs, and CT scan findings
of 13 immunocompetent and 16 immunocompromised patients with a
diagnosis based on cerebrospinal fluid (CSF) culture, sCRAG titers,
and cytologic or histologic confirmation of the presence of pulmonary
cryptococcosis were reviewed during the course of the study. Two thoracic
radiologists reviewed chest radiographs and CT scans for morphologic
characteristics and the distribution of parenchymal abnormalities, and a
final reading was reached by consensus. The correlation between serial
radiographs and sCRAG titers was examined in 9 immunocompetent and
10 immunocompromised patients.
Results The most common clinical symptom was cough, which was
present in 24 patients (82.8%). Pulmonary nodules were the most frequent
radiologic abnormality. Cavitation within nodules and parenchymal
consolidation were significantly less common in immunocompetent
patients compared to immunocompromised patients (p = 0.02 and p
= 0.05, respectively). Immunocompromised patients tended to have a
larger extent of pulmonary involvement than immunocompetent patients,
the changes seen on their serial radiographs were more variable,
and their corresponding sCRAG titers were higher (> 1:256). In the
immunocompetent patients, the radiographic characteristics of lesions
usually improved with a corresponding decrease in sCRAG titers over time.
Conclusions Our study suggests that pulmonary cryptococcosis
usually follows a benign clinical course in immunocompetent patients.
Immunocompromised patients often undergo an evolution to cavitary
lesions that represent a more aggressive disease nature. Serial
radiographic changes and changes in sCRAG titers reliably reflect disease
progression and the response to therapy.
Keywords Lung, CT, Infection
CH012
High-Resolution CT Open a New Window on Diagnosis of
Smear-Positive Pulmonary Tuberculosis at Emergency Room
Jun Jun Yeh¹, Ming-Ting Wu²
¹Department of Thoracic Medicine, Pingtung Christian Hospital,
Taiwan
²Department of Radiology, Kaohsiung Veterans General Hospital,
Taiwan
Taiwan
Department of Diagnostic Imaging, School of Medicine, West
Garden Hospital, Yang-Ming University, Taiwan
3
CH045
CT Findings of Tuberculosis Endobronchitis
Sing Fai John Shum, Wing Ho Kwan, Sunny Chi Sing Cheng
Department of Radiology, Hong Kong College of Radiologists,
Hong Kong, China
Purpose To evaluate the CT findings of tuberculosis endobronchitis.
Methods From Jan 2007 to October 2009, all the microbiological
confirmed cases of mycobacterial infection with CT evidence of bronchial
wall thickening and narrowing are retrospectively reviewed. The CT
parameters are retrospectively analyzed.
Results 5 patients in total. 1 male and 4 female. Age ranged from 17
to 29. All are confirmed cases of active Mycobacterium tuberculosis
infection. No non-tuberculosis mycobarterial infection is seen in our cases.
All of them have left lung involvement. No tracheal involvement is seen
in any of our patients. All but one patient have smooth short segment
(<2cm) narrowing. Only one patient has short segment irregular narrowing
of bronchus. Circumferential bronchial wall thickening is seen in the
majority of cases (n=4), and one patient has eccentric wall thickening. In
patients with segmental bronchus involvement, there is atelectasis of the
involved lung segment (n=2). 1 patient has 2 narrowings at the left main
bronchus, 1 has left upper lobe bronchus narrowing, 1 has left upper lobe
anterior segmental bronchus narrowing, 1 has apical segmental bronchus
narrowing in left lower lobe, 1 has left main bronchus and left upper lobe
483
Others
guided biopsy of ground-glass opacity (GGO) pulmonary lesions.
Methods Forty four patients (22 male and 22 female, age 65.2±10.8
years) with GGO pulmonary lesion at computed tomography (CT) received
diagnostic CT-guided biopsy. The accuracy of diagnosis was evaluated
based on the characteristcis of the lesions, including the lesion location,
size, and the percentage of the GGO component. The complications of the
procedure were also reviewed regarding pneumothorax and hemoptysis.
Results Twenty seven patients were diagnosed to have malignant lesions,
with 89% true-positive (24/27)and 11% false-negative rates. Seventeen
patients were found to have benign lesions with one false-positive result,
for a specificity of 94%. The overall diagnostic accuracy was 94%, with a
positive predictive value of 91% and a negative predictive value of 805%.
Nine patients (20%) had pneumothorax and seven patients (15%) suffered
from mild hemoptysis occurred in seven (13%) patients.
Conclusions Pulmonary GGO lesions are associated with high-risk
malignant entity. CT-guided biopsy could provide satisfactory diagnostic
accuracy and acceptable procedure-related complications.
Keywords Lung, Biopsy, CT
E-Poster
2010.03.22
GU029
Multi-Detector Row CT Evaluation of Renal Cell Carcinoma
before Laparoscopic Surgery
Wei-Yi Ting, Shu-Huei Shen, Jia-Hwia Wang, Cheng-Yen Chang
Department of Radiology, Taipei veteran general hospital, Taiwan
Purpose Laparoscopic nephrectomy has become the trend for the
treatment of renal cell carcinoma (RCC). Because of limited surgical field,
higher complication rate has been reported. Tumor staging and vascular
variants are important for preoperative radiological evaluation. The recent
progression of multi-detector row CT (MDCT) combining 3D reconstruction
technique has efficiently improved the image quality. In this report, we
demonstrate our experience in the preoperative evaluation of RCC by
MDCT, focusing on staging accuracy and vascular variances.
Methods During 2003 to 2007, 47 patients of RCC were referred
for MDCT before the laparoscopic surgery. Thirty-four patients who
had complete three phase CT (non-contrast, corticomedullary and
nephrographic phases) were recruited in this study. Twenty two of them
also had delayed scan (secretory phase). The CT images were reviewed
the by two radiologists. Tumor staging and vascular variants were
recorded for each patient. The results were correlated with operative and
pathological findings.
Results Vascular variance was encountered in 27 patients, listed as
following: accessory renal arteries (N=2, 6%), capsular arteries (N=12,
35%), extra-hilar branching of renal artery (N=15, 44%), accessory renal
veins (N=2, 6%), triple renal veins (N=1, 3%), extra-hilar branching of
renal vein (N=11, 32%), gonadal vein variants (N=4, 12%) and lumbar vein
variant (N=1, 3%). Most of the tumors were T1 (N=27, 82%), three (9%)
were T2 and 3(9%) were T3a disease. The diagnostic accuracy by threephase CT is 90% for T1 disease, 90% for T2, and 81% for T3a disease.
Combining secretory phase, the accuracy elevated to 95% for T1, 90% for
T2, 85% for T3a.
Conclusions Renal vascular variances is frequently encountered in
patients underwent laparoscopic nephrectomy, and MDCT can provided
detail anatomical information concerning renal vasculature preoperatively.
For accurate tumor staging, we recommend secretory phase in the MDCT
protocol.
Keywords Kidney, Anatomy, Angiography, CT, Staging, Imaging Sequences
GU014
Comparison of Multiple Logistic Regression, Artificial Neural
Network, and Support Vector Machine in the Diagnosis of
Prostate Cancer: Image Based Clinical Decision Support
Hak Jong Lee, Sung IL Hwang
Department of Radiology Assistant Professor, Korea
Purpose To develop a multiple logistic regression model (MLR), artificial
neural network (ANN), and support vector machine (SVM) model for the
prediction of prostate cancer and to compare the accuracies of each model.
Methods From 2005 to 2007, 1077 consecutive patients who had
undergone transrectal ultrasound (TRUS) guided prostate biopsy were
enrolled in the study. The patients were divided into training group (n =
600) for training the decision models, and the test group (n = 477) for the
484
GU015
Midline Cysts in the Prostate: Incidence in Healthy Men on
Transrectal US and Clinical Importance
Eun Kyoung Lee, Sun Ho Kim
Department of adiology, Dongguk University Ilsan Hospital, Korea
Purpose To know the incidence of prostatic midline cysts in healthy men
on transrectal US and their clinical importance.
Methods Between May 2005 and June 2009, 1175 transrectal US
examinations were performed in 1086 men (aged between 22 and 85
years; mean 48.5 years) in the health promotion center. Among them,
incidence and size of midline cysts in men without any symptom in
genitourinary tract (‘healthy men’) were investigated, according to age,
prostate volume, and transrectal US findings in the prostate and seminal
vesicle. We also reviewed clinical records of men with midline cysts to
know any symptom was present.
Results Incidence of midline cyst in all men was 28% (304/1086), and not
different significantly in healthy men (280/999; 28%). Diameter of midline
cysts was 7.2 mm in mean (1-30 mm). According to age, the incidence in
men older than 60 years was the highest (32/102; 31.4%) and the size was
the smallest in this group (6.2 mm in mean). According to prostate volume,
the incidence in prostate larger than 20ml was 33.2% (157/473) and in
prostate smaller than or equal to 20ml was 23.4% (123/526) (chi-square
test, p <0.05). Abnormal US findings in the prostate and/or seminal vesicle
other than midline cysts were found in 196 men, and common findings
were chronic prostatitis (N=96) and undetermined focal lesion in the
peripheral zone (N=61). Among them, the incidence of midline cysts was
high with seminal vesicle abnormalities (5/11; 45.5%). In men with midline
cysts, only three had symptom that might be associated (3/304; 0.9%).
Conclusions The incidence of prostatic midline cysts in healthy men
on transrectal US is much higher than the result of previous studies on
transabdominal US or on autopsy. The incidence is higher in enlarged
prostate than prostate of normal size. Midline cysts smaller than 30 mm
are usually asymptomatic.
Keywords Cysts, Prostate, Ultrasound
GU028
Factor Analysis of Complications of Renal Access Creation
and Dilatation for Subsequent Percutaneous Nephrolithotripsy
Chen-Chih Huang, Li-Jen Wang, Yon-Cheong Wong, ChengHsien Wu, Chen-Te Wu
Department of Medical Imaging and Intervention Radiological
Society of Republic of China, Taiwan
Purpose To report the experience of renal access creation and dilatation
for subsequent percutaneous nephrolithotripsy (PCNL), to analyze risk
factors of complications of these procedures.
Methods We retrospectively reviewed 102 patients undergoing creation
and dilatation of renal access for PCNL. Review of the data of these
procedures included patient characteristics, disease status characteristics,
and technique characteristics. The outcomes of renal access were recorded
according to the successful or failed renal access, renal access related
complications, repeat PCNL procedures, and secondary procedures. The
associations of PCNL outcomes with parameters were analyzed.
Results Of the 102 patients, ninety nine (97.1%) patients had successful
renal access created by the radiologists. Fourteen (13.7%) patients
underwent repeat PCNL procedures. Thirty two (31.4%) patients
underwent the secondary procedures. Thirty nine (38.2%) patients had
minor complications including urine extravasation, fever and urinary tract
infection. Five (4.9%) patients had major complications including bleeding
requiring transfusion, hemothorax and sepsis. Multivariate analysis
demonstrated that combined the staghorn stones and the usage of
angiocatheters during the procedure was the only significant predictor for
major complications.
Conclusions Renal access creation and dilatation for PCNL by the
interventional radiologists is a safe procedure with relatively low
complication rates. The radiologists should cautiously manipulate the
angiocatheter in a PCNL procedure for management of the staghorn
stones to avoid the access related major complication.
Keywords Kidney, Percutaneous, Dilation
GU017
Imaging Findings of Urothelial Carcinomas of the Upper
Urinary Tract on Multidetector Computed to Mography
Urography in Kidney-Transplant Patients
Li-Jen Wang, Yon-Cheong Wong, Chen-Chih Huang
Department of Medical Imaging and Intervention, Linkou Chang
Gung Memorial Hospital, Chang Gung Universtiy, Taiwan
Purpose To understand imaging findings of urothelial carcinoma (UC)
of native kidneys and ureters on multidetector computed tomography
urography (MDCTU) in kidney-transplant patients.
Methods We did a computerized search for all kidney-transplant
patients undergoing MDCTU from 2002, June to 2007, March. Patients
had subsequent histological proofs of UC of the UUT within 6 months
of MDCTU were included in this study. Initial MDCTU report and
retrospective MDCTU reading without knowledge of pathological results
were reviewed to determine detection rates of UC. With a full knowledge
of pathological findings, a final review of MDCTU was further done to
determine UC characteristics on MDCTU.
Results Five patients had 14 UC in 9 native kidneys and ureters verified
by pathological examinations. Both initial report and retrospective blind
reading detected 8 (89 %) of 9 UC by per location analyses. By per tumor
analyses, initial MDCTU report and retrospective blind reading detected 11
(79 %) and 12 UC (86 %), respectively. With full knowledge of pathological
findings, all 14 UC in 9 locations were detected on MDCTU in the final
review. Enhancing masses were found in 8 UC, thickened walls in 2 UC,
spindle sign in 3 UC and fork sign in 1 UC.
Conclusions Being familiar with UC characteristics of native kidneys
and ureters on MDCTU could help increase detection rate of the easily
overlooked tumors of kidney-transplant patients.
Keywords Kidney, Neoplasms-Primary, CT
GU042
The Accuracy of Virtual Magnetic Resonance Cystoscopy in
Detection of Uretererocele Anatomy
Reza Seyed Hosein Beigi
Department of MRI, MR Rradiographer, Iran
Purpose To evaluate the accuracy of Virtual Magnetic Resonance
Cystoscopy (VMRC) in confirmation of ureterocele and the precise
anatomy of ectopic ureterocele in children.
Methods Thirty children with duplex collecting system and suspicious
ureterocele on ultrasonography were enrolled in this study. The children
were examined with a three-dimensional T1-weighted spoiled grass echo
(TR=30-50 ms, TE= 2-8 ms, echo train length 8). The virtual cystoscopic and
multiplanar reconstructions were performed. The accurate anatomy of upper
and lower urinary tracts systems was observed in all children. The VMRC
findings were compared with conventional imaging studies and cystoscopy.
Results Virtual MR Cystoscopy was the most sensitive method in
detection of ureterocele anatomy (97.7%). The role of this method was
significantly enhanced in confirmation of bilaterally, and the anatomy of
ureterocele in contrast to the other imaging methods.
Conclusions Virtual MR Cystoscopy provides a promising non-invasive
and safe technique in detection of ureterocele, and delineates the ectopic
type in children prior to surgery. It could have a considerable role in
precise anatomy of the ureter especially the distal site and it permits whole
evaluation of the following abnormalities in genitourinary system. This
adjuvant technique could facilitate the preoperative planning, especially
in poor functioning upper moiety, ectopic vaginal ureter in contra-lateral
system and cecoureterocele.
Keywords Anatomy, Bladder, MR
HN028
Comparison of Echoplanar and PROPELLER DiffusionWeighted MRI for the Assessment of ADC Values of the
Salivary Glands
Chun-Jung Juan1, Hing-Chiu Chang2, Chun-Jen Hsueh1, YinCheng Huang3, Hsiao-Wen Chung3, Hua-Shan Liu4, Cheng-Yu
Chen4, Guo-Shu Huang4
1
2
Department of Applied Science Laboratory, GE Healthcare,
Taiwan
3
Department of Electrical Engineering, National Taiwan
University, Taiwan
4
Purpose To evaluate the image distortion and quantification variation of
parotid apparent diffusion coefficient (ADC) in diffusion-weighted magnetic
resonance images (DW-MRI) using periodically rotated overlapping
parallel lines with enhanced reconstruction (PROP-DWI) and echoplanar
DW-MRI (EP-DWI), and to investigate the relationship between parotid
ADC values and parotid fat content.
Methods This prospective study was approved by a local institutional
review board. Written informed consents were obtained from all enrolled
volunteers. Thirty-three healthy volunteers (15 men, 18 women) with
age of 36.4±11.8 years (mean ± standard deviation) were enrolled. All
participants had non-fat-saturated PROP-DWI (NFS-PROP-DWI), fatsaturated PROP-DWI (FS-PROP-DWI), non-accelerated EP-DWI (NAEP-DWI) and two-fold accelerated EP-DWI (A-EP-DWI) examinations at
1.5T. Image distortions in DW-MRI were qualitatively scored and parotid
ADC was quantitatively analyzed. Correlation between parotid ADC
and parotid fat content was evaluated using linear regression analysis.
Wilcoxon Signed rank test and t test were used for statistical analysis with
Bonferroni correction for multiple comparisons.
Results EP-DWI showed image distortion, which was completely
remedied by PROP-DWI. The parotid ADC values measured by
NFS-PROP-DWI (ADC=0.670±0.149×10 -3 mm2/s), NA-EP-DWI
(ADC=0.892±0.128×10-3 mm2/s), A-EP-DWI (ADC=1.088±0.124×10-3 mm2/s)
and FS-PROP-DWI (ADC=1.307±0.217×10-3 mm2/s) differed significantly
from one another (all P <.001). Parotid ADC showed a significantly
negative association with parotid fat content (X) measured by NFS-PROPDWI: ADC = -0.0087X+1.1173 (×10-3 mm2/s) with a correlation coefficient=
0.80 (P <.001)
Conclusions PROP-DWI pulse sequences can provide distortion-free
images for parotid ADC measurements and allow quantitative evaluation
of the relationship between parotid ADC and parotid fat content.
Keywords MR, Salivary Glands
HN037
Usefulness of Diffusion-Weighted Imaging in Characterization
of Lymph Nodes in Head and Neck Cancer Patients
Chiencheng Chen, Shu-Hang Ng
485
evaluation of the accuracies in each decision model. A focal lesion as
seen on TRUS was evaluated in detail, with evaluation of lesion location,
outline, shape, and vascularity. To predict the probabilities of prostate
cancer associated with variables, three types of clinical decision support
models including a MLR, ANN, and SVM were constructed. Areas under
the receiver operating characteristic curve were calculated to evaluate the
performance of each decision model. Pairwise comparison of ROC curves
was performed.
Results The Az values of the ROC curves for the use of MLR, ANN and
the SVM were 0.768, 0.778 and 0.847, respectively. Pairwise comparison
of the ROC curves determined that there was a statistical difference
between the use of SVM and ANN (p = 0.023) and between the use of the
SVM and MLR (p = 0.023).
Conclusions The performance of the SVM was superior to the
performance of the use of the ANN or the multiple logistic regression
model in the prediction of prostate cancer based on TRUS findings.
Keywords Prostate Ultrasound
E-Poster
bronchus narrowing. All of them are associated with tree-in-bud nodules.
Two patients have associated cavitating lesions. Only one out of five has
enlarged mediastinal and hilar lymph node. None have lymph node close
to the involved bronchus. 4 patients had bronchoscopic correlation, all
showing compatible findings.
Conclusions Mycobacterium tuberculosis is the most common cause
of mycobacterial endobronchitis in our locality. It is frequently associated
with CT findings smooth short segment narrowing of the bronchus and
bronchial wall thickening. Tree-in-bud nodules and cavitating lesions
are commonly associated features in active disease. Mediastinal
lymphadenopathy is not a frequent finding.
Keywords Lung, CT
Others
2010.03.22
Purpose Neuroendocrine carcinoma (NEC) encompasses a spectrum of
malignant epithelial neuroendocrine neoplasms and rarely occurs in the
head and neck. The purpose of this study was to investigate the CT, MR
imaging, and PET/CT findings of NEC of this area.
Methods We retrospectively reviewed CT (n=9), MR imaging (n=5), and
PET/CT (n=3) findings in 9 patients (7 men and 2 women; mean age, 59
years; age range, 37-79 years) with histologically proved NEC in the head
and neck. Eight patients had a single lesion and 1 patient had 4 separate
metachronous lesions, making a total of 12 lesions included in this study. We
analyzed the CT and MR imaging findings with emphasis on the location,
size, margin, internal architecture, and enhancement pattern of the lesion.
Results All lesions appeared as well-defined (n=2) or ill-defined (n=10),
aggressive masses, ranging in size from 1.3 cm to 7.3 cm (mean, 3.5 cm).
The sinonasal cavity was the most common site of involvement seen in 6
lesions and the epiglottis, parotid gland, hypopharynx, nsopharynx, palate,
and lacrimal sac were the other sites of involvement seen in 1 lesion
each. Nine lesions including all of 6 sinonasal lesions were accompanied
by bone destruction. Calcifications were noted in 1 lesion. Regional lymph
node metastases were found in 3 patients. While most lesions showed
homogeneous isoattenuation on precontrast CT scans and homogeneous
isointensity on T1-weighted MR images, the signal intensity on T2weighted MR images and the enhancement pattern were variable among
the lesions. All lesions demonstrated high FDG uptake on PET/CT images
with a mean SUV of 5.
Conclusions Although rare, NEC is an aggressive tumor that arises in
various locations of the head and neck, most commonly in the sinonasal
cavity. Although nonspecific, the CT and MR imaging can display softtissue invasion and bone destruction, which are frequently associated with
NEC, to help determine the treatment plan.
Keywords MR, Neoplasms-Primary, Paranasal Sinuses, CT, Pharynx,
Radionuclide Studies
IN005
Emergency Transcatheter Pelvic Embolization in Massive
Post-Partum Hemorrhage
Kam Ying Lau, John Sing Fai Shum, Jeriel C K Lee, Alan NL Sy,
486
Purpose To evaluate the efficacy of emergency transcatheter pelvic
embolization in massive post-partum hemorrhage (PPH).
Methods Between 1996 and 2009, 21 patients presented with massive
PPH had emergency pelvic embolizations performed within 24 hours of
presentation. The specific artery embolized, the duration of the procedure,
the embolization technique, the complications and the outcome were
retrospectively reviewed.
Results 26 embolizations were performed in 21 patients and technically
successful. 5 patients had 2 embolizations: 4 re-embolizations were done
within 24 hours and 1 re-embolization was done 16 months after 1st
embolization due to PPH in her second pregnancy. Age ranged 28 - 44
years (mean = 33.4). The amount of bleeding ranged from 1200 - 5000
ml (mean = 2900, n=13). Gelfoam pledgets were used in all occasions.
Embolization of the both uterine arteries was performed in 5 procedures,
both internal iliac arteries (IIA) in 13 procedures, the anterior division
of both IIAs in 3 procedures, the IIA and anterior division of IIA in 2
procedures, the IIA and uterine artery in 3 procedures. The duration of
the procedure including re-embolization ranged from 15 to 120 minutes
(mean = 66.8 minutes). 5 French catheters, Cobra 1 in 25 occasions and
RC 1 in 1 occasion were used. No pelvic abscess or procedure related
complication was noted. 1 patient required subsequent hysterectomy
and 1 required subtotal hysterectomy and right salpingo-oophorectomy. 1
patient became pregnant 1 year after embolization but sought for abortion
for social reasons. Another patient gave birth to a full term baby 16 months
after embolization.
Conclusions Emergency pelvic embolization is a safe and an effective
life saving measure to treat massive PPH. This procedure will not only
prevent hysterectomy, but also allowing the possibility of future pregnancy.
Embolization using gelfoam pledgets alone is often sufficient to control
hemorrhage.
Keywords Embolization
IR045
Pilot Study of Transcatheter Arterial Chemoembolization
during Portal Vein Occlusion for Unresectable Hepatocellular
Carcinoma with Marked Arterioportal Shunts
Fumie Sugihara¹, Satoru Murata¹, Fumio Uchiyama¹, Jun
Watari², Hiroyuki Tajima¹, Shinichiro Kumita¹
¹Department of Radiology, Nippon Medical School, Japan
²Department of Radiology, Ebina General Hospital, Japan
Purpose To assess the clinical effects of transcatheter arterial
chemoembolization (TACE) during the corresponding portal vein occlusion
(TACE-PVO) in patients with hepatocellular carcinoma (HCC) and marked
arterioportal shunts (AP shunts).
Methods This was a pilot study of TACE-PVO in patients with HCC who
had marked AP shunts. The subjects were 16 patients with unresectable
HCC and marked AP shunts who underwent shunt embolization with the
use of coils and/or gelatin-sponge particles (group A: n = 7) or by TACEPVO (group B: n = 9). Written informed consent was obtained and the
study was approved by the hospital IRB. Clinical parameters and data
on embolization of AP shunts and on tumor response were assessed
prospectively. Our primary aim was to assess the safety and efficacy of
TACE-PVO in patients with unresectable HCC and marked AP shunts.
Results No major procedure-related complication occurred in either
group. Effectiveness for AP-shunt treatment was significantly better in
group B than in group A in terms of both immediate results (P = 0.009) and
subsequent results (P = 0.028). Tumor response in the therapeutic target
area was significantly (P = 0.002) better in group B than in group A. The
1- and 2-year survival rates in group A were 28.6 % and 0 %, respectively,
whereas the 1-, 2-, and 3-year survival rates in group B were 88.9 %, 66.7
%, and 44.4 %, respectively. Survival was significantly (P = 0.008) better
in group B than in group A.
Conclusions TACE-PVO may be a safe and useful therapy for selected
patients with unresectable HCC and marked AP shunts.
Keywords Angiography, Liver,Chemoembolization, Interventional
IR027
Comparative Study of 5 Year Survival between Surgical
Resection and Transarterial Chemoembolization of
Hepatocellular Carcinoma in Buddihist Tzu Chi General
Hospital , Hualien Medical Center
Andy Shau-Bin Chou¹, Hsin-Wen Huang1, Kuo-Hsien Chiang1,
Pau-Nyen Chong2, Cheng-Hui Chiu1, Chang-Ming Ling1, ChauChin Lee1
1
Department of Radiology, Visiting Supervisor, Taiwan
2
Department of Radiology, Division Chief , Taiwan
Purpose To compare the survival of hepatocellular carcinoma (HCC)
patient in a size year period between surgical resection and transarterial
chemoembolization in a single medical center in eastern Taiwan.
Methods From the year 2002 to 2007, there were 777 HCC patients
enrolled in this study. There are 578 male and 199 female patients with
age range from 5 to 103 years old, mean of 62.16 years old. The patients
were classified according to TNM staging system with 1 to 5 years survival
rate for surgical resection and TACE.
Results Total of 146 patients underwent surgery with overall survival of
77.7, 70.2%, 62.65%, 57%, and 57% from one to five years. Total of 215
patients underwent TACE with overall survival of 38.7%, 23.8%, 18.3%,
135, and 11.5% from one to five years.
Conclusions Surgical resection has better one to five years survival rate
than TACE with a lower stage in surgical treated patients and high stage
in TACE patients.
IR034
Biplane Fluoroscopy-Guided Radiofrequency Ablation
Combined with Chemoembolization for Hepatocellular
Carcinoma: Initial Experience
Young Jun Kim², Min Woo Lee1 , Sang Woo Park2, Nam C Yu3
1
Department of Radiology "Samsung Medican Center,
Sungkyunkwan University School of Medicine", Korea
2
Department of Radiology "Konkuk University Hospital, Konkuk
University School of Medicine", Korea
3
Department of Radiology "University of California Los Angeles,
David Geffen School of Medicine", United States
Purpose The purpose of our study was to assess the technical
feasibility and local efficacy of biplane fluoroscopy-guided percutaneous
radiofrequency (RF) ablation combined with transcatheter arterial
chemoembolization (TACE) for HCC ≥2 cm.
Methods From April 2006 to January 2008, RF ablation combined with
TACE was performed for the patients with HCC who met the following
inclusion criteria: 1) three or less HCC with a diameter ranged from 2
cm to 5 cm; 2) Child-Pugh class A or B; 3) absence of vascular invasion
or extrahepatic metastases. Shortly (median; 2 days) after segmental
TACE, percutaneous RF ablation was performed with guidance of biplane
fluoroscopy if the index tumor was visible on the both anterioposterior
and lateral fluoroscopy projections secondary to retained iodized oil. If the
tumor was not clearly demonstrated on fluoroscopic images, US or CT
was used for the procedure. Technical success was defined as presence
of a nonenhancing area surrounding the index tumor with an ablative
margin of 0.5 cm or larger on CT immediately after the procedure. Onemonth follow up CT was used for evaluation of technical effectiveness.
Thereafter, the patients were followed up every 3 months.
Results During the study period, 18 consecutive patients with 19 HCCs
(mean diameter, 2.5 cm) met the inclusion criteria and were included in our
analysis. Ten (53%) nodules were located in the liver dome. After TACE,
18 (95%) of 19 HCCs were clearly visible on biplane fluoroscopy and thus
were ablated with fluoroscopy guidance. After biplane fluoroscopy-guided
single-session RF ablation, both technical success and primary technical
effectiveness were achieved in all 18 cases. No major complications
were observed in our study. No local tumor progression was found during
follow-up period (median 20 months; range 5-30 months).
Conclusions Biplane fluoroscopy-guided RF ablation combined with
TACE is technically feasible and effective for treatment of HCC.
Keywords Ablation Procedures, Liver, Chemoembolization, Fluoroscopy
IR035
Biplane Fluoroscopy-Guided Radiofrequency Ablation
for Hepatocellular Carcinoma Resistant to Transarterial
Chemoembolization: Initial Experience
Min Woo Lee, Dongil Choi, Hyunchul Rhim, Young-sun Kim,
Sung Ki Cho, Sung Wook Shin, Kyo K. Lim, Lim Do
Department of Radiology and Center for Imaging Science,
Samsung Medical Center, Sungkyunkwan University School of
Medicine, Korea
Purpose To assess the technical feasibility and local efficacy of
biplane fluoroscopy-guided percutaneous radiofrequency ablation
(RFA) for hepatocellular carcinoma (HCC) resistant to transarterial
chemoembolization (TACE).
Methods Our prospective study was approved by the institutional review
board and informed consent was obtained from all patients. Twenty two
patients with 23 viable HCCs around retained iodized oil on CT and/or MRI
were enrolled in our study. All patients had history of TACE for HCC (mean
number: 4.8 times, range: 1-12). The size of HCC for total, iodized oil, and
viable HCC was 3.3, 2.7, and 2.0 cm, respectively. The retained iodized
oil around viable HCCs were visible on fluoroscopy in all cases. Instead
of repeated TACE, all patients were treated with biplane fluoroscopyguided RFA with the concurrent use of ultrasound. We evaluated major
complications, rate of technical success at immediate post-RFA CT and
local tumor progression at follow-up CT.
Results Primary technical success was achieved for all 23 viable HCCs.
Major complications were not observed in any patients. During follow-up
period (mean, 6.6 months; range, 1-12 months), local tumor progression
developed only one tumor.
Conclusions Biplane fluoroscopy-guided RFA is technically feasible and
effective for HCC resistant to TACE.
Keywords Ablation Procedures
IR053
Radiofrequency Ablation in the Treatment of Medium to
Large Hepatocellular Carcinomas by Using Switch-Control
System: Short-Term Result and Analysis
Chia-Bang Chen, Yi-You Chiou, Yi-Hong Chou, Cheng-Yen
Chang, Jen-Huey Chiang, Cheng-Yen Chang
Department of Radiology, Taipei Veteran General Hospital,
Taiwan
Purpose Evaluate the short term result of RFA in the treatment of medium
to large hepatocellular carcinomas by using switch-control system with
multiple probes.
Methods Eleven patients with a HCC larger than 3 cm in diameter were
treated with RFA using multiple- electrode system and an impendancebased “Switch control" system. Follow-up CT or MRI was reviewed for
evaluating tumor necrosis, tumor recurrence, and new metastasis
Results Five of these 11 patients received 2 times of RFA in the course, and
6 received RFA once. Because of the large tumor size, 10 of the 11 tumors
are located in the “Risk location”, including adjacent to the diaphragm (4
patients), portal veins (2 patients), ascending colon (2 patients), gallbladder
(1 patient) and stomach (1 patient). The average total ablation time was 26
minutes, and the average post- RFA temperature was 55.9 degrees. Viable
tumors were found in patients with larger tumor (5.3 vs 4.2 cm) or lower
post-RFA tip temperature (51.3 vs 57 degrees)
Conclusions Multiple electrode radiofrequency ablation is a safe and
effective method for local control in medium to large hepatic malignancies
at short-term follow-up. In patients with larger tumor size or lower post-
487
HN024
Neuroendocrine Carcinoma of the Head and Neck: CT, MR
Imaging, and PET/CT Findings
Hyung-Jin Kim, Ji Hye Min, Eunhee Kim, Sung Tae Kim
D e p a r t m e n t o f R a d i o l o g y, S a m s u n g M e d i c a l C e n t e r,
Sungkyunkwan University School of Medicine, Korea
Vincent K P Fung, John K W Chan, Alex S L Lee, K K Tang
Department of Radiology Pamela Youde Nethersole Hospital,
China
E-Poster
Purpose The purpose of this study is to evaluate the usefulness of
diffusion-weighted imaging (DWI) and PET/CT in characterization of lymph
nodes in head and neck cancer patients.
Methods We enrolled 17 patients with oral cavity cancer and total 51
lymph node levels were examined with fast spin echo T2-weighted images
in axial planes and DWI-MRI at 1.5T (b-values of 0 and 800 s/mm2) and
and then apparent diffusion coefficient (ADC) maps were reconstructed.
All cases underwent PET/CT and surgical neck lymph node dissection
within 10 days after MRI study. ADC-values and SUVs were compared by
using linear-regression analysis. Diagnostic performance was assessed by
receiver operator characteristic (ROC) analysis using pathological results.
Results The ADC value of 26 malignant lesions was statistically lower
than that of 25 benign lesions for mean ADC-value (0.79±0.20 vs.
1.26±0.30 x 10-3 mm2/s, P <0.01). In ROC curve, the threshold value was
1.12 *10-3 mm2/s (b = 800). There was no statistical correlation between
ADC value or SUV with cell differentiation.
Conclusions DWI enables us to discriminate between benign and
malignant neck lymph nodes in oral cavity cancer patients with a
diagnostic accuracy superior to size criteria. Our data suggest that DWI
could have prognostic importance and possibly influence the management
of the patient.
Keywords Metastases, MR, Tongue
Others
2010.03.22
Purpose To retrospectively evaluate the relationship bwtween postablation margins and local tumor progression following radiofrequency
ablation (RFA) of hepatic metastases.
Methods Between November 2003 and July 2009, 54 patients (27 men
and 27 women) with 69 hepatic metastases (size range, 1.0-6.3 cm; mean,
2.5 cm ± 1.21) underwent ultrasound (US) or computed tomography (CT)guided percutaneous RFA. Post-ablation margins were calculated on onemonth follow-up contrast-enhanced CT or magnetic resonance imaging
(MRI) studies. Efficacy was evaluated at one-month post ablation, then at
3-month intervals for the first year and biannually thereafter.
Results The results of the Fisher's exact test showed that the threshold
post-ablation margin of 0.5 cm (P = 0.185) and 2.5 cm (P = 1.000) did not
significantly correlate with local contral for hepatic metastases. The results
of the Fisher's exact test also showed that the threshold tumor size of 2
cm (P = 0.535) and 6 cm (P = 0.198) did not significantly correlate with
local contral for hepatic metastases.
Conclusions The size of post-ablation margin up to 2.5cm dose not
influence the rate of local tumor progression for percutaneous RFA of
hepatic metastases.
Keywords Ablation Procedures, Liver, Metastases
IR003
Comparison of Concurrent Chemo-Radiation Therapy and
Hepatic Arterial Infusion Chemotherapy in Patients with
Portal Vein Thrombosis Related to Hepatocellular Carcinoma
See Hyung Kim, Young Whan Kim
Department of Interventional Radiology, Keimyung University
Dongsan Hospital, Korea
Purpose We compared retrospectively therapeutic efficacy and safety of
concurrent chemoradiation therapy (CCRT) and hepatic arterial infusion
chemotherapy (HAIC) in patients with portal vein thrombosis (PVT) related
to hepatocellular carcinoma (HCC).
Methods Between January 2004 and May 2009, 41 patients (male: 34,
Female: 7, mean age: 58) with PVT related to HCC were enrolled in this
study. CCRT group (n=20) was performed with a total of 4500 cGy over 5
weeks followed by 2 cycles of HAIC. In HAIC group (n=21), 5-Fu, Cisplatin
and Leukovorin were administered consecutively 5 days every 3 weeks.
CT was performed after 2 cycles of HAIC and concurrent radiotherapy to
evaluated therapeutic efficacy. Data regarding to tumor response, survival
and complication were analyzed by Fischer exact test and Kaplan-Meier
method with log rank test for inter-group comparision
Results Mean follow-up period was 176 days in CCRT group and 161
days in HAIC group. There was no statistical difference in age, causes
of liver cirrhosis, Child-Pugh score, AFP level and tumor stage between
each group. The CCRT group achieved better response rate (disease
progression: 15%, partial response: 60%, stable disease: 25%) than the
HAIC group (disease progression: 47.6%, partial response: 28.6%, stable
disease: 23.8%) Difference between both values is significant at p value
of 0.025. Six months survival rate were 44.8% in CCRT group, and 33.3%
in HAIC group. (p=0.082). Otherwise there were no significant differences
between the other criteria evaluated in both groups.
Conclusions Even though CCRT achieved better tumor response rate
than HAIC, it didn’t affect improvement of survival rate in patient with PVT
related to HCC.
Keywords Liver, Radiation Therapy/Oncology
488
Purpose Diabetic Foot is the main reason for amputation and limb loss in
Diabetic patients. The purpose of this study was to evaluate the treatment
outcomes after limb-salvage PTA/S for poor surgical candidate patients
with Type II Diabetes and with Critical Limb Ischemia (CLI).
Methods We analyzed retrospectively results of 31consecutive high
surgical risk patients with CLI treated with PTA/Stent. All patients had
occlusion of previous bypass graft and were considered poor candidates
for a new bypass operation. Pre-procedural and post-procedural anklebrachial index (ABI), TcPO2 and TcPCO2 were measured. Color-DopplerUS, MR angiography, and MsCT angiography were performed to define
the location of lesions and to plan the revascularization strategy. Ulcers
were photographically recorded for core laboratory assessment. Post
procedure follow-up was scheduled 1, 3, 6 months and yearly thereafter.
The cumulative primary assisted patency was calculated by Kaplan-Meyer
analysis. The data’s were analyzed with the Student t test; significant
difference was assumed for p<0.05.
Results Technical success was achieved in 30 (93.7%) of 32 limbs. Preprocedural level of TcPO2 was 13.8 ± 6 mmHg; in patients with technical
success this parameter was increased up to 52.4 ± 0.22 (p<0.001).
Preprocedural mean of TcPCO2 was 71.2 ± 27 mmHg, but postprocedural
mean, after first week, was decreased significantly. (p<0.001) The ABI
improved to 0.86 ± 0.18 (p<0.001 versus pretreatment). The cumulative
primary assisted patency calculated by Kaplan-Meyer analysis was
92% and 88%, respectively, at 12 and 24 months. The limb salvage rate
approached 90% at 30 months.
Conclusions Limb-salvage angioplasty can be successfully achieved
in diabetic patients with CLI with optimal results. Our opinion is that
successful recanalization of the arterial tract previously considered
unsuitable for endovascular approach is allowed by improved competency
and experience of vascular specialists, as well as the advances made in
catheter and guidewire technology.
Keywords Angioplasty, Obstruction/Occlusion, Interventional
iliac artery. No procedural related complications occurred. The mean
post operative stay was 15.4 days (range 7 - 32 days). At a mean followup of 572 days (range 8 - 2519 days), no late rapture and SG-related
complications occurred. Three patients (16.7%) complained of buttock
claudication, however it diminished at follow up state. The aneurismal
diameter was decreased in 13 cases (65%), had no change in six cases
(30%) and was increased in one case (5.6%).
Conclusions Endovascular SG placement for isolated IAAs repair is a safe
and effective treatment. It can be offered as a first-line treatment of isolated
IAAs, however further studies with long-term follow-up will be necessary.
Keywords Aneurysms, Stents, Interventional
IR023
Endovascular Stent Grafts in the Treatment of Traumatic
Aortic Injuries
Kook Seon Kim, Dae Hyun Hwang, Young Hwan Ko, Mi Nyong
Choi, Jun Young Jeon, Yu Mi Han
Department of Radiology, Hangang Sacred Heart Hospital,
Hallym University, Korea
Purpose To demonstrate the feasibility and safety of endovascular stentgraft placement for treatment of traumatic aortic injury.
Methods Three patients with traumatic aortic injury were treated with
endovascular stent-grafts. One patient had exposured to dissel explosion
in front of face. He presented with massive hematemesis after surgery for
esophageal rupture. Angiography demonstrated aorto-esophageal fistula.
Another patient with abdominal aortic pseudoaneurysm, fell down from
forth floor for suicide. He had multiple trauma in spine and calcaneus.
The pseudoaneurysm was detected incidentally during the surgery and
refered to our department. The last one had multiple trauma by pedestrian
traffic accident. Pseudoaneurysm was observed at abdominal aorta in
abdominal CT scan.
Results Stent-graft (Seal, S&G cooperation) placement and thrombosis
of the aneurysmal sac were successful in all patients. There is no
complication during the procedure. Endovascular suture device (Perclose
Proglide, Abbott) was used in all patients. Mean procedural time was one
hour forty minutes. There was no endoleak on CT scan during follow-up
periods (mean 4.3months) in all patients.
Conclusions Transluminal placement of endovascular stent-grafts is
a technically feasible method for treatment of traumatic thoracic aortic
aneurysm and may be an effective alternative to open-chest surgery.
Keywords Aneurysms, Stents, Grafts, Trauma, Interventional
IR016
Stent-Graft Placement for Isolated Iliac Artery Aneurysms
Masato Yamaguchi, Koji Sugimoto, Takuya Okada, Kenta Izaki,
Kensuke Uotani, Kazuro Sugimura
Department of Radiology/Center for Endovascular therapy, Kobe
University Hospital, Japan
IR026
Endovascular Treatment of Peripheral Vascular Disease
Andy Shau-Bin Chou¹, Hsin-Wenm Huang1, Kuo-Hsien Chiang1,
Pau-Nyen Chong2, Kuo-Hsien Chiang1, Chang-Ming Ling1, ChauChin Lee1
1
Department of Radiology, Visiting supervisor, Taiwan
2
Department of Radiology, Division chief, Taiwan
Purpose The purpose of this study is to evaluate the safety, efficacy
and midterm result of stent-graft (SG) placement for isolated iliac artery
aneurysms (IAAs).
Methods SG placement for repair of 20 IAAs was performed in 18
patients (14 male, mean ages 75.0 ± 6.1 years) from September 2002
to August 2009. Six patients (33%) had previous open abdominal aortic
aneurysm repair. In three symptomatic cases (16.7%), procedures were
carried out under emergency. The mean aneurismal diameter was 41.5
± 12.0 mm. After embolization of the proximal portion of internal iliac
artery (IIA), SGs were placed in nine aneurysms, located in common iliac
artery (CIA). However, in one case there was no proximal landing zone,
therefore, bifurcated aorto-iliac SG was placed. Eleven SGs were placed
(seven in IIA and three in IIA and CIA aneurysm) after embolization of IIA
distal branches. The mean SG diameter was 14.0 ± 3.3 mm (Ten SGs
were taper type) and the mean length was 83.7 ± 20.8 mm.
Results The technical success was 95% (19/20 procedures). In one case,
insertion of SG delivery system was unsuccessful because of tortuous
Purpose To evaluate the usefulness of endovascular treatment
[percutaneous balloon angioplasty (PTA) and endovascular stent] in
treatment of peripheral vascular disease.
Methods From 2002 to present, 11 male and 4 female with ago ranged
from 49 to 87 years old with mean ago of 68.73 years old were enrolled in
this study. There were 10 aortoiliac, 7 femoropopliteal, 1 femorotibial, and 3
combined lesions in those patients. Six PTA were done on 4 femoropopliteal,
1 popliteal tibial, and 2 aortoiliac lesions. Nine PTA combined stenting
were done on 6 aortoiliac, 2, aortoiliac combined femoropopliteal, and 1
femoropopliteal lesions. Two stentings were done after PTA.
Results The technical successful rate was 100%, the clinical successful
rate were 14/15 (93.3%). Only 3/15 (20%) had one-year follow-up studies.
No repeat endovascular treatment or surgical intervention was done on
the same lesions. Patient had no procedure related complications.
Conclusions PTA and stenting may be an alternative method for high
surgical mortality and mobility PAOD patient with a fair patency rate.
Keywords Angioplasty
IR024
The Effect of Frequency and Amount of Ligation in EVL
on the Survival of Patients Receiving TIPS Procedure for
Gastroesophageal Variceal Hemorrhage
Wen-Sheng Tzeng
Department of Medical Imaging, Chi-Mei Medical Center, Taiwan
Purpose To evaluate if there is correlation between the condition of
endoscopic variceal ligation (EVL) and the survival of patients receiving
transjugular intrahepatic portosystemic shunt (TIPS) for gastroesophageal
variceal hemorrhage (GEVH).
Methods This study is a retrospective cohort study. From August 1,
2003 to July 31, 2008, 86 consecutive patients who had received
TIPS procedure for GEVH were enrolled in this study. Retrospective
review of the medical records of all of the patients was performed and
the clinical data were collected, including type and severity of varix,
Child-Pugh scores before and after TIPS, INR before TIPS, the initial
time of diagnosis, the frequency and numbers of EVL, frequency of
panendoscopy, the survival time from initial diagnosis of varix and TIPS.
The frequency of TIPS and amount of ligation of varix at each session
were also recorded.
Results Seventeen (20.2%) patients did not received EVL and 67 (79.8%)
patients received EVL at least once before TIPS. The average follow-up
time was 2.12 ± 2.1 years (0-9.09 years). Kaplan-Meier survival analysis
showed that the survival of the patient group who received EVL 0 to 2
times before TIPS was longer than the other groups (p=0.026). In the
overall treatment period (from initial diagnosis to death), the numbers of
EVL significantly affect the patient's survival time (p=0.022). The patient
group with Child-Pugh scores ≤8 and INR ≤2.0 had the survival time
longer than another groups (p=0.013, and p<0.001) after receiving TIPS.
Conclusions The numbers of EVL before TIPS significantly affect the
survival of patients with GEVH. Earlier TIPS (EVL = 0) or aggressive EVL
treatment (EVL >7) may improve the patient’s survival.
Keywords Liver, Cirrhosis, Hemorrhage, Varices, Interventional
IR013
Factors Affecting Longevity of Tunneled Central Venous
Catheters
Jongmin Lee, Ji-Won Park, Yoo_Jin Lee, Sang-Yeob Lee, Hui
Joong Lee
Department of Radiology, Kyungpook National University
Hospital, Korea
Purpose To evaluate factors which affect the longevity of tunneled central
venous catheters (T-CVCs)
Methods A retrospective study was conducted on 410 T-CVCs that had
been inserted into patients in our institute between March 2003 and
August 2008. We evaluated the relevant factors affecting the longevity
of the T-CVCs, such as age, gender, indication for catheterization, site
of entry vessel, diameter and type of T-CVC, catheter tip position, and
underlying diseases. Statistical analysis was performed using Cox
proportional hazards.
Results Of the 410 T-CVCs which had been inserted, 372 (90%) were
placed through the right internal jugular vein (RIJV) and 38 (9%) were
placed through the left internal jugular vein (LIJV). The vessel through
which the T-CVC was placed was the most significant predictor of
increased longevity of the T-CVC; the RIJV was associated with better
results than the LIJV (P = 0.001; RR = 0.161; 95% CI, 0.080-0.325). The
catheter tip position influenced the longevity of the T-CVC. The short limb
of the catheter tip placed either at the SVC-right atrium junction (SA jx.)
or below the lower margin of the right main bronchus (RMB) had a good
prognosis (P = 0.000; 95% CI). Also, male gender and a dual lumen with a
split-type catheter were associated with better results (gender: P = 0.000;
RR =0.497; 95% CI, 0.260-0.947; catheter type: P = 0.000; RR = 2.215;
95% CI, 1.018-4.821).
Conclusions The entry vessel, catheter tip position, catheter type, and
gender were important factors in determining the longevity of T-CVCs. A
larger gauge dual lumen with a split-type T-CVC placed through the RIJV
in which the catheter tip position is at the level of the SA jx. significantly
489
IR015
Radiofrequency Ablation of Hepatic Metastases: Effect of
Post-Ablation Margin on Local Tumor Progression
Chang-Hsien Liu, Chih-Yung Yu, Wei-Chou Chang, Guo-Shu
Huang
IR057
Endovascular Treatment Solution of Diabetic Foot
Erdembileg Tsevegmid1, Roberto Gandini2, Roberto Chiappa2,
Livio Di Vito 2, Luca Boi 2, Massimiliano Di Primio 2, Giovanni
Simonetti2
1
Department of Radiology, Health Sciences University of
Mongolia, Mongolia
2
Department of Diagnostic Imaging, Interventional Radiology,
Molecular Imaging and Radiotherapy, University of Rome Tor
Vergata, Italy
E-Poster
RFA tip temperature, it was more frequent for them to have viable tumors.
Keywords Ablation Procedures, Liver
Others
2010.03.22
Purpose The management of infertility is one of the most difficult tasks for
Gynecologists. But interventional radiologist can help in great extent in the
management by evaluating congenital, endometrial and tubal pathologies
by hysterosalphingography and treatment by fallopian tube recanalisation
in infertile patients.
Methods Hysterosalphingography was carried out during 6 months period
from November 2006 to April 2009 in 100 infertile patients at Radiology
department, GMCH Nagpur. Selective patients with cornual block were
treated by Fallopian tube recanalisation and follow up ultrasound was
carried out to confirm pregnancy.
Results 19 patients had congenital anomalies starting from unicornuate
uterus to uterine didelphys uterus. Endometritis was seen in 14 patients.
Cornual block was seen in 38 patients and successful fallopian tube
recanalisation was done in 28 patients and 9 patients conceived on further
follow up.
Conclusions Hysterosalphingography can diagnose congenital,
endometrial and tubal pathologies and fallopian tube recanalisation can
treat infertility in approximate 24% patients of cornual block.
Keywords Pregnancy, Fluoroscopy, Hysterosalpingography, Interventional
IR043
Stony-Hard Bony Sclerosis after Percutaneous Vertebroplasty
Wen-Chin Hsu, Ting-Chen Lee
Department of Medical Imaging, Tzu Chi Dalin General Hospital,
Taiwan
Purpose To present our experience in 5 cases with stony-hard bony
sclerosis after vertebroplasty.
Methods In the past 3 years and 6 months (from Dec. 2004 to Jun.
2008), percutaneous vertebroplasty with the mixture of PMMA and barium
powder were done in 498 vertebral bodies of 271 cases with osteoporotic
compression fractures. Among them, 5 cases with stony-hard bony
sclerosis in 7 vertebral bodies were included in this study. All are female
with mean age of 74 years old. It occurred in 1 case before second time
repeat vertebroplasty and 4 cases before third time repeat vertebroplasty.
Results It became a difficult and time consuming job in those cases; we
managed to accomplish all the procedures but one vertebral body. The
results are good, either in terms of subjective pain reduction or objective
functional scores improvement. No further posterior vertebral body
collapse occurred during follow up.
Conclusions Stony-hard bony sclerosis can occur after percutaneous
vertebroplasty. It can hinder the process of the operation. But interestingly,
it can potentially lead to a better result than those that bony sclerosis
did not occur by preventing further collapse of the posterior vertebral
body. It is more reasonable to consider it as a post operative change
rather than complication. It can make repeat vertebroplasty fail if samelevel compression fracture or loosening of the previously injected
cement occurs. The mechanism are unknown, it may relate to the high
temperature released during polymerization of the cement mixture or
relate to the toxic effect of chemical solvent used in the procedure.
However, through some unknown reason it can rapidly strengthens the
posterior vertebral body even in a very soft osteoporotic bone.
Keywords Spine, Vertebroplasty, Interventional
IR047
Alternating Unilateral Transpedicular Puncture Used in
Percutaneous Vertebroplasty for Multiple Osteoporotic
490
Leo Leung-Chit Tsang , Hsin-You Ou
Department of Diagnostic Radiology, Chang Gung Memorial
Hospital-Kaohsiung Medical Center, and Chang Gung University
College of Medicine, Taiwan
Purpose To present our experience in 10 cases using alternating
unilateral transpedicular puncture in percutaneous vertebroplasty for
treating multiple osteoporotic spinal compression fractures.
Methods In the past 4 years and 6 months (from Dec. 2004 to Jun.
2009), percutaneous vertebroplasty with the mixture of PMMA and barium
powder were done in 567 vertebral bodies of 314 cases with osteoporotic
compression fractures. Among them, 10 cases with multi-level (4 or above)
painful fractures were included in this study. All but one was female with
mean age of 77 years old. In them, alternating unilateral transpedicular
puncture in percutaneous vertebroplasty for multiple osteoporotic spinal
compression fractures were used. Totally, they were 9 sessions for 4-level
puncture, 2 sessions for 5-level puncture, 1 session for 7-level puncture
and 1 session for 8-level puncture. One patient received 2 sessions
of operation and another received 3 sessions of operation. They were
later followed in our outpatient clinic after operation. Subjective pain and
objective functional statue were recorded if possible.
Results This method has been successfully used in all of the 10 cases.
No evident procedure related complication was found. They all recovered
well with satisfactory pain and functional status improvement.
Conclusions This method is feasible and can be performed safely for
victims with painful multi-level osteoporotic spinal compression fractures.
Keywords Vertebroplasty, Interventional
Purpose Splenic artery ligation is one of the modality for modulation of
portal graft inflow in adult living-donor liver transplantation (ALDLT). In
this study, we investigated the contribution of splenic artery ligation in
preventing small-for-size syndrome (SFSS).
Methods From Dec. 1993 to Dec 2007, 340 LDLT were performed
at the Chang Gung Memorial Hospital - Kaohsiung Medical Center,
Taiwan. Of these recipients, 5 adult recipients with high portal inflow
and post intra-operaion splenic artery ligation and another 87 recipients
with pre-operative splenomegaly and without splenic artery modulation
received right lobe liver graft were included for analysis. We conducted a
retrospective analysis of the clinical issues and image results of Doppler
ultrasound and CT.
Results Among the 5 patients who underwent splenic artery ligation, no
one developed SFSS. The high portal flow (375±97 ml/min/100gmGW)
decreased to normal range (176±76 ml/min/100gmGW) splenic artery
ligation (p=0.0022). The splenic size decreased ratio is 36%±13.6%
(p=0.0132) and showed no difference compared with the control group
(p=0.89). No splenic infarction or other complication was noted after
splenic artery ligation.
Conclusions Patients who underwent splenic artery ligation alone
showed markedly decreased portal inflow and splenic size without
splenic infarction or other major complication. There is no difference in
their splenic volume shrinkage when compared with standard recipients
.Intra-operation splenic artery ligation is one of effective choice on portal
hyperperfusion in preventing SFSS in ALDLT.
Keywords Intraoperative, Liver, Spleen, Transplantation
IR049
Preclinical Experimental Study of Retrograde Outflow
Isolated Hepatic Perfusion with Interventional Approach
Satoru Murata, Shiro Onozawa, Takahiko Mine, Tatsuo Ueda,
Hiroyuki Tajima, Shin-ichiro Kumita, Tatsuo Kumazaki
Purpose Isolated hepatic perfusion (IHP) for liver tumors has reported
promising results. However, it has not been used as a therapeutic strategy
because it requires aggressive surgical intervention and can be performed
only once. Establishment of safety and repeatable IHP therapy may be
significant and useful for management of liver tumors. The aim of this
study was to establish a safety percutaneous IHP with interventional
radiology techniques.
Methods Eight male pigs were used. We performed a retrograde outflow
IHP with a double balloon blocking outflow into the inferior vena cava
(IVC) and allowing outflow via the portal vein. Blood with cisplatin (2.5
mg/kg) in the extracorporeal circuit was circulated in the liver with rotary
pumps under isolation with balloon catheters. The period of IHP therapy
was fixed at 30 min. The maximum platinum concentration (C-max)
and concentration-time curve (AUC) were measured, and organs were
removed for histopathologic evaluation.
Results (1) Isolated hepatic angiography confirmed that contrast media flew
into the portal veins, and the hepatic veins and IVC were not opacified in
all 8 pigs. (2) Hepatic C-max (86.8 mg/L) was 54-fold higher than systemic
C-max (1.6 mg/L), and hepatic AUC (1307.8 min mg/L) was 27-fold greater
than systemic AUC (47.7 min mg/L). (3) Histopathologic examinations
showed neither ischemic changes nor other abnormal findings in the organs
which were the liver, duodenum, small intestine and colon.
Conclusions Repeatable percutaneous IHP therapy with only
interventional radiology techniques may be realize, safety and useful for
management of liver tumors.
Keywords Angiography, Animal Investigations, Liver, Interventional
IR029
Images Analysis for Post Intra-Operation Splenic Artery
Ligation on Portal Hyperperfusion in Adult Living Donor
Liver Transplantation
Chun-Yen Yu, Yu-fan Cheng, Tung-Liang Huang ,Tai-Yi Chen,
Neuroradiology (NR)
NR036
Mimics of Imaging Findings in Abnormal Limbic System.
Could We Find an Expeditious Way for Imaging Differentiation?
Shy-Chyi Chin¹, Rou-Shayn Chen²
¹Department of Medical Imaging and Intervention, Chang-Gung
Medical Center at Linko, Taiwan
²Department of Neurology, Chang-Gung Medical Center at Linko,
Taiwan
Purpose To get acquainted with manifold clinical entities including herpes
encephalitis (HSE) and limbic encephalitis (LE) that involve limbic system
and find a useful imaging approaching method for differentiation and thus
make correct impression as possible.
Methods A retrospective survey of the hospital record in the past 10
years for the discharge diagnosis being herpes encephalitis and limbic
encephalitis. The study was proven by local Institutional Review Board.
Results The diagnosis of LE is markedly under-recognized in both clinical
and radiological aspects, whereas HSE is a fairly common and undoubted
impression once in the presence of petechial hemorrhage. The anatomical
proximity of subfrontal orbital cortex to the insular gyrus can be used as
a clue to distinguish HSE from LE or other metabolic entities like Behcet
Disease.
Conclusions The treatment and prognosis of HSE and LE are totally
different, for which the precise pretreatment diagnosis is of great value to
pursue. We concluded that our result can facilitate this goal.
Keywords MR
NR038
Age and Gender Related Effect on White Matter Integrity and
Coherence as Reflected in Diffusion Tensor Imaging
Huang Hsiao Hsuan1, Jung-Lung Hsu 2, Jiun-Jie Wang 1, Yau-Yau
Wai 3, Yung-Liang Wan 3, Jiann-Der Lee 4
1
Department of Radiology, Chang Gung University, Taiwan
2
Department of Neurology, Shin Kong Wu Ho-Su Memorial
Hospital, Taiwan
3
Department of Radiology, Chang Gung Memorial Hospital,
Taiwan
4
Department of Electrical Engineering, Chang Gung University,
Taiwan
Purpose To investigate the age induced decline and the gender related
difference in the neuron fiber integrity and coherence using diffusion
tensor imaging (DTI).
Methods DTI were obtained from 263 health participants, aged between
32–73 years (155 males and 108 females) using a 3T MR scanner. The
imaging parameters are TR/TE = 7600/82 ms, b-value=1000 s/mm2
in 12 non-collinear directions using whole brain coverage. Diffusion
anisotropy indices were calculated, including Fractional Anisotropy (FA)
and InterVoxel Diffusion Coherence (IVDC). FA is a standard clinical
index to measure the diffusion anisotropy within a voxel of interest.
IVDC is a new index, which measures the directional coherence among
a group of voxels. Voxel-based analysis was performed using the
statistical nonparametric mapping package (SnPM ) which assessed for
the significance using a standard nonparametric multiple comparison
procedure based on randomisation testing. Age and gender related white
matter changes were identified using two-sample t-test with age as a
covariate. Significance was reached at a threshold of p<0.005.
Results FA was negatively correlated with age in precentral, cingulate, and
anterior temporal WM areas. IVDC was positively correlated with age in
hippocampal gyrus, lateral ventrial, cingulate, thalamus, subcallosal area,
fornix and anterior temporal WM areas. The regional analysis showed
that the both FA and IVDC in the temporal and occipital regions were not
correlated with age. A significantly lower FA and higher IVDC in the right
deep temporal regions were noticed in females, when compared to males.
Conclusions The current study suggests that age related changes in WM
organization, such as neuron integrity and directional coherence, can be
successfully detected by DTI. Gender induced difference in local regions
of interest indicated a sexual dimorphism in the diffusion characteristic of
brain white matter.
Keywords MR, Statistics
NR071
Assessment of Brain Parenchyma Damage in Neonates with
Hypoxic Ischemic Injury Using Quantitative Diffusion Tensor
MR Imaging
Xiangyu Zhu
Department of MR, MR, China
Purpose To determine the altered pattern of FA and ADC change in in
serially studied neonates with mild, moderate or severe hypoxic ischemic
injury (HIE).
Methods The study included 20 normal babies as age/sex-matched
control and 20 babies (32 term neonates) who were diagnosed with mild
(n = 8), moderate (n = 7) and severe (n = 5) HIE within 7 days after birth
and again at the age of three month with conventional and serial diffusion
tensor cerebral MR imaging. Neurodevelopmental outcome was assessed
at the time of the 2nd study.
Results On comparing FA and ADC changes over time using twoway analysis of variance between neonates with HIE and controls, we
observed significant differences in age-related FA increase (p <0.05)
in anterior limb of internal capsule and periventricular white matter of
parietal, occipital, and temporal lobes. Significant differences in agerelated ADC decrease (p <0.05) was observed in the caudate nuclei, and
temporal white matter among these groups. Significant positive correlation
was observed between neurodevelopmental outcome and FA. There
was significant difference between conventional MR imaging and DTI in
detecting sequelae at the end of three month.
Conclusions The results suggest that abnormal FA and ADC values help in
early and more accurate assessment of microstructural damage in HIE that
may have predictive value for long-term neurofunctional outcome in these
neonates.DTI is superior to other imaging modalities in detecting sequelae.
Keywords MR, Brain/Brain Stem
491
IR004
Evaluation of Congenital, Endometrial and Tubal Pathologies
by Hysterosalphingography and Treatment by Fallopian
Tube Recanalisation in Infertile Patients
Kishor B Taori, Jawahar Rathod, Nischal G Kundargi
Department of radiology, Governemnt Medical College, India
Spinal Compression Fractures
Wen-Chin Hsu, Ting-Chen Lee
Department of Medical Imaging, Tzu Chi Dalin General Hospital,
Taiwan
E-Poster
increased the longevity of T-CVCs.
Keywords Angiography, Catheters, Heart, Veins, Vena Cava, Interventional
Others
2010.03.22
NR018
The Compared Study of Head DE-CTA and Neuro-DSA
Dan Han
Department of Radiology, the fist affiliated hospital of Kunming
Medical College, China
Purpose To investigate the advantage and disadvantage of dual energy with
dual-source CT in cerebral angiography through compared with Neuro-DSA.
Methods From March, 2008 to January, 2009, 250 patients (146 Males
and 104 Females, ranged from 18 to 82 years old, mean age was 48
years old) enrolled in the First Affiliated Hospital of Kunming Medical
College were performed dual energy scan (Group A, 200 patients) and
Neuro-DSA scan (Group B,50 patients) using DSCT. The patients were
randomly divided into Group A and Group B. The comparison of two scan
approach was based on image quality, radiation does, postprocessing
methods, time of scanning and subtraction and data storage amount.
Results 1. The image qualities of Group A were not significantly different
from Group B’s(P>0.05). In four grades, the number of cases having
Grade I image quality was higher than other three grades. 2. Radiation
does, time consume, data storage were statistically significant different
between Group A and Group B (P<0.05), particularly, The time of
enhanced scan in DE-CTA was longer than Neuro-DSA and the data
storage were larger. However, the radiation does of DE-CTA was lower
than Neuro-DSA’s. the time of whole exam process and subtraction in DECTA were shorter than Neuro-DSA.
Conclusions 1. There were no significant difference of image quality
between DE-CTA and Neuro-DSA. Main cerebral vessels and details can
clearly displayed in DE-CTA and Neuro-DSA. 2. For patient’s benefits, DECTA was recommended due to lower radiation does (about low 26.3%)
employed. Since the shorter time of substraction and once scan enough
in DE-CTA, moving-fake was omitted and the stability of examination was
guaranteed. 3. Multiple postprocessing methods ensured the image of DECTA to be clear, visible, direct, with splendid information for diagnosing.
492
NR049
Anatomical Configuration of the Anterior Cerebral Artery
May Influence the Development of Anterior Communicating
Artery Aneurysms
Yoshiyuki Watanabe1, Akihiko Uemura2, Yuji Numaguchi2, Nobuo
Kobayashi2, Satoshi Honda2, Yukihisa Saida1
1
Department of Radiology, St Luke's International Hospital,
Japan
2
Department of Radiodiagnosis, Care Hospitals, Hyderabad,
India
Purpose The aim of this study was to analyze the relationship between
the anterior cerebral artery (ACA) configuration and development of
aneurysm through evaluation of the configuration of A1 and A2 segment
of ACA in patients with anterior communicating artery (ACOM) aneurysm
and in the age-matched control subjects.
Methods We retrospectively reviewed the radiological reports from
January to December 2008 and selected the patients who were diagnosed
as an ACOM aneurysm and performed MRA or CTA. We selected the age
and sex matched control subjects who underwent the brain MRI screening
study in the same week for patients with ACOM aneurysm. MRA was
performed at 1.5T unit and CTA was examined by 64-slice MDCT. We
classified A1 segment in following three categories; (1) unilateral, (2)
asymmetry with unilateral hypoplasia, (3) no asymmetry. The branch
number of A2 at the origin of ACOM was also counted.
Results A total of 43 patients with ACOM aneurysm were evaluated in
this period. The patients consist of 27 male, 16 female, average of age
66-year-old, and 11 ruptured, 23 unruptured aneurysms. The average size
of aneurysm was 4.7mm (2.0mm-10.0mm). The configuration of A1 was
classified as (1)=12, (2)=21, (3)=10 for aneurysm patients, (1)=6, (2)=11,
(3)=26 for control subjects. Hypoplasia of A1 was seen with significantly
high prevalence in aneurysm patients compared to the control subjects
(p<0.005, Mann-Whitney U test). The branch number of A2 segment
was not significantly different between aneurysm patients and control
subjects (2 branchs: 35pts, 3 branchs:8pts for both groups). There was
no significant difference between ruptured aneurysm and unruptured
aneurysm with regard to the configuration of A1.
Conclusions There was significantly high prevalence of A1 hypoplasia in
patients with ACOM aneurysms. A1 hypoplasia might be a risk factor for
development of ACOM aneurysm.
Keywords Anatomy, Aneurysms, Arteries, Brain/Brain Stem
Others (OT)
OT011
About All the Things You Should Know about Radiation
Dose Reduction for Abdominal CT
Jae Young Byun, Seung Eun Jung, Ho Jong Chun
Department of Radiology, Seoul St. Mary's Hospital, School of
Medicine, The Catholic University of Korea, Korea
Purpose To understand amount of radiation dose for current abdominal
and pelvic CT. To learn how to reduce radiation dose using optimized
protocols. To provide various approaches to reduce radiation dose for
abdominal and pelvic CT exams
Methods We demonstrate how to measure and evaluate CT radiation
dose, current status of radiation dose for abdominal and pelvic CT in
Korea, and strategies for dose reduction in abdominal CT scan, using
tables, graphs, diagram and sample clinical images.
Results CT radiation dose measurement is performed by direct
measurement using phantom and ion chamber or calculation mathematical
phantom. CT dose index (CTDI), dose length product (DLP) and effective
dose are parameters for CT radiation dose evaluation. Data from our
previous study, Mean CTDIvol, total DLP and effective dose were 12.7
mGy, 1227.9mGy*cm and 18.4 mSv, respectively, at abdominal CT. Mean
CTDIvol and DLP values (740.7 mGy*cm) of one phase CT scanning
protocol were below the European diagnostic reference levels. But, Mean
DLP values were increased for two phases of CT scan (non-enhanced CT
scan and enhanced CT; 1146 mGy*cm). There was considerable increase
in the DLP and patient radiation dose for multiphase CT scans, such as
dynamic CT of the liver or kidney. Strategies for dose reduction can be
accomplish by optimization of scan and recon parameters, use of CT
dose modulation techniques, imaging postprocessing, limting multiphases
scans, and Limiting scan length. Nothing is more important than education
for decreasing technologist mistakes and awareness for radiation dose
among physicians and radiologists.
Conclusions The implications for further dose reduction in CT are clear.
It is essential to implement multifaceted approaches of radiation dose
reduction for abdominal and pelvic CT in our radiology practice.
Keywords CT, QA/QC, Radiation Effects
OT009
Salmonella Infections: Spectrum of Imaging Findings
Sudhakar Kundapur Venkatesh, Hind B Alsaif
Diagnostic Radiology, National University Health System,
Singapore
Purpose To describe the spectrum of imaging findings in Salmonella
infections.
Methods Salmonella infection is endemic in the developing countries.
With the advent of new migration patterns, increased intercontinental
travels, development of antibiotic resistance and increased incidence of
AIDS; the disease is resurging in the non endemic areas of the world,
with an increase in unusual manifestations. Depending on the serotype
and host factors, salmonella can disseminate from its primary site, usually
intestine, to virtually anywhere in the body.
Results A spectrum of plain x-ray, ultrasound, and CT and MRI findings in
salmonella infections will be presented. Common and uncommon findings
are described. Typical findings include bowel wall thickening, particularly
terminal ileum, hepatosplenomegaly, mesenteric lymphadenopathy,
ascites, and acalculous cholecystitis. Perforation of intestine and bleeding
can occur. Chest manifestations include lobar pneumonia, pleural effusion
and pyothorax. Uncommon manifestations may be caused by S. Typhi
and S. Paratyphi as well other Salmonella species. These include toxic
megacolon, colorectal abscesses, appendicitis, hepatic and splenic
abscesses, empyema of gall bladder, cholangitis, peritonitis. Polymyositis,
osteomyelitis, arthritis and abscesses in superficial and deep soft tissues
are well demonstrated on MRI. Neurological manifestations present as
meningitis, encephalitis and rarely abscess. Periaortic collection with gas
on CT indicates a mycotic aneurysm and Salmonella have predilection
for involving large vessels. Cystitis, pyelonephritis and genitourinary tract
abscesses may be found on imaging of the genitourinary tract.
Conclusions Knowledge of radiological manifestations of salmonella
infections is important to aid in the early diagnosis and timely initiation of
appropriate management.
Keywords Infection
OT010
Association of Hospital Characteristics and Diagnosis
with Repeat Use of CT and MR Imaging: A Nationwide
Population-Based Study in an Asian Country
Ran-Chou Chen1, Herng-Ching Lin2, Dachen Chu3, Tom Chen1,
Sheng-Tzu Hung3, Nai-Wen Kuo3
1
Department of Radiology, Taipei City Hospital, Taiwan
2
School of Health Care Administration, Taipei Medical University,
Taiwan
3
Department of Neruosurgery, Taipei City Hospital, Taiwan
Purpose The medical imaging industry has grown rapidly in recent years.
Healthcare cost increases are related to high-cost imaging modalities
such as magnetic resonance (MR) imaging, and computed tomography
(CT). Previous research has found that repeat imaging accounts for nearly
one-third of the significant cost associated with radiological examinations.
The purpose was to assess the association of hospital characteristics
and diagnosis with repeated utilization of CT and MR imaging using a
nationwide population-based Taiwan National Health Insurance database
(NHI).
Methods All CT and MR examinations for in-patient, out-patient and
emergency services were identified from 2004-2005 NHI data obtained
from the National Health Research Institute. All scans repeated within 90
days, whether CT, MR or a combination of both, were noted and recorded.
Logistic regression with generalized estimating equations using SAS
package was used for multivariate analysis to explore the relationships
between hospital characteristics, diagnosis and the use of CT and MR
scans repeated within 90 days.
Results A total of 2,189,894 CT and MR scans were performed, 21.10%
of them were repeated within 90 days. Medical centers and not-for-profit
hospitals performed the most scans overall, and the most repeated scans.
Medical centers accounted for 52.4% of total repeat scans. Malignancy,
neurological disorder, and musculoskeletal diseases required the most
absolute number of scans. Scans repeated within 90 days were most
commonly done on patients with malignancies (30.6%), neurological
disorder (20.8%), and brain and spinal injuries (8.1%). All the differences
were statistically significant (P<0.001).
Conclusions Our study shows that repeated use of CT and MR is related
both to diagnosis and to hospital characteristics. This knowledge should
aid review of healthcare policies, so guidelines may be tailored to different
levels of hospitals and different diseases, in order to achieve maximum
efficiency with a limited health care budget.
Keywords MR, CT, Health Policy and Practices
OT016
Preclinical Studies to Investigate the Role of Renal
Impairment in the Pathology of NSF
Martin A Sieber 1, Thomas Steger-Hartmann 2, Maren Hecht 3,
Thomas Frenzel1, Joachim Huetter1, Hubertus Pietsch1, Marian
Raschke1
1
Cardiovascular Imaging and Contrast Media Research, Bayer
Schering Pharma AG, Germany
2
Nonclinica Drug Safety, Bayer Schering Pharma AG, Germany
3
Global Medical Affairs Diagnostic Imaging, Bayer Schering
Pharma AG, Germany
Purpose Nephrogenic systemic fibrosis (NSF) has been observed
in patients with renal disease only. These patients have a reduced
capacity to eliminate gadolinium-based-contrast-agents (GBCAs),
as well as hyperphosphatemia and elevated cytokine levels. The
aims of these preclinical studies were to evaluate the potential role
of hyperphosphatemia and prolonged circulation time of GBCAs in
development of NSF. Furthermore, the potential induction of cytokines by
GBCAs was evaluated.
Methods To evaluate the influence of hyperphosphatemia, Gd release
from marketed GBCAs in human serum with normal and elevated
phosphate levels was evaluated in vitro by HPLC-coupled-MassSpectrometry. To evaluate the influence of reduced GBCA clearance,
renally impaired 5/6 nephrectomized rats were injected with GBCAs. Gd
skin concentrations were measured, and animals were examined for
macroscopic skin lesions. Furthermore, changes in serum cytokine levels
following administration of GBCAs were determined.
Results In vitro, higher phosphate levels caused an increased release
of Gd from linear GBCAs. Nephrectomized rats receiving linear GBCAs
showed higher Gd skin concentrations over time than healthy rats. Both
findings were most pronounced for non-ionic linear GBCAs. No changes
in release of Gd or in Gd concentration were observed with macrocyclic
GBCAs. Nephrectomized rats showed a higher propensity to develop
NSF-like skin lesions after administration of non-ionic linear GBCA. In a
further experiment, NSF-like skin changes were preceded by elevated
levels of cytokines, including MCP-1 and MCP-3.
Conclusions In this in vivo study, a reduced renal elimination of
GBCAs correlated with increased Gd retention in skin, in particular after
administration of non-ionic linear GBCAs. For macrocyclic compounds,
493
Purpose We have developed a sequence named flow-sensitive blackblood (FSBB) that uses dephasing gradients and well depicts fine vessels.
We assessed its value in visualization of the lenticulostriate arteries (LSAs)
in patients with lacunar infarct in their territory.
Methods In 25 patients with lacunar infarct in the basal ganglia and/or
corona radiata, the FSBB scan was performed on a 1.5-T imager using
a 3D gradient-echo sequence with parameters as follows: TR/TE, 35/20
msec; flip angle, 20°; motion probing gradients, b=4 sec/mm2 in three
axes; FOV, 17.9 x 20.5 mm; scanning matrix; 224 x 256; and imaging
slab, 48 mm. The coronal slab was set to include the M1 portion of the
middle cerebral artery. Source images were postprocessed by minimum
intensity projection to generate images with thickness of 5-8 mm. We
assessed the demonstration of the LSAs grouping the patients to one
of following four categories: category 1, LSAs on both sides were well
depicted; category 2, LSAs on the unaffected side were poorly depicted;
category 3, LSAs on the affected side were poorly depicted; and category
4, LSAs on both sides were poorly depicted. In addition, we counted the
number of LSAs and calculated an asymmetry index defined as follows:
(A-N)/(A+N) (A, number of LSAs on the affected side and N, that of LSAs
on the unaffected side).
Results The numbers of patients classified to the four categories were
13/0/5/7 (category 1/2/3/4). The average asymmetry index was -0.16.
Thus the LSAs tended to be poorly depicted on the affected side, but they
were often poorly visualized on both sides.
Conclusions The FSBB sequence can demonstrate abnormalities of the
LSAs related to lacunar infarcts in their territory. Such abnormalities are
often found not only on the affected side but also on the unaffected side.
Keywords Ischemia/Infarction, Arteries, Blood
Keywords Angiography, CT
E-Poster
NR068
Demonstration of the Lenticulostriate Arteries by a FlowSensitive Black-Blood Sequence: Experience in Patients
with Lacunar Infarct in Their Territory
Kazuhiro Tsuchiya
Department of Radiology, Kyorin University, Japan
Others
2010.03.22
PA001
Initial Experience of Coupling De-Paper Engineering and Digital
Signage Broadcasting for a Modern Radiology Department
Tsung Lung Yang, Wei-Chung Chen, Kuen-Huang Chen
Department of Radiology, Kaohsiung Veteran General Hospital,
Taiwan
Purpose To share the initial experience of the results of coupling Depaper Engineering and Digital signage broadcasting to enhance the
patient safety and satisfaction during radiology visit.
Methods A new digital platform is rendered to incorporate the LEDbased service call system, radiology information coupling module as well
as digital signage broadcasting on large-LCD TVs to implement the first
phase of de-papering process for radiology information system.
Results Series of timestamps could be available for online processing
and analysis to provide the associated results of parameters to determine
the objective quality of patient safety and patient satisfaction including
study completion time, study waiting time, technician performance, etc.
Conclusions Being filmless, what's the next step for a modern radiology
department? Paperlessness is no doubt the next milestone to be reached.
Here we present our initial experience of coupling de-paper engineering
and digital signage broadcasting for a modern radiology department.
Some in-depth comparison and analysis of the pre-depapering and postdepapering results regarding influence on daily radiology study workflow
will be discussed and some further advice will be provided.
Keywords PACS
PE003
Bilateral Renal Masses in Children: Clinical, Multidetector
Computed Tomography and Histopathological Characteristics
Yun Peng
Imaging center, Beijing Children’s Hospital, China
Purpose The purpose of this study was to evaluate the potential
diagnostic value of multidetector computed tomography (MDCT) of
bilateral Wilms’ tumor and/or bilateral disease in children using clinical and
histopathological data.
Methods We retrospectively reviewed eight children (6 girls and 2 boys,
ages ranged from 5 to 23 months, mean age 13.6 months) scanned with
MDCT to evaluate bilateral kidney disease. At presentation, all patients
were diagnosed as having stage V disease, bilateral renal Wilms’ Tumor. All
patients underwent surgery and/or biopsy after preoperative chemotherapy.
Results A total of 26 mass-like lesions were detected by an initial MDCT
in these 8 patients, histopathological diagnosis of these mass revealed
14 Wilms’ Tumor, 3 cystic partially differentiated nephroblastoma and
6 nephrogenic rests. Three lesions were not amenable to resection or
biopsy and were only depicted by MDCT.
Conclusions A thorough understanding of bilateral renal disease,
including clinical and histopathological data, is crucial to optimal diagnosis
and management in children. We have shown that MDCT can play a
crucial role in the detection and ongoing management of bilateral renal
masses in the pediatric population.
Keywords Kidney, CT
PE004
Assessment of Cystic Renal Masses in Children: Comparison
of Multislice Computed Tomography and Ultrasound Imaging
494
Purpose To retrospectively compare contrast-enhanced multislice
computed tomography (MSCT) and ultrasound (US) imaging for the
assessment of cystic renal masses in children using the Bosniak
classification system.
Methods Twenty-two consecutive patients (age 1 month to 5.2 years,
mean 2.4 years) with 24 cystic renal masses (7 benign, 17 malignant)
pathologically confirmed after surgical resection underwent both MSCT
and US imaging, and were retrospectively analyzed using the Bosniak
classification. A senior and a junior radiologist retrospectively and
independently reviewed imaging findings. The sensitivity, specificity,
positive predictive value and negative predictive values of MSCT and US
were assessed using diagnostic statistics. The statistical significance of
differences was determined by the McNemar test.
Results Both radiologists accurately predicted lesions of categories I
and IV with the Bosniak classification using MSCT and US. All masses
classified as Bosniak class I and II were proven to be benign, and
all malignant lesions were correctly characterized in all cases both
on ultrasound images and on the contrast-enhanced CT (CECT)
images. Two benign multilocular cystic nephromas and one multicystic
dysplastic kidney were classified into category III or even IV based on
the classification scheme because of their multilocular nature and thick
septation. The diagnostic accuracy of CECT was slightly better than
ultrasound (CECT vs. US: senior reader, 92% vs. 88%; junior reader, 88%
vs. 83%). However, there was no statistically significant difference the two
sets (p>0.05). The two radiologists had perfect inter-observer agreement
on the two modalities.
Conclusions Both MSCT and US provide highly accurate diagnosis
for the malignant renal cystic masses in children using the Bosniak
classification system, but assessment of benign masses still needs
improvement.
Keywords Kidney, CT, Ultrasound
PE008
Evaluation of Image Quality and Radiation Dose of Lowdose Multi-detector Row CT Urography in Children with
Ureteropelvic Junction Stenosis
Yingkun Guo, Fu-min Zhao
Department of Radiology, West China Second University
Hospital, Sichuan University, China
Purpose To date, there is not enough experience in the use of low-dose
multi-detector row CT urography (CTU) in children with ureteropelvic
junction stenosis (UJS). The improvement of CT technology encourages
us to pay more attention to pediatric patients with this new technique. The
aim of this study was to assess the radiation dose and image quality with
CTU for the evaluation of children with UJS.
Methods Thirty children with UJS who underwent CTU were classified
randomly 3 groups (115mA, 100mA and 75mA). Consecutive acquisitions
including weighted-CT-dose index (CTDWI), dose long product (DLP) and
effective mAs were obtained in each patient and compared for each group.
Patient radiation dose was calculated by multiplying dose length product
by conversion coefficient of 0.017. Two experienced chest radiologists
who were unaware of the CT technique reviewed CT images for overall
image quality using a 3-grade scale (excellent, good and worst). The data
were analyzed using a parametric analysis of variance test and Wilcoxon’s
signed rank test.
Results The CTDIw of three groups were 7.63±0.83 mGY, 6.29±0.51
mGY, and 4.72±0.18 Mgy, respectively. Mean CTDIw reduction was 30.2%
when 75mA group compared with 115mA group (p<0.001). The DLP of
three groups were 173.89±29.88 mGY.cm, 145.96±26.21 mGY.cm, and
102.78±12.72 mGY.cm, respectively. The mean radiation dose reduction
was 40.9% (75mA group v.s. 115mA group, p<0.001). The assessment
of image quality showed no significant differences with the same protocol
and post-processing technique (Wilcoxon’s signed rank test, p>0.05).
There was good agreement for image quality scoring between the two
reviewers (Kappa = 0.79).
Conclusions Low-dose CTU should be considered as a promising
technique for the evaluation of children with UJS because it could save
radiation dose and obtain accepted image quality.
Keywords Pelvis, CT, Technical Aspects, Ureters
PE014
The Imaging Features of Infantile Urolithiasis Resulted from
Melamine
Xinyu Yuan, Yang Yang
Purpose To investigate the imaging features of infantile urolithiasis
resulted from Melamine and the diagnostic value of different imaging
examinations.
Methods The imaging data (including Abdominal plain films, Nonenhanced helic CT and Dopplor Ultrasound) of 17 infants with Urolithiasis
caused by melamine (melamine group) were reviewed retrospectively and
were compared with the data of control group comprised of 7 cases with
urinary stones without relation to melamine(non-melamine group).
Results Of the melamine group, 8 cases could be found several stones in
urinary tract. CT attenuation of the stones in melamine group were lower
than those in non-melamine group. In two patients, the amount of stones
were found with CT was more than that with US.
Conclusions Multiple, small size and lower attenuation composed the
imaging feature of melamine-related stone. Non-enhanced helic CT is
more sensitive than US in diagnosing urinary stone.
Keywords Kidney, Ureters, Urethra
PE022
MRI in Evaluation of Sphincter Musculature in Anorectal
Malformation
Abhijit D Pawar, Hariqbal Singh, Sushant Hari Bhadane
Department of Radiology, S.K.N. Medical College, Pune, India
Purpose To assess the role of MRI in evaluation of sphincter musculature
in anorectal malformation (ARM).
Methods A prospective comparative study was conducted at a tertiary
care centre over a period of one year. Thirty five patients of ARM
underwent MRI ( 0.35 T). Out of these, 25 patients had not undergone
any previous repair surgery and were evaluated pre-operatively (Group I).
Ten patients had previously undergone a repair surgery ( posterior sagittal
anorectal plasty- PSARP) and had fecal incontinence (Group II). MRI of
group I patients were analyzed for development of sphincter musculature
and the distance between blind pouch to perineum. In group II patients,
the MRI was evaluated for degree of development of the puborectalis
and external sphincter muscles, levator hammock symmetry and the anorectal angle. MRI findings were compared with surgical findings.
Results In group I, MRI revealed well developed musculature in 15
patients, poorly developed in 9 patients and in one case the muscles were
not identified. In all these cases, the distance between the blind pouch
and perineum could be accurately measured on sagittal images. In group
II, MRI revealed poorly developed puborectalis and external sphincter
muscles in 5 patients, levator hammock asymmetry in 8 patients and
abnormal ano-rectal angle in 7 patients.
Conclusions MRI is an useful tool in the evaluation of sphincter
musculature in pre and post-operative cases of ARM
Keywords Pelvis, Rectum
PE015
Differentiation between Hirschsprung Alied Disease and
Hirschsprung’s Disease in Childhood with Barium Enema
Xinyu Yuan, Shuo Chun Wo
E-Poster
Using the Bosniak Classification System
Yun Peng
Imaging center, Beijing Children’s Hospital, China
Purpose To compare the Barium enema features between Hirschsprung
alied disease (HAD) and Hirschsprung’s disease (HD).
Methods Randomly nineteen cases of HAD aged from 30 days to 10
years and nineteen cases of HD aged from 42 days to 8 years were
enrolled in this study. All cases were confirmed by surgical operation
and pathology and performed with barium enema examination prior to
operation. The X-ray data were reviewed to calculate the appearance
rate of the narrow zone, ‘truncation sign’, spasm notch, and R/C ratio (the
longest diometer of rectum/ that of colon) respectively by two experienced
pediatric radiologists independently. Otherwise, the position of barium
retained was observed. Statistically, the parameters of both groups were
compared by SPSS11.5, and P<0.05 was considered to be significant.
Results Appearance rate of the narrow zone: group HAD is 9/19, group
HD is 18/19, 2=10.364, P=0.001<0.05; Appearance rate of the ‘truncation
sign’: group HAD is 4/19, group HD is 1/19, P=0.34>0.05; Appearance
rate of the spasm notch: group HAD is 3/19, group HD is 1/19,
P=0.604>0.05; R/C ratio: group HAD is 0.42±0.15, group HD is 0.29±0.12,
t=2.892, P=0.006<0.05; Position of barium retained: as HAD concerned,
distal descending colon 37% (7/19), distal sigmoid colon 5% (1/19), distal
transverse colon 5% (1/19), total colon 32% (6/19); as HD concerned,
distal descending colon 16% (3/19), distal sigmoid colon 68% (13/19),
distal rectum 16% (3/19).
Conclusions There are differences between HAD and HD on Barium
enema though they have similar clinic experience. HAD appears less
narrow zone and less R/C ratio than HD; HAD and HD have similar
appearance rate of the ‘truncation sign’ and the spasm notch; Most
position of barium retained of HAD is distal descending colon, while that of
HD is distal sigmoid colon. Therefore, position of barium retained should
be a helpful parameter for differentiation.
Keywords Large Bowel
Others
no long-term retention of Gd in the skin was observed. The in vitro and in
vivo study results support the view that the complex stability of GBCAs is
an important consideration. Furthermore, the data suggest a possible role
of Gd in the induction of cytokines.
Keywords Contrast Agents
2010.03.22
495
Purpose To compare the clinical performance of parameters used in
elastography with conventional ultrasound features in distinguishing
benign and malignant breast lesions.
Methods Ninety-nine women with 110 sonographically visible breast
lesions were evaluated independently with conventional ultrasound,
elastography and combined ultrasound and elastography (CUSEI).
Images were acquired with a Siemens Antares Ultrasound unit and BIRADS scores were assigned to standardise ultrasound interpretation.
The elastogram was classified as benign, malignant or equivocal;
based on the strain pattern, the length and area ratios. By correlating
with histopathology, the sensitivity, specificity, PPV, NPV and accuracy
of ultrasound, elastography and CUSEI were obtained. ROC curves
were plotted using the BI-RADS scores and elastogram ratios and the
area under the curve compared to assess diagnostic performance. The
performance of each elastographic parameter and ultrasound feature was
compared.
Results Of the 110 breast lesions, 26 were malignant and 84 were benign
on histology. The sensitivity, specificity and accuracy of ultrasound was
88.5%, 42.9% and 53.6% respectively. The sensitivity, specificity and
accuracy of elastography was 100%, 76.2% and 81.8% respectively, and
that of CUSEI was 84.6%, 81% and 81.8% respectively. Elastography and
CUSEI achieved significantly better results than conventional ultrasound
(P<0.0005). The elastographic parameters and ultrasound features were
rated in order of best to worst performance as follows: elastogram area
ratio, elastogram distance ratio, shape, orientation, margin, doppler
vascularity, posterior acoustic feature, elastogram strain pattern,
calcifications and echopattern.
Conclusions Breast elastography has a higher sensitivity, specificity and
accuracy than conventional ultrasound. CUSEI gives higher specificity
and accuracy but reduces sensitivity, relative to elastography alone. Area
and distance ratios on elastography are superior to every sonographic
feature in distinguishing benign and malignant breast lesions. A combined
algorithm consisting of both elastographic parameters and ultrasound
features potentially enables a more accurate diagnosis of breast cancer.
Keywords Biopsy, Observer Performance, Comparative Studies,
Ultrasound
BR004
Differentiating Granulomatous Lobular Mastitis from Breast
Cancer at MRI: Value of Diffusion Weighted Imaging
Shotaro Kanao, Kazuna Takeda, Tomohisa Okada, Kaori
Togashi, Takeshi Kubo, Shigeaki Umeoka
Department of Diagnostic Imaging and Nuclear Medicine, Kyoto
University Graduate School of Medicine, Japan
Purpose Granulomatous lobular mastitis (GLM) is a rare chronic
inflammatory disease that has clinical and radiological findings similar
to those of breast cancer. We focused on the finding that GLM usually
contains abscess component (hyper-intensity on T2 weighted image
(T2WI) and low apparent diffusion coefficient (ADC)), we evaluated the
usefulness of Diffusion Weighted Imaging (DWI).
Methods We performed a retrospective analysis of 44 cases of containing
hyper intensity area on T2 Weighted MR Image (T2H) between June
2008 and August 2009. The diagnoses for these cases were as follows;
malignant tumor (n=20), benign tumor (n=19) and granulomatous mastitis
(n=5). Breast MR studies of dynamic series, T2WI, and DWI were
performed using prone type breast coil. ADCs of both T2H and hypo- or
iso-intensity area on T2WI (T2L) were calculated from b values of 0 and
1000 sec/mm2.
496
BR005
Ultrasound Appearance of Breast Ductal Carcinoma in Situ
Chin-Yu Chen, Chee-Wai Mak, Mei-Chun Chou, Chia-Hui Chen,
Wen-Sheng Tzeng
Department of Radiology, Chi-Mei Medical Center, Taiwan
Purpose Breast ultrasound is well recognized to be a useful adjunct of
mammography to detect subtle breast cancers, especially in patients with
dense fibroglandular tissue. Using ultrasound to screen breast cancer is
also an attracting alternative in east Asian countries. Imaging lexicons
of breast ultrasound were already addressed by the ACR BI-RADS® 4th
edition and published in 2003. However, the ultrasound findings of early
breast cancers such as ductal carcinoma in situ (DCIS) were not well
described and still difficult to characterize.
Methods Retrospective collection of twenty-two patients with pathological
diagnosis of breast ductal carcinoma in situ (DCIS) between August 2007
and July 2009, we present and describe the different ultrasound image
patterns with corresponding mammography. Linear ultrasound transducers
with frequency between 8 to 12 MHz were used for scanning. Among the
22 patients, only 6 (or 27%) of them were palpable, the rest 14 (or 73%)
of patients were impalpable. All the patients underwent tissue proof either
by sono-guide core needle biopsy or excision. Finally 19 of the 22 patients
had confirmed pathological diagnosis by partial or total mastectomy.
Results The ultrasound image shows different pattern. 9 patients (41%)
were detected with microcalcifications, the rest 13 (59%) patients didn’t
show any microcalcification. 15 patients (68%) were revealed to have
mass in ultrasound, the sizes were variable, where the rest 7 patients
(32%) showed non-mass intraglandular or intraductal hypoechoic
proliferative lesions, these lesions couldn’t be properly described by
ACR BI-RADS® lexicons. Among the 7 non-mass lesions, only two had
microcalcifications, and also two were palpable.
Conclusions Non-mass intraglandular proliferative lesion should be
an important type of early breast cancer in ultrasound images, can be
presented with or without microcalcifications. Although DCIS with this
pattern is hard to diagnose, it should be reasonable to consider its
inclusion into the standardized ACR BI-RADS® ultrasound lexicons.
Keywords Mammography, Ultrasound
BR012
Efficacy of Three-Dimensional Ultrasound Using U-System
Tomoyuki Ohta
Department of Radiology, Kawasaki municipal Tama hospital,
Japan
Purpose Clarify the efficacy of three-dimensional (3D) ultrasound for
breast lesions, in particular those acquired using the SomoVu U-system.
Methods Several breast lesion sonograms acquired using U-system were
collected and reviewed retrospectively. The relationship between coronal
and axial (or sagittal) images and the correlation between conventional
mammograms and wide-viewed coronal sonograms were evaluated.
Results A complementary relationship was observed between the
coronal and axial (or sagittal) U-system images. Furthermore, a strong
correlation was found between wide-viewed coronal U-system images and
mammograms, especially for findings of an architectural distortion in some
breast cancer series.
Conclusions The present results suggest that sonographic diagnoses
could be made with a high degree of confidence when assessments in
two different planes were combined. And that breast lesions were able to
more easily correlated between US images taken by wide-viewed coronal
U-system images and mammograms.
Keywords Ultrasound
BR013
Can False Negative Mammograms Be Reduced?
Huay-Ben Pan1, Giu-Cheng Hsu2, Chen-Pin Chou3, Jer-Shyung
Huang3, Tsung-Lung Yang3
1
Department of Medical Education and Research, Taiwan
2
3
Department of Radiology, Kaohsiung Veterans General Hospital,
Taiwan
Purpose We reviewed the 176 false negative cases out of the 320,963
mammography screenings and by analyzing those cases we hope to
improve our screening quality.
Methods First is to place the 176 false negative cases being referred to
34 experienced radiologists of around 10,000 cases. Second, we gathered
4 experienced radiologists, and each of them individually went through
and reviewed all 176 false negative cases. Then examine the nature of
the cases.
Results There were four cases that are truly false negative, as they could
not be identified by either primary screening doctors or subsequently, the
four experience radiologists.
Conclusions The analysis of the characteristics and features of those
cases would be invaluable education material to all radiologists.
Keywords Breast Calcifications/Calculi
BR014
The Performance of Mammography Screening in Taiwan
Huay-Ben Pan1, Giu-Cheng Hsu2, Chen-Pin Chou3, San-Kan
Lee4, Yi-Hong Chou5
1
Department of Medical Education and Research, Taiwan
2
Taiwan
4
Department of Deputy Superintendent, Taichung Veterans
General Hospital, Taiwan
3
5
Department of Radiology, Taipei Veterans General Hospital, Taiwan
Purpose The aims of this study are to evaluate the consistent of quality of
screening mammography.
Methods The service-screening program with mammography in Taiwan is
implemented for the 50- to 69-year age population in each 2 years since
2004.
Results The recall rate was 10.6 % in 2004 (n = 1786/16884); 12 % in
2005 (n = 7365/61323); 9.8 % in 2006 (n = 10286/105409) and 9.3% in
2007 (n=11751/126639). PPV1 was 5.2%; 3.4%; 4.1% and 4.4%. The
sensitivity was 86%; 82 %; 84% and 82%.
Conclusions The outcomes of mammography screening in our data are
concordant with the literature and the performance benchmarks.
BR029
MRI of Phyllodes Breast Tumors
Wang Teh-Chen1, Chang Yeun-Chung2, Wang Yi-Ting2, Huang
Chiun-Sheng3, Shih Tiffany Ting-Fang2
1
Department of Radiology, Taipei City Hospital Yang-Ming
Branch, Taiwan
2
Department of Radiology, National Taiwan University College of
Medicine, Taiwan
3
Department of Surgery, National Taiwan University College of
Medicine, Taiwan
Purpose The purpose of our study was to evaluate MRI appearance of
phyllodes breast tumors.
Methods MR images of 8 patients with 10 phyllodes breast tumors (2
malignant, 1 borderline malignancy, 7 benign) were analyzed with respect
to morphology and contrast enhancement. A 1.5T superconductive MR
scanner with dedicated breast coils was used for all studies. All breast MR
studies included DCE study of both breasts for kinetic information followed
by bolus-enhanced high spatial resolution breast MRI for morphologic
information.
Results Well-defined margins were seen in 90% of the phyllodes tumors.
Lobulated shape was seen in 90% and oval shape was seen in 10% of
the phyllodes tumors. A heterogeneous internal structure was observed
in 100% and 40% of them contains internal cysts. Enhancing internal
septations were found in 60% of the phyllodes tumors. Complex SIs (mixed
hypointense and hyperintense) were seen in 30% of the phyllodes tumors
and 80% of the phyllodes tumors appeared heterogeneous hyperintense
SI on T2-weighted images. After the administration of contrast material,
50% of the phyllodes tumors showed type II or type III signal intensity-time
course. The average size of the phyllodes tumor is 4.41 cm.
Conclusions MRI of the phyllodes tumors appear large smooth
marginated, lobulated shape and heterogeneous internal structures.
Complex T1-weighted images were seen when the tumor size is huge
(more than 6cm). Half of the lesions showed suspicious or malignant
signal intensity-time course after contrast administration.
Keywords MR
BR030
Medical Audit of Screening Breast Ultrasound – Comparison
with Mammography
Chin-Yu Chen, Mei-Chun Chou, Chee-Wai Mak, Chia-Hui Chen,
Wen-Sheng Tzeng
Purpose Breast ultrasound is a useful imaging tool in detecting breast
cancers. Its role in screening high-risk women was widely discussed.
In Taiwan, ultrasound became an alternative screening tool to
mammography. Since there are still debates in whether beneficial or not
by ultrasound screening, we propose this medical audit to objectively
compare both.
Methods Following the standards of ACR BI-RADS®, we retrospectively
collect 2,380 screening breast ultrasound exams between December
2004 and August 2009. The ages are ranged from 17 to 90 years old, with
the mean age of 44 years old. To purify the data for screening, patients
with major symptoms and positive physical findings are excluded in this
study. The published medical audit data (JACR, 2008) of 8,249 screening
mammography of the same hospital is used for comparison.
Results The recall rate is as low as 3.5% of ultrasound, compare to
8.5% of mammography. The PPV1 is higher in ultrasound (7.3%) than
mammography (3.1%), but the PPV2 and PPV3 are lower in ultrasound
(7.8% and 11.1%) than mammography (16.2% and 24.7%). There is
no significant difference of per-thousand cancer detection rate between
ultrasound (2.5) and mammography (2.7). The minimal cancer percentage
is higher in mammography (50%) than ultrasound (33.33%). The
sensitivity of ultrasound (85.7%) and mammography (81.5%), as well as
the specificity of ultrasound (96.8%) and mammography (91.7%) are not
much different.
Conclusions Ultrasound screening has lower recalls than mammography,
especially for the “category 0”. This makes ultrasound better in PPV1.
However, ultrasound tends to make more conclusions of “category 3 and
4”.That makes more follow-ups, benign biopsies and lower PPV2 and
PPV3. Although minimal cancer percentage is lower in ultrasound, it is
still acceptable under BI-RADS recommendation. According to our data,
screening with ultrasound is quite acceptable. However, we also expect
more data in the future to make further conclusions.
Keywords Mammography, QA/QC, Ultrasound
BR031
Impact of Digital Mammography in Breast Cancer Detection:
Mackay Memorial Hospital Experience
Kun-Shuo Huang, Chin-Yin Sheu, Suk-Ping Ng, Fei-Shih Yang
Department of Radiology, Mackay Memorial Hospital, Taiwan
497
BR002
Clinical Use of Elastographic Parameters and Ultrasound
Features in Assessment of Breast Lesions – Which Is
Better?
Llewellyn Sim, Lester Leong, Yien Sien Lee
Department of Diagnostic Radiology, Singapore General
Hospital, Singapore
Results ADCs (10 -3 mm 2/sec) at T2H were 0.81 +/- 0.12 (standard
deviation), 1.95 +/- 0.46, and 1.90 +/- 0.40 for GLM, malignant tumor, and
benign tumor respectively. ADCs at T2L were 0.96 +/- 0.21, 1.08 +/- 0.31,
and 1.44 +/- 0.18 for GLM, malignant, and benign respectively. ADCs of
GLM at T2H were significantly (p<0.001) lower than that of malignant tumor.
Conclusions Diffusion Weighted Imaging is useful for differentiating
granulomatous mastitis from breast cancer.
Keywords MR
E-Poster
Others
2010.03.23
BR032
Comparison between Ultrasound Guided Hookwire
Localization and U l t r a s o u n d G u i d e d R a d i o i s o t o p e
Localization of Impalpable Breast Lesions for Surgical
Excision
Kai Yan Kwok, Lai Sheung Wong, Hing Ngai Wong, Long Fung
Chiu, Hon Shing Fung, Chi Wai Siu, Kwok Hung Lai, Tak Shun To
Purpose Impalpable breast lesions may be visualized by ultrasonography.
These lesions can be localized for surgical excision by hookwire insertion
or radioisotope injection, i.e. radioguided occult lesion localization (ROLL),
under ultrasound guidance. This study aims to compare the rate of
adequate excision of impalpable breast lesions during primary surgical
attempt between the two methods of lesion localization.
Methods This was a retrospective study. Cases of impalpable breast
lesions with ultrasound guided hookwire localization or ROLL for surgical
excision between 1st January 2007 and 31st August 2009 were reviewed.
The relevant clinical information, radiological images and pathology
reports were analyzed.
Results From 1st January 2007 to 31st August 2009, 88 impalpable
breast lesions underwent ultrasound guided hookwire localization for
surgical excision. Upon immediate ultrasound assessment of the surgical
specimens, 100% of the lesions were adequately excised radiologically.
19 lesions turned out to be malignant. 11 out of the 19 lesions (57.9%)
had involved or close histological margins which needed further excision
by another operation. On the other hand, 10 impalpable breast lesions
underwent ultrasound guided ROLL for surgical excision. Upon immediate
ultrasound assessment of the surgical specimens, 100% of the lesions
were adequately excised radiologically. 3 lesions turned out to be
malignant. 2 out of the 3 lesions (66.7%) had involved or close histological
margins which needed further excision by another operation. None of the
following factors including lesion size, border or depth from skin surface
had significant influence on the outcome.
Conclusions Both ultrasound guided hookwire insertion and ultrasound
guided radioisotope injection (i.e. ROLL) were effective methods to locate
impalpable breast lesions for surgical excision. There was no significant
difference in the radiological or histological adequacy of lesion excision
498
BR040
Imaging and Pathological Correlation of Indeterminate
Breast Lesions (BI-RADS III and IV)
Anugayathri Makudamudi, Bagyam Raghavan, Jayaraj
Govindaraj
Department of Radiology and Imaging Sciences, Apollo
Speciality Hospital, India
Purpose To describe the role of mammography and ultrasonography
in characterizing indeterminate breast lesions and its correlation with
histopathological diagnosis.
Methods 75 patients were selected for the study (March 2007-December
2008) with mammographic findings of indeterminate lesions, BI-RADS III
or IV category. All patients were followed with ultrasonography and few
patients with elastography for characterization, ultrasound guided FNAC/
biopsy for confirmation of imaging diagnosis.
Results Of 75 patients, 24 required imaging to guide clinical management
and 22 for identifying the pathology. Imaging diagnosis of majority were
malignancy (41.3%), complex cyst (22.7%) and indeterminate lesions
requiring further workup for final diagnosis (12%). Majority of the biopsy
proven lesions were malignancy (40%), hyperplasia with mild atypia
(17.3%), fibrous tissue (13.3%). There was statistically significant
correlation between mammography and ultrasonography to define the
shape and margin of lesion, identifying intralesional calcifications and
perilesional parenchymal distortion. There was correlation between
clinical and imaging diagnosis in 30.7%, in contrary to correlation between
imaging and pathological diagnosis (65.3%). USG had better sensitivity
(79.07%) than mammography (39.53%). Likewise, mammography
(96.87%) had better specificity than USG (87.5%).
Conclusions Screening program for breast will help in detecting
lesions at an earlier stage in asymptomatic women with good prognosis.
Combining mammography with ultrasound increases the detection
rate of smaller lesions, especially in young women with dense breasts,
characterizing lesion and helps in upgrading or down staging the lesion.
Ultrasound guided biopsy or FNAC is required for all indeterminate lesions
of the breast, which is the gold standard.
Keywords Mammography, Ultrasound
BR037
Diagnoses on Inflammatory Breast Lesions with Full-Field
Digital Mammogrophy
Wanhua Liu, Xiao-Ying Zeng, Yuan-Yuan Ye, Shu-Shu Pan
Department of Radiology, China
Purpose To evaluate the diagnostic significance of full-field digital
mammography (FFDM) for inflammatory breast lesions.
Methods 175 cases inflammatory lesions come from during April 2003 July 2009 were all examined using FFDM and proved by pathology.
Results (1) The main direct finding of acute mastitis is density (47.06%)
and the commonest location is subareolar (62.75%);Chronic mastitis,
plasm cell mastitis and tuberbulosis are all mass. The commonest location
of them is all in the quadrant of beast. The direct sign of Inflammatory
breast carcinoma is various and Its commonest location is the quadrant
of breast (67.39%) ,but the commonest finding is diffusely increased
density (34.78%). (2) Acute mastitis is local erythema or warmth with skin
edema and pain of the breast (74.51%) and palpable mass (66.67%).
The clinical symptom of chronic mastitis and plasma cell mastitis are all
palpable mass and tendemess. They are respectively 93.48%, 82.61%
and 86.96%, 69.57%. The inflammatory breast carcinoma is diffusely
erythema or warmth with skin edema (100%) and palpable mass (91.30%).
The tuberculosis is papable mass (77.78%). (3) The misdiagnostic ratio
of tuberculosis, chronic mastitis, plasma cell mastitis, inflammatory breast
carcinoma and acute mastitis are respectively 88.89%, 54.35%, 43.48%,
17.39% and 11.76%. Mastitis is readily misdiagnosed for inflammatory
breast carcinoma (7.84%).Chronic mastitis, plasma cell mastitis
and tuberculosis are all readily misdiagnosed for breast carcinoma.
Inflammatory carcinoma is readily misdiagnosed for mastitis (8.70%).
Conclusions FFDM is helpful to diagnosing and differentiating the
inflammatory breast lesions.
Keywords Mammography, Infection, Inflammation
BR022
Imaging Findings of Granulomatous Mastitis
Shuo-Hsiu Hsu¹, Chen-Pin Chou¹, Huay-Ben Pan¹, Shong-Ling
Lin²
¹Department of Radiology, Kaohsiung Veterans General Hospital,
Taiwan
²Department of Pathology, Kaohsiung Veterans General Hospital,
Taiwan
Purpose To evaluate the radiological and sonographic findings of
granulomatous mastitis.
Methods Between September 2005 and July 2009, the mammography
and ultrasound findings of four women (35-58 y/o, average 45) with
pathology proof of granulomatous mastitis were reviewed.
Results Unilateral granulomatous mastitis at upper outer quadrant
was found in all patients. The Mammography findings included focal
asymmetry in one view (n=1), architectural distortion (n=1), and irregular
masses (n=3). The ultrasound findings included, irregular hypoechoic
masses (n=2), ductal dilatation (n=1), an ill-defined hypoechoeic area
(n=1), and hypervascularity on color ultrasound (n=2).
Conclusions The findings of granulomatous mastitis have imaging
presentation mimicking common breast disorder.
Keywords Mammography, Ultrasound, Inflammation
BR043
Characterization of Benign and Malignant Breast Lesions by
Color and Spectral Doppler Parameters
Palle Lalitha1, M.Ch Reddy Balaji2
1
General Department, Focus Diagnostics, India
2
Department of Radiology, Focus Diagnostics, India
Purpose To evaluate color and spectral Doppler parameters in benign
and malignant lesions and to determine the sensitivity and specificity of
Resistive Index and Peak Systolic Velocity values in characterizing benign
and malignant lesions
Methods This prospective study was performed over a period of one
year .It includes two hundred women with two hundred and seventy eight
lesions in the age group of 16 to 80 years. Color and spectral Doppler
evaluation was performed in all the. The resistive index and peak systolic
velocity were calculated for all the patients, and a comparison was made
between the values of benign and malignant lesions
Results The values of resistive index were significantly different in benign
and malignant lesions. Peak systolic velocity however did not show a
significant correlation and there was a considerable overlap between the
benign or malignant lesions
Conclusions There was a significant correlation between high resistive
index and malignant nature of the disease. However Peak systolic velocity
did not show a significant correlation with benign or malignant nature of
the disease
Keywords Ultrasound
CV002
Quantitative Measurement of Aortic Valve Regurgitation
Using 64-Silce Multi-Detector Row CT: Comparison with
Magnetic Resonance Imaging and Echocardiography
Yingkun Guo, Zhigang Yang, Gang Ning
Department of Radiology, West China Hospital, Sichuan
University, China
Purpose To assess the severity of isolated aortic valve regurgitation
by measuring ventricular volumetrics as compared to MRI and
echocardiography.
Methods Thirty-eight patients (15 men, 23 women; mean age, 46±11
years) with isolated aortic valve regurgitation underwent retrospectively
ECG-gated 64-MDCT, echocardiography and MRI for assessing the
severity of aortic valve regurgitation. Stroke volumes of left and right
ventricle were measured for 64-MDCT and MRI. Based on these
measurements, regurgitation volumes (RV) and fractions (RF) were
calculated and compared. The agreement between MDCT and MRI was
tested by linear regression and Bland-Altman analyses. Regurgitation
fractions were compared with corresponding echocardiographic grades by
using Spearman rank order correlation and a weighted κ test.
Results No significant differences were found in calculated RV and RF
between the 64-MDCT and MRI (paired t test, p=0.63, 0.77). Regression
analysis showed that 64-MDCT correlated well with MRI for the
measurement of RV (r=0.91, p<0.001) and calculating the RF (r=0.94,
p<0.001). Bland-Altman analysis showed no significant differences in RV
and RF between the 64-MDCT and MRI. The severity of regurgitation
estimated by echocardiography correlated well with 64-MDCT (r=0.94,
p<0.001) and MRI (r=0.96, p<0.001).
Conclusions ECG-gated 64-MDCT provides quantitative information
with high accuracy for determining the severity of isolated aortic valve
regurgitation.
Keywords MR, CT, Heart, Valves
CV004
Using Prospective Gated Cardiac 320 MDCT in Daily
Routine- Higher Proportion of Patients Scanned Using Low
Dose Is More Important Than Absolute Lowest Dose
John Hoe
Department of Radiology, Mt Elizabeth Hospital, Singapore
Purpose To evaluate proportion of patients scanned in daily routine using
320MDCT prospective gated one heart beat (1HB) scan and estimating
radiation dose in this group as well as those who required two heart beat
(2HB) scans and to compare this to lowest radiation dose achieved.
Methods Retrospective analysis of 417 consecutive patients scanned
.Patients with heart rates <65bpm were scanned using prospective
gated 1HB scan with exposure window of 70-80% RR interval, while
those with HR 65-70bpm or variable HR >5-10bpm were scanned using
exposure window of 40-80%.Patients with arrhythmias, atrial fibrillation or
HR>70bpm (after betablocker or if betablocker use contraindicated) were
scanned using 2 HB scan with exposure window 40-80%
Results 354 patients or 85% were scanned using 1HB scan, using 100
or 120 kVp. Of these patients 95% were scanned with exposure window
70-80%, 5% with 40-80% exposure window. Average estimated radiation
dose was 3.7+/-1.26 mSv for 1HB scan.. Mean image quality assessed to
be in good to excellent range. Absolute lowest dose was 1.54 mSv. 15%
of patients were scanned using 2HB scan, estimated average dose was
11.5 mSv +/-4 mSv. Mean image quality was assessed as good. Of the
417 patients, tube voltage 100 kVp was used in 20% (BMI <25) 120kvp
was used in 80%.
Conclusions Our ability to achieve low dose prospective gated 320MDCT
cardiac scan in 85% of all patients with good to excellent image quality
still means 15% of patients are not scanned using a low dose technique .
Achieving the absolute lowest dose in a few patients is less important than
having very high percentage of patients having low dose scans. Continual
attention to patient preparation and scan technique improvement, as well
as technology improvements, will be needed to increase the percentage
of low dose scans to 90-95% of daily workload.
Keywords CT, Heart
CV005
Diverse Presentation of Aberration of Left Brachiocephalic
Vein Including Persistent Left Side SVC
2
1
499
between these two methods.
Keywords Localization, Surgery, Ultrasound
E-Poster
Purpose To compare the results between fullfield digital mammography
system (FFDM) and conventional screenfilm mammography system (SFM)
in the assessment of breast lesions via needle localization performed in
Mackay Memorial Hospital.
Methods 259 patients detected with breast lesions using a SFM system
(Senographe DMR, GE Medical Systems, Milwaukee, USA) between 1991
and 2003 were compared against another 260 cases revealed by a FFDM
system (Lorad Selenia, Hologic company, Bedford MA, USA) between
2007 and 2009 at Mackay Memorial Hospital. All of the above lesions
were histologically confirmed via needle localization with subsequent
excisional surgical biopsy.
Results In the 259 cases where a SFM system was used to detect breast
lesions, subsequent needle localizations of excisional biopsy revealed
37 invasive ductal carcinoma, 3 invasive lobular carcinoma, 2 tubular
carcinoma, 22 ductal carcinoma in situ, 1 focal lobular carcinoma in situ,
as well as 194 benign lesions. 35% of the pathologically proven breast
cancers were malignant precursors corresponding to stage 0, and the
overall positive predictive rate was 25%. In the other group of 260 cases
where a FFDM system was used, following biopsies showed 21 invasive
ductal carcinoma, 1 diffuse large B cell lymphoma, 1 mucinous carcinoma,
39 ductal carcinoma in situ, and 198 benign lesions. 63% of malignant
neoplasms were stage 0 of breast cancer, and the calculated positive
predictive rate was 24%.
Conclusions According to the Mackay Memorial Hospital experience,
it appears that the positive predictive value of FFDM is similar to that
of SFM. However, FFDM may be a better tool than SFM in early breast
cancer detection.
Keywords Mammography, Biopsy, Breast Calcifications/Calculi,
Conventional Radiography, Digital Radiography
Others
2010.03.23
Purpose To evaluate the accuracy and feasibility of left ventricular function
measurement using DSCT (Somatom Definition, Forchheim, Germany) in
comparison with echocardiography (GE VidVid-7 color Doppler).
Methods 95 patients clinically-indicated for coronary angiography
and 29 healthy volunteers underwent both DSCT coronary CTA and
echocardiography within 72 hours. The correlation of the measurements
(EDV、ESV、SV、EF、IVST-ED、IVST motility、LVPWT-ED、LVPW
motility、LVFS、LVEDD) by DSCT and by echocardiography were
evaluated respectively. DSCT coronary angiography identified 32 patients
with coronary artery stenoses and compared with left ventricular function
parameters such as FS, SV, EF, LV, the positive rate of abnormal left
ventricular myocardial mass (LVMM) of these 32 patients was up to 63%.
Results There was strong correlation between DSCT and echocardiography
on the parameters of EDV, ESV, SV, IVST-ED, LVPWT-ED, LVFS and
LVEDD in 29 healthy volunteers (r=0.939,0.847,0.912,0.866,0.932,0.
943,0.973); DSCT was slightly smaller by DSCT when compared with
echocardiography on the parameters of EF, IVST motility and LVPWT
motility in all 29 healthy volunteers group (r=0.684,0.781,0.607).
Moreover, strong correlation between DSCT and echocardiography was
also found on parameters of EDV, ESV, SV, IVST-ED, LVPWT-ED, IVST
motility, LVPWT motility, LVFS and LVEDD in 95 patients group (r=0.96
3,0.977,0.831,0.862,0.857,0.802,0.854,0.938,0.812); however, EF was
slightly smaller (r=0.607). The values of EF, SV, FS in healthy volunteers
were all higher than that of the patients with heart disease by DSCT,
with the exception of LVMM which was lower. The positive rate (up to
63%) of LVMM was the highest among the other left ventricular function
parameters in all 32 patients with coronary artery stenoses.
Conclusions The parameters of left ventricular function measured by
DSCT coronary angiography were accurate and can be applied in clinical
diagnosis. The quantitative measurement of LVMM which can be only
obtained from DSCT was a more sensitive parameter.
Keywords Angiography, Cardiac Assist Devices, CT
CV013
The Application of Carotid Plaque MRI in Stent-Treatment
Decision for Carotid Atherosclerosis Patients
Yan Song¹, Zhou Cheng1, Min Chen1, Nan Luo1, Chun Jia Liu2,
500
Purpose To evaluate the efficiency of carotid plaque MRI in stent-treatment
decision for patients with carotid atherosclerosis by compared with DSA.
Methods 16 symptomatic and 11 asymptomatic patients were
enrolled in this study, and totally 17 symptomatic carotid arteries and
37 asymptomatic carotid arteries were evaluated by MRI and DSA
respectively. Carotid plaque MRI examination included T1W, T2W, PDW,
TOF , MP-RAGE and post-contrast T1W. Coronal and lateral view of
carotid DSA were taken. The interested items were the stenosis of the
lumen and whether there was FC rupture. Intraplaque hemorrhage and
calcification were also evaluated by MRI. Paired T-test and Fisher’s exact
test was used for the statistic analysis.
Results There was no statistic difference between the degree of lumen
stenosis measured by MRI and DSA(t=0.204 for symptomatic group and
1.377 for asymptomatic group, and p>0.05 both). There was statistic
difference in the detection of FC rupture by MRI and DSA for both
groups (p<0.01). As to determine the stent treatment for symptomatic
vessels, 14 vessles according to MRI and 11 vessels according to DSA
needed stentng, there was no statistic difference (p>0.05). While for
the asymptomatic vessels, 16 vessels according to MRI and 4 vessels
according to DSA needed stenting, there was significant statistic difference
(p<0.01).
Conclusions For symptomatic carotid atherosclerosis patients, MRI
had no more obvious advantage compared with DSA in stent treatment
decision, but MRI can provide a lot of information about the plaque
morphology which is helpful for clinic. While for the asymptomatic patients,
MRI is superior to DSA in stent treatment decision, especially for patients
with carotid artery narrowing less than 70% due to its ability in detecting
FC rupture, and is of much help for treatment decision.
Keywords Ischemia/Infarction, Angiography, Arteriosclerosis, MR, Stents
CV014
Imaging Evaluation of Late Complications of Post-Repaired
Tetralogy of Fallot: before and after Pulmonary Valve
Replacement
Tsun-Hou Chang¹, Harold Litt1, Guo-Shu Huang2
1
Department of Radiology, University of Pennsylvania School of
Medicine, United States
2
Department of Radiology, National Defense Medical CenterTriservice General Hospital, Taiwan
Purpose 1. Understand the importance of imaging follow-up for adult
Tetralogy of Fallot (TOF) patients. 2. Recognize the imaging features of
late complications of TOF. 3. Identify the causes of late complications of
surgical TOF cases and timing of pulmonary valve replacement (PVR). 4.
See the results of post pulmonary valve replacement.
Methods We look up related CT or MRI follow-up images in the database
of the Hospital of University of Pennsylvania during 2006~2009.
Results To describe the cases of late complications of surgical TOF
cases. The conditions between pulmonary regurgitation and right
ventricular dilatation are the cause & effect. PR is related to the use
of transannular patch during RVOT reconstruction, and aggressive
infundibulectomy involving the pulmonary valve annulus. Residual RVOT
obstruction can persist after initial corrective surgery due to hypertrophied
muscle in the subvalvular region, annular hypoplasia, pulmonary valve
stenosis or branch pulmonary artery stenosis. The decision regarding
the timing of PVR is based on a combination of both clinical as well as
investigational features.
Conclusions To demonstrate the imaging features of before or after PVR
of TOF cases.
Keywords MR, Cardiac Assist Devices, CT
CV017
Comparison of Absolute Coronary Calcium Score and MESA
Percentile Rank in the Prediction of Angiographic Coronary
Artery Stenosis
Yenhuai Lin, Ming-Huei Sheu, Chun-Ku Chen, Mei-Han Wu,
Cheng-Yen Chang
Taiwan
Purpose The aim of this study was to compare the efficacy of absolute
coronary artery calcium (CAC) score and Multi-Ethnic Study of
Atherosclerosis(MESA) percentile rank in the prediction of significant
coronary artery stenosis using conventional coronary angiography(CAG)
as reference standard.
Methods This was a retrospective study. A total of 100 patients who
received coronary calcium scoring and coronary CT angiography (CCTA)
by a 64-detector row CT scanner and subsequent CAG (mean time
interval : 23.54 days) were enrolled. Absolute CAC score was expressed
by Agatston algorithm. Percentile rank was assigned as published by
MESA, and divided into 4 ranges: <25%, 25% to 75%, 76% to 90% and
> 90% percentile ranks. Significant coronary artery stenosis was defined
as the presence of more than 50% luminal narrowing in either single
or more than one coronary artery verified by CAG. Receiver operating
characteristics (ROC) curves and the area under the curve(AUC) was
used to analyses and compare the performance of absolute CAC score
and percentile rank in the prediction of significant coronary artery stenosis.
Results Significant coronary artery stenosis was found in 74 (74%)
patients by CAG. The incidence of significant coronary artery stenosis was
84.3% (43/51) in > 90% percentile rank group, 75% (21/28) in 76%-90%
percentile, 58.3% (7/12) in 25%-75% percentile and 33.3% (3/9) in <25%
percentile rank group. For predicting significant coronary artery stenosis,
the AUC of absolute CAC was 0.722, AUC of MESA percentile rank was
0.691, no significant difference was found in between (p= 0.317).
Conclusions Both absolute CAC and MESA percentile rank have
moderate degree of predictive value correlate to angiographic stenosis.
The higher the percentile rank is, the higher the incidence of significant
coronary artery stenosis is. There is no statistical difference between
the performance of absolute CAC score and MESA percentile rank in
predicting significant coronary artery stenosis.
Keywords Heart
CV022
Is Cardiac Chamber Survey Is Necessary as Part of Brain CT
Angiography for Patients Sustaining Cerebral Infarction?
Shy-Chyi Chin¹, Jung-Huei Chung1, Yeu-Jhy Chang2, Tsong-Hai
Lee2
1
Department of Medical Imaging and Intervention, Chang-Gung
Medical Center at Linko, Taiwan
2
Department of Neurology, Chang-Gung Medical Center at Linko,
Taiwan
Purpose To seek the culprit thrombus in patients with clinically-evident
cerebral infarction that the cardiogenic embolism is the possible cause.
Methods This is a IRB-certificated prospective study for the patients with
obvious symptoms of cerebral infarction in which the delayed contrastenhanced heart chamber survey was performed in conjunction with
brain CT angiography. From Oct, 15 to Dec, 31, 2009, approximately 80
patients will be enrolled.
Results Out of 80 cases of heart chamber survey, only three patients
were found having intracardiac filling defects in the left atrial appendages,
which were later proven by transesophageal echocardiography to
be intracardiac thrombi. All of three patients sustain the chronic atrial
fibrillation and impaired left ventricular function.
Conclusions In terms of few positive results, CT-based heart chamber
survey seems not necessary for general stroke patients. The necessity of
this study for high-risk needs further investigation.
Keywords CT
CV035
Comparison of Coronary CT Angiography and Myocardial
Perfusion Imaging in Patient with Kawasaki Disease Using
Fusion Imaging Method: First Clinical Experiment
Tomonari Kiriyama
Purpose Long-term follow-up is essential for coronary abnormalities in
patients with Kawasaki disease using some kinds of imaging modalities.
Recently coronary CT angiography (CTA) has been widely used to
evaluate coronary anatomy and stenosis instead of invasive coronary
angiography. On the other hand, myocardial perfusion imaging (MPI) still
has a great independent value for risk stratification. We examined relation
between coronary anatomy and perfusion abnormality using cardiac
fusion imaging.
Methods Eleven participants underwent CTA and MPI within 1 month
interval in follow-up period of Kawasaki disease. Using 64-detecter multislice CT, coronary abnormality was classified into 3 categories; Group 1,
both stenosis and aneurysm is absent; Group 2, patients have aneurysm
without stenosis; Group 3, aneurysm with stenosis or other abnormalities
like braid-like appearance. Fixed and reversible defects were also
assessed using adenosine stress MPI. Fusion imaging was performed to
ensure the corresponding coronary artery.
Results In all 14 arteries of Group 3, 6 abnormal coronary arteries
corresponded to perfusion abnormality, while rest of 8 arteries did not.
On the other hand, only each 1 artery in Group 1 and 2 corresponded to
perfusion abnormality.
Conclusions Perfusion abnormality is rare in coronary arteries without
stenosis in patients with Kawasaki disease, while discordance between
CTA and MPI was seen in this study.
CV034
Utilization of 64-Multislice Coronary Computed Tomography
Angiography in Predicting Future Major Cardiac Events
Yen-Shu Kuo1, Mei-Shu Lai2, Ming-Huei Sheu3
1
Institute of Preventive Medicine /Department of Radiology,
College of Public Health, National Taiwan University/Taipei
Veterans General Hospital, Taiwan
2
Department of Institute of Preventive Medicine, College of
Public Health, National Taiwan University, Taiwan
3
Taiwan
Purpose The study aimed to demonstrate the predictive value of coronary
CT angiography and to propose the best-performing CT angiographic
predictors for future major cardiac events in patients with suspected
coronary artery disease.
Methods The study retrospectively enrolled 425 subjects who underwent
64-multislice coronary CT angiography from May 2006 to December 2007.
Agatston Calcium score, segment-by-segment analysis for atherosclerotic
plaque composition and percentage of luminal stenosis was performed
and composite scores including modified Duke CAD index, segment
stenosis score, segment involvement score and three-vessel plaque score
by Min, and number of obstructive vessels, either ≥50% or ≥70% luminal
stenosis, were given to determine severity of coronary atherosclerosis.
The occurrence of major cardiac events (revascularization 90 days after
coronary CT angiography, unstable angina requiring hospitalization, and
myocardial infarct) were observed for mean follow-up period of 22 months.
The association between composite scores and occurrence of major
cardiac events was analyzed using Cox proportional hazard regression
model. The predictive value of each score was performed using receiver
operating characteristic curves and area under the curve analysis.
Results Increased hazard ratios were universally observed for higher
composite scores. After adjustment, the hazard ratios were 6.88 (95% C.I.
1.27-37.25) for modified Duke CAD index 3-6 vs. 0, 6.11 (1.08-34.57) for
segment stenosis score >5 vs. 0, and 5.81 (1.44-23.44) for three-vessel
plaque score 1 vs. 0. The hazard ratio was 6.08 (1.06-34.81) for presence
of ≥70% obstructive vessels, either one or more. Segment stenosis score,
modified Duke CAD index, and the number of obstructive vessels showed
501
CV008
A Comparative Study of the Left Ventricular Function
Measurements: DSCT versus Echocardiography
Dan Han, Hui Duan
Department of Radiology, the Fist Affiliated Hospital of Kunming
Jun Li Wang2, Yuan Fu1
1
Department of Radiology, Beijing Hospital, China
2
Department of Neurosurgery, Beijing Hospital, China
E-Poster
Purpose The aberration left brachiocephalic vein (A-LBCV) including
persistent left side SVC (PLSVC) is a rare condition of the major thoracic
veins. The purpose of our study was to calssify the several types of A-LBCV
and describe the incidence of each types.
Methods During last 7 years (July, 2002 ~ June, 2009), whole chest
CT scans of our institute were retrospectively reviewed by chest
radiologist. Total three courses of venous drainage (preaortic course of
LBCV, subaortic course of LBCV and PLSVC) were demonstrated. 63
consecutive patients (30 men, 33 women) were represented A-LBCV.
We classified A-LBCV into three types and several subtypes. Type I is
only one course of venous drainage (Ia – preaortic course of LBCV, Ib
– subaortic course of LBCV, Ic – PLSVC). Type II is double course of
venous drainage (IIa – Ia + Ib, IIb – Ia + Ic, IIc – Ib + Ic). Type III is triple
course of venous drainage (Ia + Ib + Ic).
Results The patients included 37 (59%) cases of type Ic, 15 (24%) cases
of type Ib, 6 (10%) cases of type IIa, 4 (6%) cases of type IIb and 1 case
of type III. Type IIc was absent. And 5 patients have coexisting anomaly. 3
patients have right side aortic arch (each one of type Ib, Ic and IIa), 1 have
dextrocardia (type Ic) and the rest have absence of right side SVC.
Conclusions A-LBCV is a rare condition of the major thoracic veins,
but those have diverse presentation. Our classification will be helpful for
explain the A-LBCV. And, based on our classification, the most common
A-LBCV were type Ic, type Ib, type IIa and type IIb; all other types are rare.
Keywords Lung, Veins
Others
2010.03.23
Purpose To map global MR perfusion data of osteosarcoma (OGS) in an
innovative way to assess its accuracy in differentiating viable and necrotic
lesions post chemotherapy.
Methods Under waiver of IRB approval, at 1.5T MR, 27 patients with
known OGS, after chemotherapy treatment, were scanned with 2D
dynamic scans (FSPGR) (3 slices/2 seconds) scanning from 0 to 120
seconds following intravenous contrast administration. Next via curve
fitting algorithms were calculated on a pixel by pixel basis to generate
slope maps. Five parameters calculated from the fitted curve were used
to assign each pixel to seven curve types. The percentages of pixels
with fast wash-in and wash-out were calculated for selected regions of
interest. Thus necrosis rate of OGS was calculated and correlated with
pathological specimen.
Results 24/27 (88.9%) of OGS with perfusion map consistent good
pathological correlation, including 17/18 (94.4 %) with good response (
>90% necrosis) and 7/9 (77.8 %) with poor response (<90% necrosis).
The Pearson correlation = 0.746, p =0.000. MR necrosis revealed
prediction of skip bone metastasis with statistically significant difference in
patients with good vs. poor chemotherapy response (p = 0.003).
Conclusions Innovative graphical pixel based maps of perfusion data
of OGS by curve fitting technique and curve pattern classification show
promising in detection of vascularity, viable tumor, and extent of necrosis
of OGS. Accurate assessment of necrosis extent of OGS may be
predictive of patient’s treatment response and prognosis.
Keywords Long Bones, MR, Neoplasms-Primary, Extremities
MS030
Ulnar Variants and Their Complications, a MRI Investigation
Terence Tan
Taiwan
Purpose To investigate the complications caused from ulnar variants,
both ulnar plus and ulnar minus by magnetic resonance imaging (MRI)
and dynamic enhanced MRI (DE-MRI).
Methods 12 patients with ulnar impaction syndrome and fifteen patients
of Keinbock disease were studied by MRI and eleven cases with DE-MRI.
The length from distal radius platform was measured on plain radiographs
to determine the existence of ulnar variants if the difference exceeded by
502
recorded. Statistical analysis was done by using SPSS software (version
17). ANOVA test was applied to compare the mean of hospital stay with
different modalities of treatment (conservative, surgery or ultrasonography
guided aspiration).
Results A total of 19 patients were treated during the two years period.
The age ranged from 3 years to 58 years with the mean age of 25.5 ±
16.4 years. Male: female ratio was 1.37:1. The most common presenting
symptom was pain (present in 18 cases). The triad of pain, fever and
flexion deformity was present in 9 patients only. Highest number of
patients (8 patients; 42.1%) presented to the hospital with the symptoms
ranging from 6-10 days. Psoas muscle of right side was most commonly
involved (52.6%). The shortest hospital stay was found in patients who
underwent ultrasonography guided aspiration and it was stastically
significant. Primary psoas abscess was more common (in 15 patients)
than secondary psoas abscess. Staphylococcus aureus was the most
common causative organism.
Conclusions Primary psas abscess was the commonest type with
Staphylococcus aureus being the most common causative organism.
Ultrasonography guided aspiration was better than conservative or
operative management.
Keywords Abscess, Percutaneous, Drainage, Surgery, Ultrasound
MS034
Focal Osteonecrosis after Ultrasound Diathermy for Soft
Tissue Injuries: Five Case Reports
Hui-Chung Teng¹, Meng-Yuan Tsai1, Kuen-Huang Chen1, LeeRen Yeh2, Chiao-Wen Hwang3
1
Taiwan
2
Department of Radiology, E-Da Hospital, Taiwan
3
Department of Physical Medicine & Rehabilitation, Kaohsiung
MS048
Accuracy of Peri-Articular Soft Tissue Measurement on
the Radiograph, in Predicting Acromio-clavicular Joint
Degenerative Arthritis – Comparison with Magnetic
Resonance Imaging
Lalitha Palle¹, M.Ch Reddy Balaji²
¹General Department, Focus Diagnostics, India
²Department of Radiology, Focus Diagnostics, India
Purpose Ultrasound diathermy is a common modality used in the
treatment of soft tissue injuries for its thermal, mechanical and analgesic
effect. It used to be considered to be safe and effective. We present five
cases of focal osteonecrosis after ultrasound diathermy.
Methods Five cases with focal osteonecrosis following ultrasound
diathermy are described. Three cases are at the shoulder, and the other
two are at the knee.
Results The initial symptoms of these five patients included local pain,
limitation of range of motion, or instability. Under the impression of rotator
cuff tear, tendinitis, or internal derangement of the knee, ultrasound
diathermy was applied. The subsequent MRI depicted subcortical ring
or arc lesions with low signal intensity on T1-weighted image, which
brightened on T2-weighted image, characteristic of the manifestation of
osteonecrosis. Follow-up MRI of two patients showed regression of the
lesions after cessation of the ultrasound diathermy for a period of time.
Conclusions To our knowledge, the complication of focal osteonecrosis
following ultrasound diathermy hasn’t been reported before. Because
ultrasound diathermy is widely used for soft tissue injuries, such kind of
complication should be attentive.
Key words Knee, Complications, Shoulder, Treatment Effects, Ultrasound
Purpose To evaluate the accuracy of peri-articular soft tissue
measurement on a standard anteroposterior radiograph, in predicting
acromio-clavicular joint degenerative arthritis and to compare the
radiographic appearance with Magnetic resonance Imaging.
Methods All the patients referred to our center for MRI shoulder for
various reasons, were included in the study. There were a total of seventy
five patients. A standard anteroposterior radiograph of shoulder was
performed before the routine shoulder MRI. The thickness of the periarticular soft tissue shadow adjacent to the Acromio-Clavicular joint
was measured on the radiograph. Then the appearance of the AcromioClavicular joint was evaluated on the MRI. Then a comparison of
radiographic Acromio-clavicular joint soft tissue measurement and MRI
appearance was made.
Results Radiographic measurement of peri-articular soft tissue shadow
co-related well with the magnetic resonance images of the joint, even in
the absence of bone changes in the acromio-clavicular joint
Conclusions Radiographic measurement of peri-articular soft tissue
shadow has a significant co-relation with the magnetic resonance
appearance of the joint. This measurement is a sensitive predictor of
Acromio-clavicular joint pathology on the radiograph, even in the absence
of bone changes.
Keywords Shoulder
MS039
A Two - Year Retrospective Study of Psoas Abscess
Prakash Sharma, Anish Ghimire
Department of Radiology, Nepalgunj Medical College Teaching
Hospital, Nepal
Purpose This study was done to know the common pattern, causative
organism and compare the outcome of different modalities of treatment
(conservative, surgery or ultrasonography guided aspiration).
Methods A retrospective review of psoas abscess was conducted
from June 2007 to May 2009 in Nepalgunj Medical College Teaching
Hospital, Nepal. We reviewed the clinical data from 19 patients who
were classified as a case of psoas abscess. Demographic data, clinical
features, laboratory investigations and radiological investigations were
recorded. All the treatment modalities used to treat the patients were also
MS053
Analysis of MRI Features in Skeletal Muscle Metastases
Qi Li¹, Bo Jiang1, Shinong Pan2, Lei Wang1, Qi Yong Guo2
1
Department of Radiology, Liaoning Electric Power Central
Hospital, China
2
Department of Radiology, the Shengjing Hospital of China
Medical University, China
Purpose To define MRI features in skeletal muscle metastases.
Methods 25 cases with skeletal muscle metastases proven by histology
were performed by MR, radiography and CT. And 10 cases with MR
enhancement, 15 cases with CT enhancement and 2 cases with PET-CT
among them. The primary malignant tumors included lung cancer (n=5),
cervical cancer (n=5), urothelial tumors (n=4), colon and rectal cancer
(n=4), gastric cancer (n=3), breast cancer (n=2), thyroid cancer (n=1),
liver cancer (n=1).
Results 25 cases were classified into 3 types according to shape,
relationship with surrounding tissues and bone destruction in MRI. (1)
Localized type (n=6): 5 cases, 4 cases in psoas muscle and 1 in thigh
musculature, showed blur borders masses involving single muscle with
slightly low signal on T1WI and slightly high signal on T2WI in MRI. And
3 cases underwent MR enhancement examination showed moderate rim
enhancement with low attenuation centre. Another one case in chest wall
musculature showed thickened blur borders muscle with mixed signal in
MRI. All 6 cases showed soft tissue swelling with blur borders in CT. The
5 cases performed CT enhancement showed moderate rim enhancement
and 2 cases performed PET-CT showed FDG hypermetabolism in lesions.
(2) Diffuse type without bone destruction (n=9): All in abdominal wall
muscle or pelvic wall muscle. MRI showed diffused lesions (more than one
group of muscle involved) with remarkable hyperintensity signal and part
of lesion with feather changing on T2WI and T2WI-SPAIR and 3 cases
with heterogenous enhancement. (3) Diffsed type with bone destruction
(n=10): 5 in iliopsoas with ilium or sacrum involved, 5 in psoas muscle
with vertebrae involved. They showed mixed signal, irregular masses,
and 4 cases with heterogenous enhancement in MRI and worm-like bone
destruction in CT.
Conclusions MRI could effectively reflect pathologic features of Skeletal
Muscle Metastases, which is beneficial for diagnosis and rational therapy
of skeletal muscle metastases.
Keywords Metastases, MR
MS010
Superior-Capsular Elongation and Its Significance in
Atraumatic Posteroinferior Multidirectional Shoulder
Instability at a MR Arthrography
Yi-Chih Hsu
Department of Radiology, MD, Taiwan
Purpose To determine the significance of superior-capsular elongation
and its relevance to the atraumatic posteroinferior multidirectional
shoulder instability at magnetic resonance (MR) arthrography.
Methods MR arthrography was performed in 21 patients with atraumatic
posteroinferior multidirectional shoulder instability and 21 patients without
shoulder instability. One observer made the measurements in duplicate
and was blinded to the two groups. The superior-capsular measurements
(linear distance and cross-sectional area) under the supraspinatus
tendon, and the rotator interval were determined on MR arthrography and
evaluated for each of the two groups.
Results In patients with atraumatic posteroinferior multidirectional
shoulder instability, superior-capsular elongation for linear distance
measurements was significantly more frequent under either the
supraspinatus tendon (P<0.001) than the rotator interval (P=0.15);
moreover, for the cross-sectional area measurements was significantly
more frequent either under the supraspinatus tendon (P<0.001) or the
rotator interval (P=0.01). The linear distance longer than 1.6 mm under
the supraspinatus tendon had a specificity of 95% and a sensitivity of
90% for diagnosing atraumatic posteroinferior multidirectional shoulder
instability. The cross-sectional area under the supraspinatus tendon larger
than 0.3 cm2, or an area under the rotator interval larger than 1.4 cm2 had
a specificity of more than 80% and a sensitivity of 90%.
Conclusions The superior-capsular elongation as well as its diagnostic
criteria of measurements by MR arthrography revealed in the present
study could serve as references for diagnosing atraumatic posteroinferior
shoulder instability and offer insight into the spectrum of imaging findings
corresponding to the pathologies encountered at clinical presentation.
Keywords Arthrography, MR, Shoulder
MS015
Comparison of High Resolutional Ultrasonographic Imaging
with Water Bath Immersion Technique and MRI with
Microscopic Coil in the Evaluation of Hand
503
MS020
Perfusion Maps with Curve Fitting and Curve Patterns: An
Innovative Way to Present MR Dynamic Data and Necrosis
of Osteosarcoma with Pathological Correlation and
Prediction of Prognosis
Hung Ta Wu1, Yi-Hsuan Kao2, Chih-Shueh Paul Chen3, ChuehChuan Yen4, Chao-Hsuan Yen1, Hong-Jen Chiou1, Cheng-Yen
Chang1, Wei-Ming Chen5
1
Taiwan
2
Department of Biomedical Imaging and Radiological Sciences,
3
Department of Pathology, Taipei Veterans General Hospital,
Taiwan
4
Department of Internal Medicine, Taipei Veterans General
Hospital, Taiwan
5
Department of Orthopaedics and Traumatology, Taipei Veterans
± 2 mm.
Results All patients with ulnar impaction syndrome had ulnar plus variant.
Ulnar impaction syndrome demonstrated classical impingement of lunate
with the protruding distal ulna bone with cystic change or osteosclerosis.
Although the triangular fibrocartilage may demonstrate signs of impaction,
a complete tear was not observed. DE-MRI demonstrated bone edema
at the impaction. Seven patients with Kienbock disease had ulnar minus
variant. Characteristic findings of Kienboch disease of different stages
ranging from bone edema, subchondral fracture and total collapse
of lunate were observed. In two cases, DE-MRI demonstrated early
bone edema of Keinbock disease despite of any destruction of bony
architecture.
Conclusions Ulnar impaction syndrome is resulting from ulnar plus variant
although in many cases ulnar plus variant may not necessary to produce
the syndrome. A strong relationship of ulnar minus variant and Kienbock
disease exist although other causes may also lead to the disease. MRI
and DE-MRI provide information not only the stage of disease but also the
pathophysiology of Keinbock disease from compromising arterial supply to
the lunate.
Key words Ischemia/Infarction, MR, Normal Variants, Contrast Agents
E-Poster
sensitivities approaching 100% and specificities of 81-89%.
Conclusions The study demonstrated the predictive value of 64-multislice
coronary CT angiography and proposed segment stenosis score, modified
Duke CAD index, and number of obstructive vessels to be the bestperforming CT angiographic predictors.
Keywords Angiography, Arteriosclerosis, Outcomes Analysis, CT
Others
2009.03.23
2010.03.23
MS063
The Association of Meniscal Pathology with Osteoarthritis
of the Knee
Hung Lit Chow1, Carmen C.M.2, Cho, CK So1
1
China
2
Department of Radiology, Prince of Wales Hospital, Hong Kong,
China
Purpose In the past, the relationship between osteoarthritis and meniscal
structural damage has been implicated, yet not fully proven. This study
aimed to characterize the association of meniscal pathology in patients
with osteoarthritis of knee.
through 31 June 2009 were reviewed retrospectively by, two MSK
radiologists for the presence of meniscal pathology. The demographic
data, presence of osteoarthritic changes; cartilage loss, subchondral
marrow edema and compartmental distribution were also recorded.
Results A total of 86 patients (male/female=52/34, age 35-82, average
53) with 90 meniscal tears were identified (46 medial, 34 lateral and
10 both). Among those, 60/90 (67%) tears involved the posterior horn,
24 (27%) tears involved the anterior horn and 6 involving the body of
meniscus. There were 14 radial tears involving the meniscal root, 6 of
them demonstrated meniscal extrusion. Concomitant cartilage loss was
observed in 56 patients, 30/56 (54%) over the medial tibiofemoral joint,
12/56 (21%) involving lateral compartment, and 14/56 (25%) over both
side. Patellofemoral osteoarthritis was present in 50 (89%) patients
and subchondral edema was noted in 26 (46%) cases. 93% (52/56) of
the patients demonstrated osteoarthritic changes on the ipsilateral side
of meniscal pathology, including all of the radial tears with meniscal
extrusion. Posterior horn tear (85%) was also found to be more prevalent
in patients with osteoarthritis.
Conclusions Meniscal pathology is strongly associated with osteoarthritis
of knee. In particular, radial tear involving the root, tear of the posterior
horn, and meniscal extrusions are highly associated, thereby predisposing
patients to progressive cartilage loss and degeneration of the knee.
Keywords Joints, Knee
504
NR072
Parkinsonism after Carbon Monoxide Intoxication: Evaluation
of the Substantia Nigra with Inversion-Recovery MR Imaging
Cheng-Yu Chen 1, Nai-Yu Cho 2, Hung-Wen Kao 1, Chun-Jen
Hsueh1, Chun-Jung Juan1, Chun-Jung Chung3
1
Departmen of Radiology, Tri-Service General Hospital, Taiwan
2
Department of Biomedical Engineering, National Yang-Ming
University, Taiwan
3
University, Taiwan
Purpose To investigate the signal change of the substantia nigra (SN), as
measured with inversion-recovery (IR) magnetic resonance (MR) imaging,
in patients with parkinsonism following carbon monoxide (CO) intoxication.
Methods The study was institutional review board approved. Thirteen
patient with CO-induced parkinsonism (COIP group; 9 male and 4 female
subjects; age range, 22-68 years; mean age, 39.7 ± 12.1 years), 13 agematched CO-intoxicated patients without parkinsonism (CONP group;
8 male and 5 female subjects; mean age, 39.9 ±12.4 years), and 13
age- matched healthy volunteers (Normal group; 8 male and 5 female
subjects; mean age, 38.9 ±11.0 years) were examined with IR grey
matter suppression MR imaging. Three experienced neuroradiologists
independently defined the SN as region-of-interest (ROI), and then the
ROI was automatically segmented into three equal parts with the signal
ratios of each part to the temporal white matter calculated. Kendall
W coefficients of concordance (K) were computed to compare reader
assessment of the ROI.
Results The interobserver agreement of the ROI in three groups was
excellent (K >0.9 for each groups). The signal ratios in the lateral part
of the SN were significantly lower in the parkinsonism group (P <.05) as
compared to either COIP or control groups. CONP and Normal groups did
not show significant difference in signal ratios for all three segments.
Conclusions Although the causes of parkinsonism can be many, CO
intoxication-induced parkinsonism may be contributed in part by direct
injury of the lateral aspects of SN. Gray matter suppression IR MR
imaging is a valuable tool in depicting the injury following CO intoxication.
Keywords MR, Brain/Brain Stem, Image Manipulation/Reconstruction,
Imaging Sequences
NR026
A Spectrum of Neurological Disorders during Pregnancy
and Postpartum Peroid: Our Experience
Ameya Jagdish Baxi, Belman Murali, Sripathi Vidyasagar,
Kishorelt Tourani, Thanugonda Nagendra
Radiodiagnosis, Care Hospitals, Hyderabad, India
Conclusions Diseases of the Nervous system develop and continue
despite pregnancy. Changes in haemodynamics, blood volume &
hormonal effects may alter the clinical spectrum and response to therapy.
In all the instances, status of the fetus needs to be carefully weighed. We
sought to characterize common neurological disorders during pregnancy
with special emphasis on timing, etiology, risk factors and outcome based
on radiological findings.
Keywords Brain/Brain Stem, Pregnancy
HN035
Dynamic CT Assessment of Vocal Cord Dysfunction and
Other Laryngeal Conditions That Produce Wheeze
Kenneth K Lau
Department of Diagnostic Imaging, Monash Medical Centre,
Australia
Purpose Paradoxical vocal cord dysfunction (VCD) is a common disorder
characterized by the inappropriate closure of the vocal cords during
breathing, associated with stridorous wheezing mimicking asthma. VCD is
often paroxysmal that may be precipitated by both organic and non-organic/
psychological causes. The condition can resolve spontaneously, through
the use of sedatives, speech therapy or breathing exercises. It is often
misdiagnosed as asthma and could lead to excessive medical therapy and
unnecessary high dose steroid. 30% of asthmatics may have an element of
VCD present. Laryngoscopy by direct visualization of laryngeal structures
has been the gold standard test for VCD. However, expertise to operate a
laryngoscope is often not available in the acute clinical setting. The recent
advent of 320-slice multidetector CT (320-MDCT) has the ability to provide
a dynamic volume assessment of the entire laryngeal airway during the
respiratory cycle. The purpose of this study is to evaluate paradoxical glottic
closure in VCD and other laryngeal pathology.
Methods 52 adult patients with clinical suspicion of VCD were referred for
the 320-MDCT assessment of the larynx. The vocal cord and laryngeal
pathology and degree of laryngeal movement on the CT were recorded.
Results 24 patients (46%) had VCD during inspiratory or expiratory
phase. 2 patients with vocal cord palsy, 2 with subglottic stenosis, 1
with tracheomalacia, 1 with tonsillar enlargement and 1 with thyroid
enlargement were encountered. 21 patients showed no VCD and the
wheeze were attributed to asthma.
Conclusions The 320-MDCT can be a valuable tool in the dynamic
assessment of laryngeal movement and pathology, including VCD, and
becomes a non-invasive alternative to laryngoscopy. Its associated
radiation dose is relatively low because of the excellent soft tissueairway interface in this region. This CT technique would allow better
understanding of the underlying laryngeal pathophysiology.
Keywords Larynx, CT, Technical Aspects
E-Poster
Purpose Both high resolutional ultrasonographic imaging with water
bath immersion technique (WBIT) and MRI with microscopic coil have
been used to evaluate hand pathology. This study directly compared both
techniques performed simultaneously on the same patients.
Methods Thirty nine cases of the US imaging in hand lesions were
evaluated. Final diagnoses included mass (21 cases), tendon and
ligament pathology (15), others (3). We used ATL HDI 3000 /5000 5 to
12 MHz linear transducer with WBIT. We evaluated the contour change
of the lesions (margin, septation, internal echo textures, and sonic
enhancement), and adjacent structures. US findings were compared to
MR imaging (Philips, Gyroscan, Intera) with microscopic coil (47 mm in
diameter).
Results All 39 patients (100%) had improvement of the superficial
resolution of the lesions with preserved the original contour using WBIT
technique US. Above lesions are well correlated with MRI with microscopic
coil. On thirty five cases (90%), WBIT was more useful in the evaluation
of the lesion because of the dynamic examination. Four cases (10%) (3:
giant cell tumor of the tendon sheath, 1: arteriovenous malformation) were
same result.
Conclusions The WBIT US was superior to understand the anatomy and
pathology of hand. It is an easy, simple, and useful tool for assessment of
the superficial lesions in hand without image distortion. In addition, WBIT
US has the advantage of dynamic assessment of the lesion compared
with the MRI with microscopic coil.
Keywords Ligaments, MR, Tendons, Hand, Ultrasound
Neuroradiology (NR)
Purpose 1. To study common and uncommon neurological disorders during
pregnancy and postpartum period. 2. To review characteristic radiological
features and outcome of these neurological disorders. 3. To study
etiopathogenesis, types and manifestations of stroke during pregnancy.
Methods Pregnant patient can present with variety of neurological
conditions. These disorders may be unrelated to pregnant state
(e.g., meningitis) or peculiar to or more prevalent during pregnancy
(e.g., eclampsia, infarctions, mostly hemorrhagic and cortical venous
thrombosis). Pregnancy may affect the course of pre-existing neurological
disorders such as epilepsy. These disorders may influence the
management of otherwise uncomplicated obstetric cases.
Results This study was carried out at Care hospital, Hyderabad between
February 2004 and August 2009. All pregnant patients undergoing
neurological consultation for headache, seizures and altered sensorium
were included. We performed MRI of the brain in 58 such patients and
contrast study was done in 7 patients after delivery. We did axial T1,
T2, FLAIR, DWI, ADC and Hemo sequence. We came across epilepsy,
seizures, arterial infarctions and vasospasms, cerebral venous sinus
thrombosis, reversible posterior leukoencephalopathy.
Others
I Yang, HJ Kim, JY Woo, AY Jung, HS Hong, SY Chung
Department of Radiology, Kangnam Sacred Heart Hospital,
505
Purpose Appropriate graft weight is important for liver transplantation to
provide better graft regeneration and avoid small-for-size syndrome with
graft failure. However due to donor safety, the left liver may always be
selected as the graft. The aim of the study is to evaluate the regeneration
rate of the left lobe liver graft in adult living donor liver transplantation
(ALDLT).
Methods Nine left and 145 right liver grafts ALDLT were enrolled in this
study at the Chang Gung Memorial Hospital-Kaohsiung Medical Center,
Taiwan. The records, preoperative and postoperative images performed
6 months after liver transplantation was reviewed. The volume of the
graft 6 months after transplant divided by the standard liver volume was
calculated as the regeneration ratio. The regeneration rate of the group
with left lobe graft ALDLT was compared with the other right lobe graft
group in our hospital.
Results The liver graft regeneration ratio of left lobe was 85.3±11.0 (range,
61-97), slightly lower than the right liver graft (91.2 ± 12.6%; range, 58151). In the group of GRWR > 1, the regenerative rate was slightly higher
than the group of GRWR < 1.
Conclusions Either right or left liver graft can achieved sufficient
regeneration in ALDLT with slight lower regeneration rate in the left liver
and GRWR<1 groups.
Keywords Liver, CT, Surgery, Transplantation
AB011
Inoperable Hepatocellular Carcinoma Following High
Intensity Focused Ultrasound Ablation - MRI Findings and
Outcome: Early Experience in 11 Patients
Ferdinand Chu¹, Francis Cho¹, Kenneth Chok²
¹Department of Radoplogy, Queen Mary Hospital, Hong Kong
China
²Department of Surgery, Queen Mary Hospital, Hong Kong China
Purpose High Intensity Focused Ultrasound (HIFU) is a new modality for
the treatment of inoperable Hepatocellular Carcinoma (HCC). We plan to
evaluate the imaging characteristics of the treated lesions after HIFU and
the outcome based on serial follow up MRI findings.
Methods In 2008, total of 11 patients underwent HIFU ablation treatment.
13 foci of inoperable HCC were treated using HIFU ablation. They were
followed up by serial contrast MRI at 1, 3 and 6 months interval.
Results Following HIFU ablation, the centre of the treated area is typically
T1 weighted hyperintense with or without an enhancing rim. The enhancing
rim typically fades as time elapses. Out of thirteen lesions, five lesions in
four patients were completely treated. Three lesions in two patients had
residual active disease adjacent to the treated area. One of these patients
had further transarterial oily chemoembolization (TOCE), the other was
managed conservatively. Five lesions in four patients had new HCC foci
away from the treated area. Two patients had further TOCE, one had
repeat HIFU and the remaining one had partial hepatectomy. Average
power, time and total energy of ablation were 368W, 1597s and 658329J.
Conclusions MRI imaging features of HCC treated by HIFU are
characteristic. HIFU offers an alternative in the treatment of inoperable
HCC in cirrhotic patients. It offer complete cure in some patients, while
506
AB013
Gd-EOB-DTPA Enhanced MR Findings of Intrahepatic
Cholangiocarcinoma
Yoshihisa Kodama¹, Yasuo Sakurai¹, Taiki Fukuda¹, Hirotaka
Ikeda¹, Kenji Murakami¹, Kunihiko Tsuji², Jong-Hon Kang²,
Hiroyuki Maguchi²
¹Department of Radiology, Teine Keijinkai Medical Center, Japan
²Department of Gastroenterology, Teine Keijinkai Medical Center,
Japan
Purpose To evaluate Gd-EOB-DTPA enhanced MR findings of
intrahepatic cholangiocarcinoma.
Methods From January 2008 to July 2009, 10 patients with intrahepatic
cholangiocarcinoma performed Gd-EOB-DTPA enhanced MR were
enrolled this study. There were 3 men and 7 women. Ages ranged from
65 to 85 (median 69) year-old. Size of tumor ranged from 19 to 60 mm
(median 28.5) in maximum diameter. 10 patients with hepatic metastasis
performed Gd-EOB-DTPA enhanced MR in contemporary period set as
control. Qualitative analysis for tumor detectability was assessed using
by 5 point scale in T1WI, T2WI, DWI, and hepato-biliary phase (HBP). In
HBP, tumor-to-liver signal intensity ratio was calculated as quantitative
analysis. Student t test was used as statistical analysis, and p value less
than 0.05 was defined as significant.
Results Average scores of intrahepatic cholangiocarcinoma in T1WI,
T2WI, DWI, and HBP were 4.3, 4.1, 4.8, and 3.7 respectively. Average
scores of hepatic metastasis were 4.5, 3.1, 4.7, and 4.9 respectively.
Comparison between sequences, DWI had significant higher
score than the other sequences. Comparison between intrahepatic
cholangiocarcinoma and metastasis, p values in T1WI, T2WI, DWI, and
HBP were 0.31, 0.04, 0.31, and 0.006. The detectability of intrahepatic
cholangiocarcinoma in HBP was significant lower than that of metastasis.
Tumor-to-signal intensity ratio of intrahepatic cholangiocarcinoma and
intrahepatic metastasis were 0.79 +/- 0.14 and 0.51 +/- 0.18. Tumor-toliver signal intensity ratio in hepatic metastasis was significant lower than
that of intrahepatic cholangiocarcinoma (p=0.0006).
Conclusions HBP of Gd-EOB-DTPA enhanced MR is not useful for
detecting intrahepatic cholangiocarcinoma. DWI is the most useful
sequence instead.
Keywords Liver, MR, Neoplasms-Primary
AB018
Intraluminal versus Infiltrating Gallbladder Carcinoma:
Differences in Clinical Presentations and Sensitivities of
Ultrasound and Computed Tomographic Assessment
Jiun-Lung Liang¹, Sheung-Fat Ko¹, Chung-Cheng Huang¹, TzeYu Lee¹, Shyr-Ming Sheen-Chen², Hsuan-Ying Huang¹
¹Department of Radiology, Chang Gung University, College of
Medicine, Chang Gung Memorial Hospital- Kaohsiung Medical
Center, Taiwan
²Department of Surgery, Chang Gung University, College of
Medicine, Chang Gung Memorial Hospital- Kaohsiung Medical
Center, Taiwan
Purpose To analyze the differences in clinical presentations and
sensitivities of ultrasound (US) and computed tomographic (CT)
assessment between intraluminal and infiltrating gallbladder carcinoma
(GBCA).
Methods This retrospective study evaluated 65 cases of GBCA which
were morphologically categorized into the intraluminal-GBCA group
(n=37) and the infiltrating-GBCA group (n=28). The clinical and laboratory
findings, presence of gallstones, gallbladder size, T-staging, nodal
status, sensitivity of preoperative US and CT studies, and outcome were
compared between the two groups.
Results There were no significant differences between the two groups
with respect to female predominance, presence of abdominal pain,
serum aminotransferases level, T2-T4 staging, and regional metastatic
nodes. Compare with the patients with intraluminal-GBCA, the patients
with infiltrating-GBCA had significantly older age, higher frequencies of
jaundice and fever, higher alkaline phosphatase and total bilirubin levels,
higher frequency of gallstones, smaller gallbladder size and shorter
survival. The sensitivities for diagnosing intraluminal-GBCA with and
without gallstones were 63.6% and 91.3% on US and 80% and 100% on
CT respectively. The sensitivities for diagnosing infiltrating-GBCA with and
without gallstones were 12.5% and 25% on US and 71.4% and 75% on
CT respectively.
Conclusions In contrast to intraluminal-GBCA, infiltrating-GBCA is easily
overlooked on US. In elderly females with suspected small gallbladder
and gallstones on US, especially those with jaundice, fever, and high
serum alkaline phosphatase and total bilirubin levels, CT is recommended
for surveying underlying infiltrating-GBCA
Keywords Neoplasms-Primary, CT,Gallbladder, Ultrasound
AB020
Noninvasive Liver Fibrosis Method for Measurement and
Study of the Utility Using ARFI
Gaku Igarashi 1 , Fumio Tsujimoto 2 , Nobuyuki Matsumoto 3 ,
Masasumi Miyazaki3, Atsuki Koike4, Yasuo Nakajima5, Sachihiko
Nobuoka2, Takehito Otsubo3, Fumio Ito3
1
Department of Internal Medicine, Division of Gastroenterology
and Hepatology, St. Marianna University School of Medicine,
Japan
2
Department of Laboratory Medicine, St. Marianna University
School of Medicine, Japan
3
Department of Gastroenterology, St. Marianna University School
of Medicine, Japan
4
Department of Pathology, St. Marianna University School of
Medicine, Japan
5
Department of Radiology, St. Marianna University School of
Medicine, Japan
Purpose The accurate diagnosis of fibrosis related to chronic liver
diseases is crucial for prognostication and treatment decisions. Although
liver biopsy is the gold standard, it has limitations because of its invasive
nature. Thus development of new non-invasive methods is desired to
diagnose hepatic fibrosis. Recently, Acoustic Radiation Force Impulse
(ARFI) imaging is developed as a non-invasive modality to evaluate
stiffness of tissues. ARFI imaging theoretically measure liver stiffness of
all the segments independently. The aim of this study is to assess the
applicability of ARFI imaging for the diagnosis of liver fibrosis.
Methods The study enrolled 20 healthy volunteers as a control group, and
histologically diagnosed 42 chronic liver disease patients. Pathological
fibrosis stagings by new Inuyama classification were F1 to F4 in 11, 17,
5, 9 patients respectively. ARFI Vs values were acquired with a Siemens
Acuson S2000 (Siemens Medical Systems, Germany), which has been
modified to obtain ARFI images. We obtained ARFI Vs values from S2 to
S8 of Cuinaud's segmentation system by 3 consecutive measurements.
We calculated interquartile range/median (IQR/M) and standard deviation
(SD) of these 3 data.
Results The dispersion of IQR/M (1.1) was smaller than that of SD (2.4),
suggesting the existence of outlier in ARFI Vs values. Therefore, we chose
median to represent ARFI Vs values of each segments. And average of
ARFI Vs values of all segments were calculated as the ARFI Vs value
of whole liver. The laboratory blood tests, which showed statistically
significant correlation to fibrosis staging by Pearson’s correlation
coefficient, were PT-INR(r=0.576, p<0.001), ICGR15(r=0.497, p<0.001).
ARFI Vs value showed the best correlation (r=0.766, p<0.001) compared
to blood results.
Conclusions In this study we showed that fibrosis staging is significantly
correlated with whole liver stiffness which was obtained by ARFI, which
enables us to quantitatively estimate stiffness of each segment of a liver.
Keywords Liver, Ultrasound, Imaging Sequences
AB022
Retroperitoneal Ectopic Pancreas: Imaging Findings
Li-Han Lin¹, Sheung-Fat Ko¹, Chung-Cheng Huang¹, Shu-Hang
Ng¹, Jui-Wei Lin², Shyr-Ming Sheen-Chen³
¹Department of Radiology, College of Medicine, Chang Gung
University, Chang Gung Memorial Hospital Kaohsiung Medical
center, Taiwan
²Department of Pathology, College of Medicine, Chang Gung
University, Chang Gung Memorial Hospital Kaohsiung Medical
center, Taiwan
³Department of Surgery, College of Medicine, Chang Gung University,
Chang Gung Memorial Hospital Kaohsiung Medical center, Taiwan
Purpose Ectopic pancreas is an uncommon finding and the estimated
incidence is 0.55-13.7% according to autopsy analyses. Most ectopic
pancreatic lesions are found in the gastrointestinal tract and frequently
involve the stomach, duodenum, and jejunum and less commonly,
Meckel’s diverticulum or the ileum. Though rare, ectopic pancreas in
the lung and the mediastinum has also been documented. However,
retroperitoneal ectopic pancreas has not previously been documented.
Methods We report a 48 year-old man with retroperitoneal ectopic
pancreas imitating bilateral adrenal tumors on ultrasound and magnetic
resonance imaging. Subsequent computed tomographic-guided biopsies
confirmed an ectopic pancreas.
Results The lesions remained stable during follow-up for 7 years.
Conclusions In retrospect, the similarity in signal intensities and
enhancement pattern between the retroperitoneal masses and the
pancreas may have been a clue to the diagnosis of this rare entity.
Keywords Adrenal, Biopsy, MR, Pancreas, CT, Ultrasound
AB023
Computer-Aided Diagnosis in Thickness Measurement
of Ultrasonographic Peritoneal Membrane in Peritoneal
Dialysis Patients
Tsung Chun Lee1, Syu Jyun Peng2, Yu Yeh Yang3, Jenq Wen
Huang3, Hsiu Po Wang2, Hsuan Ting Chang2
1
Department of Internal Medicine, National Taiwan University
Hospital and College of Medicine, National Taiwan University,
Taipei, Taiwan
2
Department of Electrical Engineering, National Yunlin University
of Science & Technology Yunlin Taiwan, Taiwan
3
Department of Internal Medicine, Far Eastern Memorial Hospital
Banchiao Taipei Taiwan, Taiwan
Purpose Peritoneal dialysis relies on adequate filtration function of
the peritoneal membrane to remove daily body wastes. Recently we
published non-invasive measuring techniques utilizing trans-abdominal
ultrasonography. However, previous measurement was restricted by
limited point-to-point measurement and by lacking the measurement of
variability, which might also be an important index. We aim to establish
computer-aided analysis algorithms to solve these problems.
Methods We segmented each image to extract a whitish band of
peritoneum by using image processing algorithms semi-automatically.
First, the examiner selected a region of interest (ROI) that encompassed
the external border of the band. Second, because of heterogeneity
of the images, we adopted only clear bands with adequate intensity
(whiteness) continuously for an adequate length of 200 pixels or more.
Third, we proposed an applicative algorithm to extract out peritoneal
band. Fourth, we calculated the thickness of each local peritoneal
segment perpendicular to the long axis of the band. Owing to objective
measurement, the variability in the width of the peritoneal band could
be calculated as well. Finally, we compare the data of measurement
subjectively by the examiner with that objectively with our algorithm.
Results We adopted 276 and 232 ultrasonographic peritoneum images
from 90 right and 89 left upper quadrant subjects, respectively. The
measured peritoneal thickness ranged from 0.3 to 1.2 mm. Compared
to the examiner’s measurement (only three pairs of smearing points),
our algorithm provided more than 200 pairs of measuring points in each
507
AB010
Outcome of Left Liver Grafts in Adult Living Donor Liver
Transplantation: Comparison with Right Liver Grafts
Hsiu-Ling Chen¹, Chao-Long Chen¹, Tung-Liang Huang², Tai-Yi
Chen², Leo Leung-Chit Tsang², Hsin-You Ou³, Chun-Yen Yu², YuFan Cheng²
¹Department of Surgery, Chang Gung Memorial HospitalKaohsiung Medical Center and Chang Gung University College
of Medicine Taiwan, Taiwan
²Department of Diagnostic Radiology, Chang Gung Memorial
Hospital-Kaohsiung Medical Center and Chang Gung University
College of Medicine Taiwan, Taiwan
³CTRC, GE Healthcare, China
does not preclude subsequent treatment by other means.
Keywords Ablation Procedures, Liver
E-Poster
Others
Standing Poster
AB087
Texture Mapping and Electronic Biopsy for Diagnosis of
Colorectal Cancer during CT Virtual Colonoscopy
Shao-Jer Chen 1, Lih-Shyang Chen 2, Yu-His Hsieh 3, Ta-Wen
Hsu4, Wen-Yao Yin4, Chih-Wen Lin5, Ku-Yaw Chang5
1
Department of Radiology, Buddhist Dalin Tzu Chi General
Hospital, Chia-Yi, Taiwan
2
Department of Electrical Engineering, National Cheng-Kung
University, Tainan, Taiwan
3
Division of Gastroenterology, Department of Medicine, Buddhist
Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan
4
Department of General Surgery, Buddhist Dalin Tzu Chi General
Hospital, Chia-Yi, Taiwan
5
Department of Computer Science and Information Engineering,
Da-Yeh University, Changhua, Taiwan
Purpose To evaluate the efficacy of MDCT in differentiating diseases
involving giant gastric folds (GGF) and to identify features best able to
predict gastric malignant disease.
Methods Institutional review board waived the need for informed written
consent from the group of patients studies herein. We retrospectively blind
reviewed and analyzed the images taken by 16-row MDCT scans for 64
patients who had previously been found to have GGF by endoscopy. Thirty
were histopathologiclly proven to have scirrhous carcinoma, 15 large B-cell
lymphoma, 14 acute gastric mucosal lesions (AGML), and 5 Mẻnẻtrier
disease. Unenhanced transparency volume rendering (VR) images were
assessed for the whole gastric morphology. Post-contrast images were
used to analyze the wall thickness, stratification, enhancement pattern
and the perigastric conditions. We calculated the overall diagnostic
accuracy of MDCT in different gastric disorders by the Cramer's phi-prime
correlation coefficient, the scatter plot of overall diagnostic score and the
receiver-operator characteristic (ROC) curve method for the neighboring
two diseases were employed to locate the cut-off values for the best
diagnostic accuracy. We used exact logistic regression to identify which
MDCT image features might best predict gastric malignant disease.
Results For large B cell lymphoma, the gastric wall was found to be
significantly thicker than in other disorders (p<0.001). MDCT had a overall
100% diagnostic accuracy in the four diseases respectively. We found the
best MDCT predictor of malignancy to be loss of wall stratification.
Conclusions MDCT imaging features may provide a reliable non-invasive
diagnosis in patients with endoscopically detected GGF and be used to
differentiate benign from malignant disease.
Keywords CT
AB050
Acute Pancreatitis, Its Complication and Prognostic
Correlation by Modified CT Severity Index
Amit Disawal, Nischal G Kundargi, Kishor Taori
Purpose Study conducted to establish the ability of CT in depicting
and quantifying the pancreatic parenchymal injury, to detect pancreatic
necrosis and complications. CT severity index (Modified) is a scoring
system that combines CT grading and percentage of necrosis to obtain a
number that correlate with the risk of developing serious complications,
which in turn correlates with increased morbidity and risk of death.
Methods Prospective study for 2 years, sample size 100, Age distribution
14-71years. CT scan machine: MDCT somatom Volume access, Siemens.
Protocol: CT scanning abdomen after oral and IV administration of
contrast in both arterial and portal venous phase. 5mm collimation,
Results Acute pancreatitis found to be common in 3-5th decade. Out
of 100 patient 41 (41%) developed complication related pancreatitis.
Pseudocyst was the most common complication (23%) and others with
less percentage include pancreatic abscess, necrosis, GI and biliary tract
invovlment etc. Most of the mortality are due to necrotizing pancreatitis.
Grading by Modified CT severity index revealed least morbidity (10%)
(length of hospital stay) and mortality (<1%) in mild (points 0-2)
508
Purpose To further explore the internal nature of the lesion beneath the
surface, texture mapping and erosion are applied to display the CT virtual
colonoscopic images in our studies.
Methods The virtual colonoscopy system takes a spiral CT scan of the
patient's abdomen in prone position after the entire colon is fully cleansed
and distended with room air or CO2. Several hundred high resolution
CT images are rapidly acquired during a single breathhold of about 3040 seconds, forming a volumetric abdomen data set. A model of the
real colon is then segmented from the abdomen data set mainly using
gray level threshold and marching cubes. Surface rendering technique
without and with texture mapping are compared. Electronic biopsy is also
performed over the selected interested area.
Results Our methods not only provide good stereovision as surface
rendering but also can investigate the interior structures for the colon
lesions. The visible lesions on colon surface such as polyps, cancers,
retention stool, fluid, or just extrinsic lesions compressed the colonic wall
can be shown by their gray levels pattern in the CT image.
Conclusions Virtual colonoscopy, as an alternative screen method to
optical colonoscopy and barium enema, is made possible by employing
advanced computer graphics and visualization techniques. It is also
helpful in staging colorectal cancer and preoperative evaluation.
Keywords Large Bowel, CT, Rectum, Screening, Endoscopy, Staging
AB099
Biliary Intraductal Papillary Mucinous Neoplasm
Yung-Yi Chen, Yung-Yi Cheng
Department of Radiology, Taichung Veterans General Hospital,
Taiwan
Purpose To evaluate imaging features of biliary intraductal papillary
mucinous neoplasm (IPMN).
Methods We report five cases of biliary IPMT, between November 2008
and July 2009. They were composed of three males and tow females with
an age range from 45 to 85 years.
Results Four of five tumors were in left lobe of liver, and the other
one was in common bile duct. All of the patients were evaluated with
imaging studies of CT or MRI, and underwent surgical resection with
hystopathological investigation.
Conclusions Intraductal papillary mucinous neoplasms (IPMN) are known
to occur in the pancreas. IPMN of bile duct is rare, which is a recently
recognized entity which closely resembles an IPMN of the pancreas.
These tumors secrete mucin that may form mucous plugs resulting in
AB112
Quantifying Classification of Normal Liver, Chronic Liver
Disease and Fatty Liver Using Logistic Regression Based
on Sonographic ROI Features
Nan-Han Lu1, Tai-Been Chen2, Lee-Ren Yeh1
1
Department of Radiology, E-DA Hospital, Taiwan
2
Department of Medical Imaging and Radiological Sciences,
I-Shou University, Taiwan
Purpose To demonstrate a novel method for quantifying classification of
normal liver, chronic liver disease and fatty liver using logistic regression
model based on extracted features of regions of interest (ROI) from liver
sonographic images.
Methods From August 2008 to August 2009, we collected 189 patients
who were 112 female (77 male) and age range from 23 to 88 years old
had received the ultrasound examination of liver condition. Reviewing of
clinical chart diagnosis, sonographic images and their liver function was
retrospectively analyzed. We utilized logistic regression model to identify
quantified measurement from six extracted features by hand-drawing ROI
of liver sonographic images. Positive samples (113) and negative samples
(32) were performed for validation.
Results The quantifying classification of normal liver, chronic liver disease
and fatty liver by applied RL.Std (i.e., standard deviation of pixels intensity
in ROI from right liver image) are (14.3, 16.03), (12.5, 14.2) and (11.1,
12.3) under 90% confidence interval. The sensitivity, specificity, and
overall accuracy are respective to 81.3%, 87.6%, and 86.2% (P=0.01).
Positive predictive value and negative predictive value are 94.3% and
65%. There is a very clear cutoff value (14.3, RL.Std) for differentiation of
normal liver and abnormal liver condition using liver ultrasound images
Conclusions Application of logistic regression model based on extracted
features of ROI from liver ultrasound images can provide the quantitative
information for evaluation of liver condition. Also, the proposed method
can assist physician easy to realize the severity degree of liver diseases
in real time ultrasound examination.
Keywords Liver, Ultrasound
BR020
Advanced Breast Cancer Patients with Dynamic Contrast
Enhancement Parameters in Multidetector Computerized
Tomography and Microvessel Count Analysis
Yu-Hsiang Juan¹, Yun-Chung Cheung1, hir-Hwa Ueng2, hin-Cheh
Chen3
1
Department of Medical Imaging and Intervention, Linkuo Chang
Gung Memorial Hospital, Chang Gung University, Taiwan
2
Department of Pathology, Linkuo Chang Gung Memorial
Hospital, Chang Gung University, Taiwan
3
Department of Surgery, Linkuo Chang Gung Memorial Hospital,
Chang Gung University, Taiwan
Purpose To investigate the enhancement parameters on dynamic
contrast-enhanced multidetector computerized tomography (DCE-MDCT)
and the angiogenesis biomarkers (CD31) on post-chemotherapy locally
advanced breast cancers.
Methods This retrospective study analyzed the proven locally advanced
breast cancers treated with 3 courses of neoadjuvant chemotherapy
(Epirubicin + Texotere) and subsequent mastectomy. All the patients
received DCE-MDCT after chemotherapy consisting of precontrast and
postcontrast scans at 1, 3, 5 minutes. The chemotherapeutic responses
were counted using RECIST criteria and the surgical excised cancers
were immunohistochemically stained with CD31 for microvessel counts.
These data were statistical analyzed by Pearson coefficient and
independent variable t-test analysis.
Results Twenty-eight patients (age range: 35-69, mean age: 47.90)
were enrolled for analysis. For overall cases, the enhanced attenuation
had poor correlation to CD31 either at 1 minute (Pearson coefficient
= .36, p=.06), 3 minutes (Pearson coefficient = .40, p= .03), 5 minutes
(Pearson coefficient = .51, p= .01) or net maximum enhancement
(Pearson coefficient =.38, p=.05). Responders (n= 24, complete + partial
responders) had lower mean enhancement than nonresponders (n= 4,
stationary and progressed), revealing 52.8 VS 73.2 at 1 minute (p=.01),
60 VS 93.4 at 3 minutes (p=.02) and 62.9 VS 84.9 at 5 minutes (p=.11).
Moreover, the enhancements at 3 minutes was inversely correlated to
the percentages of tumor size reduction after chemotherapy (Pearson
coefficient = -0.562, p<.01), as well to the net maximum enhancement
(Pearson coefficient = -0.390, p=0.04).
Conclusions Post-chemotherapy responders had significant lower
enhancement (at 1 and 3 minutes) than non-responders, while the
dynamic enhancement parameters have only weak linear correlation with
MDCT findings.
Keywords Neoplasms-Primary, Pathology, Treatment Effects
AB047
Multi Detector Computed Tomography of Giant Gastric
Folds: Differential Diagnosis
Chiao-Yun Chen, Gin-Chung Liu, Twei-Shiun Jaw, Yu-Ting Kuo,
Ding-Kwo Wu
Department of Medical Imaging, Kaohsiung Medical University,
Taiwan
biliary stasis, biliary duct obstruction and dilation. Severe dilatation of
the lobar or segmental intrahepatic bile ducts with crowding and severe
atrophy of the hepatic parenchyma are helpful imaging findings.
Keywords Liver, Bile Ducts, MR, CT
E-Poster
pancreatitis to highest morbidity (93%) & mortality (23%) in severe (points
8-10) pancreatitis. CT has an overall accuracy of 91%, with sensitivity and
specificity of 96% and 93% respectively.
Conclusions 1) CT is the most sensitive and specific imaging modality for
the evaluation of acute pancreatitis and its complication. 2) The modified
CT severity index has a stronger prognostic correlation and could also
predict the length of hospital stay and development of organ failure.
Keywords Complications, Pancreas, Inflammation
BR027
Metaplastic Carcinoma of the Breast: Report of 4 Cases and
Review of Literatures
Ng Suk Ping
Department of Radiology, Metaplastic carcinoma of the breast:
report of 4 cases and review of literatures
Purpose Metaplastic carcinoma of breast is a rare form of breast cancers
with a poorer prognosis than other breast malignancies. The imaging
diagnosis of this tumor before operation is often difficult due to its rarity.
The imaging features of this rare tumor were discussed.
Methods Computer search for metaplastic breast carcinoma were
searched from 2003 to 2009. Breast malignancies with pathological
proof of metaplastic breast carcinoma were collected. The medical chart
and imaging pattern were reviewed by 2 well experienced radiologists.
Imaging features were analyzed and recent literatures were reviewed.
Results Only 4 cases with pathologically proven metaplastic breast
carcinomas were found in operated breast malignancy during the period
of 2003 to 2009. All of the cases showed ill-defined margin, the size of the
tumor ranged from about 1 cm to 8 cm. Only one of the cases presented
with clustered microcalcifications.
509
Others
image frame along with the objective data of variability of thickness in
each frame. We can extract more complete information of the peritoneal
band by using the image processing schemes.
Conclusions For the first time, our study evaluated non-invasively the
peritoneal membrane thickness and variability in peritoneal dialysis
patients by computer-aided diagnosis algorithms. Further work on
correlation with these image data with clinical information is undergoing.
Keywords Peritoneum, Image Manipulation/Reconstruction
BR033
F-18-Fluoro-2-Deoxyglucose Positron Emission
Tomography/Computed Tomography for Postoperative
Follow-Up of Breast Cancer
Ryusuke Murakami, Shin-ichiro Kumita, Keiichi Ishihara,
Tomonari Kiriyama, Yasuhiro Kobayashi, Takahiko Mine, Tatsuo
Ueda
Department of Radiology Nippon Medical School Hospital, Japan
Purpose To evaluate the clinical role of combined positron emission
tomography (PET)/computed tomography (CT) for detection of breast
cancer recurrence and metastasis after initial surgical resection.
Methods One hundred thirty-three patients with surgically resected breast
cancer underwent 18F-FDG PET/CT. The PET and CT images were first
510
Purpose Singapore General Hospital replaced its screen-film
mammographic unit with a full-field digital mammogram (FFDM) system in
2007. An audit was performed for the reported BIRADS scores, recall rate
and breast cancer detection rate for screening mammograms in our initial
clinical experience with the FFDM system.
Methods We retrospectively reviewed all the mammogram screening
cases performed on FFDM from 2007 to 2008. We performed an audit
for the Breast Imaging Reporting and Data System (BIRADS) scores and
recall rate. We also traced the histopathology of all the cases that had
biopsy from which we derived the breast cancer detection rate and the
positive predictive value (PPV).
Results There were 2847 FFDM screening cases performed from 2007 to
2008. There were 214 (7.52%) cases with a BIRADS 0 score, 741 (26.03%)
cases with a BIRADS 1 score, 1701 (59.74%) cases with a BIRADS 2
score or 126 (4.43%) cases with a BIRADS 3 score, 59 (2.07%) cases
with a BIRADS 4 score and 6 (0.21%) with a BIRADS 5 score. There were
15 breast cancer cases detected. Recall rate was 2.49% (71/2847) and
breast cancer detection rate was 0.53% (15/2847). The positive predictive
value (PPV) was 21.13% (15/71).
Conclusions Our early experience with FFDM shows that the initial
statistics on BIRADS scores, recall rate and breast cancer detection rate
in mammographic screening are comparable to those in other breast
screening programs that have been published in the literature.
Keywords Mammography, Screening
BR035
Breast Density Measurement Based on Multispectral
Analysis of MRI
San-Kan Lee 1, Hsian-Min Chen 2, Jyh-Wen Chai 1, Jeon-Hor
Chen 2, Siwa Chan 1, Chih-Ming Chiang 1, Clayton Chi-Chang
Chen1, Chein-I Chang3
1
Taiwan
2
Department of Radiology, China Medical University Hospital,
Taiwan
3
Department of Remote Sensing Signal and Image Processing
Laboratory, Department of Computer Science and Electrical
Purpose Independent component analysis (ICA) has shown great
promise in multuspectral analysis and recently has been applied for
effective classification of function MRI and segmentation of brain MRI.
In this study, we tried to investigate the new clinical application of ICA
algorithm for density measurement for breast MRI.
Methods MR breast images, acquired by a whole body 1.5-T MR system,
included axial spin echo T1 weighted images (TR/ TE = 11/4.7 ms), and
T2 weighted images (TR/ TE = 2500/218 ms), without fat saturation. Two
sets of breast images were processed ICA to enhance tissue contrasts
and then classified by support vector machine (SVM) to segment breast
gland and adipose tissues from other chest wall and skin tissues. In
this experiment, the intra- and inter-operator variability was tested for
evaluating the reproducibility of the proposed method.
Results The proposed ICA+SVM technique could effectively segment
breast gland tissues and reliably measure breast density by using T1WI
and T2WI. The coefficients of variations (CV) of intra- and inter-operator
variability were in the range of 3%-4% among three trials of one operator
or among three different operators.
Conclusions The conducted experiments provided evidence that the
ICA+SVM method has shown promise and potential in applications to
classification of breast MRI and density measurement of breast gland
tissues.
Keywords Anatomy, MR, Breast Calcifications/Calculi, Computer
Applications
BR036
Promote Screening Mammography and Integrate Medical
Healthcare of Patient by Radiologist - Sharing Experience
and Preliminary Result
Chi Hsiang Hsu
Department of Radiology & Community Medicine, Jen-Ai
Hospital, Taiwan
Purpose From the diagnosis and treatment point of view, Taiwan's
Radiologist in addition to improving the quality and accuracy of diagnostic
mammograms, at the same time can be a leading integrated medical
resources and healthcare within the hospitals. Radiologist can play an
important role in enhance life quality of breast cancer patients in area of
body, mind, and spirit. The roles include teaching knowledge of breast
cancer, report screening and diagnostic mammography, abnormal report
tracking and patient callback, referred to an experienced surgeon, and
attend cancer support group.
Methods Integration activities are summarized in three phases: the
first phase includes the design medical information, promote screening
mammography and self-examination in Da-Li community monthly and
training professional volunteers who are complete treatment of patients.
The second stage of integration of professional medical team, including
general surgeon, radiologist, oncologist, social workers, so that patients
can get greatest benefit from ‘in’ to ‘out’ hospital. The third phase: patients
invited to attend the supportive group after discharge from hospital, and
learning medical knowledge.
Results In past year, a total of 28 promoting health activities was held
and services 628 persons (average 23 people per activity). Numbers of
screening mammography added 448 persons in same period last year
(50-69 years old women), and an increase rate of 69.4% (703/1191).
The abnormal rate of mammography (BI-RADS category 045) is 7.47%.
Patient come back for diagnostic procedure or other evaluation is 77.53%.
Professional volunteer visits and to provide psychological support for all
patient that prepared to accept surgery (Modified Radical Mastectomy).
Total of 208 people have participated medical knowledge course after
discharge.
Conclusions In Taiwan, radiologists can play a key role in the integration
of breast cancer patient’s ‘medical services chain’ and strategy develop
another way of administration.
Keywords Mammography
BR039
The Relationship of Breast Parenchymal Patterns and the
Female Breast Diseases
Yi-Hong Chou1, Shao-Lin Han2, Chui-Mei Tiu1, Yi-Hong Chui1,
Wen-Yung Sheng3, Hong-Jen Chiou1, See-Ying Chiou1, Benjamin
Kuo4
1
Taiwan
2
Department of Physical Medicine and Rehabilitation, Tao-Yuan
3
Department of Neuroscience Center, Taipei Veterans General
Hospital, Taiwan
4
Department of Medical Research and Education, Taipei
Purpose There have been limited articles discussing about the breast
parenchymal pattern on ultrasonography (US). With the rapid advent of
real-time high-resolution US, the US breast parenchymal patterns (BPP)
can be further analyzed. The purpose of this study is to establish the
relationship between US BPP and age, and between BPP and breast
diseases.
Methods A total of real-time US of the breasts in 2053 patients were
enrolled in this study. The BPPs were classified as glandular (G), more
glandular and less fibrotic (G+f), less glandular and more fibrotic (g+F),
and fibrotic patterns.
Results In the 2053 patients, 1409 were noted to have abnormal
findings on US. Breast cancer accounts for 13.6 %, and fibro cystic
changes account for 55 %. In patients with glandular pattern (G pattern),
malignantly accounts for only 6 %. Breast cancer accounts for 18.8 % in
patients with G+f pattern, and 29 % in patients with g+F pattern, 48.4 % in
F pattern.
Conclusions Only F pattern is significantly related with older age group,
and only breast cancer is significantly related to BPP.
Keywords Breast Calcifications/Calculi, Ultrasound
BR041
Choristoma of the Breast
Yoshiko Takahashi 1, Fumio Kotake 2, Ryota Nishio 2, Keiichi
Iwaya3
1
Department of Radiology, Medical Doctor, Japan
2
Department of Radiology of Tokyo medical University, Ibaraki
Iryo Center, Medical Doctor (Radiologist), Japan
3
Department of Pathology of National Defense Medical Collage,
Medical Doctor (Pathologist), Japan
Purpose We experienced Choristoma of the breast. Several times
announcement in the pathology is accomplished, but there is not the
report of the radiological image diagnosis so far.
Methods A left breast tumor on group mass was pointed out in a
neighborwood mass screening for breast cancer by mammography in and
she visited to our hospital to have further examinations.
Results Various examinations such as CT, MRI, needle biopsy and
mammotome system, failed to yield a deference diagnosis.
Conclusions A postoperative pathological diagnosis was made as
choristoma. We report this case and review the literature bibliographical.
BR042
Study of the Mean Glandular Dose and Tabar Classification
during Full-Field Digital Mammography in Our Hospital
Norie Azilah Kamarudin¹, Zainun A. Rahman1, Siti Nor Badriati
Sheik Said1, Swee Shing Leongm2, Hasni Abdullah3
1
Department of Radiology¹, Radiologist, Malaysia
2
Department of Radiology, Physicist, Malaysia
3
Department of Radiology, Radiographer, Malaysia
511
Purpose Lean is a systematic methodology which aims to identify and
eliminate waste (non-value-added activities). After acquiring a single full
field digital mammography (FFDM) unit, we aim to improve our workflow
using Lean methodology.
Methods Staff including patient service clerks, healthcare attendants,
nurses, mammographers and radiologists underwent a two-day Lean
workshop from 3–4 May 08. Staff were taught Lean methodology by
qualified facilitators. Inputs and suggestions to improve workflow (Kaizens)
were then identified and documented using Value Stream Mapping (VSM).
VSM was used to identify the following components that constituted all the
activities of the patient: 1) Total cycle time (the time from when the patient
arrives to the time the patient leaves 2) Process time (the time spent on
value added activities for the patient 3) Waiting time (the time spent on
non-value added activities for patient). The pre-Lean VSM data of 265
patients were collected from 19/10/07- 9/11/07. Following implementation
of 11 Kaizens using Lean methodology, VSM data of another 250 patients
were collected from 6 to 29 July 09.
Results The pre-implementation VSM showed the total cycle time (TCT)
was 65 minutes, the process time (PT) was 16 minutes and the waiting
time (WT) was 49 minutes. The post-implementation VSM showed the
TCT was 39 minutes, the PT was 17 minutes and the WT was 21 minutes.
Hence, there was slight increase in the PT with significant reduction in the
TCT and the WT.
Conclusions Using Lean methodology, we were able to reduce the
time patients spent on non-value added activities, resulting in significant
decrease in their time spent in our Mammography centre while
simultaneously increasing their proportion of value-added activities. This
translates to providing better quality care through more meaningful time
spent on patients while reducing their waiting time.
Keywords Mammography, Observer Performance, Cost-Effectiveness
BR034
Screening Mammograms with Full-Field Digital
Mammography: Initial Experience at Singapore General
Hospital
QinHui Soh, Shao Jen Llewell yn, Sim Chee Hao Lester Leong,
Lina Lee, Anne Wong, MeiYong Lim, Yien Sien Lee
Department Of Radiology, Singapore General Hospital,
Singapore
Engineering, University of Maryland, Baltimore County, United
States
E-Poster
BR028
Introducing LEAN into Mammography Process: The Initial
Experience
Lily Lai¹, Shao-Jen SIM², Mei Yong LIM², Ivy Heng², Aye Myat
Myat Htun²
¹Department of Diagnostic Radiology, Singapore General
Hospital, Singapore
²Department of Diagnostic Radiology, Radiologist, Singapore
analyzed separately, then the fused images were interpreted, blinded to
the results of the other modalities. The results of PET, CT, and PET/CT
were compared with each other and correlated with the final diagnosis.
Results Eighteen (14%) patients had tumor recurrence or metastases,
and 115 (86%) patients showed no further evidence of disease. On a
patient basis, the overall sensitivity, specificity, positive predictive value
(PPV), negative predictive value (NPV) and accuracy of PET/CT were
94%, 96%, 81%, 99% and 96%, respectively. PET/CT compared with
separate PET and CT had a higher sensitivity (94% vs. 89% and 61%),
specificity (96% vs. 89% and 92%), PPV (81% vs. 57% and 55%),
NPV (99% vs. 98% and 93%), and accuracy (96% vs. 89% and 88%).
Differences between PET/CT and CT (P<0.01) and PET/CT and PET
(P<0.01) were significant.
Conclusions In patients with breast cancer, 18F-FDG PET/CT had high
performance indices and was superior to PET and CT separately for
diagnosis of tumor recurrence and metastases. The high predictive value
of 18F-FDG PET/CT may allow tumor stage and has a role in determining
the subsequent clinical management of these patients.
Keywords Metastases
Others
Conclusions Metaplastic carcinoma of breast is rare tumor, accounting
for less than 5% of breast cancers. The tumor is regarded as ductal
carcinoma that undergoes metaplasia into a nonglandular growth pattern.
Metaplastic breast carcinoma usually occurs in woman older than 50. It
often presents as a rapidly growing, palpable mass On mammography,
reported patterns of the tumors include well-circumscribed mass, with
irregular or spiculated margin, or as predominantly circumscribed,
noncalcified mass with a spiculated border. Associated architectureal
distortion had also been reported. The diagnosis of metaplastic carcinoma
should be included in the differential list whenever there is rapidly growing,
ill- or well-defined mass.
Keywords Mammography, Neoplasms-Primary
Purpose Stereotactic breast biopsy is performed using the Hologic
Multicare Platinum prone breast biopsy table and Suros ATEC vacuumassisted biopsy device. Successful positioning of the suspicious lesion
within the compression paddle opening and lesion targeting are critical to
the success of the procedure. Some cases are technically challenging due
to breast size, type of lesions and their location. In this presentation, we
will discuss some of the techniques we have employed to overcome these
challenges.
Methods Review of all the stereotactic vacuum-assisted breast biopsies
performed from 1 May 2008 until 31 October 2009 was retrospectively
done. We reviewed the type of breast lesion and whether the procedure
was straightforward or challenging. Reasons for the case being
challenging and techniques used to overcome them were evaluated.
Histological correlation was performed on all cases. Technically
challenging cases included lesions near the chest wall or axilla; lesions
in thin breasts; faint microcalcifications and densities seen only in one
mammographic view.
Results A total of 118 stereotactic biopsies were performed, of which
61 were wire localizations and 57 vacuum-assisted biopsies. Of the
57 stereotactic vacuum-assisted biopsies, there were 2 (3.5%) failures
involving failure to retrieve microcalcifications.
Conclusions With the introduction of national breast screening
programme in Singapore in 2002, there has been increased detection of
small non-palpable breast abnormalities. Stereotactic vacuum- assisted
biopsy is the procedure of choice for the diagnosis of suspicious breast
lesions detected on mammograms. Satisfactory positioning of the breast
lesion on the dedicated prone biopsy table is the key to ensuring a
successful biopsy. Knowledge of the various techniques to overcome the
technical challenges is therefore vital for achieving successful removal of
the lesion, important for accurate preoperative diagnosis and subsequent
management.
Keywords Mammography, Biopsy, Breast Calcifications/Calculi, Technical
Aspects, Interventional
512
Purpose In Japan, cancer is the leading cause of death with lung cancer
as the number one cause. Since the survival rates of those with lung
cancer are low, earlier detection and early treatment are important. In
addition, chronic obstructive pulmonary disease (COPD) appears to be in
the top ten cause of death in 2000, and more than 5.3 million Japanese
older than 40 years old have this disease. Specifically, treatment for
pulmonary emphysema is difficult, therefore early detection of the disease
at an early stage is important The present study aims to develop an earlier
detection system for lung cancer and COPD based on multi-slice CT
image obtained from lung cancer screening.
Methods This system analyzes the chest structures such as the body,
spine, bone, trachea, bronchial tube, mediastinal space, and right and left
lung fields. Next, the nodule extraction is done by using the database of
the chest structure and the blood vessel and the lung nodule. In addition,
the low attenuation volume (LAV) is extracted as pulmonary emphysema.
Results This system could detect lung node, hydrothorax and pleura
affected by the disease, with a detection rate of 88% (80/90), and 1.3 per
person number of false positive (FP).
Conclusions We could perform a highly accurate extraction of lung
cancer with a minimal FP by analyzing the chest structure. In addition, we
could quantitatively evaluate LAV and could show the effectiveness of the
image analysis.
Keywords Lung, Computer Applications, CT
CA007
Classification Algorithm of Lung Lobe and Lung Segment
Based on Multi-Slice CT Images
Mikio Matsuhiro¹, Shinsuke Saita², Yoshiki Kawata², Noboru
Niki², Yasutaka Nakano³, Hiromu Nishitani4, Hironobu Ohmatsu5
¹System Innovation Engineering Graduate School of Advanced
Technology and Science, The University of Tokushima, Japan
²Institute of Technology and Science, The University of
Tokushima, Japan
³Department of Respiratory Medicine, Shiga University of
Medical Science, Japan
4
Institute of Health Biosciences, The University of Tokushima
Graduate School Dept.of Medicine, Japan
5
National Cancer Hospital East, Japan
Purpose This study was performed to classify lung lobe and pulmonary
segment.
Methods Classification algorithm of lung lobe is described as follows. 1.
Classification of lobe bronchus and lobe blood vessel. 2. Construction
of each space of lobe blood using Delaunay method. 3. The points
which are in equal distance from each space of lobe blood vessel are
set to boundary, and we classify lung lobe. 4. Extraction of interlobar
fissure around boundary of classified lung lobe, and adjustment around
boundary of classified lung lobe using interlobar fissure. Classification
algorithm of lung segment is described as follows. 1. Classification of
CA008
Comparative Reading CAD System for Lung Cancer CT
Screening
Hidenobu Suzuki1, Shinsuke Saita2, Yoshiki Kawata2, Noboru
Niki2, Hironobu Ohmatsu 3, Kenji Eguchi 4, Masahiro Kaneko 5,
Noriyuki Moriyama6
1
Department of Optical Science, The University of Tokushima,
Japan
2
Institute of Technology and Science, The University of
Tokushima, Japan
3
National Cancer Center Hospital East, Japan
4
School of Medicine, Teikyo University, Japan
5
National Cancer Center Hospital, Japan
6
National Cancer Center for Cancer Prevention and Screening,
Japan
Purpose The purpose of this study is to construct a comparative reading
CAD system for lung cancer CT screening and to evaluate the system
using large-scale CT images.
Methods The system consists of two methods, detection of pulmonary
nodules and as an assistance of comparative reading. In the detection,
lung region, blood vessel, trachea, tracheal bifurcations, and nodules are
detected. As assistance for comparative reading consists of 3 steps. In the
first step, slice positions of past images are matched with slice positions of
current images by features of pulmonary blood vessel. In the second step,
nodules of past images are matched with nodules of current images. The
regions of nodules are excluded because they are changing with time.
Therefore, the features of pulmonary blood vessel regions surrounding the
nodules are used. In the third step, pulmonary nodule’s degree of change
is evaluated using size and average CT value. The degree of change is
classified into five types, appearance, expanding, stable, shrinking, and
disappearance. The system classifies nodules into five types based on
size of nodule. Then, the system classifies nodules into three types based
on average CT value if the type was classified to stable type at previous
classification.
Results We performed an experiment to evaluate the effectiveness of our
system using large-scale sets of present and past CT images obtained
from lung cancer CT screening. The result showed that the method can
match current CT images with past CT images, and classify nodule's
degree of change with high accuracy.
Conclusions The system can assist physicians for a smooth comparative
reading of CT images obtained from lung cancer CT screening. It is effective
for quantitative evaluation of pulmonary nodule’s degree of change.
Keywords Lung, Computer Applications, CT, Screening
CA011
Evaluation Method of Degradation for Flat Panel Detector
Atsushi Teramoto¹, Takahiko Kajihara1, Shoichi Suzuki1, Kazuo
Kinoshita2, Masatoshi Tsuzaka3, Hiroshi Fujita4
1
Faculty of Radiological Technology, School of Health Sciences,
Fujita Health University, Japan
2
Department of Radiology, Banbuntane Soutokukai Hospital,
Japan
3
Department of Radiological Technology School of Health
Sciences, Nagoya University, Japan
4
Purpose Characteristics of Flat panel detector (FPD) are degraded by
exposure of radiation. In order to manage FPD system properly, it is
important to evaluate the image degradation. In this paper, we propose
the daily management system for FPD.
Methods In order to evaluate the degradation of FPD, the number of defect
pixels and lines, offset level of pixel output, MTF, and RMS granularity are
introduced. In the experiments, indirect conversion FPD (FPD1) and direct
conversion FPD (FPD2) were evaluated by proposed system.
Results The offset level of FPD1 increased exponentially with exposure
time; no trends are seen for the number of defect pixels and defect lines.
Result of MTF in FPD1 was 1.75 times better than that of FPD2; RMS
granularity of FPD1 was 11 times larger than FPD2.
Conclusions The required time for the evaluation of FPD was about
1 minute, and it needs no special skill for analysis; this system may be
useful for performance management of FPD.
Keywords QA/QC, Image Manipulation/Reconstruction
CA013
Automated Nodule Detection Using Cylindrical Filter and
FP Reduction in Chest CT Images: Performance Evaluation
Using Lung Imaging Database
Atsushi Teramoto¹, Hiroshi Fujita²
¹Faculty of Radiological Technology, School of Health Sciences,
Fujita Health University, Japan
²Department of Intelligent Image Information, Graduate School of
Purpose In order to detect the solitary nodules in chest CT images, we
propose the high-speed initial detection using Cylindrical Filter and FP
reduction technique based on Support Vector Machine. We evaluate the
performance of these technique using Lung Imaging Database.
Methods Initial detection of nodule employs a cylindrical filter kernel that
outputs the difference in pixel value between the maximum value of a
cylindrical kernel and the center pixel. Nodule candidates are classified
into TPs and FPs using some characteristic values and Support Vector
Machine. Evaluation of these techniques is performed using 80 nodules
from Lung Imaging Database.
Results TPF was 0.85 after FP reduction, and FP was reduced to 1/3.
Computation time was five times faster than existing 3D methods.
Conclusions We proposed the high-speed detection method and FP
reduction technique for chest nodule in CT images. Results indicated that
these techniques were useful for diagnosis of chest nodule.
Keywords Lung
CA014
C h a n g e i n Wa t e r Tr a n s p o r t B a l a n c e i n C a v e r n o u s
Hemangioma as Visualized in Dynamic Contrast Enhanced
MRI, Susceptibility Imaging and Diffusion Maps
Tzu-Yen Kao1, Yu-Hsuan Tsai1, Yau-yau Wai2, Jiun-Jie Wang1,
Yu-Chun Lin2, Yih-Ru Wu3
1
Department of Medical Imaging and Radiological Science,
2
Department of Medical Imaging & Intervention, Chang Gung
Memorial Hospital-Linkou Medical Center, Taiwan
3
Department of Neurology, Chang Gung Memorial Hospital and
University College of Medicine, Taiwan
Purpose To image the tumor microenvironment of cavernous hemangioma
using dynamic contrast enhanced, diffusion and susceptibility weighted MRI.
513
CA006
Detection System for Lung Cancer and COPD Based on
Multi-Slice CT Images
Eiji Takahashi¹, Shinauke Saita 1, Yoshiki Kawata 1, Noboru
Niki1, Hiromu Nishitani2, Yasutaka Nakano3, Hironobu Omatsu4,
Noriyuki Moriyama5
1
Institute of Technology and Science, The University of
Tokushima, Japan
2
Institute of Health Biosciences, The University of Tokushima
Graduate School, Department of Medicine, Japan
3
Department of Respiratory Medicine, Shiga University of
Medical Science, Japan
4
National Cancer Center Hospital, Japan
5
National Cancer Research Center for Cancer Prevention and
Screening, National Cancer Center, Japan
segmental bronchus and segmental artery. 2. Construction of each space
of segmental artery using Delaunay method. 3. The points which are in
equal distance from each space of segmental artery are set to boundary,
and we classify lung segment.
Results We applied the classification algorithms of lung lobe to multislice CT images of 20 cases. To evaluate the accuracy of the classified
lung lobe, we examined agreement rate with the manually marking
data. The average agreement rates of lung lobe were, for right upper
lobe (RUL):97.01%, for right middle lobe (RML):92.64%, for right lower
lobe (RLL):97.90%, for left upper lobe (LUL):96.71%, for left lower lobe
(LLL):97.10%. There were 50 nodules that were classified in lung segment
using this algorithm.
Conclusions In this study, we proposed classification algorithm of lung
lobe and pulmonary segment. Classification algorithms showed high
accuracy rate. Classifying lung into lung lobes and lung segments gives
useful information to diagnosis and treatment of lung diseases.
Keywords Lung, Computer Applications, CT
E-Poster
BR044
Tips and Tricks of Stereotactic Vacuum-Assisted Breast
Biopsy
Clarisse Chia Li Chong, Selina Liew, Siew Hwa Chiang
Department of Radiology, Changi General Hospital, Singapore
Others
Purpose The objective of this study was to measure the mean glandular
dose (MGD) and to evaluate the relationship between MGD and
mammographic patterns using Tabar classification among women who
underwent full-field digital mammography (FFDM) in our hospital.
Methods This study was conducted from January 2009 till August 2009.
The clinical data were collected from 300 women who underwent FFDM.
Women with palpable breast mass and previous history of breast surgery
were excluded. The demographic data were recorded accordingly. The
value of MGD, kVp, mAs, force and compressed breast thickness (CBT)
were measured digitally and recorded. The breast glandular content of
each mammogram was classified according to the mammographic pattern
of Tabar classification. MGD per woman was calculated by summing
the MGDs for all films and averaging it over both breasts. All data were
analysed using SPSS database.
Results The MGD per film was 1.89 mGy and 1.99 mGy for the
craniocaudal (CC) and mediolateral oblique (MLO) views, respectively.
The MGD per woman was 3.89 mGy. Most of the women had
mammographic pattern of Tabar I (63%). High MGD per woman was found
in mammographic pattern of Tabar V. Statistical analysis revealed that
Tabar classification had a significant effect on MGD per woman (P<0.05).
Conclusions The MGD per film for both CC and MLO views and MGD
per woman in this study were slightly higher compared with other studies
using screen/film mammography. Tabar classification had a significant
effect on MGD per woman.
Keywords Mammography, Comparative Studies, Physics, Dosimetry
Purpose Independent component analysis (ICA) coupled with support
vector machine (SVM) has shown promise and potential in applications to
classification of brain MRI. The method based on a supervised approach
by selecting a small set of training data requires operator intervention and
may suffer from intra- and interoperator variability. This paper presents a
new application of using a widely used endmember extraction algorithm,
called pixel purity index (PPI) to find training samples directly from the
data for unsupervised classification of MR brain image.
Methods Synthetic T1, T2 and proton density MR data of normal brain
were used to evaluate the efficacy of our purposed method. At first, we
utilized ICA to generate three new statistically independent component (IC)
images. Secondly, small region of interest (ROI) at each image center was
automatically extracted for calculating the PPI to find out an appropriate set
of training sample. Finally, SVM, with active learning from the appropriate
training data, was used for classification of three IC images. The Tanimoto
index was measured to statically evaluate the results of the GM and WM
volumes with the ground truth data of the simulated brain images.
Results The experimental results demonstrated that the proposed method
using PPI could significantly improve MR brain tissue classification.
Conclusions This evidence suggested that PPI could be implemented
as an effective unsupervised training sample algorithm and offers the
opportunity to develop a fully automated classification and segmentation
of brain MRI.
Keywords Anatomy, MR, Brain/Brain Stem, Computer Applications
514
Purpose Role of the five line sign which appeared at the border of a
peripheral lung cancer on MIP reconstruction was evaluated for diagnosis
and prognosis.
Methods Cases of 63 peripheral lung cancer and 30 benign masses were
presented. GE lightspeed VCT with the workstation of AW 4.3 was used,
rebuilding slice 1.25 mm, thickness of MIP 6.2 mm.
Results Of 63 lung cancers, 36 cases appeared five line sign or multyline shadow at the margin of the tumor,among them 12 cases were
not found hilus and mediastinum lymphadenopathy on sugery and
pathology, 3 of which belonged to early lung cancer which showed that
the five line shadow was arising from the tumors edge, paralleled to each
other, integrity and uniform, the space between lines being clear,lines
length being relatively long. The rest of 33 cases appeared five line
sign destroyed to different extent. No five line shadow was found in 27
cases,bands and strings was found between tumor and pleura, or tumor
and pleura being adhesion. All of the 27 cases occured mediastinum
lymphadenopathy or remote metastasis. Five line signs presented at the
edge of benign masses of inflam mass, tuberculoma and fungus infection
were destructive mostly. Distal ends of band shadow between mass and
pleura revealed short five line shadow as comb-like in 4 benign masses
and 7 cancers.
Conclusions It should have some help for five line sign to diagnose
peripheral lung cancer, yet judgement should be made combining other
signs carefully. The five line sign would provide a better role in prognosis
of peripheral lung cancer and diagnosis of early cancer of the lung.
Keywords Lung, Neoplasms-Primary, CT, Image Manipulation/
Reconstruction
CH008
Unilateral Diaphragm Paralysis Diagnosed by Multidetected
Computed Tomography in Inspiration And Expiration: A
Case Report
Chiung-Ying Liao, Shang-Yun Ho, Kwo-Whei Lee
Department of Radiolog, Changhua Christian Hospital, Taiwan
Purpose The diaphragm is a chief muscle of inspiration. Its paralysis
can lead to dyspnea and can affect ventilatory function. Diaphragmatic
paralysis can be unilateral or bilateral. Unilateral diaphragm paralysis is
an important and often unrecognized cause of dyspnea. The diagnosis of
unilateral paralysis is often delayed, unless it follows obvious trauma or
thoracic surgery.
Conclusions It is frequently discovered as an incidental finding on chest
X-ray and confirmed with sniff test or phrenic nerve stimulation/diaphragm
electromyography. Chest MDCT scanning in inspiration and expiration
can demonstrate abnormal diaphragm position and motion, and may
provide additional data regarding alternate diagnoses of dyspnea such
as parenchymal lung disease or pulmonary vascular disease. Prognosis
is good in unilateral paralysis, especially in the absence of underlying
neurological or pulmonary process.
Keywords CT, Diaphragm
CH014
How accurate can Radiographers Select mas for Non-Bucky
Chest Radiography
Siu Ki Yu1, Ting Hei Wong2, Po ChungLau2, Wing Chung Chan2,
Purpose Radiation dose to patients is a concern in general radiography
in chest X-ray (CXR) because of the massive number performed annually.
Although automatic exposure control (AEC) can maintain good image
quality with adequate radiation dose, this technique is not suitable
for mobile X-ray in wards and for non-bucky technique used in CXR
examination of children. In these scenarios, the selection of imaging
parameters is solely relied on radiographer’s experience. It is the aim
of this study to investigate the accuracy of the mAs selection based on
radiographer’s experience.
Methods Without any selection criteria, one hundred consecutive patients
(age from 2 to 95) underwent CXR were included in this study. Fifteen
radiographers participated in this study were divided into two groups
(7 in group A; 8 in group B) according to their experience in general
radiography (group A: <10 yrs; group B: >10 yrs). In each case and using
default kVp, each radiographer determined individually the required
mAs based on experience before actual exposure taken using AEC.
The accuracy was calculated as the percentage difference between the
estimated mAs and the mAs auto-set by the AEC.
Results The accuracy for group A (mean = –10%, Std = 27%, maximum =
102%, minimum = -71%, N = 101, skewness = -0.29) was found statistical
comparable to group B’s results (mean = –8%, Std = 25%, maximum
= 61%, minimum = -80%, N = 129, skewness = 2.36) using two-tailed
unpaired t-test (p = 0.53). The overall mean accuracy was –9% with
standard deviation of 26% (maximum = 102%, minimum = -80%, N = 230,
skewness = 0.02).
Conclusions Selection of mAs by radiographer’s experience is unreliable
with large variation regardless of their experiences. It may lead to large
over-exposure or under-exposure in non-bucky CXR examination.
Keywords Dosimetry
CH015
Pulmonary Intralobar Sequestration Associated with Giant
Branching Aberrant Systemic Artery: A case report
Chi-Wen Chen1, Chun-Ku Chen1, Teh-Ying Chou³, Ming-Huei
Sheu1, Mei-Han Wu1, Wen-Hu Hsu2, Cheng-Yen Chang1
1
Taiwan
2
Department of Surgery, Taipei Veterans General Hospital,
Taiwan
³Department of Pathology, Taipei Veterans General Hospital,
Taiwan
Purpose Pulmonary sequestration is rare. Intralobar sequestrations
represent a mass of nonfunctioning bronchopulmonary segment having
an anomalous systemic arterial blood supply and being surrounded by
visceral pleura. We report a case of intralobar pulmonary sequestration
with marked aneurysmal dilatation of the branching anomalous systemic
artery, whose diameter is greater than descending aorta. There has been
no previous report in the literature.
Keywords Aneurysms, Aorta, Congenital, Tracheobronchial Tree
CH017
Pulmonary Lipiodol Embolism after TACE: CT Findings and
Its Clinicoradiologic Outcome
Jae Seung Seo, Semin Chong, Byung Kook, Kwak Yang, Soo
Kim
Department of Radiology, College of Medicine, Chung-Ang
University Hospital
Purpose To evaluate the CT findings and clinicoradiologic outcome
of pulmonary lipiodol embolism (PLE) after transcatheter arterial
chemoembolization (TACE)
Methods Between January 2006 and November 2008, 179 patients
had underwent 500 examinations of TACE using digital subtraction
angiography machine (Axiom Artis, Siemens) due to HCC (n = 172) or
cholangiocarcinoma (n = 1) or hepatic metastasis (n = 6) at our institute.
They underwent CT scans (Lightspeed pro 16, GE) before and after
TACE. We retrospectively reviewed the patients' clinical, angiographic
and CT findings. We evaluated the pulmonary uptake of lipiodol (presence
or absence and location) and the associated findings (consolidation or
pleural effusion) at CT. We calculated the recovery interval, which was
defined as the time interval from the detection of pulmonary lipiodol
uptake to the disappearance of pulmonary lipiodol uptake on follow-up
CT, and assessed the overall incidence of PLE in patients who underwent
TACE.
Results Of 179 patients, 7 patients (M:F = 6:1; age range, 42 – 76 years;
mean age, 61 years) revealed PLE after TACE. At CT, pulmonary uptake
of lipiodol was located in the right lower lobe (n = 4), right middle lobe
only (n = 2) or left lower lobe (n = 1). Five patients had consolidation with
pleural effusion (n = 3) or only pleural effusion (n = 2). Three patients
presented hemoptysis (n = 2) or dyspnea with fever (n = 1). In 5 patients,
pulmonary uptake of lipiodol was not detected at CT 23 – 150 days after
(mean 55.8 days, median 29 days). In our study, the overall incidence of
PLE was 1.4% (7/500) in all examinations of TACE.
Conclusions Pulmonary lipiodol embolism after TACE shows the
pulmonary uptake of lipiodol and the associated findings such as
consolidation or pleural effusion at CT. Pulmonary uptake of lipiodol can
improve during about 2-month follow-up period.
Keywords Lung, CT, Embolism/Thrombosis, Fluoroscopy, Interventional
CH019
P ulm ona r y C T U s ing A da pt iv e S t a t is t ic a l It e r a tiv e
Reconstruction: Evaluation of Image Quality on Standardand Reduced-Dose CT
Masahiro Yanagawa, Noriyuki Tomiyama, Osamu Honda
Medicine, Japan
Purpose To evaluate thin-section CT images reconstructed by using
Adaptive Statistical Iterative Reconstruction (ASIR) on standard- and
reduced-dose CT.
Methods The study was approved by the institutional review board. The
informed consent was obtained. Eleven cadaveric lungs inflated and fixed
by the method of Heitzman were scanned by multidetectors-row CT with
tube currents (standard-dose, 400mA; reduced-dose, 10mA), and using
high resolution mode with 2496 views. The degree of ASIR was classified
into six phases: 0%, 20%, 40%, 60%, 80%, 100%. Images of ASIR (20%),
ASIR (60%), ASIR (100%) were compared to those of ASIR (0%), and
assessed for image quality on a visual scale using a 7-point scale by
three independent observers. The evaluation items included abnormal CT
findings, normal lung structures, and visual noise. Median values of three
observers were statistically analyzed. Noise values were also calculated
by measuring the standard deviation (SD) values in a circular region of
interest (ROI) on each selected image of ASIR (0% to 100%).
Results In abnormal CT findings, increasing ASIR significantly provided
high image quality on standard-dose CT (p<0.0001, Bonferroni/Dunn’s
method). On reduced-dose CT, image quality of ASIR (100%) was
significantly better than that that of ASIR (20%) (p=0.0041). However,
increasing ASIR tended to obscure intralobular reticular opacities on both
standard- and reduced-dose CT. In normal lung structures, image quality
of either ASIR (60%) or ASIR (100%) was significantly better than that
that of ASIR (20%) on both standard-dose CT (p<0.0001) and reduceddose CT (p<0.0001). Use of ASIR made a visual noise and SD values on
images significantly smaller on both standard-dose CT (p<0.0001) and
reduced-dose CT (p<0.0001).
Conclusions Using ASIR provides higher image quality with lower noise,
however, excessive ASIR may obscure fine shadow.
Keywords Lung, Artifacts, CT, Image Manipulation/Reconstruction
515
CH003
Further Analysis on Five Line Sign of MIP Rebuilding at
the Margin of Peripheral Lung Cancer in Diagnosis and
Prognosis
Yu Anle1, Li Qun1, Hu Zhongxin2, Chen Chunmei3, Wu Beihai3
1
Department of Pathology, Hainan Medical College, China
2
Department of Radiology, Wuhan Seventh Hospital, China
3
Department of Radiology, Affiliated Hospital of Hainan Medical
College, China
Weng Ho Kwan3, Gladys G Lo1, Haruhiko Machida4
Department of Diagnostic Radiology, Hong Kong Sanatorium &
Hospital, China
2
Department of Diagnostic Radiology, Tuen Mun Hospital, China
3
Department of Diagnostic Radiology, Pok Oi Hospital, China
4
Department of Radiology, Tokyo Women's Medical University
Medical Center East, Japan
1
E-Poster
CA016
Application of Pixel Purity Index for Unsupervised
Classification of Brain Magnetic Resonance Images
Jyh-Wen Chai1, Shih-Yu Chen2, Chih-Ming Chiang1, Yen-Chieh
Ouyang2, Chein-I Chang3, Hsian-Min Chen4, Clayton Chi-Chang
Chen5, San-Kan Lee5
1
Taiwan
2
Department of Electrical Engineering, National Chung Hsing
University, Taiwan
3
Remote Sensing Signal and Image Processing Laboratory/
Department of Computer Science and Electrical Engineering,
University of Maryland, Baltimore County, Taiwan
4
Taiwan
5
Taiwan
Others
Methods 10 patients of cavernous hemangioma (aged 14 to 54, gender
balanced) were included. Dynamic contrast enhanced MRI (DCE MRI),
susceptibility weighted imaging (SWI, TR/TE = 28/20 ms, 8 slice of 1.2mm) and diffusion weighted imaging (DWI, TR/TE = 5100/91 ms, 56
slice of 4-mm) were acquired. DCE MRI were acquired by a T1-weighted
gradient-echo sequence (TR/TE = 250/2.46 ms, 7 slice of 4-mm, 130
measurements, gadodiamide administration 0.1 mmol/Kg of 3 mL/
sec). Baseline longitudinal-relaxation time was calculated from three
acquisitions of different flip angles (2°, 10°, and 35°). DCE MRI was
analyzed according to Toft et al. Maps of permeability (Ktrans), volume
fraction of extravascular extracellula space (Ve) and capillary vascular
plasma space (Vp) were calculated. Apparent diffusion coefficients (ADC)
were calculated in a pixelwise manner. Regions of interest were selected
from the lesion and the contralateral normal white matter.
Results Increased Ve and Vp (786% and 76%, respectively) was
noticed, which indicated a loss of water transport balance in vasculature,
consistent with the significantly decreased vessel permeability (reduction
of Ktrans by 69 %). In ADC, increased signal in the lesion (1.43 compared
to 0.76 mm2/sec) and a dark ring in the surrounding neighborhood were
noticed. SWI showed a more extensive area of signal loss. Increased ADC
suggested an increase of free water in the extracecullar space, which is
consistent with the finding of increased Ve. The dark ring in both ADC and
SWI indicated an increased affected area and remote hemorrhage than
predicted by conventional MRI.
Conclusions DCE MRI combined with diffusion and susceptibility
weighted imaging can help to define the underlying physiological changes
in cavernous hemangioma.
Keywords MR, Hemangioma, Hemodynamics/Flow Dynamics
Purpose To evaluate the value of morphological and internal textural
features on spiral CT images of lung nodules in predicting malignancy of
lesion.
Methods From 2004 to 2006, we collected spira CT images of 82 patients
with solitary lung nodule, including 18 benign and 64 malignancy proven
by CT-guided biopsy. We analized features of morphology and dynamic
contrast medium enhancement on every lesion, including size, margin,
calcification, air-bronchogram, cavity, consistency, satellite lesion, airway
encasement, and internal textures on dynamic contrast enhancement
including density, area, circularity, entropy, energy, contrast and
homogeneity. Each continuous variable was calculated by ANOVA and
T-test and each categorical variable was calculated by chi-square test in
order to evaluate its value in predicting malignancy of lesion.
Results Useful characteristics for predicting malignancy of lesion include
irregular (P=0.000) or speculated (P=0.000) margin on morphology and
density (P=0.015), entropy (P=0.011), energy (P=0.024) on texture. Other
characteristics show no statistically significant difference in differentiating
benign or malignant lesions.
Conclusions Some morphologic and textural features on spiral CT
images are helpful in differentiating benign or malignant lung nodules.
Keywords Lung, CT
CH042
The Perception of “Ground-Glass Opacity” in Daily Practice:
A Radiologist Survey
Wei-Lin Tsai, I-Chen Tsai, Si-Wa Chan, Clayton Chi-Chang Chen
Taiwan
Purpose This survey is to summarize the perception of “ground-glass
opacity”, a usually used term, among radiologists. The definition provided
516
CV007
Eccentric Mitral Regurgitation: Assessment with 64-Slice
Multi-Detector Row CT and Real-Time Three-Dimensional
Echocardiography
Yingkun Guo, Zhi-Gang Yang, Xiao-Chun Zhang
Department of Radiology, West China Hospital, Sichuan
University, China
Purpose The eccentric mitral regurgitation is difficult to be quantitatively
assessed with conventional methods. However, the accuracy of
quantitative assessment of the severity of mitral regurgitation using the
volumetric method with 64-MDCT has not been reported to date. The aim
of this study was to prospectively evaluate 64-slice multi-detector row
CT (64-MDCT) for assessing eccentric mitral regurgitation and compare
the results with those on real-time three-dimensional echocardiography
(RT3DE), with MRI as reference.
Methods Thirty-two patients (23 men, 9 women; mean age, 41.8 years)
with isolated eccentric mitral regurgitation underwent retrospectively ECGgated 64-MDCT, RT3DE and MRI for assessing the severity of mitral
regurgitation. Stroke volumes of left and right ventricle were measured for
64-MDCT and MRI. Using these measurements, regurgitation volumes
(RV) and fractions (RF) were calculated and compared. Regurgitation
parameters of all patients by RT3DE were measured offline by using the
average rotation method. Linear regression analysis and paired Student
t test were used to compared the RV and RF calculated by 64-MDCT
and RT3DE. Agreement between imaging modalities was performed with
Bland and Altman analysis.
Results RV at 64-MDCT correlated well with that of MRI (r=0.93), and
mean value of RV had no statistical difference between two methods
(p>0.05). RT3DE underestimated the RV compared with MRI, but the
correlation coefficient was acceptable (r=0.88). RF measured by 64MDCT had better correlation with that measured by MRI (r=0.92) than that
obtained by RT3DE (r=0.83). Bland-Altman analysis showed no significant
differences in RV (bias, -1.6 ml) and RF (bias, 0.4%) between the 64MDCT and MRI.
Conclusions ECG-gated 64-MDCT provides quantitative information with
high accuracy for determining eccentric mitral regurgitation, and results
with ECG-gated 64-MDCT is similar to those with RT3DE.
Keywords MR, CT, Heart, Ultrasound, Valves
CV009
Hemopericardium Caused by a Disrupted Sternal Wire after
Ventricular Septal Defect Repair: A Case Report
Minlang Chen¹, Sheng Hsu1, Jen Te Hsu2, Yu San Liao1, Chih
Hui Lee1
1
Hospital at Chiayi, Taiwan
2
Department of Cardiology, Chang Gung Memorial Hospital at
Chiayi, Taiwan
Purpose A 49 year old woman who underwent ventricular septal
defect (VSD) repair was presented to our emergency department and
she was noticed to have impending cardiac tamponade secondary to
hemopericardium. A cardiac CT scan correctly diagnosed that a disrupted
sternal wire penetrating the anterior inferior aspect of the pericardium
Methods A cardiac CT scan (retrospective ECG-gating, 120 kV, 900 mAs,
pitch=0.2, no dose modulation) with split-bolus contrast medium injection
was performed
Results CT images demonstrated that a segment of disrupted sternal wire
penetrated through the anterior inferior aspect of the pericardium close to
RV, which was reasonable to highly suspect RV penetrating injury
Conclusions CT scan combined with MPR and VR images is an
effective tool to make the correct diagnosis in such cases. Also, if there
is hemopericardium without definite diagnosis in patients with history of
median sternotomy, the nearby disrupted sternal wire may be the cause.
Keywords CT, Pericardium, Foreign Bodies
CV011
Utility of Retrospectively Gated Breath-Hold Balanced
Single Slice TRUE FISP Trigerred Sequence for Evaluating
Mitral Valve Area by Plannimetry, Left Atrial Thrombus,
Mitral Regurgitation in Severely Breathless Patients with
Rheumatic Mitral Stenosis
Ameya Jagdish Baxi¹, Krishna Reddy1, Kishore Tourani2, Belman
Murali2, Thanugonda Nagendra2
1
Department of Cardiology, Care Hospitals, India
2
India
Purpose To evaluate and compare reliability of retrospectively gated
breath-hold balanced gradient-echo TRUE FISP sequence and
retrospectively gated breath-hold balanced single slice TRUE FISP
sequence for evaluating mitral valve area by plannimetry, Left atrial
thrombus and mitral regurgitation in severely breathless patients with
rheumatic mitral stenosis.
Methods Thirty cases of mitral stenosis coming to Care hospitals
Hyderabad, were subjected to Cardiac MRI for comparative study.
Retrospectively gated breath-hold balanced gradient-echo TRUE FISP
sequence was executed with TR of 400 ms, TE of 1.04 ms and phase
encoding was advanced every 1,200 ms. Retrospectively gated breathhold balanced single slice TRUE FISP sequence was then applied
keeping TR of 85.8ms and TE of 0.84ms and mitral valve area was
calculated.
Results Mean MVA determined using conventional gradient-echo TRUE
FISP sequence was 0.968 +/- 0.37 cm² (0.48 -2.02 cm²) and by single
slice TRUE FISP sequence was 0.967+/-0.39 cm² (0.6 -2 cm²). Two
methods produced equivalent results. No significant difference was
seen in evaluating mitral regurgitation; though conventional TRUE FISP
sequence was marginally better for left atrial thrombus.
Conclusions Conventional cine gradient-echo sequence has made
evaluation of mitral valve reliable. However, gross degradation occurs
in image quality in severe breathless patients. Retrospectively gated
breath-hold balanced single slice TRUE FISP trigerred sequence is
equally accurate and reliable in for evaluating mitral valve area, left
atrial thrombus and mitral regurgitation in severely breathless patients
with mitral stenosis. It is less time consuming and more comforting for
breathless patients without decreasing image quality.
Keywords MR, Valves
CH034
Combined Morphological and Internal Textural Analysis of
Lung Nodules
Chan-Ming Yang1, Huan-Hsun Cheng2, Yeun-Chung Chang3,
Jenn-Lung Su2, Teh-Chen Wang1, Tiffany Ting-Fang Shih3
1
Department of Division of Radiology, Taipei City Hospical
YangMing Branch, Taiwan
2
Department of Biomechanical Engineering, Chung Yuan
Christian University, Taiwan
3
Department of Medical Imaging, National Taiwan University
Hospital, Taiwan
E-Poster
Purpose To describe and illustrate various benign etiologies of
subcentimeter pulmonary nodules detected on chest CT scans.
Methods To demonstrate the wide spectrum of benign subcentimeter
nodules detected on thoracic CT scans. To know the CT features of
benign subcentimeter nodules and find features defining their etiologies.
Results Neoplastic, and non-neoplastic, infectious or inflammatory, and
miscellaneous causes of incidentally discovered subcentimeter nodules
will be described. We review the imaging characteristics of these nodules
and their pathologic results with illustrutive examples.
Conclusions Subcentimeter nodule detected on chest CT scan can
cause a dilemma. Knowledge of the various etiologies of subcentimeter
nodules can help us to interpret CT scan.
Keywords Lung
by Fleischner society is used as gold standard.
Methods Thirteen radiologists were invited to fill an online questionnaire.
The questionnaire included questions about the definition of “ground-glass
opacity” when they use it on chest radiographs and CT scans. Twenty
images (10 chest radiographs and 10 CT scans) with various diseases
imaging pattern were also provided for the respondents to answer if they
are ‘ground-glass opacity’ lesion or not. The correct rate of definition
questions and the accuracy of image interpretation were calculated and
correlated with the years of working.
Results There were 13 radiologist respondents, 10 (76.92%) were board
certified, and the work experience ranged from 2 to 31 years (9.5 ± 8.6
years). The correct rate of “ground-glass opacity” definition was 46.2%
for chest radiograph and 76.9% for CT scan. The correct rate of sample
cases between the chest radiograph group (68.5%) and the CT scan
group (92.3%) showed significant difference (p <0.001). In sample case
interpretations, the overall accuracy of respondents was 80.4% ± 12.7%.
The accuracies between the senior group (81.7% ± 12.1%) and the junior
group (79.3% ± 14.0%) showed no significant difference (p = 0.63).
Conclusions Considering the different definitions of “ground-glass
opacity” on chest radiographs and chest CT scan, and the various
perceptions among radiologists, the term is considered to be a nonspecific
radiographic descriptor of limited usefulness. Therefore, “ground-glass
opacity” may be unsuitable for the report of chest radiograph, which must
communicate precisely so that the correct information can be transferred.
Keywords Lung
CV012
MR Evaluation of Cardiac Viability: Our Experience in 622
Patients
Ameya Jagdish Baxi¹, Belman Murali, Sripathi Vidyasagar,
Thanugonda Nagendra, Kishore Tourani
Department of Radiodiagnosis, Care Hospitals , Hyderabad,
India
Purpose 1. To differentiate viable from non-viable myocardium. 2.
To demonstrate tissue characteristics, site and extent of Myocardial
infarction. 3. To demonstrate complications of myocardial infarction. 4. To
define regional wall motion abnormalities and complications of myocardial
infarction in Echo and Cardiac MRI
Methods We present our experience of cardiac viability study in
622 patients with known Coronary Artery disease .In all patients, 2D
Echocardiography and Cardiac MRI followed by 20 cc of gadolinium was
performed. This is prospective study done from February, 2006 to March,
2008. 2D Echocardiography was performed on Vivid Five, Vingmed, G E.
Cardiac MRI was performed on 1.5 T Sonata , Siemens.
Results 1. MRI differentiated viable from nonviable myocardium. 2.
Patients with more than 50% scar thickness (n=112) underwent medical
management instead of revascularization procedure. 3. MRI also depicted
subendocardial infarcts. 4. MRI was superior to Echocardiography in
517
Others
CH024
Various Benign Etiologies of Subcentimeter Pulmonary
Nodules: CT Features and Pathologic Correlation
Yoon Kyung Kim 1, Ambika Bhasin 2,Hwan Seok Yong 1, EunYoung Kang1
1
Department of Radiology, Korea University Guro Hospital, Korea
2
System, Singapore
CV026
Prevalence and Risk Factors of Atherosclerotic Plaque in
Patients with Zero Coronary Artery Calcium Score
Chun-Ku Chen¹, Chien-An Liu1, Hsiao-Ting Chang2, Ming-Huei
Sheu1, Mei-Han Wu1, Hong-Jen Chiou1, Hung-Ta Wu1, ChengYen Chang1
1
Taiwan
2
Department of Family Medicine, Taipei Veterans General
Hospital, Taiwan
Purpose To study the prevalence of the Non-calcified atherosclerotic
518
ER004
Reappraisal on the Management and Outcome of Renal
Bleeding
Wai-Man Cheang¹, Wei-Ching Lin 1, Yung-Fang Chen 1, Jian
Zhang2, Yung-Jen Ho1, Chien-Hung Lin1, Po-Pang Tsai1, Su-Tso
Yang1
1
Department of Radiology, China Medical University and
Hospital, Taiwan
2
Department of Natural Medicines, Jiangsu Provincial Academy
of Traditional Chinese Medicine, China
Purpose This study is aimed to review the efficacy and outcome to control
renal bleeding by percutaneous transarterial embolization (TAE).
Methods We retrospectively reviewed 132 cases of renal bleeding noted
on computed tomography (CT) at our institute. The etiology of injury,
demographic data, clinical laboratory data, severity of renal bleeding,
hemodynamic status, modalities of management (conservative treatment,
TAE and operation), outcome and complication were reviewed.
Results The etiologies of renal bleeding including blunt trauma (n=87),
iatrogenic (n=29), tumor bleeding (n=8) and spontaneous hemorrhage
(n=8). Thirty one patients underwent TAE for renal bleeding after blunt
trauma (n=21), percutaneous nephrostomy (PCN, n=1), Extracorporeal
shock wave lithotripsy (ESWL, n=1), biopsy (n=3), angiomyolipoma (AML)
rupture (n=4) and polycystic kidney disease (PKD, n=1); 29 patients
underwent clinical successful cessation of bleeding. Seven patients
received operation; three of them with malignancy (2 cases with RCC, one
case with TCC) received direct nephrectomy, two of them with AML larger
than 4cm received elective nephrectomy after TAE, and two patients
with blunt liver and renal trauma who underwent hepatorrhaphy and
nephrectomy after TAE. No mortality is related to renal injury. However,
4 patients occurred re-bleeding, 2 of them received repeated TAE and 2
received operation for associated hepatic injury and renal re-bleeding.
Three patients complicated with abscess received percutaneous abscess
drainage and no surgical intervention was required.
Conclusions Percutaneous TAE is an effective, superselective and
minimally invasive therapy to control active bleeding. It is also a life saving
and kidney-sparing method with good outcome. Most patients with postbiopsy bleeding who required CT follow up were all hemodynamic unstable
and all of them need emergent TAE. Patients with malignancy bleeding
required direct nephrectomy. Patients with AML rupture could be controlled
by TAE and if tumor size more than 4cm may need elective nephrectomy.
Keywords Kidney, Angiography, CT, Embolization
ER009
Traumatic Cervical Disco-Ligamentous Injuries: Correlation
of MRI and Operative Findings
Dinesh Kumar Varma
Department of Radiology, The Alfred Hospital, Australia
Purpose To investigate the diagnostic properties of magnetic resonance
imaging (MRI) scans in detecting surgically verified disruptions of the
cervical intervertebral disc and anterior (ALL) and posterior longitudinal
(PLL) ligaments.
Methods Data were extracted from the reports of cervical spine MRI
scans of patients who subsequently underwent surgical stabilization for
presumed instability following disco-ligamentous injuries of the cervical
spine. The level and severity of disc, ALL and PLL disruption was
compared with surgical findings. Unweighted kappa statistics were used to
assess agreement. The sensitivity, specificity, positive (PPV) and negative
(NPV) predictive values were calculated after findings where dichotomized
into complete rupture, yes/no. Sensitivity analyses were performed to
account for missing data.
Results The MRI and surgical findings were compared on 31 consecutive
patients. The kappa values for intervertebral disc disruption, ALL and PLL
disruption were 0.22, 0.25 and 0.31 respectively, indicating fair agreement.
Sensitivity, specificity, PPV and NPV are shown in Table 1. The false
negative rates for diagnosing complete disruption of the disc, ALL and PLL
were 0.18, 0.40 and 0.14 respectively.
Conclusions The ability of cervical MRI scans to detect surgically verified
disruptions of the intervertebral disc, ALL and PLL varied depending on the
structure examined. In this series, the cervical MRI scan reliably detected
disruption of the intervertebral disc disruption and ALL. The false negative
rates are of concern and indicate the need for additional investigations to
exclude instability in the absence of negative MRI findings.
Keywords Spine
ER012
Comparison of Emergent CT Studies, from 2007 to 2009, in
Taoyuan General Hospital
Chin-Hua Yang¹, Sheng-Yih Sun1, Wai-Yee Au1, Mei-Fang Liu1,
Chuan-Jong Tung2
1
Department of Radiology, Taoyuan General Hospital,
Department of Helath, the Executive Yuan, Taiwan
2
Department of Biomedical Engineering and Environmental
Science, National Tsing Hua University, Taiwan
Purpose Among diagnostic image procedures, the computed tomography
examinations make relative high radiation exposure. In recent years,
MDCT examinations provide good image quality and image range,
especially for the desire of quick image informations for treatment of
trauma. We compared different frequencies of emergent CT studies in
recent 3 years in Taoyuan General Hospital.
Methods During 2007, 4,733 CT examinations were performed by single
slice spiral CT. There were 5,204 CT examinations were done by 64MDCT in firest ten months of 2009. According to record of CTDI and
conversion factors, estimated effective dose of different procedures for
trauma studies and non-trauma studies.
Results There are 2,043 CT requests in 2007 and 2,711 requests in 2009,
32% increasing of emergent CT studies. Only 9% increases the total CT
study number. For brain CT study, no difference of the estimate effective
dose. 74 whole body CT exams were done in 2009 but only 21 in 2007.
The highest estimated effective dose for whole body CT is 32 mSv. After
modulation, we performed low dose whole body CT as 8.4 mSv.
Conclusions After installation of MDCT, clinicians prefer a wide range of
image information and also increasing risk for X-ray exposure. According to
principle of ALARA, low dose whole body CT is an option for trauma study.
Keywords Cost-effectiveness, CT, Trauma
ER015
CT Signs for Acute Cholecystitis with Necrosis
Cheng-Hsien Wu, Yon-Cheong Wong, Li-Jen Wang, Wan-Chak
Lo, Chao-Jan Wang, Chen-Chih Huang, Sheng-Che Hung,
Huan-Wu Chen
Memorial Hospital, Chang Gung University, Taiwan
Purpose This study aimed to evaluate the optimal image reconstruction
windows of systolic and diastolic phases for coronary CT angiography
(CCTA) on a 256-slice CT, and to assess the image quality using the
determined reconstruction windows.
Methods We recruited 126 patients for CCTA and 21 data sets were
reconstructed in 5%-step throughout the entire cardiac cycle. Further
reconstructions with 1%-step were performed in the preliminary selected
interval to locate a finer optimal window. Two independent and blinded
reviewers discriminated optimal systolic and diastolic reconstruction
windows for 15 vessel segments distributed on right coronary artery, left
anterior descending artery, and left circumflex artery. Image quality was
graded from 1 (no motion artifacts) to 4 (severe motion artifacts preventing
diagnosis).
Results For three vessels, the median optimal systolic and diastolic
reconstruction windows were 45% and 78% respectively. The mean
image quality scores for systolic (S), diastolic (D) and combined systolic
and diastolic (S+D) reconstructions were 1.8±0.3, 1.8±0.5 and 1.5±0.3,
respectively. Combined S+D reconstruction improved diagnostic
evaluability to 100% for all segments and showed less motion artifacts
as compared to S and D only for all heart rate (HR) ranges (S+D vs S,
p<0.05 for HR <85; S+D vs D, p<0.05 for HR 73–84). For patients with HR
of 60–72, motion artifacts were significantly lower for diastole than systole
(1.6±0.3 vs 1.8±0.4; p<0.001), while for HR of 73–84, motion artifacts
were significantly lower for systole than diastole (1.7±0.3 vs 2.0±0.5;
p<0.01).
Conclusions In conclusion, we have determined optimal systolic and
diastolic reconstruction windows for this 256-slice CCTA study. Diastolic
reconstruction yielded superior image quality in lower HR and vice
versa for higher HR. Combined S+D reconstruction showed less motion
artifacts compared to single phase reconstruction. The 256-slice CT has
demonstrated its superiority in CCTA for improving diagnostic evaluability
comparing to other available scanners.
Keywords Angiography, Arteries, Arteriosclerosis, Obstruction/Occlusion,
Outcomes Analysis, CT
E-Poster
CV019
Optimal Systolic and Diastolic Image Reconstruction
Windows for Coronary 256-Slice CT Angiography
Liang Kuang Chen
Department of Diagnostic Radiology, Shin Kong Wu Ho Su
Memorial Hospital, 163, Taiwan
plaque in subjects with zero coronary calcium score by 64-slice computed
tomographic (CT) angiography and to find the risk factors.
Methods This retrospective study enrolled 98 subjects who underwent
64-Slice, retrospective ECG gated, coronary CT angiography and turnout
to have zero coronary calcium score by Agatston algorithm. NCAP was
less than 130 HU and was seen at least in 2 image plane. Stenosis
ratio was assessed in multi-planar reformation. Demographic data and
risk factors include age, gender, hypertension, diabetes mellitus, serum
cholesterol, triglyceride, smoking, body mass index.
Results There are 98 patients (male: female=54:44) with mean age of
53 years. 46% of the patients have non-calcified plaque. The proportion
of patients to have mild disease, moderate disease, significant stenosis
was 17%, 26%, and 1%, respectively. There is significant difference
in triglyceride level, and body mass index for presence of plaque.
Factors independently associated with an increased risk of presence
of NCAP included male gender (odds ratio [OR], 2.77; P=0.016),
hypertriglyceridemia (OR, 3.54; P=0.011), and diabetes mellitus (OR, 6.58;
P=0.013).
Conclusions The prevalence of soft plaque in subjects with zero calcium
can not be overlooked, the risk factors associated with presence of noncalcified plaque are male gender, hypertriglyceridemia and diabetes
mellitus.
Purpose To evaluate the value of CT signs for acute cholecystitis
with necrosis
Methods From Jan to May of 2009, around 2100 abdomen CT obtained
from PACS. 159 among them were mentioned of cholecystitis in the
radiologic report. In these 159 patients, 27 ones receive operation within
3 days and histopathologic proven of cholecytitis, their CT images were
reviewed. 2 among these 27 patients were excluded owing to just chronic
inflammation found on pathology in one, and poor image quality in
another. Acute cholecystitis with necrosis was diagnosed in 17 patients
and without in 8. CT signs of wall hemorrhage, wall irregularity, mucosal
sloughing, wall perfusion defect, pericholecystic abscess and stranding,
gas forming inside/outside near gall bladder, thrombosis/gas in portal vein,
adjacent liver change, gall stone was collected and analyses
Results Significant statistical difference was noted between necrotic
and not-necrotic cholecystitis, in perfusion defect, gall stone, and
pericholecystic stranding. Each sensitivity/specificity/PPV/NPV
is 0.7/1/1/0.615 in perfusion defect, 0,53/1/1/0.5 in stone, and
0.88/0.75/0.88/0.75
Conclusions CT was valuable to differentiate acute cholecystitis with
necrosis from not-necrosis
Keywords Acute, Bile Ducts, CT, Gallbladder
519
Others
identifying small thrombi and wall motion abnormalities. (n=83)
Conclusions Viability assessment is detection of dysfunctional yet viable
myocardium .Viability scanning distinguishes non-viable scar from viable
myocardium. While Infarcted myocardium shows on cardiac MRI shows
delayed contrast enhancement, Ischemic myocardium lacks contrast
enhancement. Myocardial Infarction is the leading causes of mortality
and is associated with high morbidity. Morbidity can be reduced by early
identification and characterization of scar lesion into acute or chronic and
viable or non viable by Cardiac MRI. After acute Myocardial Infarction,
determining infarct size helps to stratify patient risk and determines extent
of salvageable myocardium.
Keywords Acute, Blood, MR
EX005
The Analysis of Time Enhancement Propertities of Contrast
Medium on Canine Caudal Aorta Using Multidetector
Computed Tomography
Kwo-Chen Hu 1, Chu-Jen Kuo 2, Lih-Seng Yeh 3, Liang-Kuang
Chen2
1
Department of Diagnostic Imaging, National Taiwn University
Veterinary Hospital, Taiwan
2
Department of Diagnostic Radiology, Shin Kong Wu Ho-Su
3
Department of Institute of Veterinary Clinical Science, National
Taiwan University, Taiwan
Purpose As the advancement of computed tomography technology
in these decades, MDCT nowadays is the most powerful diagnostic
520
GU001
Imaging Diagnosis in Different Practice Guidelines for Acute
Colic from Ureteral Stones
Chih-Cheng Liu, Chih-Cheng Lu
Department of Divsion of Urology, Department of Surgery, Chi
Mei Medical Center, Liouying, Taiwan
Purpose To assess the imaging diagnostic recommendations in different
clinical practice guidelines (CPGs) for acute colic from ureteral stones.
Methods The printed and online materials in CPGs for acute renal colic
related to ureteral stones by American College of Radiology (ACR),
European Association of Urology combined with American Urological
Association (EAU/AUA), and British National Health Service (NHS) were
reviewed.
Results The latest English versions of CPGs for acute colic from ureteral
stones of ACR, EAU/AUA, and NHS were available in 2007, 2008,
and 2009, respectively. In ACR, non-enhanced computed tomography
(nCT) was the most appropriate tool although with relative high radiation
level. The following list of suggestions according the ranking scale was
intravenous urography (IVU), sonography, MRI urography and KUB. In
EAU/AUA, the gold standard was IVU, and nCT had equal preference
by recent advanced imaging progress. KUB with sonography was a less
preferred method. In NHS, IVU was thought as the first-line investigation,
but the gold standard was suggested to be nCT. KUB was recommended
as an adjunct aid. MRI was reserved when other investigations were
contra-indicated. Retrograde urography or ureteroscopy was suggested
when other investigations were difficult to interpret but symptoms
persisted.
Conclusions In this limited review, non-enhanced CT stands the first
position for the diagnostic tools. That is quite different from our daily
clinical practice. The study may be feasible in assisting an official
guideline for acute renal colic diagnosis in Taiwan.
Keywords CT, Ultrasound, Ureters
GU007
Computed Tomography Appearance of Ovarian Fibrothecomas
Chee-Wai Mak, Wen-Sheng Tzeng, Chin-Yu Chen
Department of Medical Imaging, Chi-Mei Medical Center, Yung
Kang, Tainan, Taiwan, Republic of China, Taiwan
Purpose To describe the features of ovarian fibrothecoma on computed
tomography (CT) and to determine the possibility of detecting tumor
torsion in this kind of tumor.
Methods The CT images of 11 patients with pathologically proved ovarian
fibrothecomas in the past 8 years at our hospital were retrospectively
reviewed. The CT attenuation values of each tumor were measured
in both non-enhanced and enhanced scans. The size and degree of
enhancement were evaluated and correlated with tumor torsion.
Results Three kinds of tumor pattern were found: 1) homogeneous tumor
with significant enhancement containing scattered, low-attenuated regions
after contrast injection; 2) heterogeneous tumor with mild enhancement
after contrast injection; and 3) low-attenuated soft-tissue mass with no
obvious enhancement after contrast injection.
Conclusions Fibrothecomas usually appear as a homogeneous solid
tumor with varying degrees of enhancement. Calcification may be present
and, as these tumors enlarge, myxoid or cystic degeneration may occur,
resulting in a heterogeneous pattern. The larger the tumor, the greater
is the chance of torsion. Lack of tumor enhancement is the most reliable
sign for detection of ovarian torsion and should facilitate prompt surgical
intervention to remove damaged tissue.
Keywords Neoplasms-Primary, Ovaries, CT
GU025
Intravenous Leiomyomatosis: Diagnosis and Follow-Up with
MSCT
Cong Sun
Department of CT, Shandong Provincial Medical Imaging
Research Institute, China
Purpose To explore the clinical and image features of intravenous
leiomyomatosis, and evaluate the diagnostic and follow-up value of MSCT
on it.
Methods A retrospective study was performed in 3 cases with intravenous
leiomyomatosis and treated by surgery. All of them were female, and
had a history of hysterectomy. All cases were performed with MSCT
for diagnosis and follow-up. Two-dimensional and three-dimensional
reconstructions were performed in all cases by means of MPR (coronal,
sagittal oblique), CPR, MIP and VR. In the meantime, color doppler flow
imaging (CDFI) were also performed.
Results MSCT could display the panorama of the lesion. 3 cases could
be seen the lesion rooted from the iliac vein. 2 cases were showed with
intravenous leiomyomatosis extending through the inferior vena cava (IVC)
into the right cardiac cavities. And 1 case also had multiple rounded welldefined nodules in bilateral pulmonary. After surgery (3 months, 1 year
and 3 years, respectively), 3 cases were recurrence and accompanied by
collateral circulation. 2 cases with the subsequent development of diffuse
peritoneal leiomyomatosis.
Conclusions Intravenous leiomyomatosis is a rare disease, it often
extends through IVC into the right cardiac cavities, and its clinical and
imaging findings have some specific features. MSCT is a valuable and
necessary method in diagnosis of it and has high value in determination of
treatment plan and evaluation of prognosis.
Keywords Angiography, Metastases, CT, Uterus, Vena Cava
GU032
CT in Diagnosis of Emphysematous Cystitis with Pneumoureter
Chih-Cheng Lu
Purpose A case of emphysematous cystitis with pneumoureter was
reported. Review of literature with focusing on the role of CT imaging was
performed.
Methods A diabetic female patient was admitted to the hospital for
suffering from lower abdominal pain and dysuria for about one week. She
was 53 year-old, with poor sugar control (> 500 mg/dl). Then a KUB film
showed possible air in the whole urinary tract.
Results Immediate CT with/without contrast demonstrated bilateral hydronephroureter associated with gas within the bilateral collecting systems
and ureters. The urinary bladder with irregular bladder wall thickening and
intraluminal and intramural gas were also noted. She received parenteral
antibiotics to control infection, anti-diabetic medications and urethral Foley
for urine drainage. The urethral Foley was removed after 3 days. Her
hospital course was smooth.
Conclusions In the literature, not only clinical laboratory checkup but
the imaging study is very important for diagnosis. CT is a feasible tool for
diagnosis of choice in emphysematous cystitis.
Keywords Ureters, Infection
GU035
Sonographic and CT Findings of Acute Pyelonephritis
Chun-Han Lin, Siu-Wan Hung
Taiwan
Purpose To evaluate the sonographic and CT findings of Acute
Pyelonephritis (APN)
Methods From 2008 Jan to 2009 May, 77 patients under the impression
of APN are reviewed. Their clinical signs and symptoms such as loin
pain, tenderness or pyrexia are included in the study. The cases without
laboratory signs of bacterial infection of kidney such as leukocytosis,
pyuria, bacteriuria or positive urine culture are excluded from this study.
The findings of sonography and CT are recorded.
Results The findings such as unilateral or bilateral, focal or diffuse, focal
521
Purpose Complementing to any existent tumor necrotizing methods, by
combining our newly discovered necrosis-avid compounds, we sought
to develop a dual targeting theragnostic strategy for improved cancer
treatability or curability.
Methods Taking a tumoricidal vascular disrupting agent as an example,
Combretastatin A4 phosphate (CA4P) was used at 10 mg/kg to cause
selective vascular shutdown and tumor ischemic necrosis. After a 24h
interval, a necrosis-avid compound hypericin was radiolabelled with
iodine-131 to form monoiodohypericin (131I-MIH) for iv injection at 10
mCi/kg to kill residual malignant cells by crossfire irradiation. Rat models
of liver rhabdomyosarcoma and subcutaneous Walker 256 carcinoma
were divided into groups: group A with 2 solvents, group B or C with CA4P
or 131I-MIH, and group D with CA4P plus 131I-MIH. MR and nuclear
imaging, autoradiography, radioactivity counting and histology were
performed.
Results Within 8-12d after one episode of dual targeting treatment, liver
tumor size in group A doubled that in group B and C (p<0.05), and was
4-times larger than that in group D (p<0.01), as documented by MRI and
nuclear imaging. Autoradiography revealed intense 131I-MIH in tumoral
necrosis proven by over 30-times higher radioactivity relative to liver. Two
thirds of the subcutaneous Walker 256 carcinomas disappeared after
therapy.
Conclusions With both drugs being small-molecular, naturally
extractable, synthetically derivable and intravenously injectable, cancer
treatability or curability could be significantly improved by the present dual
targeting cancer theragnostics. Contrary to the likely expensive omicsbased individualized medicine, the present new generalized strategy
may turn out to be a workable and affordable alternative in clinical
oncology. Acknowledgement: Huaijun Wang, Marlein Miranda Cona,
Thierry Marysael, Peter de Witte, Kristof Prinsen, Guy Bormans, Alfons
Verbruggen, Lin Zhou, and Johan Nuyts are the study collaborators whose
names could not be listed due to the restriction.
Keywords Liver, Metastases, Contrast Agents, Radiation Therapy/
Oncology, Experimental Investigations, Treatment Effects
E-Poster
EX004
Improving Cancer Treatability or Curability via Targeted
Radiotherapy Mediated by Small Necrosis-Avid Molecules: A
Generalized Approach?
Yicheng Ni¹, Junjie Li¹, Ziping Sun², Jian Zhang³, Feng Chen4,
Guy Marchal4, Peter de Witte5
¹Department of Radiology, Catholic University of Leuven,
Belgium
²Nuclear Medicine, Shandong Academy of Medical Sciences,
China
³Natural Medicines, Jiangsu Provincial Academy of Traditional
Chinese Medicine, China
4
Radiology, Catholic University of Leuven, Belgium
5
Pharmaceutical Biology, Catholic University of Leuven, Belgium
equipment for clinical medicine. There are two major advantages of MDCT
use in clinical medicine, short scanning time to make dynamic scanning
can be possible and sub-millimeter slice thickness provide more detailed
diagnostic images. However, when we choose the canine as experimental
animal, there is tremendous difference of physiological condition
between the human and the canine. To obtain a better quality of canine
enhancement images, knowing the hemodynamic status of contrast
medium in canine during CT scanning become more important. Because
of the increase on MDCT scanning speed, we need more accurate
synchronization of contrast delivery system to achieve excellent images.
Meanwhile, determination of an appropriate scan delay to optimize scan
timing and reducing the amount of contrast medium are also important.
Methods All dogs were anesthetized and positioned in sternal
recumbency under 16-MDCT scanning. The total dose 500mg I/kg nonionic contrast medium (370mg I/ml) were then administrated via cephalic
vein. The injection rate was 3ml/sec., 4ml/sec. and 4ml/sec. for Group A,
B and C, respectively. We measured the attenuation values in Hounsfield
Unit (HU) for the caudal aorta at the level of trachea bifurcation which can
be showed on the image.
Results The results showed in time-enhancement curve within which the
entire properties were similar to the relative reports of human medicine.
However, an obvious difference is that the time- enhancement curve shift
leftward.
Conclusions With similar body weight, the faster injection rate, the
shorter time to reach the attenuation of initial optimal enhancement as
well as the higher attenuation of maximum enhancement and the shorter
optimal enhancement period. At the same injection rate the heavy dogs
delayed the initial time of optimal enhancement, but has longer optimal
enhancement period.
Keywords Aorta, Contrast Agents, CT
Others
Purpose We sought to prospectively assess the usefulness of 3.0 Tesla
whole-body magnetic resonance imaging (WB-MRI) and integrated
fluorodeoxyglucose (FDG) positron emission tomography (PET)/
computed tomography (CT) (FDG-PET-CT), and their visual correlation
for the evaluation of the distant-site status in patients with untreated
oropharyngeal or hypopharyngeal carcinoma.
Methods This prospective study was performed after institutional review
board approval and informed consent were obtained. Between 2006
to 2008, a total of 163 patients were recruited. Both WB-MRI and FDG
FDG-PET-CT were performed within a time frame of 10 days. The final
diagnosis was confirmed by biopsy or imaging follow-up for at least 12
months.
Results Twenty-four (14.7%) patients were diagnosed as having
distant malignancies (7 patients had distant metastases, 16 had distant
synchronous tumors, and one had both). On a patient-based analysis,
WB-MRI showed a lower sensitivity than FDG-PET-CT (83.3% vs. 91.7%,
P = 0.687). Both modalities showed similar specificities (98.6% vs. 97.1%,
P =0.5). There was a trend toward greater diagnostic capability of WB-MRI
over FDG-PET-CT (0.895 vs. 0.959, P = 0.065), while visual correlation
of WB-MRI and FDG-PET-CT showed no significant increase over either
modality alone.
Conclusions 3.0 Tesla WB-MRI demonstrated a trend toward lower
diagnostic capability than did FDG-PET-CT in assessing the distantsite status in patients with untreated oropharyngeal or hypopharyngeal
carcinoma, but the difference was not statistically significant. It can be
recommended as the first-line imaging technique for comprehensive
evaluation of such patients.
Keywords Pharynx
HN038
Is Cervical Spine MRI Indicated in Alert, Neurologically
Intact Trauma Patients with Midline Cervical Tenderness and
CT Negative for Acute Injury?
Helen M. Ackland1, Dinesh K. Varma2, Peter A. Cameron3, Rory
Wolfe4
1
N a t i o n a l Tr a u m a R e s e a r c h I n s t i t u t e ; D e p a r t m e n t o f
Epidemiology and Preventive Medicine, The Alfred Hospital;
Monash University, Melbourne, Australia
2
Department of Radiology, Department of Surgery, The Alfred
Hospital, Monash University, Melbourne, Australia, Australia
3
Department of Emergency Medicine, Department of
Epidemiology and Preventive Medicine, The Alfred Hospital,
Monash University, Melbourne, Australia
4
Department of Epidemiology and Preventive Medicine, Monash
University, Melbourne, Australia
Purpose A clinical dilemma arises with alert, neurologically intact trauma
patients with ongoing midline cervical tenderness despite normal CT
imaging, as is it unclear which patients should be investigated with MRI.
We aimed to ascertain the incidence and factors associated with MRIdetected cervical discoligamentous injury in such patients.
Methods Alert, neurologically intact trauma patients admitted to a Level 1
trauma centre with midline tenderness and normal CT, and who underwent
MRI as per the institutional protocol, were recruited prospectively. Data
522
IN001
To Demonstrate the Efficacy of PTA and Stenting along with
Cerebral Protection on the Treatment of Significant Carotid
Stenosis
Lakshmi sudha Prasanna Karanam1, Bhawna Dev2, Santhosh
Joseph3
1
Department of Radiology, Resident, India
2
Department of Radiology, Consultant, India
3
Department of Radiology, Professor, India
Purpose To demonstrate the efficacy of PTA and Stenting along with
cerebral protection on the treatment of significant carotid stenosis.
Methods The study was conducted in a period of 4 years which included
68 patients (51M, 17F) with the youngest patient being 9 years and oldest
was 82 years. Majority of patients presented with TIA. Degree of stenosis
was classified on basis of NASCET criteria. The procedure was done
under Local anesthesia with continous monitoring of the neurologic status.
EPI filters were used in all the patients for cerebral protection. Regular
follow up at intervals of 1, 3, 6, 12 months was done in all the patients.
Results Technical success was achieved in all the patients. Hypotension
devoloped in two patients. Four patients had choking of filter but carotid
flow was normal after removal of the filter. Minor stroke occured in two
patients. There was no major stroke or death in our series. The results
were analysed and compared with NASCET &ESCT studies.
Conclusions PTA with stenting is effective treatment for carotid stenosis
with higher success rate and less complications. The role of cerebral
protection in avoiding migration of the plaque material, thus preserving the
cerebral circulation was emphasized in the present study.
Keywords Angioplasty, Percutaneous, Filter Insertions, Stents
IN006
Endovacsular Management of Symptomatic Varicose Veins
with Laser Ablation
Amit Disawal, Jawahar Rathod, Kishor Taori, Nischal Kundargi
Purpose Venous insufficiency due to varicose veins causes great
discomfort and considerable morbidity to the patients. The reported
prevalence of the varicose veins is about 4.5% and it is estimated that
41% of all women will suffer from abnormal leg veins by the time they
are in the 50s. The purpose is to treat symptomatic lower limb venous
Varicosities.
Methods Prospective Study for 2years. Interventional Radiology, No. of
patients 150. In 150 patients, 200 limbs were treated with Biolitec LASER
ablator with Optical power 10 watts & wavelength of 1465 nm with pulse
mode in two year duration. The laser fiber introduced in to the superficial
venous system generates thermal energy to cause ablation of respective
veins. Perforators & superficial venous tributaries are also ablated in the
similar way. Graded compression stockings were advised to the patients
as an essential part of therapy in early post laser ablation period.
Results In our study high occlusion rate (100%) of treated veins on
follow up doppler ultrasound treatment. Significant improvements in skin
changes with high ulcer healing rates (98%) are observed. Significant
pain relief was seen in all patients. In our series no major complications
were observed however minor complications like regional inflammatory
changes (12%) & cellulitis (4%) at puncture sight were seen; which have
responded to the medications
Conclusions LASER ablation is a minimally invasive, safe & effective
OPD treatment to treat symptomatic varicose veins because 100%
occlusion rate & high ulcer healing rate with significant pain relief.
Keywords Ablation Procedures, Laser, Varices, Veins, Interventional
IN008
Characteristic Ossessous Changes Following Transosseous
Direct-Puncture Embolization of Bilateral Mandibular
523
Purpose Acute pelvic pain may be caused by utertine or ovarian disease;
either benign or malignant entity. Ruptured ovarian cyst or tumor can
complicated with hemoperitoneum and was life threaten.
Methods From Aug 2008 to Oct 2009, we found that five female patients
presenting with acute pelvic pain were related to benign ovarian diseases.
The patients were 37 to 44 years old (mean, 38.6 years). CT study was
performed in all five patients. Four patients received operation, and one
patient with PID received antibiotic therapy. The CT imaging features were
analyzed.
Results The five female patients with acute pelvic pain were caused
by following several benign ovary diseases. One case had ruptured left
ovary corpus luteum cyst complicated with hemoperitoneum. One case
had giant left ovary endometrioma (27 cm) with intra-lesional active
bleeding. One case had pelvic inflammatory disease with meso-salpinx
and adjacent mesenteric fat involvement, leading to secondary enteritis
and bowel loop dilatation. One case had right pyosalpinx; associated with
ascites. The remaining one had right tubo-ovarian abscess.
Conclusions Ovary diseases should be differentiated from appendicitis,
diverticulitis, pyelonephritis or other etiology in female patients with acute
pelvic pain. Pre-operative CT study can provide accurate diagnosis and
change the surgical plane.
Keywords Acute, Ovaries, Pelvis, CT, Fallopian Tubes, Hemorrhage
HN014
Whole-Body MRI at 3-Tesla and FDG-PET-CT in Assessment
of Distant-Site Status in Patients with Untreated
Oropharyngeal or Hypopharyngeal Carcinoma
Shu-Hang Ng1, Sheng-Chieh Chan2, Tzu-Chen Yen2, Yau-Yau
Wai1, Ho-Fai Wong1
1
Hospital, Taiwan
2
Department of Nuclear Medicine, Chang Gung Memorial
Hospital, Taiwan
pertaining to mechanism of injury, clinical assessment, patient history
and radiographic findings were collected. De-identified MR images
were reported independently by two trauma radiologists using a specific
proforma, and injuries were identified and graded.
Results There were 178 patients recruited over a two year period to
January, 2009. Of these, 78 patients (44%) had acute cervical changes
detected on MRI. There were 48 single column injuries, 15 two column
injuries and 5 three column injuries. Additionally, there were 2 patients
with isolated alar ligamentous injury and 8 patients with isolated posterior
muscle oedema. The injuries to 38 patients (21%) were considered to
be clinically significant and were treated: 33 patients in cervical collars
for 2-12 weeks, and 5 patients with operative management. Multivariate
logistic regression revealed that moderate or severe degenerative disc
disease (p= .01), stable, isolated low thoracic or lumbar fractures (p= .02),
multi-directional forces to the neck during the trauma (p= .01) and loss of
consciousness at the accident scene (p= .04) were associated with MRIdetected injury.
Conclusions The majority of patients with midline cervical tenderness
and CT negative for acute injury can be discharged in cervical collars
to be reviewed as outpatients, when MRI may be indicated if symptoms
are persistent. However, in cases where degenerative changes on CT, or
other associated factors are present, early MRI may be warranted.
Keywords Acute, Ligaments, MR, Spine
E-Poster
GU038
Acute Pelvic Pain Related to Benign Ovarian Disease: CT
Imaging Features
Hsin-Chi Chen, Ming-Chi Chiang, Ming-Mei Yang, Hui-Mei Chen
Department of Radiology, Nan-Men General Hospital, Taiwan
Others
swelling or renal enlargement are mostly found.
Conclusions APN is a clinical diagnosis process, however, awareness
of the findings of angiography of CT may helpful in case of emergency
condition.
Keywords Acute, Kidney, CT, Ultrasound, Infection
IN012
Endovascular Onyx Embolisation of Intracranial Dural
Arteriovenous Fistulas – Results and Complications
Cheng Kang Ong 1, Dang V Lam 2, Ken Le 2, Mark A Power 3,
Michelle T Ong2, Lily L Wang2, Richard J Parkinson1, Jason D
Wenderoth1
1
Department of Interventional Neuroradiology, Prince of Wales
Hospital, Australia
2
Department of Medical Imaging, Prince of Wales Hospital,
Australia
3
Department of Medical Imaging, Liverpool Hospital, Australia
Purpose Endovascular Onyx embolisation is fast becoming an
established definitive therapeutic option for patients with intracranial dural
arteriovenous fistulas (DAVFs). We present the results and complications
in our patients whose intracranial DAVFs were treated endovascularly
using Onyx as the sole embolic agent.
Methods Between July 2006 and June 2009, 23 DAVFs in 22 patients
(1 patient had bilateral cavernous sinus DAVFs which were treated on
2 separate sessions) were embolised with Onyx at our institution. There
were 11 females and 11 males, with a mean age of 57.9 years (age
range, 25–85 years). The clinical presentations, angiographic features,
endovascular embolisations, clinical and imaging outcomes of these
patients were reviewed retrospectively.
Results Of the 23 lesions, there were 11 cavernous sinus DAVFs, 10
transverse / sigmoid sinus DAVFs and 2 superior sagittal sinus DAVFs.
Eighteen of the 23 DAVFs (78.3%) were completely obliterated in the first
sessions of embolisation, while 3 of the other 5 lesions were successfully
embolised on second attempts. Residual shunts were evident in the
remaining 2 patients (8.7%), although the embolisations did convert their
524
Purpose Stroke is most common cause of life threatening neurological
disease and also it is leading cause of adult disability and third leading
causes of death. Intracranial atherosclerosis is 8 to 10% of all ischemic
strokes and reported poor outcome and high rate of morbidity and
mortality.
Methods We evaluated 203 consecutive patients (mean age 61.3, range
34-80 years) who underwent intracranial stenting between March 2004
and May 2009. The location of lesion was MCA (n=31), distal ICA (n=45),
Petro-cavernous ICA (n=9), Basilar artery (n=3), Vertebral artery (n=31),
vertebral artery orifice (n=16) and mean stenosis was 72.8%.
Results The procedural success rate was 93.5%. 6 cases are unable to
reach the target and performed Balloon angioplasty. There were overall
three complications (3.3%) within period of follow up (six months); these
included one minor strokes (0.5%), and one deaths (0.5%), one restenosis
(0.5%). The kind of stent was Precise (n=61), Endeavor (n=35), Genesis
(n=17), Neuroform (n=17), Flexmaster (n=11), Vision (n=15), Cypher
(n=14), Wall stent (n=8), Smart control (n=7), Arthos pico (n=7), Tsunami
(n=5), Guidant (n=6), Protégé ( n=9).
Conclusions In selected patients, endovascular revascularization of
intracranial arteries with stent assisted angioplasty is technically feasible,
effective and safe. Randomized multicenter trial comparing angioplasty
and stenting with medical management alone must be performed.
Keywords Aneurysms, Angiography, Angioplasty, Arteriosclerosis
IN020
Rupture during Treatment of Intracranial Aneurysms with
Guglielmi Electrodetachable Coils
Pao sheng Yen, Cheng Hui Chiu
Department of Medical Imaging, Buddhist Tzuchi Medical Center,
Taiwan
Purpose Aneurysmal rupture during endovascular treatment is one
of the most feared complications of endovascular aneurysm therapy.
The purpose of this study was to determine the frequency, causes,
management, and outcome of aneurysmal rupture that occurred during
treatment with Guglielmi detachable coils (GDCs) in an unselected series
of patients with ruptured cerebral aneurysms.
Methods From Oct 2002 to Jan 2009, we treated 177 cerebral aneurysms
with GDCs. All charts were reviewed, and patients with aneurysmal
rupture occurring during embolization were identified.
Results Five patients had an intraprocedural aneurysmal rupture. In one
patient, rupture was during contrast injection. In the other four patients,
rupture was during placement of the coils. Endovascular packing was
continued in all patients. Aniographically cerebral blood arrest was found
in 2 cases. One patient was asymptomatic. One patient died as a result of
the aneurysmal rupture. Three patients suffered from major neurological
deficits. In summary, we observed intraprocedural aneurysmal rupture in
IN022
Endovascular Management -A Successful Efficient Method
in the Treatment of Catoticocavernous Fistulae-A Study
from SRMC
Lakshmi Sudha Prasanna Karanam
Purpose To discuss the efficacy of endovascular management by various
methods as the treatment option for caroticocavernous fistulae.
Methods In our study 46 patients were included during the period from
02/02/2004 to 02/12/2008. 32 were male patients and 14 were female
patients with mean age of 37 years. 25 patients presented with Type A
carotid fistulae and 21 patients with dural fistulae. Majority of the patients
(37) presented with proptosis, the other patients had red eye (32), diplopia
(9), headache (13) and diminished vision (23). Pre procedural workup
with CT, CTA, MR, MRA was done in all the patients. High resolution
DSA was done using Advantax LCN+ (GE Biplane system). Embolisation
materials in the form of balloons were used in 15 patients and coils in 7
patients. Both balloons and coils were used in 4 patients. Glue was used
in 3 patients. Polyvinyl alcohol particles were used for embolisation in
14 patients. Onyx, the newer embolic agent was used in 3patients in our
series.
Results Complete cure in the form of total reversion of the disease both
clinically and on angiographic analysis was achieved in thirty four patients.
Improvement with residual pathology was achieved in eight patients in
whom there was complete clinical cure but angiogram demonstrated
small residual fistula with or associated pseudoaneurysm. Procedure was
abandoned because of technical reasons in one patient. Spontaneous
closure of the fistula occurred in one patient. Complications in the form of
inadvertent balloon detachment occurred in two patients. Thus complete
cure was seen in 91% of our patients which is in par with worldwide
literature of 85-87% success rate.
Conclusions Interventional neurovascular techniques to treat
caroticocavernous fistulae of traumatic or dural variety have become
accepted forms of therapy. Goal of therapy for fistulae involving carotid
artery should be preservation of vision and preservation of carotid artery.
Complete cure either angiographic or symptomatic is significant following
a proper plan and use of appropriate.
IR022
Transarterial Embolization of Uterine Arteriovenous
Malformations Using N-Butyl Cyanoacrylate: Three Cases
Experience
Yen-Chun Chen, Liang-Kuang Chen, Wai-Yip Law, Ta-Nien Lu,
Chin-Chu Wu, Cheng-Tau Su
Department of Radiology, Shin Kong Wu Ho-Su Memorial
Hospital, Taiwan
Purpose Uterine arteriovenous malformations (AVMs) are rare conditions
but may be associated with life-threatening vaginal bleeding. We report
three cases with uterine AVMs and transarterial embolization with N-butyl
cyanoacrylate (NBCA) was performed.
Methods Three child-bearing aged patients presented with severe
acute abdominal pain and abnormal vaginal bleeding. The diagnosis
of uterine arteriovenous malformations were suspected from Doppler
ultrasonography and confirmed by angiography.
Results The patients were treated successfully by selective uterine artery
embolization using N-butyl cyanoacrylate (NBCA).
Conclusions Uterine artery emboliztion with NBCA is effective and offers
an alternative to conventional surgery.
Keywords Angiography, AVM, Uterus
IR030
Endovascular Management for Hepatic Artery
Pseudoaneurysm; Six Cases Experience
Dae Hyun Hwang, Mi Nyong Choi, Kook Seon Kim, Young Hwan
Ko, Ik Won Kang, Eil Seong Lee
Department of Radiology, Hangang Sacred Heart Hospital,
Purpose Hepatic artery pseudoaneurysm is a serious complication
of acute or chronic surgical injury to the hepatic artery. Transcatheter
embolization has been considered the treatment of choice but there have
been some report trying for stenting. The purpose of this study was to
assess the efficacy of coil embolization and stenting for ruptured hepatic
artery pseudoaneurysms.
Methods Six cases in five patients (four men and one women; mean age,
50; range, 28–62) were treated with transcatheter arterial embolization
with or without stent graft between January 2007 and September 2008.
They were analyzed with regard to the clinical presentation, radiological
finding, procedure, and outcome. All patients presented with epigastric
pain and gastrointestinal bleeding. The aneurysms ranged from 0.4 to 4.4
cm in size. The aneurysms were located in the common hepatic artery
(n=2) and the left hepatic artery (n=1), junctioin area of common hepatic
artery and left hepatic artery (n=1) and proper hepatic artery (n=1).
Embolization was performed with microcoils in all aneurysms (n=8). Self
expandable stent (n=1) were also used.
Results In one patient, who had presented hepatic infarction and
performed stent insertion with coiling, rebleeded at aneurysmal neck five
days later. Emergency operation was performed and coiled aneurysmal
sac was removed. One month after, another ruptured aneurysm was
detected in angiography and performed coil packing twice. He was
expired one month later due to septic shock. Complete occlusion was
achieved other patients. And there was no recurrence of the symptoms
and bleeding during follow-up (mean, 13 months; range, 5–24 months).
Conclusions Transcatheter arterial coil embolization for ruptured hepatic
artery aneurysm is effective. We considered stenting is useful for unique
supplying artery for liver, which had spastic change, underlying hepatic
infarct. In our experience, the use of stent should be more carefully.
Further study and long term follow up is need.
Keywords Aneurysms, Embolization, Interventional
IR032
Retrograde Transhepatic Fine Needle Double Venous
525
IN015
Intracranial Angioplasty and Stenting for Cerebral
Artherosclerosis: Results of 203 Consecutive Patients
Mi Nyong Choi, Dae Hyun Hwang, Kook Seon Kim, Jun Young
Jeon, Ik Won Kang, Eil Seong Lee
Department of Radiology, Hangang Sacred Heart Hospital of
2.8 % of our patients, with a mortality rate of 20 % and long-term morbidity
of 60 %. Emergency ventriculostomy
Conclusions Aneurysmal rupture during endovascular treatment with
GDCs is a rare event; clinical severity may be variable. Embolization of the
aneurysm can be continued in most cases. The presence of intracranial
hypertension is one the major factor of determination of clinical outcome.
Keywords Intraoperative, Aneurysms, Complications
E-Poster
Purpose Arteriovenous malformations (AVMs) in mandible are rare but
potentially lethal problems. These intractable vascular diseases are
usually treated by endovascular embolization alone or combined with
surgical resection. In the literature, recurrent AVM following endovascular
embolization are frequently reported. Most authors focus on different
routes of approach and embolizers. However, we attempt to propose a
mechanism of AVM recurrence according to the characteristic radiographic
findings in our patient.
Methods We repot a case of bilateral mandibular AVM in a young girl
who was admitted for uncontrollable lower gum bleeding after dental
procedure. A review of the serial CT and angiography images of this
patient is undertaken to highlight the characteristic ossessous changes
following transossessous direct-puncture embolization with Guglielmi
detachable coils (GDCs).
Results Initially, the AVM predominantly involves the right mandibular
body and ramus without bony cortex breakthrough. The venous sac of
AVM in right mandible is well embolized. Another small saccular lesion in
mental symphysis is managed by trans-areteral embolization of feeding
arteries and trans-venous embolization of drainage veins. Seven months
later, obvious ossessous regeneration in the embolized AVM in right
mandible, suggesting optimal embolization and bony repair, is noted on
head and neck CT. However, progressive dilatation of the residual venous
sac in mental symphysis leads to a large recurrent AVM in left mandible
with marrow erosion. Soon the patient is readmitted for recurrent left lower
gum bleeding.
Conclusions This is the first documented CT evidence of ossessous
change following embolization of mandibular AVMs. We prove the
spontaneous bony repair in optimally embolized AVM and intractable
recurrent AVM arising from residual nidus despite aggressive embolization
of feeding arteries and drainage veins. Therefore, every effort should
be made to obliterate the nidus of the mandibular AVM for attempting a
successful embolization therapy without recurrence.
Keywords Angiography, AVM, CT, Percutaneous, Interventional
DAVFs from type III/IV lesions to clinically asymptomatic type I fistulas.
Complications occurred in 8 patients and included trigeminocardiac reflex
(n=3), sixth nerve palsy (n=1), periorbital haematoma (n=1), fractured
microcatheter (n=1), alopecia (n=1) and acute headache post-embolisation
(n=1), all of which resolved without resulting in any permanent disability.
At the last follow-up (range, 3 – 29 months) all patients had regained
independent clinical status although 2 patients still suffered from mild
ataxia and 1 patient had persistent diplopia.
Conclusions Endovascular Onyx embolisation of intracranial DAVFs is
effective and relatively safe, although potential for serious complications
definitely exists.
Keywords Embolization, Fistula
Others
Arteriovenous Malformation in a Young Girl
Chih-hua Yeh, Ho-Fai Wong, Yew-Liang Chen
Taiwan
IR033
Biliary Metallic Stent Placement; A Technical Review
Kim Hyun Jung1, Lee Hae Giu2, Ohm Joon Young3, Chun Ho
Jong3, Choi Byung Gil1
1
Department of Radiology, Resident, Korea
2
Department of Radiology, Professor, Korea
3
Department of Radiology, Assistant Professor, Korea
Purpose Biliary metallic stent placement is a very effective palliative
treatment of malignant disease of bile duct. The purpose of this exhibition
is to introduce various stent placement techniques to resolve obstruction
bile ducts due to malignant and benign diseases.
Methods 1. Indications of biliary stent placement. 2. Various technique in
hilar lesions, according to access route and lesions extent. 3. Utilization
of biliary stent in benign diseases. 4. Management after biliary stent
placement.
Results 1. Stents used in biliary disease. 2. Indications for biliary stent
placement: (A) Malignant disease, (B) Benign disease. 3. Placement and
management techniques: (A) CBD lesions, (B) Hilar lesions, (C) Lesions
with variation in bile duct, (D) Benign lesions.
Conclusions Biliary metallic stent placement has known as very effective
treatment tools for various malignant biliary diseases. Understanding the
placement and management techniques can extent indications of biliary
stent placement which induces improvement of life quality of patients
with inoperable malignant biliary diseases. Furthermore, in patients with
certain type of benign diseases which are very difficult to treat with other
methods, biliary stent placement can play a unique role to resolve the
lesions.
Keywords Bile Ducts, Percutaneous, Stents, Interventional
526
IR050
Transcatheter Arterial Embolization of Hepatic Artery
Aneurysm: Three Cases Report
Chien-Chih Lin, Jen-I Hwang, Siu-Wan Hung, Yung-Yi Cheng,
Chun-Han Lin, Clayton Chi-Chang Chen
Taiwan
Purpose The hepatic artery is the second most common location of
splanchnic artery aneurysms which are rare vascular abnormalities. We
report three cases of hepatic artery aneurysm treated successfully by
transcatheter arterial embolization (TAE).
Methods Patient 1: A 33-year-old man with history of choledochocyst post
operation in childhood was sent to ER due to cholangitis with obstructive
jaundice. Pseudoaneurysm formation in right hepatic artery was noted by
abdominal computed tomography (CT) after percutaneous transhepatic
cholangiography and drainage procedure. Patient 2: A 67-year-old man
was a case of cholangitis with obstructive jaundice. The abdominal CT
showed an aneurysm from proper hepatic artery, about 7cm in maximal
dimension. Patient 3: A 77-year-old man came ER due to sudden onset
of epigastric cramping pain. The abdominal CT revealed an aneurysmal
lesion from common hepatic artery, about 5.5 cm in maximal dimension
with rupture. TAE was performed with 4F RLG catheter with deployment
of Gianturco steel coils (Cook, Brisbane, Australia) and N-butyl-cyanoacrylate (NBCA) glue after the diagnostic digital subtraction angiogram
(DSA) was obtained. After the embolization, all patients had immediate
DSA and followed with helical computed tomography (CT) periodically.
Results All three patients (3 of 3 lesions, 100%) had complete occlusion
of the pseudoaneurysms demonstrated on follow-up biphasic spiral
IR059
Percutaneous Vertebroplasty in the Management of
Impending and Established Vertebral Compression
Fractures
Atul Dharmaraj Rewatkar, Rajesh Mundhada
Department of Interventional Radiology, Orange City Hospital,
India
Purpose The purpose of this study was to determine the efficacy and
safety of percutaneous vertebroplasty in the treatment of impending and
established vertebral compression fractures. The primary objectives were
pain reduction and preservation of vertebral height during follow up.
Methods impending and established vertebral compression fractures of
various etiologies were treated in 10 vertebrae in 8 patients (2 female, 6
male) by percutaneous vertebroplasty. Symptomatic levels were identified
by correlating the clinical presentation with conventional radiographs,
CT or/and MRI. During the follow up reduction of pain was determined.
Radiographic scans were performed pre- and postoperatively and after
3, 6 and 12 months. The vertebral height and endplate angles were
measured to assess the restoration of the sagittal alignment. The effects
on pain symptoms were measured on a self-reported Visual Analog Scale
(VAS) and the Oswestry score was documented. Treatment was carried
out on an outpatient basis. Pain, bone-cement leakage and complications
were monitored and recorded.
Results The median pain scores (VAS) decreased significantly for
vertebroplasty from pre- to post-treatment, as did the Oswestry score. The
mean follow-up time was 16.75 months (range 3-36). The post procedure
vertebral height was preserved on follow up. No clinical or neurological
complications were documented. Minor and asymptomatic bone-cement
leakage was observed in 3 of 10 (30%) vertebrae.
Conclusions Percutaneous vertebroplasty is an efficient and safe
interventional procedure which rapidly improves the mobility and quality
of life of patients with impending and established vertebral compression
fractures.
Keywords Vertebroplasty
IR060
Endovenous Laser Treatment of Varicose Veins with 980 nm
Diode Laser – 2 Year Follow Up Experience
Rajesh Girdhardas Mundhada, Atul Dharmaraj Rewatkar
Department of Interventional Radiology, Orange City Hospital
and research centre, Nagpur, India
limbs (98.58%). Bruising noted in 60 limbs (28.3%), palpable scarred
veins upto 3 months noted in 202 limbs (95.28%), paresthesia in 24 limbs
(11.32%), skin burns in 2 (0.94%). Healing within 2 months was noted in
149 out of 156 limbs (95.51%), while 4 limb ulcers (2.56%) with resistant
infections healed within 4 months. 3 large ulcers (1.92%) required skin
grafting at the end of 4 months. No post procedure DVT noted.
Conclusions This minimally invasive technique appears to be safe, easy
to perform, well tolerated and with high success rate and low complication
and recurrence rate.
Keywords Valves, Veins
IR061
Transarterial Chemoembolization with Consecutive
Radiofrequency Ablation for Small Hepatocellular
Carcinoma
Kyungwon Doo¹, Yun Hwan Kim1, Sung Bum Cho1, Whan Hoon
Chung2, In Ho Cha3
1
Department of Radiology, Korea University, Anam Hospital,
Korea
2
Department of Radiology, Korea University, Ansan Hospital,
Korea
3
Department of Radiology, Korea University, Guro Hospital,
Korea
Purpose The purpose of this study was to assess technical feasibility and
therapeutic effectiveness of transarterial chemoembolization (TACE) with
consecutive percutaneous radiofrequency ablation (RFA) for the treatment
of small hepatocellular carcinoma (HCC) that is invisible on ultrasound.
Methods Between March 2008 and April 2009, the study included 33
lesions in 33 patients with HCC who were treated combined therapy
(TACE followed by RFA). The lesions were invisible on initial ultrasound
examination due to location (n=20) or echogenicity (n=13) of nodules. All
of the patients were treated in the same day (time interval between TACE
and RFA, mean 91 minutes; range 25-245 minutes). They averaged 1.65
cm in diameter (range 0.8-4.0 cm). After TACE, percutaneous RF ablation
was performed under ultrasound and fluoroscopy. The technical feasibility,
rate of therapeutic effectiveness at initial follow-up CT (mean 1 month),
and local tumor progression were evaluated.
Results After TACE, percutaneous RF ablation was technically feasible in
32 (97%) of the 33 nodules. The primary technical effectiveness rate for
nodules treated by combined treatment was 100% (32/32) at initial followup CT. No residual viable tissue or local tumour progression during the
follow-up period (median 5.6 months; range 1-12 months) were found in
31 (97%) of the 32 nodules. No major complications were documented.
Conclusions Chemoembolization with consecutive RFA on the same day
in small HCC which are not visible on ultrasound is a feasible technique
and provides high local success rate.
Keywords Ablation Procedures, Liver, Chemoembolization, Interventional
Purpose To report safety and efficacy of 980 nm diode endovenous laser
in treatment of truncal varicose veins or clinically significant perforators in
24 months follow up period.
Methods This study includes 212 extremities with incompetent 201 Great
Saphenous Vein , 65 Short Saphenous Vein, 190 clinically significant
perforators, 44 Antero-lateral tributary, 21 Postero- Medial Tributary and 23
Giacomini veins (544 veins) treated with 600 microns 980 nm diode laser.
Under LA & USG guidance, 201 GSV’s and 65 SSV’s were percutaneously
accessed, using wire and angiosheath . Under fluoroscopic guidance,
4F diagnostic catheter with laser fibre within was placed few centimetres
proximal to the incompetent junction. Average energy delivered was 80 J/
cms. STD Foam sclerotherapy was performed in 99 extremities. Patients
were evaluated clinically and with duplex at regular intervals.
Results 100% successful occlusion of ablated vein was noted in all
extremities at 1 week follow up. 516/544 veins (94.81%), remained
closed on 3 months followup. 513/544 veins (94.34%) remained closed
at 2 years. Recurrence rate of less than 7%, at 2 year follow up noted.
Complete resolution of clinical symptoms at 4 months was noted in 209
Purpose To represent the importance of Interventional Radiology after
emergency laparotomy when inaccessible hematoma was found at
surgical operation. Here we report a case which could be controlled with
transcatheter arterial embolization after emergency laparotomy.
Methods A 64-year-old man with multiple blunt injury after traffic accident
was admitted on ambulance. The patient was suffered from severe
hemorrhagic shock and focused abdominal sonogram depicted massive
hemo-peritoneum. The shock state could not be recovered by rapid fluid
resuscitation, the patient was regarded as “non-responder” and damage
control surgery was managed. In the emergency laparotomy, hepatic
deep lacerations were observed and towel packing was performed for
temporary hemostasis. Hemodynamic state was not kept in spite of
blood transfusion after surgery, emergency angiography was performed.
Abdominal aortogram revealed active massive extravasation of contrast
medium from right adrenal artery, transcatheter arterial embolization (TAE)
with NBCA (N-butyl cyanoacrylate) was performed.
Results After TAE, extravasation was completely disappeared, and the
hemodynamic state of the patient recovered. Computed tomography after
TAE showed large amount of hematoma in Morison’s pouch, and not in
retroperitoneal space. The patient survived after second look operation
and intensive care.
Conclusions Severe peritoneal hemorrhage from adrenal artery injury
was very rare condition after blunt abdominal trauma. In this case,
unexpected peritoneal hemorrhage from retoperitoneal vascular rupture
was observed. Interventional Radiology following damage control surgery
was effective for hemostasis and excellent outcome could be acquired.
Keywords Adrenal, Angiography, Trauma, Interventional
CT although one patient had recanalization of aneurysm that required
additional TAE.
Conclusions TAE is an effective and safe means of treating aneurysms
involving hepatic artery.
Keywords Aneurysms, Angiography, Liver, Arteries, Embolization,
Interventional
E-Poster
Purpose To report a method using sonographic guidance to serially
puncture the portal vein and hepatic vein or IVC in patients after failed
conventional transjugular standard technique.
Methods During 1996 to 2009, 77 patients were referred to our
department for TIPS creations. Of them, 7 patients failed via conventional
transjugular fashion. One patient refused further intervention. Six patients
(5 men and 1 woman; age ranged 56-78 years) underwent adjunct
retrograde technique. The indications for TIPS were recurrent variceal
bleeding in 4 patients, refractory ascites and hydrothorax in one patient
each. Two patients had major portal vein thrombosis. Under sonography
guidance, we used a fine needle to serially puncture the portal vein and
right hepatic vein. But if the two vessels could be not scanned on a same
plane, we advanced the fine needle through portal vein directly into IVC
instead. A 0.018-in wire was inserted and grasped out from right neck. The
TIPS sheath was advanced into portal vein after a 6 mm balloon dilation
of liver parenchyma transjugularly. Then a metallic stent was deployed to
create a TIPS shunt.
Results All the six TIPS were created successfully with no procedurerelated major complications. None of the patients died within 30 day
after the procedure. Three shunts were created between hepatic vein
and portal vein, while the other three between portal vein and IVC, The
median pressure gradient before TIPS was 28 mmHg (range, 13-33) and
after TIPS 9 mmHg (range, 5-10). All patients’ clinical symptoms improved
except in one patient with gastrorenal shunt, who rebled 11 months after
the TIPS creation.
Conclusions Adjunct retrograde fine needle double venous puncture is
a safe and effective method for creation of TIPS in distorted liver venous
anatomy.
Keywords Angiography, Liver, Shunts, Stents, Technical Aspects,
Interventional
IR048
Interventional Radiology Following Damage Control Surgery
for the Treatment of Traumatic Adrenal Injury with HemoPeritoneum
Takahiko Mine¹, Hiroyuki Tajima1, Ryusuke Murakami1, Tatsuo
Ueda 1, Yasuhiro Kobayashi 1, Shigeki Kushimoto 2, Hiroyuki
Yokota2, Shinichiro Kumita1
1
2
Department of Emergency Medicine, Nippon Medical School,
Japan
Others
Puncture for Completion of Difficult TIPS
Wan-Chen Liu, Huei-Lung Liang, Jer-Shyung Huang, Yih-Huie
Lin, Huay-Ben Pan
Taiwan
527
MS023
Three-Dimensional Space Isotropic Proton Density MR
Sequence for Internal Knee Derangement Assessment at 3.0T MRI; Comparison with Routine Two-Dimensional Images
In Sook Lee1, Jong Woon Song2, Yeon Joo Jeong1, Kyung Jin
Suh3, Tae-Yong Moon1
1
Department of Radiology, Pusan National University Hospital,
Korea
2
Department of Radiology, Inje University Pusan Paik Hospital,
Korea
3
Department of Radiology, Dongguk University Gyungju Hospital,
Korea
Purpose To prospectively evaluate the usefulness of 3D isotropic PD for
internal knee derangement assessment at 3.0-T MRI.
Methods The 2D and 3D images were reviewed by two of authors for
108 knees of 103 patients. We classified the status of ACL, PCL, MCL
and LCL into 3 grades. The menisci including posterior root were judged
to be intact or torn. For articular cartilage, we classified by normal and
abnormal. We used kappa values for evaluation of intermethod and
interobserver correlation. The sensivity, specificity and accuracy of each
MR sequence were calculated for diagnostic performance.
Results The status of cruciate ligaments, menisci including posterior
root, cartilages of patella and medial femoral condyle showed over
moderate agreement and collateral ligaments and cartilage of lateral
femoral condyle showed fair agreement between two readers. Reader
1 and 2 showed over moderate agreement each about all structures
and about all structures except ACL, MCL, cartilage of lateral femoral
condyle between two MR examinations. The MR interpretations about
cruciate and collateral ligaments, menisci including posterior root and the
arthroscopic results showed higher agreement. The agreement between
528
MS025
Sequential Change of Rat Cartilage and Subchondral
Bone with Experimental Osteoarthritis Investigated by
Quantitative T2* Measurements
Ping-Huei Tsai1, Ming-Chung Chou1, Ming-Huang Lin2, ChienYuan Lin 2, Guo-Shu Huang 1, Herng-Sheng Lee 3, Hsiao-Wen
Chung4
1
2
Institute of Biomedical Sciences, Academic Sinica, Taiwan
3
Department of Pathology, Tri-Service General Hospital, Taiwan
4
Institute of Biomedical Electronics and Bioinformatics, National
Taiwan University, Taiwan
Purpose Osteoarthritis (OA) is a disease related to the degeneration of
cartilage, pathological change of subchondral bone (SB) and so force. In
addition, understanding the sequential change of knee joint after tearing
of anterior cruciate ligament (ACL) contributes to evaluating OA. The
purpose of this study is to investigate the relationships among cartilage,
menisci and SB with the progression of OA by MR T2* measurements.
Methods Eighteen Sprague Dawley rats were enrolled in this study and
randomly separated into three groups. Group 1 was the control group.
Group 2, the experimental group, was performed with right anterior
cruciate ligament transection for induction of cartilage degeneration at 8
weeks of age. Group 3 was sham group whose skin of the right knee was
wounded. At 0,4th,13thand18th week after ACL transection, all the right
knees of the rats were imaged in a supine position in a 4.7T MR system
after being anesthetized. The T2* values of cartilage, menisci and SB
were calculated for statistic analysis.
Results Compared to the control group, the T2* value of the right knee
cartilage in experimental group showed significant differences at 4th, 13th
and 18th week after ACL transaction (P<0.01). The significant difference
of the menisci T2* value was shown first at 4th week in medial meniscus
(posterior horn more significant than anterior horn), and 13th week in
lateral meniscus respectively (P<0.05). SB was the last one to have
significant difference of T2* value only at 18th week (P<0.05). In addition,
there is no significant difference between sham group and control group.
Conclusions The present study indicated the feasibility of quantitative
MR T2* imaging for investigate the sequential change of knee cartilage
and SB with the progression of OA, and this result is coincident with the
histological analysis at end point. Base on this, the in vivo model has a
potential to longitudinally monitor the therapeutic effects of OA.
Keywords Joints, Knee, MR
MS035
Diagnostic Accuracy of Acute versus Chronic Tears of the
ACL of the Knee with MR Imaging
Min-Szu Yao, Ying-Jiun Lin, Wing P. Chen
Department of Radiology, Taipei Medical University–Wan Fang
Hospital and School of Medicine, Taipei, Taiwan
Purpose The aim of this exhibition is to show the patterns and incidence
of MRI signs in diagnosing acute versus chronic tears of the anterior
cruciate ligament (ACL) of the knee.
MS037
Two-Dimensional TOF MR Angiography Assessment of
Lumbar Arterial Stenoses: Relationship to Intervertebral
Disc Degeneration
Yi-Jui Liu1, Chun-Jung Juan2, Guo-Shu Huang², Wing P. Chan³
1
Department of Automatic Control Engineering, Feng Chia
University, Taiwan
2
Department of Radiology, Tri-Service General Hospital, National
Defense Medical Center, Taiwan
³Department of Radiology, Taipei Medical University–Wan Fang
Purpose The aim of this study was to evaluate the relationship of
intervertebral disc degeneration with lumbar arterial stenosis by using
(time-of-flight magnetic resonance angiography) TOF-MRA.
Methods This study recruited 40 patients (147 vertebral bodies) with
TOF-MRA of the lumbar spine. The disc degeneration was evaluated
by sagittal T2-weighted MR images. The MRA was reconstructed by
maximum intensity projection (MIP) in two sagittal views for the left and
right segmental arteries from original TOF MRA images, respectively.
The lumen of four lumbar arteries in two adjacent vertebral bodies was
evaluated by MIP images. A general linear model was used for statistic
analyses.
Results There was significant correlation of the stenosis of upper paired
arteries with disc degeneration (p<0.05).
Conclusions The stenosis of upper paired arteries of the lumbar spine
has significant relation with disc degeneration as evaluated by TOFMRA, thereby this technique can be helpful in further research in the
pathogenesis of degenerative disc disease.
Keywords MR, Spine
MS038
Collagen-PRP Implantation in Menisectomized knee in
Rabbits: Regeneration Assessed with Quantitative MRI
Min-Fong Lin1, Wen-Fu Lai2, Wing P. Chan1
1
2
Graduate Institute of Medical Science, Taipei Medical UniversityWan Fang Hospital, Taiwan
Purpose To monitor effects of regeneration of menisectomized knee after
collagen-PRP implantation in rabbits.
Methods Twenty four adult rabbits were divided into four groups: (A)
partial menisectomy with PRP implantation (n=6 rabbits); (B) partial
menisectomy with collagen template implantation (n=6); (C) partial
menisectomy with collagen template and PRP implantation (n=6); (D)
partial menisectomy only (n=6). All rabbits received follow-up MR imaging
studies after surgery.
Results Experimental animals revealed MR signal intensity decreased in
injured menisci, suggestive of regeneration, especially in group C rabbits.
Histology revealed organized collagen bundles and deeply stained.
Conclusions Collagen- PRP can fascilate healing process of regenerated
tissue in injured menisci, and MR imaging can be feasible in monitor
regeneration of the injured meniscus of the knee.
Keywords Knee, MR
MS044
Adhesive Capsulitis of the Shoulder: The Spectrum of
Ultrasonographic Abnormalities
Howard Haw-Chang Lan
Department of Radiology / Devision of Musculoskeletal, Taichung
Veterans General Hospital, Taichung, Taiwan
Purpose To assess ultrasonographic (US) abnormalities in shoulders with
adhesive capsulitis (AC).
Methods Ultrasonographic abnormalities in 23 shoulders (group I)
having clinical and arthrographic evidences of AC were compared with 73
shoulders (group II) referred for US for shoulder pain without evidence of
AC and 20 asymptomatic shoulders in 10 normal volunteers (group III).
We measured the thickness of the coracohumeral ligament (CHL) and
the joint capsule at rotator interval (RI) and, assessed the presence of
hypoechoic tissue in the RI. The subacromial bursa (SAB) was evaluated
for presence of bursal thickening without effusion.
Results The CHL was thickened (>3 mm) in 10/23 (43.5%) of group I
shoulders, but in none of group II or III. The average thickness of the joint
capsule at RI was 2.5±0.4 mm in group I, 1.5±0.6 mm in group II and,
1.1±0.3 mm in group III. The differences of group I to group II and group
III were significant. But there was no significant difference between group
II and III. The SAB thickening without effusion was found in 13/23 (56.5%)
of group I shoulders, but in none of group II or III. Hypoechoic tissue in the
RI were noted in 19 (82.6%) group I shoulders and in 12 (16.4%) group II,
but none in group III. Detectable blood flow signals at hypoechoic tissue
in the RI on color Doppler US (CDUS) were found in 14 group I shoulders
and in 11 group II. None of 12 group II shoulders had CHL or joint capsule
thickening in the RI, or had SAB thickening without effusion.
Conclusions Thickened CHL or joint capsule in the RI, SAB thickening
without effusion, or having hypoechoic tissue with or without blood flow
signals in the RI are suggestive for the diagnosis of AC.
Keywords Joints, Arthritides, Shoulder, Ultrasound, Inflammation
Purpose To evaluate the clinical efficiency of T2W IDEAL-FSE imaging
of the cervical spine, compared with conventional fat-saturated T2W FSE,
including quantitative measurements of SNR and SNR efficiency and
qualitative scoring of diagnostic image quality in patients post internal
metallic fixation.
Methods 16 symptomatic patients with previous operation history with
metallic fixation at the cervical spine were enrolled. All patients enrolled
in the study were imaged with our routine MR protocol for cervical spine,
including frequency-selective fat-suppressed T2-weighted fast spin echo
(FSE) sequence, and the T2 IDEAL sequence using a 3.0 T scanner.
The qualitative and quantitative evaluations of frequency-selective fatsuppressed T2-weighted FSE imaging and the T2 IDEAL water imaging
were reviewed.
Results The quantitative data of IDEAL showed significantly higher than
that of frequency-selective fat-suppressed T2-weighted FSE imaging,
including signal-to-noise and contrast-to-noise ratios. In the qualitative
data, IDEAL imaging had better quality of fat suppression and less artifact
of metallic artifact.
Conclusions The results of our study have shown that T2W IDEAL-FSE
imaging provides high-SNR images with excellent fat suppression and
less metallic artifact for clinical evaluation of the cervical spine.
Keywords Artifacts, MR, Spine
Methods MR imaging obtained from 71 patients imaged within 6 weeks
(acute) and more than 6 weeks (chronic) of injury who had underwent
arthroscopy were reviewed prospectively and retrospectively for ACL
tears. All arthroscopy was performed by one senior orthopedic surgeon.
Prospective reading was interpreted by one experienced musculoskeletal
radiologist. Two radiologists read all images randomly in retrospect, and
consensus of the interpretation was reached.
Results The prospective (retrospective) diagnostic sensitivity, specificity,
accuracy, positive predictive value and negative predictive value for
complete tears of the ACL of the knee were as follows: 88% (94%), 100%
(97%), 94% (96%), 100% (97%), 90% (95%). For acute (versus chronic)
ACL tears, the occurrence rate of the MRI diagnostic signs were as
follows: fluid replacing gap 39% (chronic, 27%), cloudy appearance 28%
(7%), sulcus sign 33% (7%), anterior tibial translation 17% (27%), low-ride
orientation 6% (27%), non-visualization 44% (67%), bone marrow edema
in one bone 17% (7%), and kissing contusion 67% (13%).
Conclusions To be familiar with which MRI signs are sensitive / specific
for acute versus chronic injuries can be helpful in diagnosing ACL tears.
Keywords Knee, Ligaments, MR, Trauma
E-Poster
MS011
Iterative Decomposition of Water and Fat with Echo
Asymmetry and Least-Squares Estimation (IDEAL) Imaging
of the Cervical Spine: Clinical Application for Metallic
Artifacts
Tsyh-Jyi Hsieh1, Ming-Lun Chiu1, Yu-Ting Kuo2, I-Chan Chiang1,
Wei-Chen Lin1
1
Department of Medical Imaging, Kaohsiung Medical University
Hospital, Taiwan
2
Department of Radiology, School of Medicine, College of
Medicine, Kaohsiung Medical University, Taiwan
imaging interpretations and arthroscopic results was more higher when
read two MR examinations simultaneously. The diagnostic performance
of 3D and 2D sequences in diagnosis of cruciate and collateral ligaments,
meniscal tears showed similar or slightly higher at 3D sequence. The
diagnostic performance was more higher when read two MR examinations
simultaneously.
Conclusions Although 3D isovoxel PD had similar or slightly higher
diagnostic performance as a 2D sequences in the detection of tears of
cruciate ligament, collateral ligaments and menisci, only 3D isovoxel PD
sequence did not significantly raise diagnostic performance. Therefore
adequate mixture of 3D and 2D MR images within or less than the
previous examination time suggested to be useful and essential for raise
diagnostic performance in the knee joint assessment.
Keywords Knee, Ligaments, MR
MS046
Humeral Head Osteonecrosis after Sonographic Therapy
and Extracorporeal Shock-Wave Treatment for Rotator Cuff
Tendinopathy-- Two Cases
Chen-Te Wu
Department of Diagnostic Imaging and Intervention, RSROC,
Taiwan
Purpose Recently we found two patients with rotator cuff tendinopathy
suffering from humeral head osteonecrosis revealed by MR.
Methods One 64-year-old male patient underwent theextracorporeal
Shock-wave Treatment for 3 months. The other 72-year-old female
received the sonographic therapy for 3 months. Due to refractory to
conservative treatment and exacerbating shoulder pain, they were
referred to our orthopedic department and underwent MR study.
Results We collected their MR images and radiographs of shoulders.
Both of them underwent arthrographic surgeries for the tendinopathy.
Conclusions Bizzare color of the articular surface over the involved the
humeral head was noted in the female patient.
Keywords Ischemia/Infarction, Joints, MR, Shoulder
529
Others
Purpose To investigate the effectiveness of combining embolization and
radiosurgery for cerebral AVM.
Methods Among 830 AVM received radiosurgery in a 15-year time at our
institute. 40 of them received embolization, also. Of the 40, radiosurgery
complimented incomplete embolization in 20. Embolization targeted the
fistular components to facilitate radiosurgical effects in other 20. In two
patients, emergent embolization targeted on an engorged vascular sac that
caused devastating re-bleeding in the post-radiosurgical latent periods.
Results For the 20 AVM that embolization served as a facilitator,
total occlusion of the fistulae was achieved in 16, partial obliteration
was observed in 4. No significant peri-procedural complication of
the embolization was found. For cases that radiosurgery used as a
complimentary treatment. The combined treatment resulted in similar cure
rate as the rest of whole series AVM radiosurgery.
Conclusions Embolization provides a prompt normalization of intracranial
hemodynamics for AVM containing fistular components. Priority treatment
for AVM-related pseudo-aneurysm or bleeding vascular sac with
embolization may avoid potentially devastating re-bleeding.
Keywords AVM, Brain/Brain Stem, Radiation Effects, Radiation Therapy/
Oncology, Embolization
NR004
Is Radiological Diagnosis Using MRI Alone Sufficient for the
Management of Brainstem Lesion?
Leesien Yap
Department of Radiology, Leeds General Infirmary, United
Kingdom
Purpose Brainstem lesions can be a diagnostic and management
challenge. A wide range of pathologic entities is found in the region. Whilst
the role of stereostatic biopsy in the management of supratentorial brain
lesion is well established, its use in brainstem lesion remains controversial,
and radiology continues to play an important role. Magnetic resonance
imaging (MRI) has increased the detection of intrinsic brainstem lesions
as compared to computer tomography. The aim of this study was to
evaluate the diagnostic accuracy of intrinsic brainstem lesions using MRI
in both adults and children.
Methods A retrospective analysis was performed on 31 consecutive
patients who underwent stereotactic biopsy of brainstem lesion between
August 2000 and October 2004. All patients had diagnostic MRI preoperation. The diagnostic yield and correlation between pre-operative
radiological and histological diagnosis were analysed.
Results Histological diagnosis was obtained in 31 of the 34 biopsies
(91.2%). Four patients required a repeat biopsy as initial biopsy was
inconclusive. The pre-operative radiological diagnosis was accurate
for differentiating neoplastic from non-neoplastic lesions in 28 of 31
cases (90.3%). 2 cases of malignant neoplasia were misdiagnosed as
inflammatory lesion.
Conclusions Although MRI has a high diagnostic accuracy in
differentiating neoplastic from non- neoplastic lesion, it is inadequate in
providing histological detail. Further advancement in MRI techniques is
necessary, until then, current MRI technique cannot replace histological
diagnosis essential for optimal treatment planning of brainstem lesion.
Keywords MR, Brain/Brain Stem, Neoplasms-Primary
NR009
MR imaging Biomarkers for Differentiating Parkinson
530
Purpose To identify MR imaging biomarkers for differentiation of Parkinson
disease patients form healthy age matched controls using diffusion tensor
imaging (DTI) and tractography on 3 Tesla MRI. To assess detectable
abnormalities along the nigrostriatal pathway in PD patients as compared
with controls at an earlier stage when conventional MRI is normal.
Methods Ten patients with de novo PD and ten age matched normal
controls were scanned on a 3.0 T MR scanner. DTI data was acquired
using a single-shot EPI sequence. DTI data were analyzed using the
Functool software. Region of interest method was used to calculate the
fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values
along the nigrostriatal pathway. Symmetrical ROI’s were placed in the
caudate nuclei, putamen, globus pallidus of basal ganglia, pars reticulata,
pars compacta and red nucleus of substantia nigra. Voxel-based
analysis was used to compare ADC and FA maps in the basal ganglia
and substantia nigra of the two groups and statistical significance was
determined using the student t test.
Results DTI images in patients with PD demonstrated significantly
reduced FA values (p value <0.05) in the caudate nucleus and putamen
of basal ganglia and the pars compacta and red nuclei of the substantia
nigra, with increased ADC values (p value >0.05). This accounted for
loss of dopaminergic neurons characteristic of this disease. No significant
difference was observed in the FA and ADC values of pars reticulata in PD
as compared with normal controls.
Conclusions Visualization of the selective degeneration of individual
structures along the nigrostriatal pathway using DTI on 3 Tesla adds
qualitative data facilitating the early diagnosis of PD. Ideally future
biomarkers for PD will be oriented towards basic biochemical pathology of
the disease process. DTI is noninvasive and does not require the use of
radioactive tracers, suggesting its potential safe application for longitudinal
follow-up and repeated assessments.
Keywords MR, Brain/Brain Stem, Imaging Sequences
NR022
Evaluation of Brain Perfusion in Patients with Extracranial
Carotid and Intracranial Arterial Occlusion by 64-MDCT
Yen-Jun Lai¹, Chung-Jung Lin1, Feng-Chi Chang2, Chiu-Ping
Huang1, Kao-Lun Wang1
1
Department of Medical Imaging, Far Eastern Memorial Hospital,
Taiwan
2
Taiwan
Purpose To evaluate the CT brain perfusion data of regional cerebral
blood volume (rCBV), regional cerebral blood flow (rCBF) and mean
transit time (MTT) in patients with extracranial carotid and intracranial
arterial occlusion.
Methods We retrospectively selected 24 patents with CT angiographic
demonstration of 10 patients with unilateral intracranial arterial occlusion
(aged 61.9±13.2 years, range 40-78 years) and 14 patients with unilateral
extracranial carotid occlusion (aged 61.0±9.8, range 44-77 years).
Visual analysis of perfusion maps of CBV, CBF and MTT were applied
and the regions of prolonged MTT mapping were determined by two
neuroradiologists through consensus. The perfusion data of chosen region
were compared to those on the mirror site in each group by Wilcoxon
signed rank test. The significance of group differences in the perfusion
parametric ratios was analyzed by the Wilcoxon rank sum test.
Results Increased MTT and decreased rCBF values were observed in
both patient groups (P<0.001), but the reduced rCBV values were not
significant (P>0.05). Seven patients with decreased rCBV ratio were
found, 6 with intracranial arterial occlusion and 1 with extracranial carotid
occlusion, and the difference is significant with P value of 0.0242.
Conclusions Vascular occlusion results in prolonged MTT and decreased
regional CBF values in both patient groups. Although the decrease of
regional CBV values is not statistically significant in each group, the ratios
of rCBV are significantly lower in patients with intracranial arterial occlusion.
Keywords Brain/Brain Stem, CT
NR037
Agatston Calcium Score of the Middle Cerebral Artery:
Correlation with Ischemic Stroke
Hung-Wen Kao¹, Cheng-Yu Chen 1, Chun-Jen Hsueh1, ChunJung Juan1, Yue-Cune Chang2, Guo-Shu Huang1
1
2
Department of Institute of Life Sciences and Department of
Mathematics, Tamkang University, Taiwan
Purpose The association of the middle cerebral artery (MCA) calcification
and cerebral ischemic stroke is uncertain, though coronary artery
calcification is a proven risk for heart disease. With the objective Agatston
calcium scoring method used in coronary arteries, we thought to determine
the association between MCA calcium burden and ischemic stroke.
Methods We retrospectively (March 2007 - December 2008) reviewed
1735 consecutive nonenhanced brain CT scans of age 30 years old
or more (age range, 30.0–70.7 years; mean age, 48.9 years; SD, 9.9
years). Cases with medical records of cerebral ischemic stroke and
matched CT or MR imaging findings were designed as stroke group; the
others as control group. Degree of MCA calcification was assessed with
the Agatston method, which originally used to quantify coronary artery
calcification. The underlying risk factors for ischemic stroke, including
hypertension, diabetes mellitus (DM), smoking, plasma cholesterol, and
body mass index (BMI), were recorded by chart review.
Results In univariate analyses, the ischemic stroke was significantly
correlated with presence of MCA calcification, higher Agatston scores, old
age, male gender, hypertension, and DM. Despite apparent association
between MCA calcification and ischemic stroke on univariate analysis (P
= 0.027), there was no independent effect evident after adjusting for other
risk factors (P = 0.495). The prevalence of MCA calcification was higher
in cases with old age and hypertension (P <0.001). In cases with MCA
calcification, all the risk factors were not correlated with occurrence of
stroke.
Conclusions MCA calcifications have no independent effect on cerebral
ischemic stroke. Old age and hypertension are major risks for developing
MCA calcifications.
Keywords Brain/Brain Stem, CT
NR041
Rebleeding Rate of Aneurysmal SAH in the Hyperacute
Stage <2 Hours: CT Angiography Experience
Te-Chang Wu, Yu-Kun Tsui, Wen-Tseng Tzeng
Department of Radiology, Chi-Mei Foundation Hospital, Taiwan
Purpose To evaluate the rebleeding rate and time distribution of
aneurysmal SAH.
Methods From June, 2007 to May, 2009, total 158 consecutive patients
underwent four-section CT angiography in the emergency room of
our hospital, a tertiary refer center. The indications in most cases are
severe explosive headache with or without conscious change and SAH
in the plain CT presumed to be aneurysm rupture. The patients with
aneurysmal SAH confirmed by angiography or consensus by two neurointerventionalists are included. Active bleeding as contrast extravasation
and the hematoma volume difference between the plain and postcontrast
enhanced CT scans are reviewed.
Results According to the inclusion criteria, total 84 patients of which had
101 aneurysms are included. Among them, three patients with contrast
extrasavation and three patients with hematoma progression (maximal
diameter change >3 mm between the plain and postcontrast CT scans)
are found. The average time interval between plain CT and CTA is 47
minutes (8-83 minutes). The location of re-ruptured aneurysm are three
in middle cerebral artery, two in anterior communicating artery and one in
intradural VA. The clinical outcome of hemorrhagic events are 3 deaths,
one modified Rakin scale (mRS) 5, one mRS 3 and one mRS 2.
Conclusions Releeding rate of aneurysmal SAH in the hyperacute
531
NR001
Priority Approach of Risky or Less Reactive Components by
Embolization in Multidisciplinary Management of Cerebral AVM
WanYuo Guo¹, Chao-Bao Luo1, Hsiu-Mei Wu1, Wen-Yuh Chung2,
Hung-Chi Pan2
1
Department of Radiology, Taipei Veterand General Hospital,
Taiwan
2
Department of Neurological Institute, Taipei Veterand General
Hospital, Taiwan
Disease from Healthy Controls Using Diffusion Tensor
Imaging on 3 Tesla MRI
Rohit Gupta
Department of Radiology, Sun Imaging Center, India
E-Poster
Purpose To evaluate the role of MRI in prediction of malignancy of soft
tissue tumors and to determine the accuracy of pathological diagnosis
made on MRI.
Methods The study was carried out on 50 consecutive patients presented
in the orthopedic OPD with a localized swelling in the limb, which seemed
to be arising from the subcutaneous or muscular plane. Following detailed
physical examination, they were subjected to MR examination. T1W &
STIR images in sagittal or coronal plane and axial T2W FSE sequences
were obtained covering the whole tumor volume for adequate depiction
of extension into the adjacent soft tissues followed by fat pre-saturated
T2W or STIR sequences. Gadolinium enhanced studies were performed
on T1-weighted imaging (T1WI) sequences in the same imaging plane as
that of the pre-contrast series. Other sequences like GRE were obtained,
as and when required. Various MR imaging characteristics of benign
and malignant musculoskeletal tumours were identified and evaluated.
Diagnosis was made after contemplating and considering the findings in
the sequences obtained. Final diagnosis was confirmed by the cytological
or histo-pathological examination wherever possible.
Results Features associated with benign diagnosis in a large percentage
of cases, are size less than 8 cm, sharp margination, homogeneous T2
signal, absence of edema, necrosis, calcification and fluid-fluid levels.
Similarly, malignant tumours are commonly associated with presence
of irregular margins, inhomogeneous signal intensity, edema, necrosis,
hemorrhage, fascial penetration, bone changes and neurovascular
involvement. A correct pathological diagnosis was reached in 65% to 75%
of cases. The sensitivity for a MRI diagnosis of malignant tumour was
95% and specificity was 84%.
Conclusions Differentiation of malignant from benign soft tissue tumors
is best made by a combination of clinical and imaging parameters rather
than by any single MR characteristic. A systematic approach markedly
improves diagnostic results.
Keywords MR
Neuroradiology (NR)
Others
MS057
MR Indicators of Malignancy in Soft Tissue Tumors – A
Prospective Evaluation
Vasanthakumar V
Department of Radiodiagnosis, Jawaharlal nehru medical
college, Aligarh Muslim University, India
NR081
Investigation of Cerebral Arterial and Venous Vasomotor
Reactivity Using Phase-Contrast Magnetic Resonance
Imaging
Chun-Jung June, Cheng-Yu Chen
Department of Radiology, Tri-Service General Hospital, Chinese
Taipei
Purpose SWI is a high-resolution, three-dimensional, fully velocitycompensated gradient-echo sequence that uses both magnitude and
phase data. The purpose of this work was to demonstrate multi-layer
sign of the capsule on contrast-enhanced (CE) high-resolution (HR)
susceptibility-weighted imaging (SWI) in patients with pyogenic brain
abscesses.
Methods Five patients with pyogenic brain abscesses (single abscess in
3 patients and multiple abscesses in other 2 patients) were studied on a
1.5-T MR scanner. In all of the patients, an HR-SWI sequence before and
after IV application of a standard dose of contrast agent was obtained. All
images were reviewed independently by three radiologists.
Results Precontrast SWI showed iso- to hypointesity of the abscess
capsule. Pyogenic brain abscesses capsule demonstrated multi-layer sign
on CE-HR-SW imaging in all patients.
Conclusions CE-HR-SWI shows multi-layer sign of pyogenic brain
abscesses, not visible with conventional MR imaging. SWI has provided
additional information valuable in the diagnosis of pyogeic brain abscesses.
Keywords Abscess, MR, Brain/Brain Stem
NR051
Reappraisal of Conventional MR Imaging of CAVM: Value
of T1-Weighted GRE Pulse Sequence on Delineation of
Angiostructure
En-Haw Wu, Alex Mun-Ching Wong
memorial hospital, Linkou, Taiwan
Purpose Cerebral arteriovenous malformation (cAVM) typically shows
signal voids or hyperintensity on conventional MR images. Therefore, it is
hard to differentiate angiostructure of the vascular anomaly. We aimed to
analyze the MR signal intensity of cAVM components on conventional MR
study, including a recently used pulse sequence, T1 gradient recall echo
pulse sequence.
Methods We retrospectively recruited 29 patients of angiographically
proven cAVM in our institute from 2006 through 2008. Patients were
excluded if they had 1) intracranial hemorrhage and 2) previous
intervention for cAVM. All recruited patients underwent MR study on a
3-T system (Magentom TIM Trio, Siemens). Pulse sequences included
T1-weighted GRE (T1GRE), T2-weighted (T2W), time-of-flight (TOF),
and contrast-enhanced T1-weighted (cT1W) images. Conventional
digital subtracted angiography (DSA) was performed in all patients as a
diagnostic gold standard. We recorded the signal intensity (hypo-, iso-,
and hyper-intensity) of each angiostructure of cAVM, consisting of feeding
artery, nidus, and draining vein, on all MR pulse sequence.
Results Totally nine patients were studied, (5 men; mean age, 39.1 years)
and nine lesions were indentified. (mean dimension 3.9 cm). Three different
signal intensities (hypo-, iso-, and hyper-intensity) of were observed in all 9
patients on T1GRE. Only one signal intensity could be seen on T2W (flow
void) and cT1W images (hyper-intensity) in 9 patients. Two different signal
intensities could be observed in all seven patients on TOF images.
Conclusions T1GRE image shows most components of cAVM when
compared with other pulse sequences, thus allowing for clearer
delineation of the angiostructure. Routine use of the T1GRE images may
532
Purpose To measure the vasomotor reactivity (VMR) of intracranial
arteries and dural sinuses using a non-triggered 2D phase contrast
magnetic resonance imaging (PC-MRI).
Methods This prospective study enrolled six healthy male volunteers
with an average age of 29 years. The gas mixtures were prepared with
0.03%, 3%, 5%, and 7% of CO2. All MR scans were performed at a 1.5 T
scanner. Five vessels including bilateral internal carotid arteries, basilar
artery, straight sinus and superior sagittal sinus, were evaluated. 2D
PCMRI measurements were performed with a bipolar gradient echo pulse
sequence. Semi-supervised fuzzy c-means (sFCM) algorithm partition
was used for segmentation of the target vessels. Pixel-based computation
of velocity of each selected vessel was performed automatically according
to the signal intensity of phase-contrast MR images on each dynamic
scan. Mean velocity and volume flow rate (VFR) of these vessels were
then calculated. Bland-Altman plots were used to evaluate the test-retest
reproducibility.
Results There was no significant difference between first and second
measurements at rest and each hypercapnic phase regarding mean
velocity and VFR measurements (P = 0.82~0.88). Baseline mean velocity
was 24.8 ± 1.6 cm/sec (RICA), 25.3 ± 1.7 cm/sec (LICA), 26.2 ± 2.1
cm/sec (BA), 12.7 ± 1.5 cm/sec (SS), and 13.6 ± 1 cm/sec (SSS). The
averaged arterial mean velocity was significantly higher than dural sinuses
mean velocity by a ratio of 1.93 ± 0.06 at room air, 1.94 ± 0.03 at 3% CO2,
1.88 ± 0.03 at 5% CO2, and 1.74 ± 0.04 at 7% CO2 (P value <0.0001).
VMRvelocity increased nonlinearly from 18.7%~23%, 37.7%~44%, to
67.3%~102% under 3%, 5%, and 7% of CO2 perturbation, respectively,
with statistical significant difference (P value <0.0001).
Conclusions PC-MRI with sFCM algorithm allows simultaneous
measurements of VMR of intracranial vessels with high reproducibility.
Keywords MR, Hemodynamics/Flow Dynamics, Image Manipulation/
Reconstruction
NR082
Hippocampal T2 Relaxometry in Temporal Lobe Epilepsy
Jyothirmayi Velaga
Department of Radiology, Barnard Institute of Radiology, India
Purpose The purpose of this study is to determine the T2 Relaxation time
of the hippocampi in patients with temporal lobe epilepsy.
Methods Hippocampal T2 relaxation time was determined by a 16-echo
(spin echo) pulse sequence using seimens Magnetom 1.5 Tesla machine
in 15 healthy control volunteers and the normal range for our machine
was established. 20 patients with temporal lobe epilepsy were evaluated
by MRI including T2 Relaxometry.
Results For the 15 control subjects, the T2 hippocampal relaxation time
was 90 to 110msec. In the study group 16 out of 20 patients showed
increased T2 Relaxation time than normal range, and 3 out of these 16
showed evidences of hippocampal sclerosis established by visual and
volumetric criteria. 4 out of the 20 patients had T2 relaxation time within
the normal range.
Conclusions Hippocampal sclerosis is the most common pathologic
condition underlying intractable temporal lobe epilepsy. Recognition of this
syndrome is especially important as it tends to be refractory to treatment
with anticonvulsants but responds extremely well to surgery. Abnormal
T2-weighted signal intensity in the hippocampus may be difficult to detect
visually. T2 relaxometry allows quantification of hippocampal signal
intensity changes and can determine whether the abnormality is unilateral
NR083
Osteoporosis in Postmenopausal Mongolia Women Using
Dual X-Ray Bone Densitometry
Oyunbold Lamid-Ochir
Department of Radiology for HSUM, Mongolia
Purpose A pilot study to estimate the prevalence of osteopenia and
osteoporosis in postmenopausal Mongolia women.
Methods Lumbar spine bone density was measured in 80
postmenopausal Mongolia women over 50 years of age using dual x-ray
absorptiometry (DXA) at the Ulaanbaatar Song Do hospital, Ulaanbaatar,
Mongolia between January 2008 to April 2008.
Results The results of the bone mineral density (BMD) in gm/cm2 were
compared to the peak bone density (PBD) in healthy young women
(T-score). Based on the definition of World Health Organization (WHO),
the T-score value was considered for analysis. Accordingly 30 subjects
showed normal result, BMD of 0.9976 0.019 and T-score of 0.1 0.17, 33
subjects showed osteopenia result, BMD of 0.8147 0.007 and T-score of
1.67 0.06 and 17 subjects showed osteoporosis, BMD of 0.6657 0.015,
T-score of -2.96 0.13. When the 80 subjects were analyzed there were
37.5% normal, 41.25% osteopenia and 21.25% osteoporosis in age over
50 years.
Conclusions Osteoporosis is high risked among postmenopausal women
and should be considered as a matter of public health. Bone densitometry
identify those who need therapy and for follow up and early diagnosis of
those with osteopenia in order to institute proper therapy and avoid future
osteoporosis.
Keywords Spine
NR084
Spectrum of MR Findings in Intractable Epilepsy in a
Tropical Set-Up
Vasanthakumar V
Department of Radiodiagnosis, Jawaharlal Nehru Medical
College, Aligarh Muslim University, India
Purpose The purpose of this study is to analyze the spectrum of imaging
findings on MRI in patients with intractable seizures in a tropical country
like India and to define the usefulness and role of MRI in the work-up of
such patients.
Methods The study was carried out in our department on 100 consecutive
patients presented with history of recurrent seizure attacks. The
selected patients were then subjected to dedicated epilepsy protocol MR
examination on 1.5T superconducting system.
Results Detectable lesions on MR were found in 74 of the 100 cases
and no lesion could be detected in 26 cases. There were 38 cases
of infectious granulomas, 11 tumors, five brain abscesses, just six
hippocampal sclerosis and four cases of MCD (malformation of cortical
development).There were also two cases of AVM and one case each
of cavernous hemangioma, Porencephalic cyst and a rare case of balo
concentric sclerosis. In five cases we could find only gliotic changes. Of
the ten cases that were referred to dedicated neuro-radiological centers
for functional MR and PET, there were three cases of hippocampal
sclerosis, one case each of focal cortical dysplasia, nodular heterotopia
and polymicrogyria that were missed in our center.
Conclusions The spectrum of etiologies in patients with refractory
epilepsies is found to be significantly different and broad in tropical set ups
from those reported from western countries. The leading cause was found
to be chronic granulomatous lesions in our center followed by tumours
and infectious abscess. In sharp contrast to western studies hippocampal
pathologies were found to be less common. The undetected lesions in our
study can be attributed at least in part to the lack of technical expertise
and instrumentation, which emphasizes the necessity for proper training in
epilepsy imaging at least for radiologists working in tertiary care centers.
Keywords MR
Others (OT)
OT008
Melioidosis: Spectrum of radiological manifestations
Sudhakar Kundapur Venkatesh, Hind B Alsaif
System, Singapore
Purpose To illustrate the spectrum of radiological manifestations of
melioidosis.
Methods Melioidosis is caused by Burkholderia Pseudomallei, an
environmental saprophyte found in wet soils and endemic in some
Asian countries. The bacteria mostly infects adult with an underlying
predisposing condition such as diabetes mellitus. The clinical
manifestations of the melioidosis range from subclinical infection to
fulminating disease with multiple organ involvement and even death. We
present a pictorial review of the imaging findings in Melioidosis.
Results Melioidosis is characterized by formation of abscesses, especially
in the lungs, liver, spleen, prostate, brain, pancreas and soft tissues.
The lung is the most frequently involved organ and on radiographs
and computed tomography, melioidosis may manifest as consolidation,
abscesses, and multiple nodules with or without empyema.The abscesses
in the liver and spleen are seen as focal hypodensities which may
show some ring enhancement. Lymphadenitis, parotitis, osteomyelitis,
meningitis and osteomyelitis are other uncommon presentations.
Septicemia without obvious source of infection is one of the encountered
presentations. The diagnosis is established by culture of the bacteria
in the abscesses or blood. Higher mortality rate is found in-patient with
pneumonia, disseminated disease with multiple organ involvements, and
in septicemia as compared to patients with single organ involvement
without pneumonia.
Conclusions Melioidosis has a wide spectrum of radiological
manifestations making it a mimicker. Diagnosis of melioidosis requires a
high index of clinical suspicion in patient presenting with septicemia or
fever of unknown origin living in or with a travel history to endemic areas.
Keywords Infection
OT013
MRI Evaluation of Fetal Body Congenital Anomalies
Amit Disawal, Kishor Taori, Nischal Kundargi
Purpose Since the development of fast imaging techniques, MRI has
been used to evaluate fetal anomalies. Fetal MRI is adjunct to ultrasound
in the evaluation of fetal anomalies. Fetal body MRI in evaluation of
congenital anomalies reviews the literature on the use of fetal MRI
advantages and disadvantages, provides a basic discussion of this
technique, and offers a pictorial overview of the spectrum of congenital
fetal body anomalies that are amenable to MRI examination.
Methods Study design - Prospective study, 1 year. No. of cases - 50
Philips achieva 1.5 Tesla. Protocols: Supine position, surface phased
array coil, RARE-sSH TSE, T2 TSE FB sense, SSh_MRCP and T2
TSE FB with FAT suppression for skeletal assessment etc sequences in
required fetal planes. Slice thickness 3 to 5 mm.
Results After the CNS, the fetal thorax has received the most attention by
those performing fetal MRI. Its role has been adjunctive to ultrasound (US),
helping to define the anatomy of large masses, examine lesions with an
atypical US appearance and aid in the prognosis of some anomalies. MRI
showed some added advantage over US in evaluation of GI anomalies,
urogenital and skeletal dysplasias. MRI is also particularly useful in the
assessment of high risk pregnancies, which can limit the diagnostic
sensitivity of US. MRI has the added advantage of providing potentially
critical information about the maternal abdomen.
Conclusions MRI is superior to other investigation for detection of fetal
anomalies with diagnostic dilemma and helps in clinical decision-making,
postnatal management & better parental understanding.
Keywords MR, Obstetrics
533
NR043
Multi-Layer Sign on Contrast-Enhanced High-Resolution
Susceptibility-Weighted Imaging in Patients with Brain
Abscesses: Initial Experience
Ping-Hong Lai¹, Hing-Chiu Chang²
¹Department of Radiology, Kaohsiung Veterans General Hospital,
Taiwan
²Department of Electrical Engineering and Applied Science
Laboratory, National Taiwan University and GE Healthcare,
Taiwan
or bilateral.
Keywords Neural Networks
E-Poster
be helpful to planning or follow-up of endovascular intervention, surgery,
or medical treatment.
Keywords AVM, MR
Others
stage <2 hours is 7.1% per patient and 5.9% per aneurysm with dismal
prognosis in this case series.
Keywords Aneurysms, Brain/Brain Stem, CT, Interventional
OT020
National Survey of Image Quality and Patient Doses for CT
in Taiwan: Preliminary Results
Hui-Yu Cathy Tsai1, HL Liu1, CC Chen2, Y S Hwang3, YL Wan2
1
2
Department of Diagnostic Radiology and Intervention
Chang Gung Memorial Hospital at Linko, Taiwan
3
Department of Koo Foundation Sun Yat-Sen Cancer Center,
Department of Medical Physics, Taiwan
Purpose The purpose of this study is to survey the image quality and
patient doses for CT in Taiwan because the survey results will be helpful
for understanding the current level of CT quality assurance before Atomic
Energy Council include CT in the Standards for Medical Exposure Quality
Assurance.
Methods Dedicated researchers conducted on-site measurements,
started from March 2009. An ACR CT accreditation phantom (Model
464, Gammex) was used to evaluate CT image quality, including slice
thickness accuracy, CT number accuracy and linearity, image uniformity,
noise, artifact, spatial resolution, and low contrast detectability. Computed
tomography dose index (CTDI) was measured by a pencil-type ionization
chamber (10X6-3CT, Radcal) inserted into head and body dosimetry
phantoms. Radiation beam width was assessed by chromic films (XRCT Dosimetry film, Gafchromic). Representative patient doses for adult
head, adult abdomen, and 5-years pediatric abdomen examinations were
evaluated, including volume CTDI (CTDIvol), dose-length product (DLP),
534
Purpose The purpose of this report is to review, compare, and
recommend physics testing of X-ray computed tomography (CT) systems,
made by the CT task group of the Chinese Society of Medical Physics,
Taipei (CSMPT).
Methods We have reviewed the reporters related to CT testing,
including ‘European Guidelines on Quality Criteria for Computed
Tomogrpahy’ by European Committee; ‘Recommended Standards
for the Routine Performance Testing of Diagnostic X-ray Imaging
Systems’ by IPEM; ‘Specification and Acceptance Testing of Computed
Tomography Scanner’, ‘Quality Control in Diagnostic Radiology’, and ‘The
Measurement, Reporting, and Management of Radiation Dose in CT’ by
AAPM; ‘Instruction Manual and Criteria for Testing the ACR CT Phantom’
and ‘ACR Technical Standard for Diagnostic Medical Physics Performance
Monitoring of Computed Tomography Equipment’ by ACR. Then, twelve
testing items were suggested for annual CT testing.
Results Twelve testing items were proposed in five categories. The
purpose, equipment, procedure and criteria were summarized for each
item. The first category is system safety evaluation. The second is
mechanical and geometric assessment, including alignment of table
to gantry, slice positioning accuracy and gantry tile accuracy. The third
is image quality assessment, including slice thickness accuracy, CT
number accuracy and linearity, evaluation of image uniformity, noise, and
artifact, spatial resolution and low contrast detectability. The fourth is dose
assessment, including dosimetry and radiation width. The final category is
image display device evaluation.
Conclusions This report is helpful for CT related workers to process CT
physics testing in the full knowledge.
Keywords CT, Physics, Dosimetry, QA/QC
OT024
Development of a New Type Optical CT Scanner by Using
a Collimated Single Laser Line with Uniform Flat-Top
Illumination
Ching Ju Ho 1, Bor-Yuan shih 2, Hong-Wen Cheng 3, Tsi-Chian
Chao2, Chung-Chi Lee2, Hsu-Ju Tu2
1
Department of Physics, National Taipei University of Education,
Taiwan
2
3
Department of Natural Science Education, National Taipei
Purpose In order to improve the scanning rate of commercial optical CT
scanner, instead of using the conventional dot laser, a collimated line
pattern with uniform illumination profile is introduced as a light source in
the scanning process.
Methods A beam shaping module is used to convert the Gaussian
laser beam into a 90° fan-angle line pattern with flat-top profile. A set of
cylindrical lens then brings the rays into a collimated light. Besides, the
optical CT scanner consists of a gel cylinder mounted inside the scanning
tank, two scanning motors to operate the rotations and movements of the
gel cylinder, and a CCD camera to record the image data.
Results We present our preliminary analysis of the sources of uncertainty
and evaluate the basic performance parameters of the optical CT scanner
in conjunction with polymer gel dosimeters.
Conclusions In order for the system to be applicable to dose verifications
with higher accuracy, an improvement of the system's stability and
reproducibility in data acquisition process may also be necessary.
Keywords CT, Dosimetry
OT032
Gray-Scale Ultrasound Artifacts – Pearls or Pitfalls?
Lau Si Min Denise
Department of Diagnostic Radiology, Singapore General Hospital
(SGH), Singapore
Purpose Ultrasonographic artifacts remain a challenge for the practicing
sonographers and radiologists, despite continual advances in ultrasound
technology and increasingly sophisticated scanning equipment. Artifacts
are echoes present in an image which do not correspond to genuine
interfaces in the subject being evaluated. Some artifacts are undesirable,
interfering with diagnosis whilst others aid in diagnosis. This exhibit aims
to increase awareness of the different appearances of ultrasound artifacts.
The ability to recognize artifacts will help to prevent and reduce potential
diagnostic errors which may lead to erroneous therapy/ management.
Methods This is a didactic exhibit with an introductory section on what
ultrasound artifacts are, the root of artifacts and the importance of
recognizing them. Diagrammatic explanations on the formation of various
commonly encountered artifacts along with pictorial presentation of clinical
cases are presented. In addition, techniques on how to overcome and
minimize those undesirable artifacts are presented.
Results Knowledge on ways to overcome or minimize undesirable
sonographic artifacts, coupled with new technologies such as tissue
harmonic imaging and compounding improves the image quality, in turn
improving diagnostic accuracy.
Conclusions Ultrasound artifacts are commonly encountered in day-today imaging practice despite optimal techniques and machine settings.
To avoid misdiagnosis, it is essential that radiologists and sonographers
understand the genesis of these artifactual echoes and recognize their
sonographic appearances. The best defense against misinterpretation of
artifacts is education and experience.
Keywords Ultrasound
OT034
Acute Adverse Reactions to Gadopentetate Dimeglumine
and Gadobenate Dimeglumine: Experience with 32,659
Injections
Rathachai Kaewlai¹, Vijaya Kosaraju², Hani H Abujudeh²
¹Department of Radiology, Massachusetts General Hospital and
Harvard Medical School, Thailand
²Department of Radiology, Massachusetts General Hospital,
United States
Purpose To retrospectively assess the frequency, manifestation and
severity of acute adverse reactions associated with administration of two
gadolinium-based contrast agents (GBCAs) in patients that underwent
magnetic resonance (MR) imaging at a single large academic institution.
Methods The investigation was approved by our hospital’s institutional
review board and was HIPAA compliant. The informed consent was
waived. From October 2007 to December 2008, collected data of
number of administration and acute adverse reactions to gadopentetate
dimeglumine (Gd-DTPA) and gadobenate dimeglumine (Gd-BOPTA) from
continuous quality assurance records at our institution were tabulated
and analyzed. Frequency and severity of acute adverse reactions were
collected.
Results There were 32,659 administrations of GBCAs for MR
examinations during the investigation period. Of these, 27,956
administrations were Gd-DTPA and 4,703 administrations were GdBOPTA. There were a total of 51 acute adverse reactions in 50 patients
(16 men, 34 women, and mean age 48 years), accounting for 0.16% of
all administrations (51/32659). Thirty-eight reactions were associated with
Gd-DTPA (38/27956, 0.14%) and 13 were associated with Gd-BOPTA
(13/4703, 0.28%). There were 43 mild, six moderate and two severe
reactions. The severe reactions were seen with the use of Gd-BOPTA.
Conclusions The rates of acute adverse reactions to gadopentetate
dimeglumine and gadobenate dimeglumine were 0.14% and 0.28%,
respectively. The overall adverse reaction rate was 0.16% in our patient
population. Direct comparison of adverse reaction rates of the two agents
was not possible due to retrospective, uncontrolled study design.
Keywords Contrast Agents, QA/QC
OT037
Population Effective Dose from Computed Tomography
Examinations in Taiwan
Tou-Rong Chen 1, Chung-Jung Tung 2, Chin-Hua Yang 2, ChihYang Yeh2, Yi-Ju Ho2, Ting-Wei E2, Chun-Ching Wang2, MengTsung Lin3
1
School of Medical Imaging and Radiological Sciences/ Chung
Shan Medical University, Chung Shan Medical University
2
3
Department of Biomedical Engineering and Environmental
Sciences, National Tsing-Hua University, Taiwan
Purpose In many countries, computed tomography (CT) examinations
contribute the largest proportion of medical exposure to the population
effective dose from man-made radiation sources. The current study
provides data and analyses of the CT examination frequency and the
corresponding CT annual per caput effective dose in Taiwan. Such data
are compared to results obtained in other countries.
Methods The frequency of CT examinations was inspected from the
database of National Health Insurance (NIH) in Taiwan. Based on the
scan regions, a survey of CT examination procedures was conducted
in 2007. CT scans were divided into head, chest, abdomen, and pelvis
examinations. Applying appropriate conversion factors from the doselength product (DLP) to the effective dose, the annual per caput effective
dose was estimated for the four types of CT examinations using DLP data
in Taiwan.
Results A total of 502,697 CT examinations were performed in 2006.
This is equivalent to 22 CT examinations per 1000 population in Taiwan,
comparable to 21 CT examinations per 1000 population in UK in 2003,
but less than 207 CT examinations per 1000 population in US in 2006 and
290 CT examinations in Japan in 2000. The percentage of CT examination
frequencies was estimated to be 28%, 39%, 27% and 6% for head, chest,
abdomen and pelvis, respectively. The annual per caput effective dose
was evaluated as 0.030, 0.053, 0.151 and 0.049 mSv for head, chest,
abdomen and pelvis, respectively.
Conclusions The annual per caput total effective dose of CT
examinations was estimated to be 0.28 mSv in Taiwan in 2006. This
number is larger than 0.18 mSv in the UK in 2003 but smaller than 1.5
mSv in US in 2006 and 2.3 mSv in Japan in 2000.
535
OT022
Review and Recommendations for Physics Testing of X-Ray
Computed Tomography: CSMPT CT Task Group Report
Hui-Yu Cathy Tsai1 , CC Chen1, YS Hwang2, HL Liu3
1
Department of Diagnostic Radiology and Intervention, Chang
Gung Memorial Hospital at Linko, Taiwan
2
Department of Medical Physics, Koo Foundation, Sun Yat-Sen
Cancer Center, Taiwan
3
Department of Medical Imaging and Radiological Sciences
University of Education, Taiwan
E-Poster
Purpose Fetal MRI is currently an established imaging service for prenatal
care as a complementary and mostly conclusive imaging tool after
sonographic screening. It is used more for twin than singleton pregnancy
because of either increasing practice of assisted reproductive technology
nowadays or higher incidence of fetal anomalies in twins. The goals of this
study are twofold: to investigate the broad spectrum of complications and
fetal anomalies in twin pregnancy depicted on MRI, and the findings of
those complications unique to monochorionic twinning.
Methods Eighteen twin pregnancies of a total 160 fetal MR studies (11%)
performed from Jan, 2004 to March, 2009 in our institute constituted
the current investigation. MR imaging was performed with 1.5 Tesla MR
scanners with an 8-channel phase-arrayed body coil. Routine scanning
included maternal pelvis survey using single shot fast spine-echo and
scanning focused on fetal brains and trunks. 2D fast imaging employing
steady-state acquisition with cine technique was used, and was useful in
depicting internal organs, especially conjoint twins. The complications and
anomalies of all twin fetuses and their MR findings were reviewed.
Results Gestational ages of the twins ranged from 18 to 35 weeks (mean
26 weeks). There were 1 (6%) growth anomalies, 11 (61%) congenital
anomalies, 3 (17%) single fetal demise, 1 (6%) placental vascular
anastomoses disorder and 2 (11%) conjoint twins. MR imaging not only
confirmed sonographic findings but also provided additional information
in cases of complicated monochorionic twins, especially in delineating the
extent of intracranial complications of monochorionic twins.
Conclusions We present the spectrum of anomalies that may occur
in twin gestation. Fetal MR imaging delineate the detailed findings of
various complications in twin gestations and add additional information to
ultrasound. Fetal MRI also extends our knowledge from morphological to
pathophysiological changes of the developing fetuses
Keywords MR, Fetus
and effective doses. The diagnostic reference levels for CTDIvol were set
at the third quartile from the survey results.
Results There are 425 CT scanners, including CT, PET/CT, SPECT/CT,
and CT simulator, in 241 hospitals in Taiwan. The preliminary results,
obtained from March to June 2009, included 67 units in 44 hospitals. The
fail items of image quality are few. The mean CTDIvol for adult head, adult
abdomen, and 5-years pediatric abdomen examinations are 61, 19, and
21 mGy, respectively. The third quartile of CTDIvol for adult head, adult
abdomen, and 5-years pediatric abdomen examinations are 72, 23, and
35 mGy, respectively.
Conclusions This study will last three years. Until June 2009, only 14%
scanners completed measurements. The preliminary results give us a
view of current level in miniature of CT image quality and patient doses in
Taiwan.
Keywords CT, Dosimetry, Imaging Sequences
Others
OT018
Fetal MRI in Twin Pregnancy: Spectrum of Anomalies and
Significance of Findings
Chihchun Wu1, Wan-You Guo2, Cheng-Yen Chang3, Shu-Huei
Shen4
1
Department of Radiology, Fellow, Taiwan
2
Department of Neuroradiology, Chief, Taiwan
3
Department of Radiology, Chief, Taiwan
4
Department of Radiology, Visiting Staff, Taiwan
PE018
Retropharyngeal Abscess in an Infant: Diffusion Imaging
and MR Imaging Features
Keng-Ming Chang, Alex Mun-Ching Wong, Cheng-Hong Toh,
Yao-Liang Chen, Ho-Fai Wang, Yau-Yau Wai, Shu-Hang Ng,
Yung-Liang Wan
Purpose Retropharyngeal abscess, a serious condition with potential
morbidity and mortality if not detected early, is an uncommon condition in
infants. We presented the diffusion weighted MR imaging (DWI) features
of retropharyngeal abscess in a 2-month-old male infant and discussed
how DWI helped arriving at an accurate diagnosis.
Methods Case Report: A 2-month-old male infant suffered from dyspnea
for 1 week with hematuria. No clinical evidence of fever, pharyngitis,
laryngitis, acute otitis media, or paranasal sinusitis. Bronchoscopy
demonstrated pharyngo-laryngomalacia. Because of progressive
respiratory distress, MRI of the head and neck region was performed.
Results MRI showed a retropharygeal or prevertebral cystic lesion at
the oropharynx level from the Clavus to C6 vertebra. Marginal contrast
enhancement of the lesion was demonstrated on postcrontrast T1WI
sequence. Axial and sagittal diffusion weighted images showed reduced
water diffusion of the cystic content. The diagnosis of abscess was
preferred to other congenital cystic anomalies commonly seen in an infant.
The diagnosis was surgically and pathologically proven.
Conclusions DWI, in addition to conventional MRI sequences, is a helpful
diagnostic tool to the differential diagnosis of cystic neck lesions in infants.
Keywords Abscess, MR, Pharynx, Infection
PE020
Malignant Melanoma Presented as Single Large Anterior
Mediastinum Mass
536
PE021
Massive Urinary Ascites in a Newborn Caused by Cloacal
Malformation: Image Findings
Yi-Fang Chen, Yu-Peng Liu, Shin-Lin Shin, Fei-Shih Yang
Purpose To demonstrate the image findings of a newborn with cloacal
malformation presented with massive urinary ascites.
Methods A one-day-old girl was born at 32 weeks gestational age with
prenatal diagnosis of ascites and suspicious hydrometrocolpus. Marked
abdominal distention and respiratory distress was noted at birth. Physical
examination revealed no anus and there was only one opening. Plain
abdominal film and abdominal sonogram showed massive ascites,
intestinal ileus, colonic stasis and a cystic mass over lower abdomen.
Under the impression of cloacal malformation, colostomy was done on the
same day, with massive urinary ascites and severe adhesion observed
intraoperatively. Vesicostomy was performed one week later. Serial
radiological studies showed a large common channel with rectovaginal
communication. Closure of vesicostomy and drainage of hydrocolpos was
performed one year later, with total urogenital mobilization three months
after that. Laparotomy, enterolysis, closure of colostomy and sigmoid
biopsy will be performed later.
Results There are various causes of massive neonatal urinary ascites,
with many of them related to obstruction in the urinary system and
subsequent rupture of the urinary system. In a newborn with cloacal
malformation, the source of urinary ascites may also be from drainage of
urine through the fallopian tubes.
Conclusions Cloacal malformation is a rare cause of massive urinary
ascites in the newborn. Image studies may complement clinical findings
for better diagnosis and treatment in this condition.
Keywords Bladder, Congenital, Rectum, Vagina
Purpose Aim of the Study: (1) To define an age correlation for rectal
diameter (RD) in children in our region as measured by transabdominal
ultrasound. (2) To determine its usefulness in assessing constipation in
children and correlation with outlet obstruction.
Methods Local children between age 3 and 12 years were recruited:
(1) control group: children receiving abdominal ultrasound screening
for random indications other than abdominal pain or constipation; (2)
constipation group: children with significant constipation symptoms and
signs (Loening-Baucke criteria). RDs in these children were measured
transabdominally: ultrasound-probe placed suprapubically with partially
filled bladder. Sphincteric pressures were measured by anorectal
manometry in the constipation group; sphincter hypertonicity with outlet
obstruction is defined by resting pressure greater 60 cmH2O.
Results The mean RDs were 24mm and 38mm in the control group
(n=59) and constipation group (n=27) respectively (p<0.005). In the control
group, correlation coefficient between age and RD was 0.35 (p=0.017). In
the constipation group, correlation coefficient between RD and sphincter
pressure was -0.7 (p=0.71); there was no statistical difference comparing
the mean RDs for children with sphincter pressures above and below 60
cmH2O. A cut-off RD value at 34.5 mm gives a positive predictive value of
88.5% for diagnosing constipation and a negative predictive value if 93.3%.
Conclusions Transabdominal ultrasound measurement of RD is a
useful non-invasive tool for assessing childhood constipation. There is
however no significant correlation with sphincteric pressure; both slowtransit constipation and outlet obstruction may contribute to increased RD.
Between the age of 3 and 12 years, a cut-off RD greater than 34mm by
transabdominal ultrasound predicts significant constipation.
Keywords Comparative Studies, Rectum, Ultrasound
PE024
Anatomic Illustrations of Cranial Ultrasound Images in the
Neonate: Objective Analysis of Oblique Sonographic Scans
Using MRI and Reconstruction Program
Young Seok Lee1, Lai Sheung Wong2, Dong Soo Yoo1
1
Diagnopstic Radiology, Dankook University Hospital, Korea
2
Purpose To evaluate the anatomy of neonatal brain ultrasound images
objectively, authors reconstructed several oblique magnetic resonance
images corresponding with the oblique ultrasound images using MRI and
multiplanar reconstruction programs.
Methods MRI 3D-SPGR axial scans of the brain were performed for
normal neonates and then we obtained reconstructed MR images on
parallel with the direction of sonographic oblique scanning plane through
anterior and posterior fontanels. We made the anatomic models of
neonatal cranial ultrasound images using axial MRI as the standard
reference on same screen.
Results We created an anatomic atlas with each representative six
oblique coronal and sagittal scans through anterior fontanel, and
eight coronal and four sagittal scans through posterior fontanel that
corresponded to the neonatal brain ultrasound images.
Conclusions This objective anatomic exhibit with using MRI and
a multiplanar reconstruction program for creating the ultrasound
oblique brain images of neonates will be very helpful for evaluating the
ultrasonographic anatomy and to apply it to clinical practice.
Keywords Anatomy, MR, Brain/Brain Stem, Ultrasound
PE027
Noninvasively Predicting Esophageal Variceal Hemorrhage
Using Maximal Diameter of the Spleen in Patients with
Biliary Atresia
Yuan Heng Mo 1, Fu Shan Jaw 2, Yung Cheng Wang 1, Shinn
Forng Peng3
1
Department of Radiology, Cathay General Hospital, Taipei,
Taiwan
2
Institute of Biomedical Engineering, College of Engineering and
College of Medicine, National Taiwan University, Taipei, Taiwan
3
Department of Medical Imaging, National Taiwan University
Hospital, Taipei, Taiwan
Purpose To assess whether the maximal diameter of the spleen is a
useful noninvasive predictor of esophageal variceal hemorrhage in
patients with biliary atresia.
Methods In this retrospective study, 22 pediatric patents with pathological
proved diagnosis of biliary atresia, without other distinct abnormality or
malformations, and undertaken Kasai portoenterostomy were collected
from April 2008 to August 2009. All of them received abdominal MRI study
for evaluation of the possible complications of liver cirrhosis and portal
hypertension. The measurements of maximal diameter of the spleen
were obtained from an axial MR image showing splenic hilum. Those
patients with symptoms of variceal bleeding received panendoscopy
study. The presence of esophageal varices was recognized according
panendoscopy findings and was recorded (none = 0, present = 1).
Analysis of biochemical data and image measurements was performed
using the unpaired two-tailed student t test. Sensitivity and specificity, as
well as the best cut-off value of image measurements for the diagnosis of
symptomatic esophageal varices were calculated using receiver operating
characteristic (ROC) curves.
Results There were 22 patients with 11 (50%) boy and a mean age of
1000 days. Eleven (50%) patients had esophageal variceal hemorrhage.
The mean value of the maximal diameter of the spleen was 8.47 ± 4.03
cm (range 4.03–18 cm). Using a maximal diameter of spleen with a cutoff value of 7.44 yielded a negative predictive value of 100.00%, a positive
predictive value of 90.91% and a positive likelihood ratio of 11.
Conclusions The maximal diameter of the spleen may be a useful tool for
prediction of the risk of esophageal variceal hemorrhage in patients with
biliary atresia noninvasively.
Keywords Bile Ducts, Esophagus, Spleen, Hemorrhage, Varices
Purpose In pediatric patients, knowledge of internal jugular vein size
and its relative position to carotid artery are important in internal jugular
vein cannulation because of its small size and anatomic variation. We
investigated the effects of head rotation in cross-sectional area of the
internal jugular vein and its relative position to the carotid artery.
Methods Eighty-eight subjects admitted for elective operations were
allocated to one of two groups: infants (<1 year, n = 38) or children (1-6
years, n = 50). After induction of general anesthesia, right internal jugular
vein was examined at the apex of the triangle formed by the two heads
of the sternocleidomastoid muscle in 15˚ Trendelenburg position using
ultrasound. The cross-sectional area of right internal jugular vein, the
degree of the carotid artery overlap and the distance between the jugular
vein and the carotid artery were measured at 0˚(neutral) 40˚ and 80˚ of
head rotation.
Results The cross-sectional area of the right internal jugular vein was
significantly larger at 40˚ and 80˚ of head rotation compared to the neutral
head position in both infants and children (P <0.05). As the head rotated,
the percent overlap of carotid artery increased significantly (P <0.05) but
the jugular to carotid distance was not different (P >0.05).
Conclusions Considering the cross-sectional area of the right internal
jugular vein and carotid artery overlap, 40˚ partial head rotation seems to
be optimal for right internal jugular vein cannulation in pediatric patients.
Keywords Ultrasound
Purpose Case
Methods A 10-years old Asian black hair and black eyes girl was
diagnosed to have giant congenital melanocytic nevi since birth. The
black patch with hair on it was found on back, trunk and extended to
bilateral thighs. There were also multiple black nevi (3 mm~2 cm) on
limbs, including palms and soles, with hairs on some of them. In addition
to diffuse nevi, there were itching red patches on all limbs and trunk, soft
subcutaneous nodule on mid-lower back since birth, on left back since 6
months old, and firm subcutaneous mass on right lower back found since
1 year old.
Results Biopsy was performed and showed presence of leiomyoma and
giant congenital melanocytic nevus. In 2008 The patient suffered from
progressive chest pain. The pain could not be relieved by anagelsics.
Image examination showed presence of soft tissue mass in anterior
mediastinum. Biopsy revealed melanoma with anterior mediastinum
metastasis. The patient suffered from trachea compression and
pneumonia. After antibiotics treatment, the patient received chemotherapy
andthen under regular follow up. However, rapid progression of disease
course and she expired because of respiratory failure due to tumor
compression.
Conclusions The natural history of melanoma in pediatrics and adults is
similar but in rising occurrence rate, melanoma in pediatrics is still rare.
Melanomas account for a sizable percentage of lesions that metastasize
to the thorax. Five percent of cases of metastases to the mediastinum
and lung are due to melanoma. Metastatic melanoma manifesting as a
large mediastinal mass is rare with only a few case reports in the literature
and more rare in pediatrics. In review of literatures, mediastinum tumors
in pediatrics most are lymphoma, followed by neurogenic tumor, germ
cell tumor and cyst lesions. Metastatic melanoma must be considered
in the diagnosis of any mediastinal lesion and appropriate histological
examinations are needed.
Keywords Mediastinum, Metastases, Neoplasms-Primary
PE023
Transabdominal Ultrasound Measurement of Rectal
Diameter: A Feasible Tool in Assessment of Childhood
Constipation?
Tsz Wo Fan1, Hariqbal Singh2, Kai Yan Kwok3, Kwok Hung Lai3,
Wai Yip Leung4, Nick Chao4
1
Department of Radiology and Imaging, Hong Kong College of
Radiology, Hong Kong, China
2
Department of Radiology, S.K.N. Medical College, PUNE, India
3
4
Department of Surgey, Queen Elizabeth Hospital, Hong Kong,
China
E-Poster
PE017
Effects of Head Rotation on Right Internal Jugular Vein in
Infants and Young Children
Eun Ha Suk1, Dong Hun Kim2, Jong Yeon Park1, Mi Jung Gwak1
1
Department of Anesthesiology and pain medicine, Asna Medical
Center, Ulsan University, College of Medicine, Korea
2
Department of Radiology, Soonchunhyang University Bucheon
Hospital, Korea
Yueh-hsun Lu
Radiology, Taiwan
PE028
Right-Sided Bochdalek Hernia with Intrathoracic Kidney in a
Newborn
Hung Shi Tseng, Cheng-Feng Ho
Department of Diagnostic Radiology, Catholic Cardinal Tien
Hospital, Taiwan
Purpose Case Report
Methods N/A
Results N/A
Conclusions Intrathoracic ectopic kidney is a very rare congenital
abnormality, occurring less than one per 10,000 cases. It is the rarest form
of all ectopic kidneys and represents less than 5% of all renal ectopias.
Often cases with this disease are asymptomatic; it is extremely rare
to discover it in the neonatal period. We present a male newborn who
was originally suspected with intrathoracic ectopic kidney by abdominal
sonography. Contrast-enhanced CT scan with reconstruction confirmed
the diagnosis and also led the medical team to discover Bochdalek
hernia associating this rare disease. Closure of the hernia via abdominal
approach was performed with the partial liver parenchyma, and right
kidney was placed back in the abdomen. Related literature is reviewed
537
Others
Purpose With advances in radiotherapy (RT) and chemotherapy, many
patients with nasopharyngeal carcinoma (NPC) can be effectively cured,
and their quality of life (QoL) has become an important issue.
Methods A cross-sectional investigation was conducted to assess the
QoL of 356 NPC patients with cancer-free survival of more than 2 years.
Among them, 106 patients were treated by two-dimensional RT (2DRT),
108 by 2DRT plus three-dimensional conformal RT (3DCRT) boost, 58
by 3DCRT alone, and 84 by intensity-modulated RT (IMRT). The QoL
was assessed by the EORTC QLQ-C30 questionnaire and QLQ-H&N35
module. A general linear model multivariate analysis of variance was used
to analyze correlations among the factors. The clinical difference of QoL
scores between groups was calculated using Cohen’s D coefficient.
Results We found that education level, annual family income, and RT
techniques were independent predictors of QoL. NPC survivors who had
higher education level and annual family income and who had received
more advanced RT treatments had better QoL outcomes. Compared with
2DRT, the impact of 3DCRT was small on most scales and moderate
(Cohen’s D: 0.53–0.67) on emotional functioning, pain, and mouth
opening; the impact of IMRT was moderate on nine scales and large
(Cohen’s D: 0.80–0.88) on swallowing, social eating, teeth, and mouth
opening.
Conclusions In addition to socioeconomic levels, advances in RT
technique played a significant role in improving QoL of NPC patients. The
therapeutic benefit of IMRT over 2DRT, especially on swallowing-related
QoL scales, needs to be further explored.
Keywords Radiation Therapy/Oncology
RO010
Radiotherapy for Locally Advanced Hypopharyngeal
Carcinoma - A Comparison between Definitive (Chemo-)
Radiotherapy and Laryngectomy Followed by Post
Operative Radiotherapy
Hideki Nishimura, Ryohei Sasaki, Kenji Yoshida, Tetsuya
Kawabe, Daisuke Miyawaki, Haruka Uezono, Takeaki Ishihara,
Kazuro Sugimura
Department of Radiation Oncology, Kobe University, Japan
Purpose We retrospectively compared the treatment outcomes between
definitive (chemo-) radiotherapy (RT) and laryngectomy followed by post
operative radiotherapy (PORT) for locally advanced hypopharyngeal
carcinoma.
Methods From August 2000 to July 2008, 101 patients with stage III or IV
hypopharyngeal carcinoma were treated with definitive RT or PORT in our
institute. Forty five patients received definitive RT and 56 received PORT.
In PORT group, all patients received total laryngectomy and neck node
dissection prior to RT. There were 91 men and 10 women. Age ranged
45 to 89 years (median: 64). Thirteen patients were stage III and 88
were stage IV. Median irradiated dose for definitive RT group and PORT
group was 70 Gyand 60 Gy, respectively. Thirty seven patients received
concurrent chemotherapy among definitive RT group, whereas 22 patients
received concurrent chemotherapy among PORT group (p <0.05).
Results Median follow-up periods for surviving patients were 26 months.
The 3-year overall survival rates for all patients were 53%. The 3-year
overall survival rates for definitive RT group and PORT group were 50%
and 54%, respectively. The 3-year loco-regional control rates for definitive
RT group and PORT group were 55% and 82%, respectively (p = 0.038).
Three patients received salvage laryngectomy after definitive RT. Distant
538
RO011
Role of Pretreatment Carcinoembryonic Antigen in Local
Failure and Distant Metastasis after Definitive Radiotherapy
for Squamous Cell Carcinoma of Uterine Cervix is
Dependent on Elevated Squamous Cell Carcinoma-Antigen
Levels or Not
Eng-Yen Huang, Chong-Jong Wang, Hsuan-Chih Hsu, Hui-Chun
Chen, Fu-Min Fang, Yu-Jie Huang, Chang-Yu Wang, Yu-Ming
Wang
Department of Radiation Oncology, Chang Gung Memorial
Hospital-Kaohsiung Medical Center, Taiwan
Purpose To evaluate prognostic roles of carcinoembryonic antigen (CEA)
and squamous cell carcinoma antigen (SCC-Ag) in patients following
definitive radiotherapy for squamous cell carcinoma of uterine cervix.
Methods From April 1993 to December 2007, 834 patients undergoing
definitive radiotherapy for cervical cancer were analyzed. Elevation of
SCC-Ag and CEA was defined as >=2 and 5 ng/mL, respectively. The
Kaplan-Meier method was used to calculate distant metastasis and
local failure rate. The log–rank test was used to compare the significant
difference. Cox proportional hazards model was used for multivariate
analysis.
Results In patients without elevated SCC-Ag levels, CEA >=10 ng/mL
was a prognostic factor of local failure (p <0.001) and distant metastasis
(p = 0.001) in addition to Stage. However, loss of significance of CEA on
pelvic failure (p = 0.955) and distant metastasis (p = 0.660) was noted
in patients with elevated SCC-Ag. In patients without elevated SCC-Ag
levels, the 5-year pelvic recurrence rates were 7.4% and 58.8% in patients
with CEA <5 and >=10 ng/mL (p <0.001), respectively. The corresponding
5-year distant metastasis rates were 11.1% and 53.4% in patients with
CEA <5 and >=10 ng/mL (p <0.001).
Conclusions Significance of CEA on local failure and distant metastasis
exists only in patients without elevated SCC-Ag. CEA measurement
should not be omitted in squamous cell carcinoma of uterine cervix
because of high probability of pelvic failure and distant metastasis in
patients with this subgroup.
Keywords Cervix, Radiation Therapy/Oncology
RO014
Prognostic Significance of 3 Tesla Magnetic Resonance
Spectroscopy in Patients with Uterine Cervical Cancer
Undergoing Radiotherapy: Initial Experience
Takashi Kawanaka¹, Akiko Kubo1, Shunsuke Furutani1, Mayumi
Takeuchi1, Kyosuke Osaki1, Kenji Matsuzaki1, Hitoshi Ikushima2,
Hiromu Nishitani1
1
Department of Radiology, University of Tokushima, Japan
2
Department of Radiation Therapy Technology, University of
Tokushima, Japan
Purpose To analyze prospectively the prognostic significance of 1H
magnetic resonance spectroscopy (MRS) at 3 Tesla in vivo recorded
before initiation of radiotherapy and during the first 2 weeks of
radiotherapy.
Methods Six patients aged 54-68 years were examined using a on a
3 Tesla MR scanner. All of 6 patients were pathologicaly proven FIGO
Stage IIB-IIIB uterine cervical cancer. Each patient had received 50 Gy
of external beam radiotherapy to the pelvis with CDDP base weekly
chemotherapy. Each patient also underwent 4 applications of high-doserate brachytherapy (median, 5 Gy to point A at each session). MRIlocalized 1HMR spectra were acquired using a single-voxel, double-spinecho sequence. Relative intensities of the choline signal was obtained by
numeric integration of fitted signal.
Results Compared to the MRS before initiation of radiotherapy, 4 patients
undergoing radiotherapy revealed a decrease in the choline after/before
ratio during the first 2 weeks of radiotherapy (median, 20 Gy to whole
pelvis). Two patients who did not revealed a significant decrease in
the choline ratios were clinically diagnosed as remaining local cancer
at initial assessment after completing chemoradiotherapy. So those
two patients had chemotherapy or boost radiotherapy as an additional
treatment. All patients who revealed a decrease in the choline ratios were
clinically diagnosed as complete response to chemoradiotherapy at initial
assessment using MRI or pelvic examination.
Conclusions Early period alteration in choline ratio using MRS in patients
with uterine cervical cancer demonstrated ability to distinguish patients
with poor reactivity to chemoradiotherapy.
Keywords MR, Radiation Therapy/Oncology, Uterus
RO023
A Treatment Planning Study Comparing Volumetric Arc
Modulation with Rapidarc and Two Fixed Field IMRT for
Nasopharyngeal Carcinomas
Pei-Ju Choai1, Tsair-Fwu Lee2, Chang-Yu Wang3, Jen-Hong Lan3,
Shi-Long Lian4, Fu-Min Fang3
1
Department of Radiation Oncology, CGMH, Taiwan
2
Department of RTO, CGMH;NKUAS, Taiwan
3
4
Department of Radiation Oncology, Kaohsiung Medical
University, Taiwan
Purpose To evaluate the dosimetric performance of volumetric
modulated arc with RapidArc and two fixed field IMRTs radiotherapy on
nasopharyngeal carcinomas (NPC). Conventional 7-field (7-F) fixed beam
IMRT was used as a benchmark.
Methods Ten consecutive NPC patients curatively treated by 7-F stepand-shoot-IMRT were examined. Plans for 7-F and 18-field (18-F) fixed
beam IMRTs, double modulated arcs with the RapidArc technique (RA2)
were optimized. The prescribed dose/fractionation was 72 Gy to the PTV,
64.8 Gy to the elective PTV, and 54 Gy to the clinically negative neck
region. The plan of 54 Gy to the PTV (PTV54) was used to evaluate
the conformity index (CI) and homogeneity index (HI). The planning
objectives for PTV were minimum dose >95%, and maximum dose
<107%. Maximum dose was limited to spinal cord (45Gy), brain stem
(54Gy) respectively. For parotids, mean dose <26Gy was assumed as the
objective. The monitor units (MU) used was also calculated.
Results Target coverage and homogeneity result improved with 18-F
IMRT plans compared to RA2 and conventional 7-F IMRT. The CI was
1.28±0.14 (RA2), 1.29±0.08 (7-F), 1.14± 0.03 (18-F) for all the three
techniques and the HI was 1.13±0.03 (RA2), 1.10±0.02 (7-F), 1.08±0.03
(18-F) respectively. The 18-F IMRT allowed a reduction of D1% to
spinal cord almost to 4Gy compared with RA2. On brain stem, D1% was
reduced from 2Gy (RA2 vs. 7-F IMRT) to 8Gy (RA2 vs. 18-F IMRT). The
mean dose to the parotids was 26Gy (18-F, and RA2) and 31Gy (7-F)
respectively. The MU used in the three techniques were 498±55, 646±26
and 737±23 for RA2, 7-F, and 18-F respectively.
Conclusions RA2 and 18-F IMRT showed some improvements in OARs
sparing, while only RA2 offered improved target coverage with respect to
conventional 7-F IMRT. Whether the dosimetric advantages in RA2 could
translate into clinical benefit deserves further investigation.
Keywords Dosimetry, Radiation Therapy/Oncology, Technical Aspects
RO038
EPID Characteristics Tests and Machine QA of RapidArc
Yen-Cho Huang1, Chien-Yi Yeh2, Jih-Hsiang Yeh1, Ching-Jung
539
Purpose To review the diagnosis and management of aberrant cervical
thymus in children.
Methods We reviewed imaging findings and medical records in 13
children with aberrant cervical thymus. Two experienced pediatric
radiologists reviewed all studies in terms of location, size and internal
content. The lesions were analyzed in terms of US echo pattern, CT
attenuation and MR signal intensity. We also evaluated the presence of
mediastinal thymus with continuity of the cervical thymus and combined
other abnormalities.
Results There were ten boys and three girls, ranging in age from 1
month to 12 years (median 5 months). The clinical presentation was
most commonly a palpable cervical mass. The most common site was
the submandibular area. The mean size was 3.5 cm. The internal content
was solid except one which was aberrant cervical thymus associated with
thymic cyst. All lesions showed well-defined, angular margins with molding
over adjacent structures. On US, the gross echogenecity appeared to
be nearly isoechoic to muscle. The echo pattern was identical to that of
thymus revealing internal linear echogenic structures and foci surrounded
by hypoechoic rim. They demonstrated homogenous intermediate signal
intensity on MR T2- WI and similar signal intensity with that of muscle on
T1-WI. The mediastinal thymus was present in all cases. The connection
between the cervical and the mediastinal thymus was demonstrated in
two. Associated abnormality was noted in one patient who had a cervical
hemangioma. Surgical excision was performed in four patients and
conservative management was done for the remaining nine patients.
Conclusions Aberrant cervical thymus occurs as a well-defined and
angular shaped solid mass most frequently at the submandibular area
in mainly infants and young children. As it shows a unique sonographic
appearance, US is likely to be the most direct and practical imaging
modality for the diagnosis of the aberrant cervical thymus.
Keywords MR, Congenital, Thymus, Ultrasound
RO003
Quality of Life Outcome for Nasopharyngeal Carcinoma
Patients after Treatment-the Effect Size of Intensity
Modulated Radiotherapy
Fu-Min Fang
Hospital - Kaohsiung Medical Center, Chang Gung University
College of Medicine, Kaohsiung, Taiwan
metastasis were developed in 11 patients among definitive RT group and
14 patients among PORT group. Most patients experienced grade 2 to 3
mucositis and odynophagia during acute phase. No sever late toxicities of
Grade 3 or greater were recorded.
Conclusions Trend of better loco-regional control was observed among
PORT group at the expense of laryngectomy, however, difference was
not observed in survival rate. This study was a retrospective analysis and
it might be underpowered to elucidate the benefit of surgical mutilation.
Further accumulation of patients is warranted.
E-Poster
PE029
Aberrant Cervical Thymus: Radiologic and Clinical Findings
in 13 Children
Soyong Yoo1, Ji Hye Kim2, Hong Eo1, In Young Song1
1
Department of Radiology, Samsung Medical Center, Korea
2
Department of Radiology, Sungkyunkwan University School of
Medicine, Samsung Medical Center, Korea
Others
and clinical correlation of this unusual combination between Bochdalek
hernia and intrathoracic ectopic kidney are discussed.
Keywords Kidney, Hernia
RO051
Primary Tumor Site as a Predictor of Treatment Outcome
for Definitive Radiotherapy of Advanced-Stage Oral Cavity
Cancers
Chien-Yu Lin1, Hung-Ming Wang2, Joseph Tung-Chieh Chang3,
Li-Yu Lee3, Chun-Ta Liao4, I-How Chen1, Eric Yen-Chao Chen1,
Kang-Hsing Fan2
1
Departments of Radiation Oncology, Chang Gung Memorial
Hospital, Taiwan
2
Division of Hematology Oncology, Chang Gung Memorial
Hospital, Taiwan
3
Pathology, Chang Gung Memorial Hospital, Taiwan
4
Departments of Otolaryngology, Head and Neck Surgery, Chang
Gung Memorial Hospital, Taiwan
Purpose To evaluate the outcome of definitive radiotherapy (RT) for oral
cavity cancers and assess prognostic factors.
Methods Definitive RT was performed on 115 patients with oral cavity
cancers at stages III, IVA and IVB, with a distribution of 6%, 47% and
47%, respectively. The median dose of RT was 72 Gy (range, 62-76 Gy).
Cisplatin-based chemotherapy was administered to 95% of the patients.
Eleven patients underwent a salvage operation after RT failure.
Results Eight-eight (76.5%) patients responded partially and 23 (20%)
completely; of these patients who responded, 18% and 57%, respectively,
experienced a durable effect of treatment. The 3-year overall survival
(OS), disease-specific survival (DSS) and progression-free survival (PFS)
were 22%, 27% and 25%, respectively. The 3-year PFS rates based
on the primary tumor sites were as follows: group I (buccal, mouth floor
and gum) 51%, group II (retromolar and hard palate) 18%, and group III
(tongue and lip) 6% (P<0.0001). The 3-year PFS was 41% for N0 patients
and 19% for patients with N+ disease (P=0.012). The T stage and RT
technique did not impact survival. The patients who underwent salvage
surgery demonstrated better 5-year OS and DSS (35% vs. 13%, P=0.015
and 53% vs. 22%, P=0.029, respectively). Subsite group, N+, and salvage
surgery are the only significant prognostic factors for survival after
multivariate analysis.
Conclusions The primary tumor site and neck stage are prognostic
predictors in advanced-stage oral cancer patients who received radical
540
RO053
The Evaluation of Retropharyngeal Lymphadenopathy of
NPC: Comparison of MRI and PET-CT Scan
Yu-Wen Wang¹, Sung-Wei Lee1, Henry WC Leung2, Su-Hua Lo1,
Chia-Chun Chen1
1
Department of Radiation Oncology, Chi Mei Medical Center,
Liouying, Taiwan
2
Department of Radiation Oncology, Taipei Medical UniversityShuang Ho Hospital, Taiwan
Purpose We want to compare the result of detection rate between
MRI and PET-CT scan for retropharyngeal lymph node metastasis in
nasopharyngeal cancer (NPC) patients.
Methods We use the criteria for MRI and PET-CT scan which had been
published in 2005 by Yen in European Journal of Nuclear Medicine to
consider if there are differences in the findings for RPLNs metastases
in 54 NPC patients. They all received PET-CT and MRI examinations at
the same time prior to chemotherapy or radiation therapy. At both sides
of retropharyngeal lymph node, the largest one was chosen to compare
in each patient. 0 to 4 score was used for each methods. Sign test was
carried out to compare these two arms.
Results 54 eligible patients among 110 NPC cases were enrolled in
this study. The score of MRI and PET-CT was identical in 38 and 39
patients over left and right side, respectively. In the group of left side
nodes, 13 patients and 3 patients got higher score in MRI and in PETCT, respectively. In the group of right side nodes, 13 patients and only
2 patients got higher score in MRI and in PET-CT, respectively. Sign
test revealed statistically significant difference in right side and left side
different rate. (p=0.01 in left side, p=0.002 in right side)
Conclusions MRI has higher score in detecting retropharyngeal
metastasis when using the above criteria.
Keywords MR, Pharynx, Radiation Therapy/Oncology
AB009
Low Dose CT Colonoscopy Using High Definition Computed
Tomography
Siu Ki Yu¹, Ka Fat Jhon Chan¹, Gladys Lo¹, Yun Shen², CW Lau¹,
Ying Guo²
¹Department of Diagnostic Radiology, Hong Kong Sanatorium &
²CTRC, GE Healthcare, China
Purpose The radiation dose in CT colonoscopy is high and that limits the
success of its clinical application. High definition computed tomography
(HDCT) is capable to provide high quality and low radiation dose imaging.
The purpose of this study was to investigate if low dose CT colonoscopy
is possible using HDCT.
Methods Six consecutive patients underwent CT colonoscopy on HDCT
with auto-adjusted mA (Noise Index: 70) were included in this study.
Axial and reformat images were reconstructed with and without using an
adaptive statistical iterative reconstruction algorithm (ASIR). The radiation
dose was recorded and the image quality was evaluated in a double-blind
manner by two radiologists using a 5-point scoring scheme (excellent:
1;bad: 5). The noise level (standard deviation of CT values) in different
tissues was also measured. Statistical t-test analysis on image quality
score and noise of the axial images were performed.
Results The average radiation dose was 0.84±0.31 mSv. The average
image quality score (at Ascending Aorta, Pulmonary Artery, Descending
Aorta level) in ASIR group (2.28±0.44) was statistically significant better
(p < 0.05) than the non-ASIR group (3.28±0.57). The average noise level
of different tissue was statistical significantly lower in ASIR group (Axial:
Air=22.26, Kidney=41.90, Bone=65.30; Reformat: 17.34) than in the nonASIR group (Axial: Air=32.04, Kidney=62.65, Bone=84.09; Reformat:
25.44). The percentage decrease in image noise of air inside the colon,
kidney tissue, vertebral column and reformat image was 31%, 33%, 22%
and 32%, respectively.
Conclusions Low dose CT colonoscopy can be achieved using high
definition CT with the adaptive statistical iterative reconstruction algorithm.
AB014
Accuracy and Inter-Observer Reliability for Surgeons and
Radiologists When Reporting Post-Fundoplication Contrast
Studies
Mitchell C. Raeside¹, Dan Madigan¹, Peter G. Devitt², Jennifer C.
Myers², Sarah K. Thompson²
¹Department of Radiology, Royal Adelaide Hospital, Adelaide,
South Australia, Australia
²Department of Discipline of Surgery, The University of Adelaide,
South Australia, Australia
Purpose A recent study conducted by our Surgical Unit found that 1 in
125 patients who underwent laparoscopic anti-reflux surgery had an
important finding on an early routine post-operative contrast swallow,
and benefited from this investigation by undergoing earlier re-operation.
The aim of this study was to determine the accuracy of contrast study
interpretation for both surgeons and radiologists and the inter-observer
reliability in each group.
Methods 11 surgeons and 13 radiologists retrospectively reviewed
the contrast studies of 20 patients who had undergone a laparoscopic
fundoplication. Studies were chosen by an experienced gastrointestinal
radiologist (Author DM) and ranged from easy to difficult to interpret.
Each observer reported on fundal wrap position; leak or extravasation
of contrast; and contrast hold-up at the gastro-oesophageal junction.
Responses were compared to DM’s interpretations (‘gold standard’) in
conjunction with available clinical notes and operative records. A kappa
coefficient was used to evaluate inter-observer reliability.
Results Surgeons were more accurate than radiologists in identifying
normal studies (specificity = 91.6% vs. 78.9%), whereas both groups had
similar accuracy in identifying abnormal studies (sensitivity = 82.3% vs.
85.2%). Accuracy in differentiating wrap migrations as partial or total was
lower for both groups (69.7% vs. 61.2%). There was higher agreement
amongst surgeons than radiologists when determining whether the
fundoplication wrap was below the diaphragm (κ = 0.65 vs. 0.54). Both
groups had fairly poor agreement when classifying an intra-thoracic wrap
migration as partial or total (κ = 0.33 vs. 0.06). Radiologists were more
likely to interpret the wrap position as abnormal (relative risk = 1.25) while
surgeons reported more contrast hold-up at the gastro-oesophageal
junction (mean score = 1.17 vs. 0.86).
Conclusions To improve inter-observer reliability, contrast studies are
best reviewed by a surgeon and radiologist together. Radiologists would
benefit from more education about the technical details of laparoscopic
anti-reflux surgery.
Keywords Anatomy, Observer Performance, Diaphragm, Esophagus,
Stomach, Surgery
AB015
Blatchford Score Evaluation of Multidetector-Row Computed
Tomography for Diagnosis of Acute Gastrointestinal
Bleeding
Wei-Chou Chang, Chih-Yung Yu, Chang-Hsien Liu , Kai-Hsiung
Ko, Guo-Shu Huang
Department of Radoplogy, Tri-Service General Hospital, Taiwan
Purpose There are no simple guidelines on when to perform
multidetector-row computed tomography (MDCT) for diagnosis of acute
gastrointestinal bleeding (AGIB). We used Blatchford scores to evaluate
the diagnostic efficacy of MDCT for patients with AGIB.
Methods Ninety-two patients with symptoms of AGIB who were
referred for an MDCT scan after unsuccessful diagnostic endoscopy
at presentation were studied. We recorded clinical data and calculated
Blatchford scores for each patient. Patients who required transfusion
of 500 mL of blood per day, surgery or angiographic intervention were
classified as high-risk patients. Two radiologists independently reviewed
and categorized MDCT signs of AGIB. Discordant findings were resolved
by consensus. The sensitivity and specificity of MDCT for diagnosis of
AGIB were determined using a receiver operating characteristic curve.
One-way ANOVA was used to compare Blatchford scores and clinical data
between groups; k statistics were used to estimate agreement on MDCT
findings between radiologists.
Results Of the 92 patients, 62 (67.4%) were classified as high-risk
patients. The Blatchford scores of high-risk patients were significantly
greater than those of low-risk patients. When an optimal cut-off value of 13
was used in the Blatchford scoring system, the sensitivity and specificity
of MDCT were 70.4% and 73.7%, respectively. Contrast extravasation
was the most specific sign of AGIB (k = .87), recognition of which would
have improved diagnostic accuracy.
Conclusions Blatchford score can predict the diagnostic efficacy of
MDCT, avoiding unnecessary invasive procedures in low-risk patients,
and help to identify the bleeders in high-risk patients.
Keywords CT, Small Bowel, Hemorrhage
AB016
Evaluation of Histological Grade of Differentiation in
Hepatocellular Carcinoma Using Diffusion Weighted MR
Imaging
Kazuhiro Saito 1, Fuminori Moriyasu 2, Katsutoshi Sugimoto 2,
Ryota Nishio 1, Dai Kakizaki 1, Daisuke Hasegawa 1, Kouichi
Tokuuye1
1
Department of Radiology, Tokyo Medical University, Japan
2
Department of Gastroenterology and Hepatology, Tokyo Medical
University, Japan
Purpose To determine the usefulness of the diffusion weighted MR
imaging (DWI) in determining the histological grade of differentiation in
hepatocellular carcinoma, those were evaluated and compared with T2
541
Purpose The electronic portal imaging device (EPID) can be used as setup verification and dosimetric evaluation. This study was to investigate the
characteristics of EPID and the EPID system was used to verify accuracy
of RapidArc.
Methods A series of tests were performed for characteristics of
EPID. First, hardware and dosimetry calibration were done for the aSi
imaging detector. Secondly, different linac dose rates were set to check
detector saturation. Then different MUs were given to look at linearity
response. Finally, three patterns were delivered several times to test
the reproducibility. To verify the accuracy of RapidArc, the EPID system
was used as a QA tool. Two picket fence patterns designed for Rapidarc
performances were used to check leaf speeds, dose rates and gantry
speeds control accuracy. Data were exported and analyzed.
Results The accuracy of detector response was within 0.5 % variation
(<400 MU/min). The MU linearity is within 1% for MU between 20 and 200.
The max deviation of detector response and MU linearity was smaller than
1.5 %. The system showed good reproducibility which was within 1%. The
analysis of dose uniformity within different strips pattern using variable leaf
speed, dose rates and gantry speed were less than 2%.
Conclusions The performances of characteristics of EPID were satisfied.
From the results of Rapidarc delivery patterns, it verified that leaf speeds,
dose rates, and gantry speeds were controlled precisely.
Keywords Physics, Dosimetry, Instrumentation
RT. The primary tumor extension and RT technique did not influence
survival.
E-Poster
Lo2, Chih-Hung Hung2, Chieh-Sheng Tsai1, Chen-Yuan Chen1
Hospital at Keelung, Taiwan
2
Hospital at Linkou, Taiwan
1
Others
E-Poster
Purpose We evaluated the effect of gadolinium-ethoxybenzyldiethylenetriamine pentaacetic acid (Gd-EOB-DTPA) on T2-weighted
imaging (T2WI) and diffusion-weighted imaging (DWI) in the diagnosis of
hepatocellular carcinoma (HCC), using both a phantom study and clinical
study.
Methods The signal intensity of the phantom containing 0.05, 0.1, 0.2, 0.4,
0.6, 0.8, 1.0 and 2.0 mmol/L of Gd-EOB-DTPA was measured on T2WI
and DWI. We also evaluated 72 consecutive patients including 30 patients
with hepatocellular carcinoma. T2WI and DWI were obtained before, and
4 minutes and 20 minutes after injection of contrast medium. The signal
to noise ratio (SNR), contrast to noise ratio (CNR) and apparent diffusion
coefficient (ADC) in the liver parenchyma and tumor was calculated. The
conspicuity of tumors was evaluated by 3 observers independently.
Results The signal intensity of the phantom increased on T2WI at a
concentration of contrast medium under 0.2 mmol/L but decreased at over
0.4 mmol/L. The ADC changed little in the phantom study. The SNR of
liver parenchyma in T2WI was significantly different between before and
4 minutes after injection of contrast medium but no significant differences
were seen at other times. On T2WI the SNR and CNR of HCC showed
no significant differences at any time. The SNR, CNR and ADC of liver
parenchyma and tumor in DWI also showed no significant differences
ay any time. The qualitative evaluations among 3 observers showed no
significant differences.
Conclusions It is acceptable to perform T2WI and DWI after injection of
Gd-EOB-DTPA for the diagnosis of HCC.
Keywords Liver, MR
AB019
Acute Pancreatitis, Its Complication and Prognostic
Correlation by Modified CT Severity Index
Nischal G Kundargi, Kishorb B. Taori
Purpose Acute pancreatitis is reversible acute inflammatory process that
causes significant morbidity and mortality. Study conducted to establish
the ability of CT in depicting and quantifying the pancreatic parenchymal
injury, to detect pancreatic necrosis and complications. CT severity index
(Modified) is a scoring system that combines CT grading and percentage
of necrosis to obtain a number that correlate with the risk of developing
serious complications, which in turn correlates with increased morbidity
and risk of death.
Methods Prospective study for 2years from June 2007 to June 2009,
sample size 100, Age distribution from 14-71years. CT scan machine:
Multidetector CT somatom Volume access, Siemens, Germany. Contrast:
542
Purpose To study the CT perfusion imaging features of prostate
carcinoma (PC), and to explore their clinical value.
Methods 20 cases of 34 prostate cancers were confirmed by pathology
and biopsy and 14 by clinical data. 25 cases of BPH were confirmed by
pathology. All cases underwent routine CT pain scan and perfusion CT
scan, were divided into three groups: the normal group (30 cases), BPH
group (25 cases), PC group (34 cases). And PC group was divided into
prior-treatment group and post-treatment group. All the original images of
perfusion CT scan were inputted to an outline workstation to create color
perfusion maps and to calculate the blood flow parameters including PF,
PEI, TTP, BV and TDC curve by using the function CT software.
Results In PC group, the value of PF was 32.5±10.86 ml/min-1•mg-1,
PEI was 7.43±10.49HU, TTP was 22.4±3.29s, BV was 523.11±257.38ml/
g. The value of PF, PEI, BV was more than that in the normal group and
the BPH group, while TTP value was less than that in the normal and BPH
group. The result showed statistically significant difference (P <0.005). In
PC group, the value of PF in prior-treatment group was more than posttreatment group; the value of PEI, TTP, BV in prior-treatment group was
less than post-treatment group. There was statistical significance in TTP
value (P <0.05). The quantity of PC cases (PF >21ml/min-1•mg-1) was
more than the quantity of PC cases (PF <21ml/min-1•mg-1). The quantity
of PC cases (TTP <25s) was more than the quantity (TTP >25s). The
result showed statistically significant difference. In conclusion, the PC
group showed features of high perfusion and early enhancement. PF, TTP
can provide valuable information about blood flow.
Conclusions MSCT perfusion in prostate will give useful information in
the diagnosis and therapy of the prostate carcinoma.
Keywords Prostate
AB028
The Value of MSCT Angiography of Inferior Vena Cava
Cong Sun
Department CT, Shandong Provincial Medical Imaging Research
Institute, China
Purpose To evaluate the clinical value of MSCT (multiple slices computed
tomography) inferior vena cava angiography in the diagnosis inferior vena
cava abnormalities.
Methods 23 patients with inferior vena cava abnormalities were
retrospectively reviewed. 64-slice spiral CT scans were performed.
Intravenous contrast material was injected at 4 ml/sec, and arterial and
venous phase images were obtained. Subsequently, venous phase images
were analyzed and made for MSCT inferior vena cava angiography. The
diagnosis was made by using axial and reconstructive images. All of the
patients were also performed Doppler color echocardiography.
Results All patients were showed inferior vena cava and inferior vena
cava abnormalities clearly with CT venous phase images. Among them,
6 patients with HCC with a tumor thrombus in the inferior vena cava, 8
patients with renal carcinomas intruded the inferior vena cava, 5 patients
with Budd chiari syndromes with inferior vena cava stenosis, 3 patients
with uterine leiomyosarcoma extending through inferior vena cava into
the right cardiac cavities and 1 patient with renal vein hemangioma.
Ultrasound examination misdiagnosed 4 of all them.
Conclusions MSCT inferior vena cava angiography is a noninvasive and
valuable method in diagnosis of inferior vena cava abnormalities and has
high value in determination of treatment plan.
AB027
In Vivo Porcine Microwave Perfusion-Adjusted Specific
Absorption Rate (SAR) Measurements
Jonathan Coe, Prakash Manley, Casey Ladtkow, Anthony Ross
Department of Interventional Oncology Research and
Development, Covidien Energy-based Devices, United States
AB029
Hepatic Capsular Enhancement on CT Imaging:
Differentiation of Benignancy and Malignancy
Dal Mo Yang
Department of Radiology, East-West Neo Medical Center, Kyung
Hee University, Korea
Purpose Many methods have been used to determine the specific
absorption rate (SAR) of radiofrequency (RF) and microwave (MW)
ablation devices, including numerical models and electrical and thermal
field measurements. This study evaluated perfusion-adjusted SAR for
microwave ablation therapy in an in vivo porcine model using thermal
profiling.
Purpose This study was designed to determine the difference of hepatic
capsular enhancement on CT imaging between patients with benign
disease and patients with malignant disease.
Methods This was a retrospective analysis of hepatic capsular
enhancement in 41 patients. There were 32 cases of benign disease (FitzHugh-Curtis syndrome, n = 23; peritonitis, n = 6; acute appendicitis, n = 2;
colonic diverticulitis, n = 1). There were nine cases of malignant disease
(a peritoneal metastasis from a hepatocellular carcinoma, n = 2; colon
cancer, n = 3; pancreatic cancer, n = 2; ovarian cancer n = 1; unknown
origin, n = 1). The following CT and clinical features were analyzed:
thickness and attenuation value of hepatic capsular enhancement, the
presence of irregularity of capsular enhancement, capsular scalloping, the
presence of perihepatic ascites and capsular enhancement of the spleen.
Results Hepatic capsular enhancement was thicker in patients with
malignant disease as compared to patients with benign disease (p =
0.000). There was no significant difference in the attenuation value of
capsular enhancement between patients with benign disease and patients
with malignant disease. Irregularity of hepatic capsular enhancement (p
= 0.000), scalloping of the hepatic capsule (p = 0.001) and the presence
of perihepatic ascites (p = 0.000) were more common in patients with
malignant disease as compared to patients with benign disease.
Conclusions When hepatic capsular enhancement is seen on CT
imaging, the thickness of capsular enhancement, irregularity of hepatic
capsular enhancement, scalloping of the hepatic capsule and the
presence of perihepatic ascites may be helpful findings to differentiate
between benign disease and malignant disease.
Keywords Liver, CT
AB032
Internal Hernia through a Defect of Broad Ligament
Kwok-Wan Yeung1, Ming-Sung Chang2
1
Department of Radiology, Fooyin University Hospital, Taiwan
2
Department of Surgery, Fooyin University Hospital, Taiwan
Purpose Internal hernia is a rare cause of intestinal obstruction. Even
rare is the hernia through defects of broad ligament, accounting for only
4% to 5% of all internal hernias. We now present a case of internal hernia
through a defect of the broad ligament with a series of imaging studies.
Methods A 58 year-old female patient suffered from intermittent lower
abdominal cramping pain and vomiting for 2 days. She had received
laparoscopic oocyte retrieval half a year apart for two times 20 years ago.
Blood analysis revealed WBC=11540/μl. A series of imaging study was
performed.
Results KUB revealed distended small bowel loop in the middle
abdomen. Sonography showed fluid-filled small bowel and ascites in the
pelvic cavity. Contrast-enhanced multi-detector CT disclosed a whirl sign
just lateral to the left aspect of the uterus, a transitional zone with afferent
dilated ileum and efferent collapsed small bowel loop, and a cluster of
ileum in the central pelvic cavity. Dorsal displacement of the rectosigmoid
colon and rightward displacement of the uterus were seen. Emergent
exploratory laparotomy uncovered a segment of ileum herniated through
a 3x3cm2 defect of the left broad ligament. The involved ileum showed
ischemic change but became revascularized again after pressure relief.
Repair of the defect was performed. No bowel infarction was noted.
Conclusions Internal hernia through a defect of broad ligament is a very
rare form of all internal hernias. Preoperative recognition and specific
CT characteristics of this rare form of internal hernia prompt emergent
operation and reduce the mortality and morbidity of the patient.
Keywords Obstruction/Occlusion, CT, Small Bowel, Ultrasound, Hernia
AB033
Jejunojejunal Intussusception Secondary to a Hamartomatous
Polyp
Kwok-Wan Yeung¹, Ming-Sung Chang²
¹Department of Radiology, Fooyin University Hospital, Taiwan
²Department of Surgery, Fooyin University Hospital, Taiwan
Purpose Solitary hamartomatous polyp is uncommon in the small
bowel. We present a case of jejunojejunal intussusception caused by
a hamartomatous polyp, which was an accidental finding seen on the
abdominal sonography (and later on the CT) performed on a young
patient shortly after blunt abdominal injury.
Methods A 15 year-old female patient suffered from severe upper
abdominal pain after being assaulted by someone’s elbow. The laboratory
543
AB026
MSCT Perfusion in Prostate Carcinoma- Initial Study
Dan Han
Department of Radiology, The Fist Affiliated Hospital of Kunming
Methods Eleven liver ablations were completed in four female swine
using the Evident™ Microwave ablation system and a 3.7 cm Evident™
MW ablation percutaneous antenna. Ablation regions were selected to
avoid vasculature and other structures that would result in a decrease in
tissue uniformity. A total of six fiber-optic temperature probes were aligned
axially with the feed point of the antenna, and spaced radially from the
probe shaft at distances of 5 mm, 10 mm and 15 mm along two separate
radii to allow for the subsequent calculation of SAR and perfusion at these
locations. The temperature field was recorded throughout the entirety of
the subsequent 10-minute ablations. Using the heat equation, and noting
that the conduction term vanishes where the temperature profile increases
linearly, the combined effect of SAR and perfusion was calculated as
the product of the time derivative of the temperature and the density and
specific heat of liver tissue.
Results Combined SAR and perfusion calculations ranged from 0.91-3.68
W/cm3 at a location 5 mm from the MW antenna, with ranges of 0.09-0.53
and 0.01-0.19 W/cm3 at locations 10 mm and 15 mm from the MW shaft,
respectively (p <0.05).
Conclusions Though thermal determination of SAR patterns have
typically been applied for short time durations, the results of this study
suggest that active tissue heating dominates the thermal response during
the first minute of an ablation. Furthermore, the results of this study
support the conclusion that SAR is a significant prediction of final ablation
temperature.
Keywords Ablation Procedures, Animal Investigations
E-Poster
AB017
Effect of Gd-EOB-DTPA on T2-Weighted Images and
Diffusion-Weighted Images for the Detection of Hepatocellular
Carcinoma
Kazuhiro Saito¹, Yoichi Araki¹, Jinho Park¹, Ryo Metoki², Fuminori
Moriyasu², Kouichi Tokuuye¹
¹Department of Radiology, Tokyo Medical University, Japan
²Department of Gastoroenterology and Hepatology, Tokyo
Medical University, Japan
Non ionic Protocol: CT scanning abdomen after oral and IV (2.5ml/sec)
administration of contrast material in both arterial and portal venous
phase. Supine position, 5mm collimation.
Results Acute pancreatitis found to be common in 3-5th decade. Out
of 100 patient 39 (39%) developed complication related pancreatitis.
Pseudocyst 21%, pancreatic abscess 8%, necrosis 14%, GI and
biliary tract invovlment 5%, solid organ involvement 4% and thoracic
complications 11%. Overall mortality-6% (6) of most of them due
necrotizing pancreatitis 66.6% (4) rest due other complications 33.4%
(2). Grading by Modified CT severity index revealed least morbidity
(10%) (Length of hospital stay) and mortality (<1%) in mild (points 0-2)
pancreatitis to highest morbidity (93%) & mortality (23%) in severe (points
8-10) pancreatitis. CT has an overall accuracy of 87%, with sensitivity
and specificity of 96% and 93% respectively for the detection of extended
pancreatic necrosis and a sensitivity of 50% if only minor necrotic areas
are present.
Conclusions 1) CT is the most sensitive and specific imaging modality for
the evaluation of acute pancreatitis and its complication. 2) The modified
CT severity index has a stronger prognostic correlation and could also
predict the length of hospital stay and development of organ failure.
Keywords Complications, Pancreas, CT, Inflammation
Others
weighted imaging and tumor hemodynamics.
Methods We evaluated 43 consecutive patients with 54 pathologically
confirmed hepatocellular carcinoma nodules. Of these, 20 were well
differentiated, 26 moderately and 8 were poorly differentiated. We also
performed MR imaging and CT during arterial portography and CT hepatic
arteriography. We evaluated the relationship between histological grade of
differentiation and DWI.
Results Apparent diffusion coefficient value (ADC values) did not
significantly correlate with the histological degree of differentiation. The
conspicuity of DWI significantly correlated with the histological degree
of differentiation (r=0.646, p<0.01). Poorly differentiated HCC showed a
significantly high abnormal signal equal to that of the spleen (p<0.05).
Conclusions The conspicuity of DWI is useful to determine the degree of
histological differentiation in HCC.
Keywords Liver, MR
Purpose 1. To review the typical and atypical presentation of hepatic
hemangiomas. 2. To correlate the imaging findings of atypical
manifestations of hepatic hemangiomas which mimick malignant lesions
with pathologic findings.
Methods We retrospectively reviewed the radiologic features of
pathologically confirmed atypical hemangiomas, vascular tumors and its
mimickers.
Results Content Organization: 1. Typical three patterns of hemangioma
1) Peripheral globular enhancement, central fill-in pattern 2) Flash, high
flow hemangioma /c or /s AP shunt 3) Slow flow hemangioma 2.Atypical
hemangiomas - mimicking HCC /c hemorrhage:complicated giant
hemangioma, cavernous hemangioma DDx. Sclerosing HCC, HCC with
peliosis - mimicking metastasis /c persistent low attenuation on CT :
Very slow flow hemangioma - with central calcification - with multilocular
cystic lesion : cystic cavernous hemangioma DDx. Biliary cystadenoma,
localized Caroli’s disease, cystic lymphangioma 3.Epithelioid
Hemangioendothelioma 4.Angiosarcoma 5.Peliosis
Conclusions The major teaching points of this exhibit are: 1. Knowledge
of the variable features observed in atypical hepatic hemangiomas
would be useful for its differentiation from malignant lesion and correct
diagnosis. 2. To recognize of the spectrums of hepatic vascular tumors,
hemangiomas, epithelioid hemangioendothelioma and angiosarcoma.
Keywords Liver, Metastases, MR, Neoplasms-Primary, CT
AB037
Extraskeletal Myxoid Chondrosarcoma in Retroperitoneal
Cavity: A Rare Case Report
Peter Chen-Hua Chiang1, Ta-Nein Lu1, Chin-Chu Wu1, ChungHsin Yeh2, Tong-Jong Chen1, Kou-Mou Huang1
1
Department of Diagnostic Radiology, Shin Kong Wu Ho-Su
2
Department of Uro-Surgery, Shin Kong Wu Ho-Su Memorial
Hospital, Taiwan
P u r p o s e E x t r a s k e l etal myxoid chondrosarcoma (ESMC) is a
malignant tumour of soft tissue origin, distinct from the primary skeletal
chondrosarcoma with myxoid alteration. It is a rare tumour accounting for
2.3% of soft tissue sarcomas in a Japanese series.
Methods We report a case of 44-year-old man with uncontrolled
544
Conclusions Inflammatory myofibroblastic tumor (IMFT) is an uncommon
soft tissue tumor characterized by proliferative myofibroblastic cells and
inflammatory infiltrations. IMFT is uncommon and usually occurs in the
lung, mesentery, retroperitoneum and omentum. IMFT with malignant
transformation is rare. We report the CT features of a surgically-proven
pelvic extraperitoneal IMFT originating from the perivesical space in
14-year-old boy manifested as a huge mass (30-cm) protruded to the
abdominal cavity with upward displacement of the bowel loops, downward
displacement of the urinary bladder, well-enhanced peripheral solid
component and massive central necrosis, as well as prominent peripheral
vascularity. Histopathologic examination revealed predominantly
epitheloid and spindle cells, staghorn vascular channels, inflammatory
cell infiltrations and high mitotic counts (14/10 high-power-field).
Immunohistochemistry revealed strongly positive for anaplastic lymphoma
kinase (ALK) and high proliferative index (ki-67=40%). Real-time
polymerase chain reaction assay disclosed strong expression of TPM3ALK fusion transcript. A final diagnosis of inflammatory myofibroblastic
tumor with malignant transformation was established. Although a definitive
diagnosis of malignant transformation might be difficult, CT demonstration
of the extraperitoneal origin and peripheral hypervascularity of the
mass was helpful for pre-operative planning. To our knowledge, this is
the largest documented case of IMFT and the first report of IMFT with
malignant transformation originating from the pelvic extraperitoneal
perivesical space. Keywords: Inflammatory myofibroblastic tumor; pelvis,
extraperitoneal space; CT.
Keywords Neoplasms-Primary, Pelvis, CT, Retroperitoneum
AB039
The Correlation of the Volume to the Area of Intra-Abdominal
Fat by Helical CT
Akira Yamaguchi, Kazunari Miyamoto, Kenichi Suzuki, Nobuyuki
Shiraga
Department of Radiology, Toho University Oomori Hospital,
Japan
Purpose Visceral fat-type obesity is known to be closely related to
hyperlipidemia and diabetes. The visceral fat area/subcutaneous fat area
ratio is used for the diagnosis of visceral fat–type obesity. In this study,
we estimated for correlation of the volume and area of the visceral and
subcutaneous fat ratio on medical examination data using conventional
helical computed tomography (CT).
Methods Subjects with hyperlipidemia (25 men, 25 women) were
recruited this study. We obtained helical CT scans with a tube current
of 150 mA, voltage of 120kV and 2:1 pith, starting at the upper edge of
AB049
Detection and Characterization of Focal Liver Lesion Using
Diffusion Weighted MR Imaging and Apparent Diffusion
Coefficient Measurement
June-Sik Cho, Youn-Sin Jeong, Kyung-Sook Shin
Department of Radiology, Korea
Purpose To assess the usefulness of diffusion weighted imaging (DWI) of
magnetic resonance imaging (MRI) and the apparent diffusion coefficient
(ADC) measurement for detection and characterization of benign and
malignant focal liver lesions (FLLs).
Methods Sixty-two consecutive patients (43 men, 19 women; mean age,
61 years) with 83 FLLs with one focal lesion of 1 cm or greater in diameter
underwent breath-hold DWI with ADC measurement. A total of 83 FLLs
(31 benign, 52 malignant) were evaluated. Retrospectively evaluated DWI
(b values of 50 and 500 s/mm2) and standard T2-weighted imaging for FLL
detection and characterization from consensus review of two observers.
Reference standard for diagnosis of FLLs was obtained from typical
imaging appearance including dynamic contrast-enhanced MRI and SPIOenhanced MRI, histopathology, or follow-up imaging. T2-weighted imaging
and DWI for FLL detection were compared, and ADC values for FLL
characterization were measured by consensus review of two observers.
Results All 31 benign FLLs were detected on both T2-weighted imaging
and DWI. All 12 cysts were hyperintense on DWI (b=50 s/mm 2) and
isointense or hypointense on DWI (b=500 s/mm2). Of 52 malignant FLLs,
44 FLLs (84.6%) were detected on T2-weighted imaging and 47 FLLs
(90.4%) were detected on DWI. Detection rate of malignant FLLs on DWI
was better than that of T2-weighted imaging, but statistically there was
no significant (p=0.374). Mean ADCs (x 10-3 mm2/s) were 3.59 for cysts
(n=12), 2.13 for hemangiomas (n=19), 1.54 for metastases (n=25), and
1.39 for HCCs (n=27). Mean ADC (1.46 x 10-3 mm2/s) of malignant FLLs
were significantly lower than mean ADC (2.70 x 10-3 mm2/s) of benign
FLLs (p=0.000).
Conclusions DWI was equal to or better than standard T2-weighted
imaging for detection of benign and malignant FLLs. DWI with ADC
measurement was useful in characterization of benign and malignant
FLLs.
Keywords Liver, MR, Tissue Characterization
AB051
Renal Doppler Indices in Sickle Cell Disease: Early
Radiological Predictors of Renovascular Changes
Amit Disawal, Kishor Taori, Nischal Kundargi, Virendra Patil
Purpose The purpose of our study was to detect changes in renovascular
resistance through renal Doppler indices in young sickle cell disease
patients with normal routine urine laboratory tests.
Methods In an 18 month period, the resistive index and pulsatility index of
renal Doppler waveforms obtained in 62 sickle affected patients in the age
group 7-30 yrs was compared with RI and PI of 50 control subjects.
Results There was a statistically significant elevation in Doppler indices
in intrarenal arteries in the Sickle cell disease affected patients in
comparison to controls. Considering cut off values of 0.70 and 1.15 for RI
and PI respectively, Doppler sonography is found to be 100%, 66.7% and
100%, 80% sensitive and specific for SS and AS groups respectively in
detecting increased intra renal resistance.
Conclusions We therefore conclude that renal Doppler sonography can
serve as an early radiological predictor of renovascular changes.
Keywords Kidney, Blood, Ultrasound, Hypertension
AB052
The Affect of Hepatic Graft Weight in the Reduction
of Spleen Size in Recipients after Living Donor Liver
Transplantation
Tai-Yi Chen¹, Yu-Fan Cheng¹, Tung-Liang Huang², Leo LeungChit Tsang¹, Hsin-You Ou¹, Chun-Yen Yu¹
¹Department of Diagnostic Radiology, Chang Gung Memorial
²Department of Medical Imaging, Kaohsiung Medical University,
Taiwan
Purpose Our aim is to evaluate whether the reduction of the spleen
volume 6 months after living donor liver transplantation (LDLT) is affected
by the size of the right lobe liver graft.
Methods 101 adult recipients with preoperative splenomegaly (spleen
volume >500 cm3 by CT volumetry) who received right lobe liver grafts
were included for analysis. The recipients were grouped according to
the graft weight-to-recipient weight ratio (GRWR >1 vs. GRWR <1). The
two groups were compared using mean postoperative spleen volume
and mean spleen volume change ratio 6 months after LDLT. The spleen
volume change ratio was defined as [(SVpreop–SV6m) / SVpreop] ×
100%, where SVpreop and SV6m represent spleen volume calculated
based on the preoperative CT and on the follow-up CT examination 6
months after LDLT, respectively.
Results The GRWR ranged from 0.67-1.66. There were 61 recipients
with GRWR >1 and 40 recipients with GRWR <1. Our analysis showed
significant hepatic graft volume regeneration and spleen volume reduction
after 6 months following LDLT. There were no differences in the mean
postoperative spleen volume and mean spleen volume change ratio
between the two groups.
Conclusions LDLT using a right lobe graft resulted in a significant
reduction of the splenic volume 6 months after the surgery but there were
no significant differences in the mean postoperative spleen volume size
and spleen volume change ratio between recipients who received different
right lobe liver graft sizes.
Keywords Liver, Spleen, Transplantation
AB053
CT Volumetry of Gastric Carcinomas: Feasibility and
Correlation with Staging
Dong Hun Kim1, Joo Nam Byun2, Eun Ha Suk3
1
Department of Radiology, Soonchunhyang University Bucheon
Hospital, Korea
2
Department of Radiology, Chosun University Hospital, Korea
3
Department of Anesthesiology and Pain Medicine, Asan Medical
Purpose To investigate distorted liver by movement of diaphragm during
full inspiration and to find usefulness of ultrasound for assessing liver
fibrosis or cirrhosis
Methods 57 patients with control (control group) and 73 patients with liver
cirrhosis (cirrhotic group) were included in this study. Cirrhosis were and
subdivided arbitrary into early cirrhosis (N=53) and overt cirrhosis (N=20).
Two sagital images of left hepatic lobe were obtained during resting state
and full inspiration with Valsalva maneuver by transabdominal ultrasound.
Length between inferior hepatic angle and midpoint of liver dome was
measured in all images. The changes of left lobe length in two images
545
AB038
Huge Pelvic Extraperitoneal Inflammatory Myofibroblastic
Tumor with Malignant Transformation: CT Features
Lu Chia-Hsun1, Hsuan-Ying Huang2, Jing-Haur Chang3, Han-Koo
Chen2, Shu-Hang Ng1, Chung-Cheng Huang2
1
Dpeartment of Radiology, The Radiological Society of Republic
of China RSROC, Taiwan
2
Department of Pathology, Taiwan Society of Pathology, Taiwan
3
Department of Pediatric Surgery, Taiwanese Association of
Pediatric Surgeons, Taiwan
liver and continuing until pelvis. The intra-abdominal visceral fat volume
was measured by drawing a line within the muscle wall surrounding the
abdominal cavity. The abdominal subcutaneous fat volume was calculated
by subtracting the visceral fat volume from total abdominal fat volume.
By comparison, the intra-abdominal visceral and subcutaneous fat area
were determining at the umbilical level by the established CT scanning
technique as the gold standard.
Results Visceral fat volume/subcutaneous fat volume were correlated
positively with visceral fat are/subcutaneous fat area. Visceral fat volume/
subcutaneous fat volume were good correlated positively with medical
examination data than visceral fat volume/subcutaneous fat area.
Conclusions The visceral fat volume/subcutaneous fat volume ratio
is used for the diagnosis of visceral fat–type obesity. In addition,
the calculated visceral fat volume was useful for good guideline for
hyperlipidemia and aware their disease.
Keywords Comparative Studies, CT, Technical Aspects
E-Poster
AB035
Unfamiliar, Different Faces of Hemangiomas
Soo Jin Kim¹, Jeong Min Lee¹, Se Hyung Kim², Jae Young Lee²,
Joon Koo Han¹, Byung Ihn Choi¹
¹Department of Radiology, Seoul National University College of
Medicine, Korea
²Department of Radiology and Institution of Radiation Medicine,
Seoul National University Hospital, Korea
hypertension for several years. Magnetic Resonance Imaging, including
Magnetic Resonance Arteriogram showed a huge well defined mixed
signal intensity tumour arising from left adrenal gland. The tumour was
resected under the impression of adrenocortical carcinoma.
Results Pathological results showed a malignant ESMC arising from
retroperitoneum.
Conclusions ESMC is a rare soft tissue tumour by itself. Most reported
cases are in the lower extremities. Our case is located in retroperitoneum
which is very rarely reported. Therefore, we should consider ESMC is one
of the differentials of retroperitoneal tumours.
Keywords Neoplasms-Primary, Pathology, Retroperitoneum
Others
findings were unremarkable. Tracing back her history, the patient felt a
dull upper abdominal pain for several months before the incident.
Results Sonography reveals a hypoechoic mass-like lesion having
a target sign on the transverse scan and pseudokidney sign on the
longitudinal view in right upper abdominal cavity. Contrast-enhanced CT
disclosed a segment of the jejunum (intussusceptum) to telescope into the
distal segment (intussuscipiens). A round and mildly contrast-enhanced
mass was seen at the leading point of the intussusception . Laparotomy
showed jejunojeujunal intussusception with a polypoid mass inside.
Segmental resection of the involved jejunum and end-to-end anastomosis
were performed. The pathological study showed a large polyp with interior
hyperplastic glands composed of benign-looking epithelial cells, which
were separated into lobules by the bundles of smooth muscle cells. The
finding was consistent with hamartomatous polyp.
Conclusions Jejunojenjunal intussusception caused by a hamartomatous
polyp is rarely encountered. It may be an incidental finding during
a sonographic workup for another reason. Characteristic signs on
sonography and CT are essential for diagnosing the disease.
Keywords Neoplasms-Primary, CT, Small Bowel, Ultrasound
Purpose 1. To review of pathophysiology of Tuberculous infection in
abdomen. 2. To review of rare affecting Tuberculous abdominal organs. 3.
To differential diagnosis of other diseases.
Methods Abdominal Tuberculous is a diagnostic challenge, particularly
when pulmonary Tuberculous is absent. It may mimic many other
abdominal diseases clinically and radiologically. Thus, Tuberculosis can
mimic a number of other disease entities, and it is important to be familiar
with the various radiologic features of Tuberculosis and to ensure early,
accurate diagnosis.
Results We reviewed pathophysiology of Tuberculous infection affecting
various abdominal organs. We also reviewed the characteristic CT
findings of Tuberculous infection common and rare affecting abdominal
organs as follows; small bowel, cecum and colon, mesentery and
peritoneum, urinary system, reproductive system, lymphatic system, liver,
spleen, and adrenal glands. We compared other differential diagnostic
diseases (inflammatory bowel diseases, peritoneal diseases) to these CT
manifestations.
Conclusions A review of the pathophysiology and imaging characteristics
of Tuberculous infection in abdomen is presented. Although these CT
appearances are nonspecific, classifying them by pattern is helpful in
narrowing the range of the differential diagnosis.
Keywords CT, Peritoneum, Small Bowel, Inflammation
AB059
Normal Peritoneal Reflections and Diseases of Peritoneum
Using Multiplanar Images
Yongsoo Kim, Woo Kyoung Jeong, Soon Young Song, Byung
Hee Koh, On Koo Cho
Department of Radiology, Hanyang University Kuri Hospital,
Korea
Purpose To display of normal peritoneal reflections using multiplanar
images. To illustrate usual and unusual peritoneal disease and to find the
imaging characteristics of individual disease.
Methods Omentum, mesentery, ligaments and peritoneum are
anatomically complicated areas to fully assess CT images. Peritoneum
can be affected various diseases, and several different forms manifested.
Results We reviewed normal peritoneal reflection, ligament, mesentery
and omentum using multiplanar CT images. We classified MDCT
findings of peritoneal disease as follows: disseminated, nodular, cystic
forms. Selected cases are presented and the imaging characteristics
are discussed. Peritoneal diseases include inflammatory diseases
546
AB060
Comparison of Endoscopic Ultrasound (EUS) and MDCT in
the Evaluation of Various Gastroduodenal Lesions
Yuri Shin
Department of Diagnostic Radiology, Catholic University of
Medicine, Korea
Purpose An amebic abscess of colon mimicked a colon cancer: case
report.
Methods Case report.
Results A 48 years old patient went to our emergency room due to fever
and severe abdominal pain. Under the suspect of intra-abdominal abscess
formation, emergent computed tomography was done. A 5.5 cm x 3.9
cm soft tissue tumor like lesion at transverse colon was noted. Obvious
mesocolon invasion and small lymph node were also noted. Colon cancer
(stage Duke C2) was considered and emergent operation was done.
Pathology result showed amebic abscess formation.
Conclusions An amebic abscess of colon mimicked a colon cancer: case
report.
Keywords Abscess
Purpose The purpose of this presentation is to present the findings
from EUS and MDCT of various gastroduodenal lesions, to compare
characteristic EUS findings with MDCT, and to specify advantage of each
modalities.
Methods We retrospectively reviewed the medical records and imaging
(EUS and MDCT) of 400 patients with pathologic findings. The lesions
include gastric carcinoma, gastrointestinal stromal tumor, leiomyoma,
carcinoid, ectopic pancreas, vascular structures, glomus tumor,
neurogenic tumor, gastritis cystic profunda and hemangioma in the left
lobe of the liver.
Results This presentation will be divided into 3 main parts; First, EUS
findings of various gastroduodenal lesions, second, Comparison of EUS
and MDCT, and finally, superiority of each modalities to correct diagnosis.
Conclusions In the past, EUS was strictly reserved for the clinicians
and radiologists only had CT available within reach. However, the current
PACS era has enabled radiologists to gain easy access to EUS images,
which is helpful for improving overall diagnostic accuracy through a
comprehensive interpretation of both EUS and CT.
Keywords CT
AB061
Differentiation of Hepatic Tumors by Use of 2D Multiple Slice
MR Hydrography
Yu Ling Su
Department of Radiology, RenAi branch, Taipei City Hospital,
Taiwan
Purpose Assessment of the feasibility of using MR hydrography for
distinguishing hepatic malignancies from benign hepatic lesions.
Methods Retrospective review of 120 patients with high signal intensity
T2WI hepatic lesions. All patients had underwent MR imaging (including
2D Multiple Slice MR hydrography, TR/TE: 8000/800).The results were
reviewed independently by two radiologists. They compared the signal
intensities in the fat saturated T2WI and MR hydrography by visual
inspection. If the signal intensity by MR hydrography is high, it was labeled
a hepatic cyst. If the SI is low, the lesion was regarded as a hemangioma.
If the lesion is not seen, it was graded as malignancy. The signal
intensities of the hepatic tumors were measured. For each lesion which
was seen in MR hydrography, the variation in signal to noise ratio (SNR)
between the MR hydrography and the fat-saturated T2-weighted images
(T2WI) was calculated and the results were validated using a Receiver of
Operator Characteristic (ROC) curve.
Results There was a significant different signal change identified by
visual inspection among the three tumors groups. The SNRs of hepatic
hemangiomas and of hepatic cysts using MR hydrograms (p<0.0001)
was also significant different. For hepatic cysts and hemangiomas, the
ROC curve revealed that the ideal cut-off value for the signal variation
ratio between the MR hydrography and the fat saturated T2WI results was
-0.99.
Conclusions Hepatic malignancy, hepatic hemangiomas and cysts have
significantly different signal intensities on non-contrast 2D Multiple Slice
MR hydrography. This approach uses a safe, free, and reliable imaging
technique to differentiate the diagnoses compared with contrast study.
Keywords Liver, MR, Cysts, Hemangioma
AB067
Phlebosclerotic Colitis: An Underdiagnosed Disease in
Asia?
Ya-Ting Jan, Fei-Shih Yang
Department of Radiology, Mackay memorial hospital; Mackay
Medicine, Nursing and Management College, Taiwan
Purpose To increase the awareness of the radiologists to the
characteristic imaging features of phlebosclerotic colitis and hoping there
will be more cases recognized in Asian persons other than Japanese and
Taiwanese.
Methods Three Taiwanese patients with quite different clinical
manifestations are presented. Characteristic imaging features are
highlighted with clarifying images.
Results The typical imaging findings are linear calcifications in the region
of the right hemicolon on plain abdominal films and colonic wall thickening
with adjacent mesenteric venous calcifications on CT.
Conclusions Phlebosclerotic colitis is a rare type of ischemic colitis
caused by fibrotic sclerosis and calcification of the mesenteric veins,
preferentially involving the right colon. The radiologist may be the first
to suggest the diagnosis because the clinical presentations are often
nonspecific. All of the reported cases were Japanese, except two, who
were Taiwanese. We think this disease may be underdiagnosed in Taiwan
and possible also other Asian countries. Knowledge of the imaging
features facilitates the radiologists to make the correct diagnosis.
Keywords Ischemia/Infarction, Large Bowel, Veins
AB068
Intraductal Papillary Muninous Neoplasms of the Pancreas
Complicated with Intraductal Hemorrhage: Malignant
Manifestations on CT and MR Imaging
Yasunari Yamada
Department of Radiology, Oita University Faculty of Medicine,
Japan
Purpose Intraductal papillary mucinous neoplasms (IPMNs) of the
pancreas complicated with intraductal hemorrhage are rare conditions.
We aimed to investigate CT and MR imaging influenced by intraductal
hemorrhage in 5 IPMN patients.
Methods Forty one patients with pathologically proven IPMNs underwent
triple-phase enhanced CT and/or MRI. Complications of the intraductal
hemorrhage were proven in 5 patients. The CT (n = 5) and MRI (n = 3)
manifestations were evaluated and correlated with surgicopathological
findings.
Results From the results of correlation between radiological and
pathological findings in 5 IPMNs complicated with intraductal hemorrhage,
atypical manifestations were recognized as follows: mural nodule
like appearance of blood clots (n = 1); mural nodule enlargement by
hemorrhage, granulation, and mucinous material extension (n = 2); rapid
enlargement of the branch duct by hemorrhage (n = 1); and rupture of
the dilated main pancreatic duct by hemorrhage and mucinous material
extension (n = 1). Intraductal hemorrhage could be detected as high
attenuating areas without enhancement on CT in 2 of 5 cases and in 1
case high and low signal intensity (SI) area on T1- and T2-weighted MR
images, respectively and in all 3 cases high SI areas on T1-weighted fatsuppressed images. In all cases, surgical resections were performed in
the preoperative diagnosis of malignant IPMNs, however, three patients
were pathologically adenoma. Denudations of the tumor epitheliums were
recognized at the hemorrhagic areas in all patients and therefore, this
finding was thought to be causative factor of the intraductal hemorrhage.
Conclusions Fat-suppressed T1-weighted MR images are useful in
evaluating intraductal hemorrhage in IPMN. In case that high SI was seen
within the dilated pancreatic duct on fat-suppressed T1-weighted images
in IPMN patients, malignant findings of the enlargement of dilated branch
ducts and mural nodules could be induced by hemorrhage and therefore,
benign conditions should be considered.
Keywords MR, Neoplasms-Primary, Pancreas, CT
AB071
Radiofrequency Ablation of Subdiaphragmatic Lesion in the
Liver Using Cool-Wet Tip Electrode: Preliminary Stu
Seung A Choi¹, Pyo Nyun Kim², Hyung Jin Won², Yong Moon
Shin²
¹Department of Radiology, Eulji University Hospital, Korea
²Department of Radiology, Asan Medical Center, Korea
Purpose To evaluate the efficacy of radiofrequency ablation (RFA) for a
subdiaphragmatic lesion in the liver using cool-wet tip electrode that is a
kind of perfusion electrode
Methods A total of 35 subdiaphragmatic lesions in 33 patients were
treated by RFA using cool-wet tip electrode ® (RF Medical, Seoul, Korea).
The electrode with 2 cm (n=26) or 3 cm active tip (n=9) was chosen
according to the lesion size. The approaching direction of an electrode
was divided into vertical (2 cm tip, n=19; 3 cm tip, n=8) and parallel (2
cm tip, n=5; 3 cm tip, n=3) to the diaphragm. 200W generator (Valleylab,
Burlington) was used. The volume and shape of the ablating zone was
measured on portal phase of immediate enhanced CT.
Results The mean volume (15.0 ml) of ablating zone with vertical
approach (VA) was smaller than that (24.1ml) with parallel approach (PA).
The mean volume of ablating zone by 2 cm and 3 cm active tip electrode
with VA were 10.5 ml and 22.3 ml, respectively. And each of that with
PA were 14.8 ml and 30.5 ml. Both of images with VA and PA showed
frequently round shape (74.1% with 20 patients and 62.5% with 5 patients,
respectively).
Conclusions RFA of subdiaphragmatic hepatic lesion using cool-wet
tip electrode seems to be a promising approach. RFA with PA frequently
revealed round shaped RF zone rather than ovoid. PA had better
efficiency in creating a larger ablation zone than does VA.
Keywords Ablation Procedures
AB073
Intussusception from the Cradle to the Grave
Hee Koh, On Koo Cho
Korea
Purpose 1. To review the ultrasonography and CT findings of
intussusception according to leading points, age and previous operation
history. 2. To know the ultrasonography and CT findings whether operation
or not.
Methods Intussusception is defined as the invagination of one
segment of the gastrointestinal tract into an adjacent one. Diagnosis of
intussusception is not complicated using ultrasonography and CT. Various
547
AB063
An Amebic Abscess of Colon Mimicked a Colon Cancer:
Case Report
Huang Ta Yi, Yang Ying Chen, Chen Ran Chou, Lin Ta Yen, Yi Ta
Huang
Department of Radiology, Taiwan
E-Poster
AB058
Abdominal Manifestation of Tuberculous Infection in NonAIDS Patients
Hee Koh, On Koo Cho
Korea
(tuberculous peritonitis, bacterial peritonitis, and actinomycosis),
peritoneal carcinomatosis (disseminated, nodular and cystic type).
Conclusions A review of the normal peritoneal anatomy, the pathology
and imaging characteristics of disseminated peritoneal disease is
presented. Although these CT appearances overlap, classifying them by
pattern is helpful in narrowing the range of the differential diagnosis.
Keywords Mesentery, CT, Peritoneum, Inflammation
Others
were calculated for evaluating hepatic distortion. The calculated lengths
were compared between each group.
Results Early cirrhosis and overt cirrhosis groups, the mean elongated
lengths (ELs) were 2.34±0.98, 1.18±0.73 and 0.53±0.54 cm, respectively
(p<0.05). In early cirrhosis group (n=53), the mean elongation in patients
with alcoholic cirrhosis was 12±7%. Although the mean elongation
in patient with alcoholic cirrhosis is lower than that of cirrhosis with
hepatitis B or C (16±11% and 16±7%, respectively), the difference of
mean elongation in three etiologic groups was not statistically significant
(p=0.417). The area under the ROC curve was 0.88(95% confidence
interval (CI), 0.82 to 0.94). Using 17 % cut-off value of liver elongation,
the sensitivity and specificity for the prediction of cirrhosis were 90% and
75.3%, respectively.
Conclusions The sonographic finding such as less change of left lobe
length (stiffer) during full inspiration may aid in diagnosis of cirrhosis and
in discrimination between the different stages of fibrosis.
Keywords Liver, Ultrasound
AB077
B e h a v i o r o f H e p a t i c H e m a n g i o m a w i t h Tr e a t e d
Hepatocellular Carcinoma
Guo-Jou Peng¹, Ran-Chou Chen1, Hsing-Yang Tu2
1
Departments of Radiology & Biomedical Imaging and
Radiological Sciences, Ho-Ping branch, Taipei City Hospital &
2
Department of Radiology, Ren-Ai Branch, Taipei City Hospital,
Taiwan
Purpose To invastigate the natural history and behavior course of hepatic
cavernous hemangioma, after series of treatment for hepatocelluar
carcinoma, with computed tomography and magnetic resonance imaging.
Methods Imaging findings of 14 hemangiomas, whose size had ever
exceeded one centimeter, in 12 HCC patients were retrospectively
reviewed. These patients underwent imaging follow-up. The number,
548
Purpose Morphine causes traction of CBD (common bile duct) and
pancreas duct, after a period of waiting, the effect will pass and both
CBD and pancreas duct will dilate. For liver donation MRCP estimation,
CBD and pancreas duct of donor are mostly too thin to be observed. In
this study, we injected extremity low dose morphine into liver donor and
observing the dilation of CBD and pancreas duct.
Methods Ten liver donors were acquired for this study, donors
were first performing routine MRCP (Magnetic Resonance
Cholangiopancreatography) scan protocols, than inject morphine slowly
into veins of the donor, keep donor staying on MRI table waiting for 40
minutes, after the period of waiting, we repeated another post-injection
MRCP scan with exactly same scan position and parameter setting for
comparing the dilation degree of pancreas duct. The capacity of morphine
depends on donor’s body weight (0.05 mg/kg) and diluted with 20 c.c.
normal saline.
Results All ten donors showed more dilation of CBD and pancreas duct
by observing their post-morphine injection MRCP images compare to
images before morphine usage.
Conclusions In this study, common bile duct and pancreas duct were
much easier to observe on MRCP images caused by dilation and it also
providing more morphological information to the surgeons for estimating
liver donation surgery.
Keywords Liver, MR
AB081
TB Spondylitis with Lt Psoas Abscess and Epidural
Involvement of Sacrum Bone: One Case Report
Tung Wei Cheng¹, Yang Ching Chen1, Lu Tseng Hsieh2
1
Department of Radiology, Songshan Armed Forced General
Hospital, Taiwan
2
Department of Internal Medicine, Songshan Armed Forced
Purpose Chronin low back with low grade fever developed. TB
spondylolitis or infection spondyloitis can not be ruled out.
Methods After admission, WBC: 14120/μL, Hgb: 10.6 g/dL, GOT/GPT:
52/251 IU/L CRP: 2.4 mg/dL. Three sets of acid-fast stain for sputum
reveal negative. Abdomen sono revealed large fluid collection in left
paraspinal area. Contrast enhanced computed tomography of abdomen
& contrast enhanced MRI of lumbar spine demonstrated two margin-
AB082
Hepatic Portal Venous Gas – A Rare Presentation of
Emphysematous Pyelonephritis
Chia-Hsing Liu, Ming-Tsung Chung, Yi-Sheng Liu, Hong-Ming
Tsai, Tzong-Nan Kuo
Department of Diagnostic Radiology, National Cheng-Kung
Purpose We presented a case of hepatic portal venous gas secondary
to emphysematous pyelonephritis, which is extremely rare, with only two
cases reported in the literature.
Methods A patient with diabetes mellitus presented with acute abdominal
pain and vomiting. On image evaluation, there is hepatic portal venous
gas secondary to left side emphysematous pyelonephritis. There is no
pneumatosis intestinalis nor mesenteric venous air.
Results The patient developed septic shock rapidly. Image-guided
percutaneous drainage resulted in gradual resolution of the infection. The
patient was discharged after five weeks of hospitalization.
Conclusions Classically, hepatic portal venous gas is considered
an ominous sign of bowel ischemia. Although rare, emphysematous
pyelonephritis should be considered when HPVG is observed.
Emphysematous pyelonephritis is lethal, which needs vigorous
resuscitation and immediate drainage or surgery
Keywords Abscess, Kidney, Liver, Infection
AB085
Successful Doppler Spectrum Assessment of Arterial
Stenosis and Post-biopsy AV Fistula in a Transplant Kidney
Ying-kai Huang, Jer-Shyung Huang, Huei-Lung Liang, Yih-Huie
Lin
Department of Radiology, VGHKS, Taiwan
Purpose 1. The role of Spectrum Doppler diagnosis of renal artery
stenosis with concurrent traumatic AV fistula. 2. The rationality of onestage treatment of renal arterial angioplasty and fistula embolization.
Methods A 56 y/o male patient of CIN related CRF in ESRD stage s/
p renal transplantation presented acute exacerbation of renal function
four months after the transplantation. Renal biopsy showed Cyclosporin
toxic tubulopathy which improved after pulse therapy and hemodialysis.
However, about one month later, another exacerbation occurred with
the creatinine level up to 9 mg/dL. Doppler sonography and MRA were
performed to evaluate the cause of exacerbation.
Results Doppler sonography showed tardus parvus pattern with a high
diastolic flow velocity, indicating main renal artery stenosis, and suspicious
AV fistula. The following MRA study confirmed a 90% renal arterial
stenosis and an AV fistula possibly related to previous renal biopsy. A
vascular stent was inserted over renal artery, while the AV fistula was
left untreated for the concern of possible compromise of renal perfusion
induced by embolization, and the assumption of high possibility of selfclosure of the AV fistula. Renal function return to almost normal after the
intervention. However, after one and half year, high BP with lower leg
edema were noted, and the angiography showed a large AV shunt and
mild stenosis of previous stent. Thus, coil embolization of the fistula track
and balloon dilatation of previous stent were performed. Patient is now in
stable condition with regular OPD follow up.
Conclusions 1. Spectrum Doppler has an important role in diagnosis of
renal artery stenosis with concurrent traumatic AV fistula. 2. One-stage
treatment of renal arterial angioplasty and fistula embolization is favored
for post-transplant kidney.
Keywords Angiography, Angioplasty, MR, Embolization, Fistula,
Ultrasound
AB088
CT Findings of Malaria Infection: P. Vivax Malaria
Hyeon Je Cho, Eun Mi Kim, Nyoung-Keun Lee, Yong Hoon Kim
Department of Radiology, Inje University Ilsan-Paik Hospital,
Korea
Purpose To investigate the findings of dynamic abdominal CT in malaria
patients.
Methods Among 405 patients who were confirmed P. vivax malaria by PB
smear, 47 patients underwent abdominal CT. CT findings were analyzed
in 34 patients (mean 48.1 year; male/female ratio 2.4). We analyzed CT
findings in non-malaria group; randomly selected 80 febrile patients (mean
48.7year; male/female ratio 1) with negative PB smear, as a control group
and 120 healthy people (mean 45.9 year; male/female ratio 2.53), as a
normal group. Clinical data and laboratory findings were retrospectively
reviewed.
Results Spleen length was statistically different among malaria group
(12.39±0.94), control group (10.22±0.65) and normal group (8.64±0.26)
(p=0.01, respectively). There was a significant difference in liver length
among malaria group (18.90±0.72), control group (17.43±0.62) and
normal group (16.43±0.33) (p=0.01, respectively). In malaria and nonmalaria group, the findings of splenomegaly [n=27(79.4%):n=65(32.5%)],
hepatomegaly [n=22(64.7%):n=57(28.6%)], focal low attenuation
[n=13(38.2%):n=8(4%)] and spontaneous splenic rupture [n=3(8.8%):n=0]
were different (p <0.01, respectively). Platelet count (73.91±23.73,
176.89±21.19, 239.37±10.36) and total WBC count (5375.59±1149.35,
13802.13±6976.68, 7325.75±628.88) were different in three groups (p
<0.01, respectively).
Conclusions CT findings of malaria group were different from CT findings
of non-malaria group.
Keywords Liver, Spleen, Infection
AB091
Enhancement and Visualization Techniques of Hepatic
Vessels in Non-Contrast X-Ray CT Images
Teruhiko Kitagawa1, Xiangrong Zhou2, Takeshi Hara3, Hiroshi
Fujita 3 , Ryujiro Yokoyama 4 , Hiroshi Kondo 4 , Masayuki
Kanematsu4, Hiroaki Hoshi4
1
Department of Electronic Control Engineering, Gifu National
College of Technology, Japan
2
Medicine, Gifu University, China
3
4
Department of Radiology, Gifu University Hospital, Japan
Purpose To develop a method for enhancement and visualization of
hepatic vessel trees on non-contrast X-ray CT images.
Methods Because the hepatic vessel regions in non-contrast CT images
have a lower CT number comparing with the other normal liver tissues, a
part of hepatic vessel regions can be extracted firstly using a p-tile method
based on the CT number distributions. We assumed that CT numbers
of hepatic vessel regions can be approximated as a normal distribution,
so that, the mean value and standard deviation of CT number in hepatic
vessels can be estimated from the CT numbers in the part of hepatic
vessel regions that were extracted in the previous step. A pre-enhanced
image (likelihood image) was generated to show the appearance of
hepatic vessel by a histogram transformation of input CT image using the
Gaussian function. This likelihood image may include many false positive
549
Purpose The objective of our study is to retrospectively characterize
Hepatic tumors enhancing pattern at different vascular phase by dynamic
contrast-enhanced ultrasonography.
Methods We reviewed pulse-inversion harmonic contrast-enhanced
ultrasonography (US) images in consecutive patients (M=56, F=27)
with pathologically proven focal hepatic lesions, namely hepatocellular
carcinoma (HCC) (n=42), metastases and other hepatic tumors (n=26),
hemangioma (n=15). After administration of micro-bubble contrast
agent Levovist (Schering AG, Berlin, Germany), images were acquired
by continuous video recording. Various vascular phases are defined
as follows: 1. pre-contrast phase. 2. arterial phase (The time taken for
development of densely echogenic hepatic arteries within the tumor). 3.
late phase (defined as the time when contrast enhancement still visible
before washout). The vascularity pattern of each group were recorded
and appreciated by two radiologists independently. Chi-square test was
used for statistic analysis. P value less than 0.05 is considered statistically
significant.
Results (HCC, metastasis and hemangioma) are as follows: 1. precontrast phase, vascularity pattern is mainly hypovascular in HCC
(59%), hypovacular in metastases and other hepatic tumors (58%), and
hypervascular in hemangioma (67%), 2. arterial phase, vascularity pattern
is mainly internal/internal-marginal enhancement in HCC (59%), no
vascularity enhancement in metastases and other hepatic tumors (58%),
and peri-nodular enhancement in hemangioma (67%), and 3. late phase,
vascularity pattern is mainly inhomogeneous in HCC (64%), hypovacular
in metastases and other hepatic tumors (54%), and isovascular in
hemangioma (60%).
Conclusions Dynamic contrast-enhanced ultrasonography helping
differentiating various hepatic tumors is evident.
Keywords Liver, Contrast Agents, Ultrasound
AB080
Improve Estimation of Liver Donor by Injecting Morphine
before MRCP Scan: Preliminary Experience
Yu-Fang Lin¹, Yung-Jen Ho¹, Wu-Chung Shen²
¹Department of Radiology, China Medical University Hospital,
Taiwan
²Department of School of Medicine, China Medical University,
Taiwan
enhanced well-capsulated lesions noted with larger one in Lt Psoas
muscle with extension into left low quadrant abdomen and anterior
abdomen wall adhesion, and another lesion in presacrum space with
invasion into epidural space of sacrum bone via sacrum neural foramen
and perifocal bony destruction.
Results ultrasound-guided fine needle aspiration was performed and
turbid dark-brownish fluid was noted with positive polymerase chain
reaction (PCR) for TB. The aspirated fluid for acid-fast stain and
subsequent TB culture were both positive.
Conclusions One foreign-labor young female with chronic low back, low
grade fever for a period time TB spondylolitis can not be ruled out.
Keywords Infection
E-Poster
AB076
Dynamic Contrast-Enhanced Sonography in Diagnosis of
Hepatic Tumors
Rong Li Wu
Department of Radiology, RSROC, Taiwan
sizes, location, attenuation, pattern of enhancement, presence of capsular
retraction, and series of treatment for hepatocelluar carcinoma were
evaluated.
Results Of the 14 large hepatic hemangiomas, four (29%) hemangiomas
decreased size after series of treatment for hepatocelluar carcinoma,
one (7%) hemangioma increased size, and the other had no change in
diameter. The three shrunk heaptic hemangioma all ever had a main HCC
nearby in the same or adjacent segment. The enlarged hemangioma
located at the diffierent hepatic lobe from the HCC and finally had no
further progression and echogenic change in the follow-up sonography.
Conclusions Coexistance of hepatic hemangioma and HCC had already
been well distinguished by CT and MRI with dynamic enahnced study.
However, the regresion and progression of hepatic hemangioma indeed
confused the radiologists and clinicians. Be aware of this natural behavior,
we could avoid misleading the clinical practice only by he tumor size
deviation.
Keywords Hemangioma
Others
leading points are present in the intussusception according to their age
and previous operation history.
Results We reviewed all types and age groups of intussusception. We
divided into intussusception age groups as infants, children, and adult.
And also we divided intussusception according leading points as follows;
benign causes (mesenteric lymph nodes, appendicitis, lipoma, transient),
malignant causes (colon cancer, metastasis), and post operative causes
(adhesion band, bypassed intestinal segments, abnormal bowel motility,
and intestinal tubes).
Conclusions Various causes develop intussusception. The methods
of treatment of intussusception are different from their causes. Imaging
findings and clinical symptoms are important to decide operation or not.
Keywords Large Bowel, CT, Small Bowel, Ultrasound
Purpose To retrospectively compare the conventional three-dimensional
(3D) interpretation method with the panoramic 3D interpretation method
with regard to the accuracy and time-effectiveness for the detection of
colonic polyps, using pig colonic phantoms as the standard of reference.
Methods One hundred and sixty-two polyps were created and analyzed
in 18 pig colon phantoms. CT colonography was performed by using
64-detector CT scanner. Three radiologists independently analyzed
the data with both the conventional 3D interpretation method and the
panoramic 3D interpretation method. The sensitivities of both methods
were compared by using McNemar test. The interpretation time was also
assessed for each interpretation method and compared by performing
Wilcoxon signed rank test.
Results Compared with the conventional method (0.96 for reviewer 1,
0.89 for reviewer 2, and 0.97 for reviewer 3), the panoramic method
revealed comparable sensitivities (0.91 for reviewer 1, 0.86 for reviewer
2, and 0.93 for reviewer 3) and no significant difference was found.
Interpretation time was significantly shorter with the panoramic method
(115.1±32.7 seconds for reviewer 1, 229.7±72.2 seconds for reviewer
2, and 282.6±113.7 seconds for reviewer 3) than with the conventional
method (218.9±59.9 seconds for reviewer 1, 379.4±117.0 seconds for
reviewer 2, and 458.7±149.4 seconds for reviewer 3) for all reviewers.
Conclusions In conclusion, compared with the conventional 3D
interpretation methods, the panoramic 3D interpretation method had
comparable sensitivity and improved time-efficiency in the detection of
colonic polyps.
Keywords CT, Experimental Investigations
AB093
Two Cases of Primary T-Cell Lymphoma of the Small
Intestine Presented as Perforated Diverticulitis
Hsing-Yang Tu
Department of Radiology, Taipei city hospital Renai branch,
Taiwan
Purpose Primary gastrointestinal lymphoma comprises a group of
distinctive clinicopathological entities. Intestinal T-cell lymphomas are
much less common. T-cell lymphoma perforates the small intestine more
easily because T-cell lymphoma infiltrates the whole layers intestinal wall,
and forms an ulcerative tumor.
Methods The imaging and pathological findings of two cases of primary
intestinal T-cell lymphomas are presented.
550
AB097
The Value of Superior Hemorrhoidal Vein in Preoperative
Prediction of Lymphovascular Invasion and Nodal
Metastasis in Rectal Cancer
Chih Chun Wu1, Rheun-Chuan Lee2, Cheng-Yen Chang3
1
Department of Radiology, Fellow, Taiwan
2
Department of Radiology Radiology, Visiting staff, Taiwan
3
Department of Radiology Radiology, Chief, Taiwan
AB102
Ability of Detection Renal Artery Stenosis Using IFIR MRA
versus Contrast-Enhanced MRA
Ching-Lan Wu, Rheun-Chuan Lee, Shu-Huei Shen, Cheng-Yen
Chang
Taiwan
Purpose To predict lymphovascular invasion and nodal metastasis of
rectal cancer by measuring the diameter of superior hemorroidal vein
(SHV) at preoperative CT.
Methods We retrospectively reviewed the preoperative CT of 60 rectal
cancer patients. We analyzed the relationship between the diameter of
SHV and the demographic variables (including age, gender and body
mass index (BMI)) and the pathological features, which included the
lymphovascular invasion and the TNM staging of the primary tumor
according to the American Joint Committee on Cancer.
Results There were 38 males and 22 females. The mean diameter of
SHV was 40mm, ranging from 23 to 68 mm. There was no significant
difference in diameter of SHV between gender and BMI (p=0.597 and
0.621, respectively). The mean diameter of SHV of the patients with and
without LVI was 49.4 and 30.67 mm, and the ratio of SHV versus inferior
mesenteric vein (IMV), 0.63 and 0.88, respectively. There were significant
difference of both the diameter and the ratio of SHV versus IMV in
lymphovascular invasion, and nodal metastases (<0.05).
Conclusions The diameter of SHV increases when lymphovascular
invasion presents. Preoperative CT is able to predict the presence of
lymphovascular invasion, which is correlated with aggressiveness and
poor prognosis in rectal cancer.
Keywords Metastases, Rectum
AB100
Pneumoperitoneum Caused by Ruptured Gas-Containing
Pyogenic Liver Abscess Mimicking Perforated Hollow
Organ: A Case Report
Chih-Wei Chen, Chung-Ming Tasi, Yeu-Sheng Tyan
Hospital, Taiwan
Purpose The term of pyogenic liver abscess means an infection and
pus collection, sometimes with air bubbles content, in liver parenchyma.
Liver abscess may rupture spontaneously when disease progresses.
Pneumoperitoneum is a rare complication of ruptured gas-containing liver
abscess mimicking perforated hollow organ. Herein we report a case of
ruptured gas-containing liver abscess with pneumoperitoneum and review
the literature.
Results A 57-year-old man with diabetes mellitus was admitted to our
hospital for high fever for 7days and sudden onset abdominal pain.
Laboratory data showed leukocytosis, abnormal liver function test and
hyperglycemia. The chest radiography revealed pneumoperitoneum
the next day. At emergent laparotomy, there was no definite hollow
organ perforation except massive purulent ascites and adhesion
between intestine. Then abdominal CT was arranged and showed a
big gas-containing abscess in right lobe of liver. Thereafter he received
Purpose To compare the ability of detecting renal artery stenosis using
non contrast inflow inversion recovery MR angiography and gadolinium
enhanced MR angiography.
Methods From April to September in 2009, totally 90 patients received
MR angiography to rule out renal artery stenosis due to secondary
uncontrolable hypertension. We excluded patients who had eGFR
less than 30 ml/min; 60 patients with eGFR >30 ml/min underwent
IFIR MR angiography before the contrast-enhanced MR angiography.
Retrospective analysis the MR angiography image qaulity by two
radiologists independently determined the rating. The image qaulity was
evaluated by using original images and 3D reconstruction images for the
renal artery. The point was rated on a 5 point scale: 5 indicated excellent
demonstration of brances of renal artery, even include interlobular artery;
4 good demonstration of branches of renal artery (including segmental
artery, but not interlobular artery); 3 well demonstration of major branches
of renal artery(not including segmental artery and interlobular artery); 2
fair demonstration of main renal artery only; 1 poor demonstration of renal
artery. All MR angiography examinations were performed with 1.5T (GE
signa HD excite) and IFIR research edition.
Results In the total 60 cases, we have 54 cases rate 5 in CEMRA; there
are 27 cases (50%) rate 5 on IFIR, 21 cases (39%) rate 4, 4 cases (7%)
rate 3 and 2 cases (4%) rate 2 due to IFIR technique failed. After we
exclude the 2 cases of failed IFIR, in 58 patients, 28 cases (48.3%) have
same image quality between IFIR and CEMRA. There was no significant
difference in the image qaulity between IFIR and CEMRA (p<0.05).
Conclusions IFIR MR angiography is a good alternative method for
detection of renal artery stenosis comparable with contrast-enhanced
MR angiography. Therefore, IFIR MR angiography can replace contrastenhanced MR angiography in detection of renal artery stenosis regardless
of the renal function.
Keywords Kidney, Angiography, MR, Contrast Agents
AB108
CT Anatomy of Splanchnic Artery: Anatomical Variations on
Angiography and Cross Sectional Anatomy
Noboru Terayama, Ryoichi Kamimura, Keiko Kobayashi
Department of Radiology, Takaoka City Hospital, Japan
Purpose With advances in multidetector-row CT (MDCT), thinner slice
acquisition resulting in better depictions of vasculature in the abdomen.
3D-CT angiography has been shown to be an alternative to catheter
angiography for evaluation of the ramifications of arteries. Meanwhile,
cross sectional CT images are essential for evaluation of the anatomical
relation between arteries and visceral organs.
Methods We provide the overview of the angiographic variations of the
splanchnic arteries and describe the cross sectional anatomy of the
splanchnic arteries.
Results In normal anatomy, the common hepatic (CHA), splenic (SA)
and left gastric arteries (LGA) arise from the celiac artery (CA). CHA runs
along the upper border of the pancreas and in front of the portal vein
(PV). In cases with a common trunk of CA and superior mesenteric artery
(SMA) (celiacomesenteric trunk), and those with SA arising from SMA
(splenomesenteric trunk), CHA shows a similar course to that in normal
anatomy, but in cases with CHA arising from SMA (hepatomesenteric
trunk), CHA may run behind PV similar to the replaced right hepatic
artery or in front of PV, passing over the head of pancreas, below it, or
penetrating it. In most cases with CHA, SA and SMA arising from the aorta
separately, CHA runs in front of PV. In cases with splenomesenteric trunk,
SA runs postero-superior to the pancreas showing a marked tortuosity
similar to that in normal anatomy. Its first bend is close to CHA and it often
resembles that in normal anatomy. In cases with CHA replaced to the
LGA, CHA runs along the hepatogastric ligament toward the left side of
the hepatic hilus like the replaced left hepatic artery.
Conclusions MDCT is useful to understand the relation between the
splanchnic arteries and the adjacent organs in each anatomical variation.
Keywords Angiography, Arteries, CT
AB110
Acute Occlusion of Abdominal Aorta and Superior Mesenteric
Artery: Demonstrated on Multislice Computed Tomography
Chien-Ta Chen¹, Ruay-Shyang Wang²
¹Department of Radiology, YongKang Veterans Hospital, Taiwan
²Department of Internal Medicine, YongKang Veterans Hospital,
Taiwan
Purpose We present a rare case of acute occlusion of abdominal aorta
and superior mesenteric vein, manifested with acute onset of abdominal
pain.
Methods An 83-year-old male patient was admitted due to bilateral
lower leg edema and mild azotemia. He received diuretic therapy during
admission with gradual resolution of leg edema. Sudden-onset of
abdominal pain occurred on 4th day of admission and deterioration of
renal function were noted. Then he was sent for CT scan evaluation.
Results Multi-slice CT scan with coronal, sagittal and 3-dimensional
reconstruction showed complete occlusion of abdominal aorta below
the level of renal arteries, complete occlusion of superior mesenteric
artery, partial occlusion of renal arteries and foci of renal infarcts. Then
the patient was immediately transferred to medical center for vascular
thromboembolectomy.
Conclusions Acute occlusion of abdominal aorta and superior mesenteric
artery is an extremely rare and catastrophic disease. Multi-slice CT scans
can promptly demonstrate intra-abdominal vascular occlusive disease and
urge early surgical intervention.
Keywords Acute, Aorta, Arteries, Embolism/Thrombosis
percutaneous abscess drainage and recovered gradually.
Conclusions Pyogenic liver abscess occasionally contains air and occurs
with comorbid illness such as diabetes mellitus. Escherichia coli and
Klebsiella pneumoniae, which fermentate glucose and generate carbon
dioxide, are the common pathogens of gas-containing liver abscess.
Spontaneous ruptured gas-containing liver abscess may present as
sudden onset abdominal pain with muscle guarding and chest radiography
revealed subdiaphragm free air. Abdominal CT is needed for evaluating
the extent of complications of ruptured liver abscess. We should keep in
mind that pneumoperitoneum may be secondary to ruptured gas-contain
liver abscess rather than perforated viscus.
Keywords Abscess, Liver
E-Poster
AB092
Accuracy and Time-Efficiency of 3D Computed Tomography
Colonography of Pig Phantoms: Conventional 3D versus
New Panoramic 3D Interpretation
Joon-Il Choi1, Se Hyung Kim2, Byung Ihn Choi2, Joon Koo Han2,
Seung Ho Kim2, Hee-Sun Park3, Jeong Min Lee2, Jae Young
Lee2
1
Department of Radiology, National Cancer Center, Korea
2
Department of Radiology, Seoul National University, Korea
3
Department of Radiology, Konkuk University Hospital, Korea
Results We encountered 2 cases (a 74-year-old woman and a 61-yearold man) of primary T-cell lymphoma of the small intestine. The initial
presentation were abdominal fullness and leukocytosis. CT revealed
encapsulated fluid and extraluminal gas collection. Exploratory
laparotomy, segmental enterectomy and drainage performed. Grossly
there were multiple diverticulum like ulcer lesions in small bowel wall.
Microscopically T-cell lymphoma involved whole thickness of intestinal
wall with focal penetration.
Conclusions Primary T-cell lympoma of small intestine should be included
in differential diagnosis of hollow organ perforation with intraabdominal
abscess formation.
Keywords Abscess, Lymphoma, CT, Small Bowel
AB115
Intraabdominal Heterotopic Ossification after Appendectomy
Mimic Undescended Testiculr Tumor -A Rare Case Report
Ruey-Sheng Chang
Department of Medical Imaging, Chia-Yi Christian Hospital,
Taiwan
Purpose Heterotopic ossification (HO) is abnormal formation of bone
outside the skeletal system. It is a well-known and extensively described
complication following total hip arthroplasty and chronic immobilisation.
Intraabdominal HO is a rare sequela of abdominal surgery may be easily
misdiagnosed. Only a few previous reports have been described in the
literature. Here, we describe a patient in whom mesenteric HO was
diagnosed after appendectomy.
Methods A 20-year-old man who underwent appendectomy 3 years ago.
He came to help due to right undescended testicle with palpable mass at
right lower abdomen.
Results Plain radiography and CT imaging showed peripheral calcified
or mineralzied soft tissue mass with puntate mineralization. Explorative
laparotomy excision was perfomred for this lesion and heterotopic
ossification was diangosed by pathologic findings.
551
Others
regions caused by the image noise. Then we have assumed that the
shape of hepatic vessels was similar to a line or cylinder, so a method that
can extracted the feature of line or cylinder components maybe useful
for hepatic vessel enhancement. And we employed a line-enhancement
method based on Hessian matrix on likelihood image, and generated a
vessel enhanced image.
Results The efficiency of the method was confirmed using 5 normal liver
cases of non-contrast X-ray torso CT images. The preliminary results
show that the proposed approach achieves the success in all cases
visually.
Conclusions We proposed an automated method to enhance hepatic
vessel trees in non-contrast X-ray CT images. And the effectiveness was
confirmed in 5 cases with normal liver.
Keywords Anatomy, Liver, CT, Veins
Purpose Fibrous disease of the breast (including diabetic mastopathy)
is a rare, benign lesion. Pathological diagnosis by biopsy is necessary,
because it is difficult to differentiate such lesions from carcinoma based
solely on imaging findings. This study retrospectively reviewed the image
findings of fibrous disease of the breast, and examined the characteristic
findings in order to clarify the differentiation from carcinoma.
Methods Six lesions (5 patients; age range, 65-74 years) with
pathologically confirmed diagnoses were evaluated. Imaging findings on
mammography and ultrasonography were analyzed. Additionally, magnetic
resonance (MR) image findings were analyzed for signal intensity relative
to surrounding breast tissue and enhancement pattern on dynamic study.
Results All lesions showed areas of asymmetric density on mammogram.
Ultrasonogram showed ill-defined hypoechoic lesion in all, with marked
acoustic shadow in 2 lesions. All lesions showed areas of isointensity
on T1-weighted images, hypointensity on T2-weighted images, and
an absence of abnormal intensity on diffusion-weighted MR images.
On dynamic contrast enhancement, these lesions showed very poor
enhancement in 3 cases, gradual enhancement in 3 cases.
Conclusions T2-weighted MR images and a dynamic enhancement
pattern that may be caused by abundant fibrosis are considered useful for
characterizing fibrous disease of the breast. Furthermore, the absence of
apparent abnormality on diffusion-weighted MR image may be useful for
differentiation from carcinoma.
Keywords Mammography, MR, Ultrasound
BR007
Ductal Carcinoma in Situ in 58 Cases from the Diagnostic
Group: Review the Clinical Presentations and the
Mammographic Findings
Ho Eo Tung, Chin Yin Sheu, Ng Suk Ping, Fei Shih Yang
Purpose We retrospectively analysed the clinical presentations and the
mammographic findings of ductal carcinoma in situ (DCIS) of the breast
from diagnostic group in our hospital from 2003 to 2005.
Methods We retrospectively analysed the clinical presentations and the
mammographic findings from diagnostic group in our hospital from 2003
to 2005.
Results In our diagnostic database, 79.3 % were clinically presented
with palpable masses and 15.5% presented with unilateral bloody nipple
discharge. 41 of the 58 cases underwent mammographic examination and
51 % of them demonstrated microcalcifications.
Conclusions In our diagnostic database, 79.3 % of the DCIS patients
presented with palpable masses. Careful self-examination of the breasts
or physical examination by clinical doctors are both very important. Two
special forms of DCIS are noted associated with well-defined masses (eg.
intracystic tumor or fibroadenoma) mammographically. And,non-calcified
DCIS is very difficult to diagnose mammographically.
BR009
Radiological Evaluation of Palpable Breast Masses during
Pregnancy and Lactation
Iman Hosny
Department of Radiodiagnosis women imaging, Faculty of
medicine Cairo university, Egypt
Purpose The goal in evaluating new breast masses during pregnancy and
lactation is appropriate diagnosis and confident exclusion of carcinoma by
the least invasive and most reliable means possible.
Methods The study group included 48 patients with palpable breast masses
552
BR010
Incidental Breast Abnormalities at Contrast-Enhanced
Computed Tomography of Chest
Wen-Chiung Lin¹, Hsian-He Hsu1, Chao-Shiang Li2, Giu-Cheng
Hsu1, Guo-Shu Huang1
1
Department of Radiology, Tri-Service General Hospital and
National Defense Medical Center, Taiwan
2
Department of Radiology, Renai Branch, Taipei City Hospital,
Taiwan
Purpose To evaluate the imaging appearance of incidentally detected
enhancing breast abnormalities on routine contrast-enhanced chest CT,
and to assess the detectability of these lesions on unenhanced CT.
Methods wenty-three patients with incidental breast lesions on contrastenhanced chest CT were included. The breast lesions were reviewed in
both unenhanced and enhanced CT; and locations, margins, enhancement
patterns were evaluated. Breast density was determined at unenhanced CT
using a four-point scale similar to that of mammography. Histopathologic
diagnosis or long-term follow-up served as reference standard.
Results Sixteen patients had malignant breast tumors and seven had
benign lesions. Thirteen (57%) cases were detected on unenhanced
CT; enhanced CT detected all of 23 cases. With unenhanced CT, breast
lesions were prone to be obscured in patients with dense breast (P=0.036)
or breast lesions located in fibroglandular tissues (P<0.001). Margins and
enhancement patterns were not reliable to distinguish malignant from
benign breast lesions (P>0.05).
Conclusions Contrast-enhanced CT may be better in demonstrating
the incidental breast lesions than unenhanced images. Dedicated breast
imaging will often be required for definitive diagnosis.
Keywords Metastases, Breast Calcifications/Calculi, Neoplasms-Primary, CT
BR011
Imaging Spectrums of the Male Breast Diseases
SeonHyeong Choi1, Hey Jeong Kim2, Soo Young Chung2
1
Department of Radiology, Kangbuk Samsung Hospital, Korea
2
Department of Radiology, Hallym University Medical Center,
Korea
Purpose To illustrate ultrasonographic and mammographic findings of
male breast disease
Methods We retrospectively reviewed total 150 cases of male breast
disease from March 2004 to June 2009. There were 147 of ultrasound
and 28 cases of mammography. Among them, 71 patients were surgically
confirmed.
Results There were various disease entities in our cases but male breast
cancer was only one case (1.4%, 1/71). The most common disease was a
gynecomastia (n=39) and the next followed one was a fibrocystic changes
(n=13). There were also a fibroadenoma, a granulomatous mastitis and
a cavernous hemangioma in our cases. They showed various imaging
spectrums on US and mammography.
Conclusions All imaging of the male breast is diagnostic unlike in
female and the reported prognosis of male breast cancer was poor due
to delayed diagnosis. Therefore, radiologists should be aware of the
characteristic imaging findings of various conditions in male breast and it
can help to correctly diagnose and to reduce additional biopsies.
Keywords Mammography, Breast Calcifications/Calculi, Emangioma,
ltrasound
BR015
Additional View: How and When to Use
SeonHyeong Choi1, Yu Jin Oh2, Soo young Chung2, Eun-Kyung
Kim3
1
Department of Radiology, Kangbuk Samsung Hospital, Korea
2
Department of Radiology, Hallym University Medical Center, Korea
3
Department of Radiology, Yonsei University College of Medicine,
Korea
Purpose To review various additional views in mammography and show
how and when to use correctly.
Methods Reviewed the variable types of additional views, their
techniques, benefits, clinical applications, and how to interpret the results.
Results There are various additional views: spot compression and
magnifications view, true lateral view, exaggerated cranio-caudal view,
cleavage or valley view, tangential view, axillary tail view, rolled view, and
implant displaced view.
Conclusions There are various additional views in mammography and
these are very useful to confirm and characterize the lesion, assess the
disease extent, and to localize the exact location. Therefore, radiologists
should know how and when to use them correctly.
Keywords Anatomy, Localization, Mammography, Digital Radiography,
Screening
BR016
Synoptic Reportingof Breast Imaging in Australia
Felicity Pool1, Mary Rickard2, Jane Grimm1, Caroline Nehill3
1
Department of Quality Use of Diagnostic Imaging program,
Royal Australian and New Zealand College of Radiologists,
Australia
2
Department of Radiologist, The Sydney Breast Clinic, Australia
3
Department of Program Manager, National Breast and Ovarian
Cancer Centre, Australia
Purpose The Synoptic breast imaging report is a checklist of critical
content items required by breast imaging reports, particularly when there
are significant lesions requiring further investigation or follow-up. It was
initially developed in Australia in 2002 by the National Breast and Ovarian
Cancer Centre (NBOCC) using the best available published evidence,
and has been endorsed by the Royal Australian and New Zealand
College of Radiologists (RANZCR). To date, use of the synoptic report
has been limited, particularly by radiologists in private practice. The 2008
(Australian) National Health and Medical Research Council-National
Institute of Clinical Studies (NHMRC NICS) RANZCR NBOCC Fellowship
(in progress) aims to increase the uptake of the report in a group private
practice setting in Sydney and regional New South Wales, Australia.
Methods Two surveys were carried out during 2008 to define barriers and
enablers to the uptake of the report. The first, among radiologists at the
practice, examined attitudes and knowledge about breast imaging reports
in general and the synoptic report in particular. The second, among key
referrers for breast imaging examined preferences with regard to the style
and content of reports.
Results The evidence supporting the Synoptic breast imaging report
will be briefly reviewed. Radiologists supported the content items of the
synoptic report, but were unlikely to use it because of lack of familiarity
and problems accessing suitable proformas on the computer system.
There were also concerns about increasing workload, loss of nuance
and referrer reactions. A majority of referrers favoured of reports which
presented critical data in tabulated form.
553
Purpose The aim of this study was to describe the diffusion-weighted
imaging (DWI) findings of pancreatic cancer.
Methods Sixty-one patients with pancreatic cancer and 31 subjects
with normal imaging findings were included in the study. All patients and
subjects underwent fat-suppressed single-shot echo-planar DWI in the
transverse plane with diffusion gradients (b=1000 s/mm2) and without
diffusion weighting (b=0 s/mm2). We evaluated imaging findings of DWI
and measured the apparent diffusion coefficient (ADC) value within the
pancreatic cancer, tumor-associated chronic obstructive pancreatitis, and
normal pancreas.
Results In 35 of 61 patients (57.4 %), pancreatic cancer was shown as
hyperintensity relative to the surrounding pancreas (type 1). Seventeen
pancreatic cancers (27.9 %) were hyperintense, but the proximal
pancreas to the pancreatic cancer showed hyperintense owing to the
tumor-associated chronic obstructive pancreatitis. Therefore, the proximal
border of the pancreatic cancer was unclear (type 2). Five pancreatic
cancers (8.2 %) were iso-intense (type 3) and 4 (6.6 %) were hypointense
(type 4) because of the surrounding hyperintense pancreas with tumorassociated chronic obstructive pancreatitis. The mean ADC value of
pancreatic cancer was 1.11±0.19 x 10-3 mm2/s, which was significantly
lower than those of the tumor-associated chronic obstructive pancreatitis
(1.23±0.22 x 10-3 mm2/s, P <0.05) and the normal pancreas (1.36±0.14 x
10-3 mm2/s, P <0.0001). In 26 pancreatic cancers (type 2, 3, and 4), there
was no significant difference of ADC value between the pancreatic cancer
and tumor-associated chronic obstructive pancreatitis (1.16±0.20 x 10-3
mm2/s vs 1.21±0.24 x 10-3 mm2/s, P=0.24).
Conclusions It was difficult to distinguish pancreatic cancer from
the tumor-associated chronic obstructive pancreatitis in 36.1% of the
pancreatic cancers, and 6.6% of pancreatic cancers were hypointense on
DWI.
Keywords Pancreas
BR006
Fibrous Disease of the Breast; Imaging Findings
Yuki Hattori, Mikoto Nakagawa, Hitoshi Abo, Hiroshi Demachi
Deptment of Radiology, Toyama Prefectural Central Hospital,
Japan
during pregnancy and lactation. All masses were investigated clinically as
well as by Ultrasound. When Ultrasound demonstrated a suspicious lesion,
a mammogram in oblique view was done .For highly suspicious lesions and
in 1 case of suspected bilateral gigantomastia, bilateral mammography was
performed. When clinical course, Ultrasound and mammography could not
rule out breast cancer, MRI of the breast was done.
Results Ultrasound showed a well defined lesion categorized as BI-RADS
2 in 25 cases, a probably benign lesion classified as BI-RADS 3 in 20
cases, 2 lesions suspected of malignancy as BI-RADS 4 and one highly
suspicious lesion classified as BI-RADS 5. In 12 cases, mammography
was done. MR breast was done in 4 lactating patients, classified as BIRADS 3, 4, and 5 by Ultrasound and mammography. Tru-cut biopsies
were done in 21 cases.
Conclusions Ultrasound is the most important tool in investigating
patients with a palpable breast mass in pregnancy and lactation.
Mammography should be done only in cases with suspicious palpable
mass. MR mammography shows limitation in the lactating period with
often high enhancement and high false positives, and of course biopsy is
the gold standard for definitive diagnosis.
Keywords Mammography, MR, Ultrasound, Interventional
E-Poster
AB116
Diffusion-Weighted Imaging Findings of Pancreatic Cancer
Yoshihiko Fukukura
Department of Radiology, Kagoshima University Graduate
School of Medical and Dental Sciences, Japan
Others
Conclusions Heterotopic ossification is a very rare entity. It can easily be
misdiagnosed and may lead to serious complications. Nevertheless, in the
differential diagnosis of intraabdominal densities after abdominal surgery
or trauma, heterotopic ossification should be considered and distinguished
from dystrophic calcification and ossifying neoplasms.
Keywords Appendix, Mesentery, CT, Surgery, Trauma
BR018
Benign or Malignant Microcalcifications on Mammography:
Are You Sure about Your Diagnosis?
Ok Hee Woo¹, Yoon Kyung Kim1, Kyu Ran Cho2, Bo Kyeung
Seo3, Eun-Young Kang¹, Hwan Seok Yong¹
1
2
Department of Radiology, Korea University Anam Hospital,
Korea
3
Department of Radiology, Korea University Ansan Hospital,
Korea
BR021
Role of MRI and US-Guided Core Biopsy in Diagnostic
Evaluation of Papillary Breast Lesions
So Mi Lee, Kyung Min Shin, Hye Jung Kim, Jong Min Lee, YunJin Jang
Department of Radiology, Kyungpook National University
Hospital, Korea
Purpose The purpose of this exhibit is to review and illustrate the
mammographic features of benign and malignant breast microcalcifications
and to analyze the correlation between microcalcifications and
histopathological findings in a wide variety of breast lesions.
Methods We reviewed mammographic characteristics of breast
microcalcifications and classified according to ACR-BIRADS. We
correlated radiologic findings with pathologic findings of breast
microcalcifications.
Results Morphologies and distributions that typically are benign and
highly suggestive of malignancy usually offer little or no problem for
management. However, there are shapes and distributions of calcifications
that are difficult to detect, characterize, and manage.
Conclusions Knowledge of the diverse features of microcalcifications
in benign and malignant breast lesions is of consequence to make
a correct diagnosis. This exhibit will be refreshment for experienced
mammographers and an introductory lesson to the resident.
554
Purpose To evaluate the usefulness of MRI in the management of benign
papillary lesions diagnosed at US-guided core biopsy (USCB)
Methods Among 45 papillary lesions diagnosed at USCB in 40 patients,
27 benign papillary lesions including 5 atypical papillary lesions in 22
patients who underwent breast MRI were reviewed. MRI findings were
considered suspicious if there were irregular, rim enhancement, or linear
enhancement in morphologic evaluation, or washout enhancement pattern
of delayed phase in dynamic enhancement characteristics. Diffusion
weight image were analyzed according to visibility. MRI findings were
correlated with pathologic results at excisional biopsy.
Results A total of 27 benign papillary lesions at USCB, 21 lesions (78%)
were diagnosed benign, 6 (22%) were malignant at excisional biopsy.
Eighteen lesions in 16 patients were detected on MRI. Sixteen lesions
showed suspicious findings on MRI, of those, 11 lesions (69%) were
diagnosed benign, 5 (31%) were malignant at excisional biopsy. On
diffusion weighted image, 12 lesions were detected, of those, 10 lesions
were diagnosed benign, 2 were malignant at excisional biopsy. MRI findings
including diffusion weight image were not significantly correlated with
pathologic results at excisional biopsy. Two lesions (9%) were diagnosed
BR023
Gauzoma of the Breast: A Case Report
Ching-Lan Wu, Chui-Mei Tiu, Yi-Hong Chou
Taiwan
Purpose Gauzoma, which is gauze fiber contained mass lesion, is a rare
iatrogenic condition may be mimicking neogrowth. This intraoperative
complication represents a diagnostic problem for radiologists besides
being a medico-legal problem for surgeons.
Methods We discuss the image appearance and differential diagnosis.
Results We reported the rare case, a 71-year-old female, who had a
gauzoma in left breast for years after breast surgery, which initial present
in a bizarre condition causing difficulty in clinical and radiology diagnosis.
Conclusions In conclusion, the gauzoma should always be included in
the differential diagnosis of a mass in the breast, especially in patients
with a previous history of breast surgery.
Keywords Breast Calcifications/Calculi, Ultrasound
Radiological, Chang Gung University, Taiwan
3
Department of Biomedical Engineering and Environmental,
National Tsing-Hua University, Taiwan
Purpose The death rate of breast cancer was 5.0 people per 100,000 in
1996, 9.5 people in 2001, and 12.8 people in Taiwan. The increasing death
rate results in the increasing frequencies of mammography examinations.
The current study analyses of the mammography examination frequency
and the corresponding mammography annual per caput effective dose in
Taiwan. Such data are compared to results obtained in UK.
Methods The frequency of mammography examinations was inspected
from the database of National Health Insurance (NIH) in Taiwan. To obtain
the average projections of examinations, a survey of mammography
procedures was conducted in 2007. Applying appropriate conversion
factors from the mean glandular dose (MGD) to the effective dose, the
annual per caput effective dose was estimated for the mammography
examinations using MGD data in Taiwan.
Results A total of 127,155 mammography examinations were performed
in 2006. This is equivalent to 5.6 mammography examinations per 1000
population in Taiwan, comparable to 29.3 mammography examinations
per 1000 population in UK in 2003. The survey shows 3.7 view projections
for each mammography in average. The collective effective dose was
evaluated as 66.3 mSv.
Conclusions Results The frequencies of mammography examinations
were 5.6 per 1000 people in 2006. It is eight folds of 0.7 mammography
examinations per 1000 people in Taiwan in 1993. The annual per caput
total effective dose of mammography examinations was estimated to be
0.029 mSv in Taiwan in 2006. This number is smaller than 0.0079 mSv in
UK in 2003.
BR045
Retake Analysis in Digital Mammography
Szu-Ching Weng, Min-Szu Yao, Wing P. Chan
Purpose The purpose of this study was to determine the underestimation
rate of ductal carcinoma in situ (DCIS) at sonographically guided
14-gauge core needle biopsy of the breast and to investigate the factors
associated with underestimation.
Methods We retrospectively reviewed 2990 lesions consecutively
evaluated with sonographically guided 14-gauge core needle biopsy
between January 2005 and December 2008. Among them, 61 lesions
were pathologically proved to be DCIS (2.04%). A total of 51 DCIS lesions
underwent surgical resection were included in this study. After surgery,
the lesion proved to be invasive was defined as underestimated DCIS.
We retrospectively reviewed and compared the clinical, pathologic, and
radiologic features of underestimated DCIS and accurate diagnosed DCIS.
Results The underestimation rate of DCIS was found to be 27% (14 of
51 lesions). The underestimation of DCIS was significantly frequent in a
clinically palpable lesion (78% vs 30%, p=0.002). The sonographically
maximal diameter of lesion was significantly larger in underestimated
DCIS than accurate diagnosed DCIS (2.84 ±± 1.40 vs 1.76 ±± 1.03,
p=0.005). There was no significant difference between accurate diagnosed
DCIS and underestimated DCIS in terms of age, lesion type, BI-RADS
category, presence of calcification, or pathologic features.
Conclusions For sonographically guided 14-gauge core needle biopsy
of the breast, the underestimation rate of DCIS was 27%. The size and
clinical symptom such as palpation were the factors associated with
underestimation of DCIS.
Keywords Biopsy, Ultrasound
Purpose Contrast-enhanced (CE) MR imaging was used to monitor
the response of neoadjuvant chemotherapy (NAC) in breast cancer
patients. The purpose of our study is to assess the role of breast MRI in
the evaluation of NAC outcome by correlating MR image findings with
histopathological response according to hormonal status.
Methods Between March 2005 to February 2009, 47 consecutive patients
who received surgical treatment for primary breast cancer after receiving
neoadjuvant chemotherapy (NAC) were reviewed. CE MRI before and
after NAC were available in 42 patients. The 42 patients were devided
into either a ER positive group, a HER-2 positive group or a triple negative
group (ER, PR and HER-2). Two radiologists assessed the response to
chemotheraphy using CE MRI images on consensus.
Results In total, 42 patients with 48 breast cancers were studied. The
mean lesion size was 3.6 cm (range 1.3-10.5 cm). Tumor characteristics
showed as follows: histologic grade 3 (62%): ER positive (29%): HER-2
positive (48%): triple negative (23%). Histopathologically response was
as follows: complete response (CR) 29%; partial response (PR) 58%; no
response (NR) or disease progression 13%. MRI diagnosed 20 cases with
complete response, and the accuracy for predicting CR was (7/12, 58%)
in ER positive, (6/6, 100%) in HER-2 positive, and (1/2, 50%) in triple
negative cancer. There was agreement between CE MRI findings and the
pathology finings in 38 out of 48 lesions (79%).
Conclusions CE MRI of breast cancer proved to be a reliable method
in predicting histopathological response to neoadjuvant chemotherapy.
Complete response determined by MRI was highly correlated to CR in
Her-2 positive patients, but had a high false-positive rate in ER positive
and triple negative cancer patients.
Keywords MR, Neoplasms-Primary
malignant at excisional biopsy in 22 benign papillary lesions without atypia
by USCB and 4 (80%) were malignant at excisional biopsy in 5 benign
papillary lesions with atypia by USCB. The pathologic results of USCB were
significantly correlated with malignancy at excisional biopsy ( p = 0.004).
Conclusions MRI is not useful diagnostic tool to predict malignancy in benign
papillary lesions diagnosed at USCB and USCB allows for correct diagnosis
in the majority of papillary lesions. However, benign papillary lesions without
atypia at US guided core biopsy may warrant excisional biopsy.
Keywords Biopsy, MR
E-Poster
BR017
Underestimation of Ductal Carcinoma in Situ at Sonographically
Guided 14-Gauge Core Needle Biopsy of the Breast
Hyo Soon Kim, Se Hee Jung, Jin Gyoon Park, Heoung Keun Kang
Department of Radiology, Chonnam National University Hwasun
Hospital, Korea
BR019
The Effect of Neoadjuvant Chemotherapy in Breast Cancer:
Correlation of MR Imaging and Histopathological Response
according to Hormonal Status
Ok Hee Woo¹, Yoon Kyung Kim1, Kyu Ran Cho 2, Bo Kyeung
Seo3, Eun-Young Kang¹, Hwan Seok Yong¹
1
2
Department of Radiology Korea University Anam Hospital,
Korea
3
Department of Radiology Korea University Ansan Hospital,
Korea
Purpose To analysis cause of retake films in digital mammography and
evaluate diagnostic values of retake films.
Methods We reviewed records of retake films obtained in mammography
room between July and November 2008. Retake digital mammography
(General Electric Senographe 2000D) was classified into suboptimal
positioning, motion artifacts, incomplete tumor illustration. Retake films
were re-interpreted by two experienced radiologists, and consensus of
reading was reached in a joint meeting.
Results A total of 48 out of 1605 patients (0.76%) retook mammography.
Of these 48 patients (49 films), suboptimal positioning accounted for
33 films (68%), 20 patients (20 films) out of 1468 people (5872 films)
were taken by senior radiologic technologist with two-year experience
in mammography, accounting retake rate of 0.3%, whereas 13 patients
(13 films) out of 134 people (536 films) were taken by less experience
technologist with 6 –month experience, retake rate of 2.3%. The less
experience technologist received continues training in an assigned training
center, the retake arte reduced to 1.02% (45/1086 people between March
and May, 2009). The additional average radiation dose was 5.45mGY to
each patient.
Conclusions The major cause of retake films in digital mammography
is suboptimal positioning by less experience technologist. Continuous
training remains an effective method to reduce the retake rate.
Keywords Mammography, QA/QC
Others
Conclusions Radiologists support synoptic report content but face
barriers with systems and familiarity. Referrers support the synoptic report.
The survey results have been used to develop implementation strategies
to promote use of the report.
Keywords QA/QC
BR046
Population Effective Dose from Mammography Examinations
in Taiwan
Chi Hsiang Hsu1, Chuan-Jung Tung2, Tou-Rong Chen2, Chih-Yang
Yeh2, Chin-Hua Yang3, Ting-Wei E2, Yi-Ju Ho2, Chun-Ching Wang2
1
Department of Radiology & Community Medicine, JenAi Hospital, Taiwan 2 Department of Medical Imaging and
555
CA010
High Specificity for Alzheimer’s Disease Diagnosis by Using
an Easy-Extractable Morphological Features in an Magnetic
Resonance Image Based Classification Framework
Hsiang Yang Ma1, Jiun-Jie Wang2, Jiann-Der Lee1, Yau-Yau Wai3,
Wen-Jun Hsu4, Hon-Chung Fung4
1
Taiwan
2
3
Department of Medical Imaging & Intervention Chang Gung
4
Department of Medical Imaging & Neurology, Chang Gung
Purpose To distinguish patients of Alzheimer’s Disease from normal
individuals in a Magnetic Resonance Image based classification
framework by using an easy-extractable volume and shape features.
Methods Twelve patients, diagnosed as probable AD (5 male, 7 female,
aged 69.8±4.3 years), were included. The diagnosis was based criteria
from the National Institute of Neurologic, Communicative Disorders
and Stroke-AD and Related Disorders Association. Fourteen normal
controls (7 males, 7 females, aged 63.1±5.7 years) were recruited from
local community. T1 weighted MPRage sequence with whole-brain
coverage was obtained from a 3T MR scanner with the following imaging
parameters (TR/TE =2000/2.63 ms, voxel size of 1 * 1 * 1 mm 3). All
MR images were normalized to an MNI152 template. Brain tissue was
subsequently segmented into GM, WM, CSF and ventricle in Statistical
Parametric Mapping 5 (Wellcome Trust centre for neuroimaging).
Clustering analysis was performed in support vector machine (LIBSVM,
National Taiwan University) using a leave-one-out trial, with the following
input features: 3D volume and 13 2D shape features, such as Circularity
Width/Height ratio and perimeter.
Results The combined features that provide atrophy information and
show statistically discriminative power (p <0.05) included the following:
556
Purpose There are different types of white blood cell (WBC) in human
blood. Doctors can use the information of the proportion of counts of
different types of WBC to diagnosis diseases. However it takes a lot of
time to perform WBC classification by manual. This paper presents an
automatic approach to increase the performance of WBC processing.
Methods The proposed method retrieves the characteristics of cell
and nucleus from white blood cells and then uses these characteristics
to classify white blood cells into: Neutrophi, Eosinophil, Monocytes,
Lymphocytes and Normoblast. The first step is to segment the nucleus in
white blood cells by K-means clustering, and then uses these sub-images
to calculate the characteristics. Label each nucleus of 8-connected
component, and take the component whose area is smaller than 10 as
noise and remove each of them. The next step is to calculate the chain
code sequence of all components. After gathering the statistics of the
numbers of every direction of chain codes in all of the sequence, sum up
each result of the statistics and then calculate the average and difference
to become the first characteristic. Then calculate the area of the nucleus
and white blood cell, and these values become the second and the third
characteristic, respectively. Finally, we classify the values by support
vector machine.
Results The experumental results show that the features using nucleus
and cell can achieve a good classification rate above 83%.
Conclusions The proposed method can classify different types of white
blood cells accurately and decrease the time of WBC Differential Count in
order to be more efficient.
Keywords Computer Applications, Segmentation, Image Manipulation/
Reconstruction
CA015
Current Status of Reformatted 3D Dental Computed
Tomography (CT): 3-Year Experience in Chung Shan Medical
University Hospital
Ming Change Ku, Teng-Fu Tsao, Yen-Sheng Tyan
Department of Diagnostic Radiology, Chung Shan Medical
Purpose Multidetector computed tomography (MDCT) has been used
widely in recent years. The axial and the reformatted images of MDCT
have created not only a new modality for viewing the jaw but also a
new partnership between dentists and radiologists. The purpose of this
retrospective study is to evaluate the role of reformatted 3D dental CT in
the jaw disease.
Methods All the 3D dental CT scans in our department in the past 3
years (from October 2006 to September 2009) were reviewed. The postprocessing 3D reformations we used included multiplanar reconstruction,
3D volume rendering, cross-sectional image, and CT panoramic view. We
CA017
Automated Mass Detection Method on Mammograms:
Reduction of False Positives Using Higher Order Local
Autocorrelation Feature in Plural Mammograms
Yuji Hatanaka¹, Hiroshi Fujita²
¹Department of Electronic Systems Engineering, The University
of Shiga Prefecture, Japan
²Department of Intelligent Image Information, Gifu University,
Japan
Purpose The purpose of this study is to improve the masses detection
method on mammograms using the false positives (FPs) reduction
method. I have been developing a masses detection method, but our
method was not able to reduce enough number of FPs. The tissues of
right and left mammograms are similar when their breasts are normal,
thus we compared similarity of both mammograms. In this study, we
used the higher order local autocorrelation feature (HOAF) as similarity
of both mammograms, and we developed the reduction of the mass false
positives using its similarity.
Methods The FPs were first reduced by comparing right and left
mammograms. Both mammograms were aligned by both nipples. Here,
the nipples were determined by the shapes of the pectoral muscle regions
and the skin lines. The mass candidate’s region and its symmetrical region
were drawn out from both mammograms. Then, HOAFs on both images
drawn out were calculated, the Euclid distance from two HOAFs was
determined as the similarity. If the similarity was high value, its candidate’s
region was determined as a mass.
Results I examined the false positives reduction scheme using 598 pairs
of mammograms, including 22 masses and 975 FPs. The number of false
positives per image was 0.81 when the true positive rate was kept 81%.
That cause was that the similarity of mass and the corresponding regions
showed high value, because our mass detection system could not extract
mass’s region correctly. Thus, I revised mass’s region manually, and I
tested this method. The 15% of FPs were removed without change of the
sensitivity.
Conclusions In this study, I presented new mass FPs reduction method
using HOAFs on right and left mammograms. In the feature, I will present
a new FPs reduction method using the similarity of masses on the
mammogram of MLO and CC.
Keywords Mammography, Computer Applications
CH005
Transthoracic CT Guided Fine Needle Aspiration of Lung
Lesions – Review of Local Experience
Kai Yan Kwok, Ka Man Chu, Sherman, Sheung Ming Lo, Tak
Shun To, Ting Lok Kwan
Department of Radiology & Imaging, Queen Elizabeth Hospital,
Hong Kong, China
Purpose The objective of this retrospective study is to review our
experience in transthoracic computed tomography (CT) guided fine needle
aspiration (FNA) of lung lesions. Immediate assessment for specimen
adequacy by pathologists is available in our institution, which is a tertiary
referral center in Hong Kong.
Methods Patients who experienced transthoracic CT guided FNA of lung
lesions between 1st March 2008 and 30th September 2008 were included
in this study. The clinical records, images of radiological investigations
and pathology reports of each patient were reviewed. The data collected
were analysed in three aspects: 1) the adequacy of specimen obtained by
CT guided FNA; 2) the accuracy of cytological diagnosis, with reference
to the clinical-radiological-pathological follow up of patients; and 3) the
complication rate of procedure.
Results Fifty lung lesions in fifty patients were included in this
retrospective study. Cytologically, 32 lesions (64%) were malignant, 14
lesions (28%) were inflammatory / non-malignant, 2 lesions (4%) were
inconclusive of malignancy or benignity, 1 lesion (2%) showed atypical
cells and 1 specimen (2%) was inadequate for diagnosis. The overall
adequacy of specimen was 98%. Upon clinical-radiological-pathological
follow up of the patients, 1 initially non-malignant lesion, 1 initially
inconclusive lesion and 1 lesion inadequate for diagnosis eventually
turned out to be malignant. The overall sensitivity of transthoracic CT
guided FNA of lung lesions to diagnose malignancy was 91.4%. Excluding
the inadequate, atypical and inconclusive specimens, the accuracy of
cytological diagnosis was 97.8%. The complication rates of pneumothorax
and hemoptysis were 28% and 6% respectively.
Conclusions Most of the specimens obtained by transthoracic CT guided
FNA of lung lesions are adequate for cytological analysis. This technique
has high sensitivity, high accuracy and limited complication rates in
diagnosing malignant lung lesions.
Keywords Lung, Biopsy, CT
CH006
Outcome of Embolization for Pulmonary Arteriovenous
Malformation with Patent Ductus Arteriosus Coil
Ryota Nishio¹, Kazuhiro Saito 1, Daisuke Hasegawa 1, Soichi
Akata1, Koichi Tokuyue1, Fumio Kotake2, Toru Saguchi3
1
Department of Radiology, Tokyo medical University, Japan
2
Department of Radiology, Tokyo medical University Ibaraki
medical center, Japan
3
Department of Radiology, Tokyo medical University Hachiozi
medical center, Japan
Purpose A Patent Ductus Arteriosus coil (PDA coil, COOK Inc.,
Bloomington, IN) is detachable and can be delivered through a 0.038
catheter. The PDA coil has high radial force and a high embolic effect;
therefore, it is considered to be useful for the embolization of pulmonary
arteriovenous malformation (AVM). We evaluated the outcome of
embolization for pulmonary AVM with a PDA coil, retrospectively.
Methods Patients with pulmonary AVMs, having feeding artery 2.5-4.5
mm diameter (mean ± standard deviation: 3.3±0.58), were eligible for this
study. We evaluated 5 patients with 10 AVMs. The procedure performed
for this study was feeding artery embolization by PDA at the nearest
venous sac. Therapeutic outcome was evaluated by CT at 1 month after
the procedure.
Results No complications occurred. One patient had an AVM with two
feeding arteries. On average, 1.2 of PDA coils and additional 2.2 of 0.0035
inch coils were used for the embolization of a feeding artery in an AVM. All
557
Purpose To compare 3D segmentation of liver based on a novel flipping
free mesh deformation method with existing segmentation methods.
Methods Segmentation of liver was performed on abdominal CT datasets
from eight subjects. The thickness of the CT slices were 1 to 3mm.
Segmentation was done with level set (LS) algorithm, Graph cut (GC)
and Flipping Free Mesh Deformation (FFMD) algorithms in all eight data
sets. Segmentation accuracy in terms of average symmetric distance and
volume overlap against the ground truth was computed and compared
between the three algorithm methods.
Results FFMD performed better than LS and GC with smaller average
symmetric disance (1.7 mm vs 10.3 mm and 10.5 mm) and larger volume
overlap (90% vs. 73% and 81.5%). The time required for segmentation
of liver was 55 seconds for FFMD with 43 iterations as against 476.3
seconds with 1051 iterations for level set. The execution time per slice is
only 0.42 seconds compared to 3.58 seconds for LS and 17.30 seconds
for GC methods.
Conclusions Algorithm is more accurate than level set and graft cut
methods and promising for segmentation of liver for clinical applications.
Keywords Liver, CT, Segmentation
CA012
Automatic Segmentation and Classification of White Blood
Cells Based on Mathematical Morphology and Chain Code
through Support Vector Machine
Hsien-Chu Wu¹, Yan-Bo Liao², Chiao-Min Chen²
¹Graduate School of Computer Science and Information
Technology, National Taichung Institute of Technology, Taiwan
²Department of Information Management, National Taichung
Institute of Technology, Taiwan
analyzed the images, referred information, radiological reports, pathologic
results, and clinical outcome in retrospect. We classified the jaw diseases
into 6 types: 1, inflammatory / infection; 2, neoplasm; 3, congenital /
development disease; 4, trauma; 5, pre-operation plan; 6, others. The
adequacy rate of the anatomy presentation from CT images and the
diagnostic accuracy of the radiological report were evaluated.
Results Forty-one scans from 40 patients (21 men and 19 women,
ranging from 7 to 70 years of age) were included into our study. All of
the 41 scans (100%) presented the anatomical details of jaw disease
adequately. Ten of the thirteen inflammatory / infection cases (76.9%)
got the accurate diagnosis by 3D dental CT. The diagnostic accuracy
to neoplasm, congenital / development disease, and trauma was 9.1%
(1/11), 75% (6/8), and 100% (2/2) respectively.
Conclusions Reformatted 3D dental CT reveals the anatomical details of
various jaw diseases adequately. The diagnostic accuracy depends on the
type of disease. Because radiologists now take an active role in the dental
imaging, they may need to become familiar with these images.
Keywords Jaw, CT
E-Poster
CA005
3D Segmentation of Liver by Flipping Free Mesh Deformation
Sudhakar Kundapur Venkatesh1, Feng Ding2, Wee Kheng Leow2,
Wenxian Yang3
1
Department of Radiology, National University Health System,
Singapore
2
Department of Computer Science, National University of
3
Department of Computer Science, Nanyang Technological
University, Singapore
global volumes(GM, WM and CSF) and the 2D local shape analysis on
ventricle (Width/Height ratio, perimeter and averaged distance from the
centre of gravity to the edge). The accuracy, sensitivity and specificity
were 92.31%, 83.33% and 100%, respectively.
Conclusions By using volume and shape features, which are easily
extractable, patients with AD can be successfully identified from normal
control in the proposed classification framework with high performance.
Image-aided diagnosis for AD is accurate and specific.
Keywords MR, Dementia, Segmentation, Image Manipulation/
Reconstruction
Others
CH010
Feasibility of Multi-Slice CT Angiography of Pulmonary
Artery with High Concentration and Low Dose Contrast
Material
Dao-Ping Wang
CH013
Image Quality of Multiplanar Reconstruction: Comparison
of Conventional Multislice CT and Multislice CT with GarnetDetector
Osamu Honda¹, Masahiro Yanagawa 1, Atsuo Inoue 1, Ayano
Kikuyama1, Noriyuki Tomiyama1, Shigeyuki Yoshida2, Hiromitsu
Sumikawa1, Kazunori Tobino1
1
Medicine, Japan
2
Department of Radiology, Minoh City Hospital, Japan
Purpose To study the feasibility of multi-slice CT angiography of
pulmonary artery (CTPA) with high concentration and low dose contrast
material.
Methods Forty patients with chest dynamic enhanced using multi-slice
CT body-perfusion protocol, were divided into two groups according to the
dosage of the contrast material: Group A, 300 mgI/mL (contrast material
100 mL and saline 30 mL); Group B, 400 mgI/mL (contrast material 60 mL
and saline 30 mL). Injection rate was 4 mL/s. The time-density curve (TDC)
of the trunk of pulmonary artery (PA) was delineated. PA peak time, PA
peak enhancement, PA enhancement begin to 200 HU time (Tb200) and
period when PA enhancement is 200 HU or greater (T200) was calculated.
Results PA peak time and PA peak enhancement, Group B was earlier
and higher than Group A. T200 and Tb200 had a significant difference
statistically between the two groups.
Conclusions It is feasible to use high concentration and low dose
contrast material for multi-slice CT pulmonary artery angiography.
Keywords Contrast Agents, CT
Purpose To investigate the image quality of multiplanar reconstruction
(MPR) scanned by garnet-detector CT with High Resolution Mode (HR
Mode) or non-High Resolution Mode (non-HR Mode) in comparison with
conventional multidetector CT (MDCT).
Methods Five inflated and fixed lungs were scanned by conventional
MDCT (LightSpeed VCT, GE) and garnet-detector CT (Discovery
CT750HD, GE) with HR Mode or non-HR Mode. High dose (400 mA) and
low dose (10 mA) CT images were obtained with 0.625 mm collimation
and bone algorithm. MPR images with 0.6 mm slice thickness were
obtained, and 15 images (three images in each lung) were selected from
the each scan series. MPR images of garnet-detector CT with HR Mode
or non-HR Mode were compared to those of conventional MDCT. Two
independent readers evaluated the pulmonary normal structures, artifact,
noise and total image quality, the scores were assigned on a visual scale
(1=definitely inferior, 2=slightly inferior, 3=unchanged, 4=slightly superior,
5=definitely superior).
Results On high dose CT, the mean scores of garnet-detector CT with
558
CH016
Acquisition of Multiplanar Reconstruction Images Using
an Angiographic C-Arm System: Initial Experience in the
Transthoracic Fine-Needle Aspiration Biopsy of the Lungs
Jae Seung Seo, Semin Chong, Yang Soo Kim
University Hospital, Korea
Purpose To assess the feasibility of a 3D-enabled hybrid C-arm system
in the evaluation of immediate postprocedural complications after
transthoracic fine-needle aspiration biopsy (TFNAB).
Methods Eighteen patients (M:F=10:8, age range 17 - 76 years, mean
58 years) with intrathoracic lesions seen at CT underwent TFNAB using
a 3D-enabled hybrid C-arm system (Axiom Artis dBA; Siemens Medical
Solutions, Erlangen, Germany) in our institute. Before or after TFNAB,
rotational radiography was performed and then multiplanar cross-sectional
images were reconstructed on a workstation (X-Leonardo; Siemens) with
use of 3D reconstruction software (DynaCT; Siemens). When the target
lesion couldn’t be seen at projectional image, radio-opaque marker was
used for localization of the target lesion. We assessed the presence
or absence of pneumothorax, the presence or absence of hemorrhage
surrounding the target lesion, and visibility of needle tract at multiplanar
reconstruction images (lung or mediastinal window CT-like images), we
called, DynaCT images. We compared these DynaCT images with followup conventional chest radiographs (interval rage 0 – 6 hours, mean 2
hours).
Results At DynaCT images, 14 patients showed pneumothorax (n=7),
hemorrhage surrounding the lesion (n=9) or visible needle tract (n=9). In
two (30%) of seven patient, the pneumothorax was only seen at DynaCT
images. In cases of hemorrhage surrounding the lesion and visible needle
tract, 60% (5 of 9 hemorrhage surrounding the lesion) and 100% (9 of 9
visible needle tract) was only seen at at DynaCT images, respectively.
Ten patients underwent the localization using DynaCT images with radioopaque marker when the target lesion couldn’t be seen at projectional
image.
Conclusions 3D-enabled hybrid C-arm system can be helpful in the
evaluation of immediate postprocedural complications during/after TFNAB.
During the procedure, DynaCT images can be used for safe image
guidance of TFNAB because DynaCT images can supply CT-like images
in a patient with invisible lesion at conventional C-arm system.
Keywords Lung, Biopsy, Fluoroscopy, Interventional
CH018
A Case Report of Pulmonary Benign Metastasizing
Leiomyoma and Review of Literature
Chang Yin-Lin, Chang Hsio-Yun, Wang Yung-Cheng
Department of Radiology, Cathay General Hospital, Taiwan
Purpose To present the imaging features of benign metastasizing
leiomyoma.
Methods A 52-year-old female came for abdominal CT study due to
suspicious liver tumor on sonography. The abdominal CT revealed few
pulmonary nodules at bilateral basal lung fields. She received chest
CT study and multiple pulmonary nodules scattered bilateral lungs with
largest up to 1.6 cm in RLL are noted.
Results VATS was performed in July 2009. The pathology shows
nodular proliferation of bland-appearing smooth muscle cells with
entrapped bronchiolar epithelium. Tracing back her history, she received
hysterectomy for uterine leiomyoma 16 years ago. Diagnosis of benign
metastasizing leiomyoma is confirmed.
Conclusions Benign metastasizing leiomyoma (BML) is a rare disease.
The afflicted extrauterine organ has been reported including lung,
intraperitoneal space, skull and spine. The lung is the most common site
of involvement. Patients often came for other purposes and incidental
observation of pulmonary lesions which usually appear multiple wellcircumscribed nodules without predominant location of bilateral lung fields.
The differential diagnosis of benign metastasizing leiomyoma should be
keep in mind in asymptomatic patients who undergo hysterectomy for
uterine leiomyoma with multiple pulmonary nodules.
Keywords Lung, CT
CH021
Computed Radiography and Direct Radiography of Chest
Radiographic Imaging: Investigation of Entrance Skin Dose
and Image Quality with Six Digital Systems
Zhonghua Sun1, Kwan-Hoong Ng2, Chenghsun Lin1, YeuSheng
Tyan4
1
Department of Imaging and Applied Physics, Curtin University of
Technology, Perth, Australia, Australia
2
Department of Biomedical Imaging, University of Malaya, Kuala
Lumpur, Malaysia, Malaysia
3
Department of Radiological Technology, Central Taiwan
University of Science and Technology, Taiwan
4
Department of Radiology, Chungshan Medical University and
Hospital, Taichung, Taiwan
Purpose The aim of the study was to compare the entrance skin dose
(ESD) and image quality in chest radiography for three computed
radiography (CR) and three direct radiography (DR) systems.
Methods The study was performed using a chest phantom made from
a tissue-equivalent PMMA block with regional test objects (a matrix of
contrast-detail objects and line-pair phantom) were incorporated into the
chest phantom for image quality assessments Chest phantom images
were acquired using three different CR systems, Konica, Agfa and Philips,
and three different DR systems, Siemens, Philips and Toshiba. Imaging
parameters were selected with mAs ranging from 1.0, 2.0, 4.0 and 8.0,
and tube potential ranging from 100, 110 and 120 kV. ESD was measured
using a solid state detector (PTW Diados, Germany). Quantitative
measurements of image quality were performed at 7 regions of interest to
determine the relationship between image noise (SD-standard deviation),
imaging parameters and different digital systems. Statistical analysis was
performed using ANOVA and Duncan’s multiple-comparison test.
Results The ESD measured with Konica CR was the lowest (mean
dose: 0.09 mGy) and the highest with Agfa CR system (mean dose: 0.19
mGy) among the six digital systems. ESD increased significantly with
increase of mAs (p<0.0001) and kVp (p<0.01). The SD measured in
different regions of interest decreased significantly (p<0.001) when the
mAs was increased, however there was no significant difference of SD
when the kVp value was changed (p=0.11-0.78). The SD measured with
DR systems was significantly lower than that measured with different CR
systems (p<0.001).
Conclusions Our results showed that chest radiographic imaging with
different CR and DR systems can be optimised by reducing the kVp from
120 to 100 without compromising image quality, while reducing the ESD
significantly. The overall performance of DR system was superior to that
of CR system.
Keywords Digital Radiography, Dosimetry
CH022
Air Trapping Is Critical Determinant of Fixed Air Flow
Obstruction in Moderate to Severe Asthmatics: Follow-Up
Study Using MDCT
Jai Soung Park¹, Sang Hyun Paik1, Sun Hye Jeong1, Aleum Lee1,
559
Purpose Primary spontaneous pneumothorax (PSP) is a common
disease in adolescents and young adults, and most occur on unilateral
side. Simultaneous bilateral PSP (SBPSP) is rare entity, and might be
life threatening due to potential of progression to tension pneumothorax.
Although many reports of case studies have been published, it has not
shown the distinctive clinical features associated with SBPSP.
Methods All patients with PSP diagnosed and treated in our hospital
between June 1996 and June 2006 were reviewed. The clinicoradiologic
features and treatment of these patients were collected and evaluated.
Results Of the 616 patients with 807 episodes of PSP, 13 patients
presented with SBPSP (1.6 %) at first presentation. All patients with
SBPSP are male with mean age of 20.9 ± 4.7 years (16 to 25 years). In
patients with PSP, patients with SBPSP had significant lower body weight
(p= 0.02), lower BMI (p= 0.004) and higher body height/body weight (BH/
BW) ratio (p= 0.003) than with non-SBPSP. Patients with SBPSP also had
significant higher frequency of blebs/bullae appearance in high resolution
of computerized tomographic scan (HRCT) of the lung (88.5% v.s. 61.2%,
p=0.026). In multiple regression hazard analysis, higher BH/BW ratio
and presence of blebs/bullae in HRCT are the most important significant
risk factors for SBPSP (p=0.008 and 0.024 respectively). All patients with
SBPSP received bilateral video-thoracoscopic surgery (VATS) for elective
treatment. All patients recovered uneventfully. The mean follow-up period
is 6 months to 7 years (mean 3.6 years).
Conclusions SBPSP is rare condition. Patients with SBPSP own
significant high BH/BW ratio and appearance of abnormal blebs/bullae.
SBPSP needs urgent assessment and management, and bilateral VATS
treatment is a safe and effective procedure.
Keywords Lung, Surgery
Purpose The purpose of this study is to analyze the coronary artery
calcification (CAC) relating to the gender, age, smoking using with the low
dose multi-detectors computed tomography (LD-MDCT) of lung.
Methods Under the sponsor by Chang Gung Memorial Hospital Research
Program, we selectively used LD-MDCT to the participants who did not
have heart disease history or cardiac discomfort between 2007 Aug to
2008 Dec. Using the software originally provided by SIMEMS to identify
the CAC and measure the calcium scores. Ages, genders, prevalence of
calcification, smoking history were compared.
Results Totally, 655 participants (average age: 57.5 y/o) were analyzed.
In the male non-smokers, the prevalence of CAC in ages less than 50,
between 50 to 59, between 60 to 69 and greater than 69 were 11.63%,
36.36%, 57.14% and 71.43% and the average calcium scores were
0.37, 34.76, 55.35 and 231.68 respectively. Both the male or female
gender revealed that the incidence and degree of calcifications were
directly increased with the patient’s ages or the CAC scores (P<0.001).
In comparing the smokers and non-smokers, the incidence of CAC was
37.22% for non-smokers and 49.28% for smokers. The calcium scores of
the smokers was higher than non-smoker (averagely 104.31 VS 67.46,
p=0.109). Otherwise, the incidence of CAC was directly proportion to the
smoking duration counting as 22.5% for less than 19 years, 44.9% for
20 to 39 years, 70.69% for over 39 years, and the calcium scores were
respectively to 24.49, 64.00 and 225.89 as well. Both were statistically
significant (p<0.001).
Conclusions Age and smoking relates to the coronary arterial
calcification. The ungated LD-MDCT of lung can provide additional
information of risk stratification and coronary arterial calcification by the
same session of lung examination.
Keywords Arteries, CT
HR Mode was 4.03 - 4.87 in each item, and those with non-HR Mode was
2.90 – 3.80. The mean scores of garnet-detector CT with non-HR Mode
were more than 3 except artifact. The scores of each item with HR Mode
were superior to those with non-HR Mode (p<0.05). On low dose CT, the
mean scores of with HR Mode was 2.83 – 3.37 in each item, and those
with non-HR Mode was 2.83 – 3.30. There was no significant difference
between the score with HR Mode and that with non-HR Mode in each item
on low dose CT.
Conclusions On high dose CT, the MPR image qualities of garnetdetector CT with HR Mode were superior to those with non-HR Mode.
However, MPR image qualities with HR Mode were equal to those with
non-HR Mode on low dose CT.
Keywords Lung, Artifacts, Comparative Studies, CT
E-Poster
CH009
Simultaneous Bilateral Primary Spontaneous Pneumothorax
Hsian-He Hsu¹, Wen-Chiung Lin1, Wei-Chou Chang1, YeungLeung Cheng2, Guo-Shu Huang1
1
Department of Radiology Tri-Service General Hospital, Taiwan
2
Division of Thoracic Surgery, Department of Surgery Tri-Service
CH011
Low Dose Computed Tomography Evaluating the Dependent
Relationship of Coronary Arterial Calcification to Age and
Smoking
Yun Chung Cheung¹, Tsung-Yuan Wu²
¹Department of Diagnostic Imaging and Intervention, Chang
²Department of Medical Imaging and Intervention, Chang Gung
Others
AVMs had disappeared or changed to scar on follow-up CT.
Conclusions The usefulness of the PDA coil for embolization of
pulmonary AVM with feeding artery is 6 mm or less diameter was
confirmed by present study.
Keywords Lung, AVM, Embolization
CH025
Small Pulmonary nodules Detected on CT Scans:
Radiological and histopathological correlation in resected
cases
Yoon Kyung Kim, Ok Hee Woo, Hwan Seok Yong. Eun-Young
Kang
Purpose To characterize radiological findings of small pulmonary nodules
detected on CT scan and to correlate with histopathological findings.
Methods We evaluated 63 lung nodules with the size of 10 mm or less
in diameter resected from 49 patients (29 men and 20 women, mean
age 57.7 years, wedge resection in 41 patients and lobectomy in 8). The
clinical records, the CT findings, and histopathological features of resected
nodules were analyzed.
Results 12 patients had smoking history. 30 patients had primary
malignancy in lung (n=7) or other organ (n=23). 23 (36.5 %) nodules were
malignant (metastasis in 15, adenocarcinoma with bronchioloalveolar
pattern in 5, bronchioloalveolar carcinoma in 3), 2 were premalignant
(atypical adenomatous hyperplasia), and 38 (60.3 %) nodules were
benign (intrapulmonary lymph node in 17, anthracotic nodule in 9, others
in 12). Of 43 nodules in patients with known primary malignancy, 17 (39.5
%) nodules were malignant. Malignant nodules were larger than benign
nodules in average (8.0±2.1 mm and 5.6±1.3 mm, respectively). They
were round shape in 29 (13 malignant, 2 premalignant, and 14 benign
nodules) or oval shape in 25 (10 malignant and 15 benign nodules).
Polygonal shape was only seen in benign nodules (n=9). 7 (11.1 %)
nodules showed lobulated margin and 6 of them were malignant. 51 (81.0
%) nodules were solid (17 malignant, 1 premalignant, and 33 benign
nodules), 9 (14.3 %) were ground-glass (4 malignant, 1 premalignant, and
4 benign nodules), and 3 (4.8 %) were mixed GGO and solid nodule (2
malignant, and 1 benign nodules). Pleural attachment was more frequently
seen in benign (n=13) than malignant (n=4) nodule.
560
Purpose We report a case of primary mucosa-associated lymphoid tissue
(MALT) lymphoma at the upper airway associated with two nodular lung
lesions and positive 13-urea breath test.
Methods A 50-year-old woman visited our hospital due to shortness of
breath and hoarseness with mild dyspnea on exertion for 3 months. Upper
airway obstruction was suspected from wheezing and the results of the
pulmonary function test. CT scan showed symmetrical narrowing over the
upper trachea close to the subglottic region. The narrowest region was
approximately 4.3 mm in diameter and 15 mm in length. PET-CT showed
SUV to be 5.2 in early scan and 5.7 in delayed scan.
Results Fibrobronchoscopy revealed multiple nodular lesions with
protrusion into the trachea with severe narrowing of the lumen. Simple
excision was performed for the removal of the subglottic tumor, and
pathology revealed MALT lymphoma. Steroid inhaler and gastric H. pylori
eradication regimen were used, and the patient’s symptoms improved with
no evidence of disease progression observed for more than 4 months of
follow-up.
Conclusions Non-gastrointestinal MALT lymphomas are rare, and they
are usually associated with a chronic inflammatory disease, such as H.
pylori infection, which is a prerequisite for MALT lymphoma proliferation.
No well characterized chronic inflammatory process has been identified
as a precursor of MALT lymphoma in the upper airway, including the
subglottic region. This case is a primary MALT lymphoma at the upper
airway treated with conservative management of steroid inhaler and
eradication of gastric H. pylori infection.
Keywords Larynx, Lymphoma
CH027
Case Reports of Pulmonary Inflammatory Pseudotumor
Mimicking Malignant Process
Chun-Han Liao¹, Su-Tso Yang², Wei-Ching Lin², Yung-Jen Ho²,
Wu-Chung Shen¹
¹Department of Radiology, China Medical University Hospital,
Taichung, Taiwan, RSROC, Taiwan
²Department of Radiology, China Medical University Hospital,
Taichung, Taiwan ; School of Chinese Medicine, College of
Chinese Medicine, China Medical University, RSROC, Taiwan
Purpose Inflammatory pseudotumor (IPT) is a quasineoplastic lesion with
an unidentified etiology and can occur in nearly every site of the body.
Pulmonary IPT is a rare benign lung lesion, more commonly seen in the
young patients and behaves as a malignant tumor both clinically and
radiologically. Two cases of pulmonary IPT with the presentation of left
lung masses and an endobronchial lesion accompanied by left upper lobe
collapse, respectively, are being reported because of their rarity, diverse
presentation and difficulty to diagnose.
Methods Two cases of pulmonary IPT with radiologic and pathologic
correlations were reported. Their clinical presentation, pathologic features,
imaging findings, and different clinical diagnoses were summarized in
comparison with the cases in the literature review.
Results Imaging features of IPT are variable and nonspecific. Pulmonary
IPF is typically a well-marginated, lobulated mass of heterogeneous
attenuation with variable patterns of contrast enhancement and
calcification and an anatomic bias for the lower lobes. CT is helpful in
CH028
The Comparison of 3D CT Imaging to 2D CT
Akira Yamaguchi
Department of Radiology, Toho University Oomori Hospital,
Japan
Purpose Pulmonary emphysema lesions are known to low attenuation
area on computed tomography (CT). Three-dimensional (3D) CT imaging
can be calculating for volume as the entire lesions in whole both lungs
as new technique of estimate pulmonary emphysema lesions. Twodimensional (2D) CT imaging can be calculating for area as the lesions
at few levels as the known technique. The purpose of this study was
to compare of 3D CT imaging to 2DCT imaging to use a computerized
objective quantitative technique to measure the lesions associated with
pulmonary emphysema to compare with pulmonary function tests.
Methods The subjects of this study consisted of 30 patients diagnosed
with pulmonary emphysema on the basis of clinical tests including
pulmonary function tests. Chest CT imaging was performed. The
lesions of 3D CT were detected for the whole bilateral lung field using a
computerized objective quantitative method. The lesions of 2D CT were
detected at the three levels. The ratio of pulmonary emphysema to the
whole pulmonary field and each level were calculated and compared with
pulmonary function tests.
Results Good correlations were able to be obtained between the
detection of emphysema lesions by both 3D CT and 2D CT images using
a computerized objective quantitative method and pulmonary function
tests for all subjects. Quantified 2D CT images were more closely
pulmonary function test than quantified 3D CT images in this study.
Especially quantified 2D CT images were good correlation to pulmonary
function test.
Conclusions Detection of emphysema lesions using a computerized
objective quantitative method was superior in terms of objectivity,
reproducibility and quantitative characteristics. We obtained a good
correlation with pulmonary function tests rather 2D CT imaging than 3D
CT imaging.
Keywords Lung, CT, Technical Aspects
CH029
CT-Guided Lung Biopsy: A Comparison between Coaxial
Method and Single Needle Method
Reng-Hong Wu, Wen-Sheng Tzeng, Shih-Chin Chang, ChiaHuei Chen, Mei-Chun Chou
Department of Radiology, Chimei Medical Center, Taiwan
Purpose To evaluate which percutaneous core biopsy method,
coaxial needle or single needle in lung biopsy, has lower incidence of
complication.
Methods There were 552 patients who received percutaneous lung core
biopsy either using coaxial method or single needle method between
Jan 2003 and Dec 2005 in Chimei hospital. To perform single needle
method, 18G biopsy needle was used while 18G biopsy needle plus 17G
outer needle was used for coaxial method. The patient selection criteria
were intrapulmonary lesion without pleural attachment, intrapulmonary
lesion with pleural attachment with the lesion size smaller than 3 cm and
mediastinal lesion with the needle tract pass-through lung parenchyma.
From each group, 100 subjects were randomly selected from patients who
met the study criteria. The incidence of pneumothorax and pulmonary
hemorrhage, diagnostic accuracy was compared between these two
methods.
Results There was no significant demographic difference between the two
groups, except the mean age for coaxial method was 61 years old and
the single needle method was 65 years old (p <0.05). In addition, there
was no significant difference in the incidence of pneumothorax and the
accuracy rate between the two groups, yet the severity of pneumothorax
was greater in the coaxial group. The occurrence of pulmonary
hemorrhage is higher in the group of single needle group. Furthermore,
the pulmonary hemorrhage was increased in single needle group if the
distance between pleura to lesion was greater than 0.6cm (p<0.05).
Conclusions The coaxial method lung biopsy seems more suitable for
deep lesion. However, if the patient is prone to the risk of pneumothorax,
single needle method would be better.
Keywords Lung, Biopsy, Comparative Studies, CT, Percutaneous,
Interventional
CH032
Spontaneous pneumomediastinum
Shih-Yi Lee 1, Chin-Yin Sheu 2, Chien-Liang Wu 1, Jeong Nam
Heo³
1
Department of Chest Medicine, Mackay Memorial Hospital,
Taiwan
2
3
Korea
Purpose Spontaneous pneumomediastinum is clinically distinct
from pneumomediastinum occurring secondary to thoracic hollow
organ perforation. The latter may be a catastrophic event requiring
invasive intervention,but it is questionable whether such interventions
are necessary in spontaneous pneumomediastinum. Limited data
are available regarding the characteristics of history and radiologic
manifestations in spontaneous pneumomediastinum. The present study
aimed to systematically evaluate the initial and subsequent clinical and
radiologic manifestations of spontaneous pneumomediastinum as well as
the need for additional diagnostic procedures and therapy.
Methods A retrospective study of patients with a diagnosis of spontaneous
pneumomediastinum in a tertiary medical center from January 1990 to
November 2006 was performed. The patients’ clinical information and
results of radiologic interventions were analyzed.
Results A total of 42 patients were included. Spontaneous
pneumomediastinum was diagnosed in all cases by chest films. A left
pericardial airstrip was the most common initial manifestation. In this
series, there was only one patient with a pneumothorax, and none of the
patients developed pleural effusion or mediastinal fluid as shown by chest
X-rays after the disease onset.
Conclusions Spontaneous pneumomediastinum occurs mostly
in non-elderly patients. Evaluation of typical clinical information
and uncomplicated serial chest X-ray findings of spontaneous
pneumomediastinum could avoid unnecessary invasive procedures
and intensive care unit stays, which could put pressure on medical
resources. A plain film X-ray is adequate for diagnosing spontaneous
pneumomediastinum as long as the appropriate findings are sought and
there is adequate application of lateral radiography.
Keywords Lung, Mediastinum, CT
CH039
CT manifestations of trachea bronchus using MDCT
Shang-Yun Ho¹, Chiung-Ying Liao1, Kwo-Whei Lee1, Yeu-Sheng
Tyan2
1
Department of Medial Imaging, Chang-Hua Christian Hospital,
Taiwan
2
Department of Medical Imaging, Chung Shan Medial University
Hospital, Taiwan
Purpose Trachea bronchus is uncommon anomalies and usually arises
561
CH026
Primary Mucosa-Associated Lymphoid Tissue (MALT)
Lymphoma at the Upper Airway: A Case Report
Jerry Chih-Hong Tsai, Ming-Ting Wu, Yi-Luan Huang
Taiwan
demonstrating the extent of the potentially aggressive disease, such as
central airway invasion. High standardized uptake value (SUV) can be
seen on the PET/CT scan.
Conclusions When clinical presentation of pulmonary neoplasm or
infection is atypical or problematic, such as round pulmonary masses
noted in the lower pulmonary lobe of an asymmetric young patient or
an endobronchial lesion in a similar age setting, pulmonary IPT should
be considered. Because IPT mimics malignant tumor both clinically and
radiologically, it is important for the radiologists to be familiar with this
entity and to proffer it as a diagnostic possibility. The unnecessary radical
surgery would then be avoided.
Keywords Lung, CT ,Inflammation
E-Poster
Purpose To investigate which changes in airway morphology could clarify
the characteristics of the fixed airway obstruction following the treatment
Methods 22 moderate to severe asthmatics were recruited. Pulmonary
function test (PFT)s and multi-detector row computed tomography
(MDCT) were done simultaneously twice at first visit and at follow-up time
when FEV1 reached at the constant level after prolonged treatment over
12 months. Bronchial wall area% (BWA%), Air trapping (AT, the proportion
of lung volumes with attenuation values below -910 and -950HU), and
centrilobular nodules (CN) were measured.
Results During the follow-up period, the FEV1 was recovered over 75%
of predicted value (Recovered group) in 18 asthmatics and less than 75%
(fixed group) in 14 ones. There were no significant differences between
the two groups in terms of age, sex, atopy, smoking status at the initial
visit and follow up check of MDCT. The follow-up duration and combination
steroid inhaler dosage were comparable in the two groups. 1) At the
first visit, PFTs, Expiratory air trapping (AT), BWA%, and CN showed no
differences between the two groups. 2) In the recovered group, follow-up
CN, and Expiratory AT were markedly decreased compared to those of
first visit (p= 0.001 and P= 0.026 respectively), although BWA/R did not
changed significantly (P=0.082). 3) In the fixed group, follow-up BWA%,
expiratory AT, and CN were not significantly different compare to that of
first visit. 4) At the follow-up time, Expiratory AT was signicantly greater
in the fixed group than that in the recovered (P= 0.008). 5) Regression
analysis demonstrated a good association of expiratory AT with FEV1(%)
at the follow-up check (P= 0.002).
Conclusions Air trapping could be one of main risk factor for the fixed
airflow obstruction observed in unrecovered asthmatics even after
prolonged and intensive inhaled combination steroid.
Keywords Lung, CT
Conclusions Small pulmonary nodules detected on CT scans were
malignant or premalignant lesion in approximately 40% of resected cases.
CT features such as polygonal shape or lobulated margin were helpful for
predicting the histopathology of the small pulmonary nodules.
Keywords Lung
Others
Dong Hun Kim1, Jung Hwa Hwang2
Department of Radiology, Soonchunhang University Buchenon
Hospital, Korea
2
Department of Radiology, Soonchunhang University Seoul
Hospital, Korea
1
Purpose CT-guided core biopsy is playing an increasing role in benign
disease diagnosis, cellular differentiation, somatic mutation analysis and
molecular fingerprint analysis. In this essay, we wish to summarize the
basic concepts, protocols and techniques that we use for CT-guided core
biopsy of lung lesions for the beginners.
Methods The basic concepts are reviewed, including respiratory
motion, cardiac motion, chest wall vessels, preprocedural laboratory
check, fissures, shock wave injury during biopsy and informed consent.
The techniques are also introduced, including scan protocols, coaxial
technique, local anesthesia, sterile drape as needle holder, dynamic
needle manipulation, final manipulation, biopsy under pneumothorax, and
biopsy groove length selection.
Results With above-mentioned concepts and techniques, CT-guided
biopsy could be performed safely even in difficult cases, such as lesions
near diaphragm, small (<10 mm) nodules or hilar lesions. In our institute,
the complication rates are 27.9% for pneumothorax (21.3% resolved
spontaneously, 6.6% requiring tube drainage), 14.8% for hemoptysis,
0.3% for severe hemothorax requiring endotracheal intubation, and 0% for
procedure-related mortality, which is similar to previous reports.
Conclusions Because CT-guided core biopsy is playing an increasing
role in benign disease diagnosis, cellular differentiation, somatic mutation
analysis and molecular fingerprint analysis, radiologists should be familiar
with the associated techniques so that they may safely obtain diagnostic
specimens while minimizing complications.
Keywords Lung, Biopsy
CH046
Birt-Hogg-Dubé Syndrome: imaging features of multiple
pulmonary cysts
Natsuka Muraishi, Katsunori Oikado, Masaki Matsusako,
Takayuki Nohara, Yukihisa Saida
Department of Radiology, St. Luke's International Hospital,
Japan
Purpose Birt-Hogg-Dubé (BHD) syndrome is a rare autosomal-dominant
inherited disorder characterized by the presence of firm facial papules
which usually represent fibrofolliculomas. Patients with BHD syndrome
have a high predisposition to associate with malignant renal tumors.
Several studies have shown a high prevalence of bullous emphysema,
thin-walled cysts, and spontaneous pneumothorax in BHD patients. The
purpose of this study is to elucidate the characteristics of multiple cysts of
BHD syndrome.
562
CV001
Bilateral Lower Limb Ultrasound Doppler for Suspected
Deep Vein Thrombosis - Analysis of Local Data
Lily Wong¹, Jessie Yeung², Johnny Ma²
¹Department of Radiology and Organ Imaging, United Christian
²Department of Radiology, Princess Margaret Hospital, Hong
Kong, China
Purpose To evaluate the yield of bilateral lower limb doppler scans and to
analyze the symptoms and risk factors of deep vein thrombosis.
Methods All bilateral lower limb doppler examination during the period
of 01/01/07 to 30/06/08 in Princess Margaret Hospital were reviewed,
clinical data were obtained in the electronic patient records (ePR). Follow
up examinations and patients whose data is unavailable on the ePR
were excluded. 189 cases were studied. Reasons for request, lower limb
symptoms, risk factors for deep vein thrombosis (DVT) and concomitant
causes for lower limb symptoms were analysed.
Results 23 (12.2%) patients had lower limb DVT and 7 (4%) of these
patients had bilateral DVT. DVT was detected in 13.6%, 25% and 11.1% of
patients with bilateral, unilateral and no lower limb symptoms respectively.
The side of DVT corresponded to side of symptom in all except one
patient, who had bilateral DVT and bladder cancer as predisposing
factor. Among the patients with lower limb cellulitis, normal D-dimer level,
outpatient status and presence of varicose veins, none of them had
DVT. Only 1 patient (3.7%) with lower limb redness had DVT. Pulmonary
embolism and malignancy are the risk factors with strongest association
with DVT, their p value were 0.014 and 0.067 respectively
Conclusions The yield of bilateral lower limb doppler for presence of
bilateral lower limb DVT is low in our population, unilateral examination
should be adequate for patients with unilateral symptoms. D-dimer is a
useful screening test in view of high negative predictive value. Outpatient
status, the presence of lower limb redness, varicose veins and cellulites
have negative association with DVT. Pulmonary embolism and malignancy
had the strongest association with positive scan result
Keywords Extremities, Ultrasound, Veins
CV003
Spontaneous Coronary Artery Dissection Revealed on
Coronary CT Angiography in a Patient with Polycystic
Kidney Disease and Atypical Chest pain
Chih-Chia Lee, Sheung-Fat Ko
Kaohsiung Medical Center, Chang Gung University, College of
Medicine, Taiwan
Conclusions Autosomal dominant polycystic kidney disease (ADPKD)
may associate with various cardiovascular abnormalities, especially
intracranial aneurysms and cervical artery dissection. Spontaneous
coronary artery dissection in ADPKD patients is rare and only three such
cases have been documented while all three cases were symptomatic
with acute coronary syndrome. We report an extremely unusual case
of spontaneous coronary artery dissection in a 59-year-old man with
ADPKD presented with atypical chest pain. He had no prior history of
thoracic trauma or cardiovascular intervention. Coronary CT angiography
revealed an intimal flap extending from the left main to the left anterior
descending coronary artery. Functional study was refused because
the symptoms were worsen and the patient feared further dissection.
However, the cardiac enzymes level, laboratory and electrocardiographic
findings were unremarkable. Subsequent catheter coronary angiography
and intravascular ultrasound confirmed the diagnosis and transcatheter
insertion of a drug-eluting stent was successfully accomplished. There
were no procedural complications and the patient was discharged after 5
days. To our knowledge, this is the first report the spontaneous coronary
artery dissection in patient with ADPKD and atypical chest pain diagnosed
by coronary CT angiography, highlighting the usefulness of coronary
CT angiography in revealing the inadvertent hazard and potentially lifethreatening cardiovascular complications in patients with ADPKD.
Keywords Connective Tissue Disorders, CT, Dissection
CV006
Radiologic Findings of Subaortic Left Brachiocephalic Vein
1
2
Purpose Anomalous left brachiocephalic veins (A-LBCV) are a rare
condition of the major thoracic vein anomalies. Most common type
of A-LBCV is persistent left side SVC (PLSVC), but subaortic left
brachiocephalic vein (SLBCV) is not uncommon. We represent various
patterns of SLBCV.
Methods Since 2002, a total of 22 cases (group A) of SLBCV have
been reported in patients receiving CT scan of chest, and was mainly
an incidental diagnosis. Another 11 patients reveal SLBCV (group B)
on follow up CT during various treatments (8 in chemotherapy for lung
cancer, 3 in mediastinal fibrosis by tuberculosis). We retrospectively
reviewed CT scans of the pathway of left brachiocephalic venous return
and size of each veins.
Results In group A, fifteen of 22 patients (68%) reveal SLBCV only, 6
patients (22%) represent double LBCV (containing preaortic and subaortic
course), and one patient (5%) shows triple LBCV (containing preaortic,
subaortic, and PLSVC). In group B, the diameter of SLBCV is smaller than
prevascular vein which representing collateral veins.
Conclusions SLBCV is not uncommon central venous anomaly and
its presentations are diverse. According to group B, SLBCV is possible
collateral pathway when LBCV flow is interrupted.
Keywords Veins
CV010
Dual-Source CT for the Clinical Application of Myocardial
Bridge
Dan Han
Department of Radiology, the fist affiliated hospital of Kunming
Purpose To explore the characteristic features and clinical meaning
of myocardial bridge (MB) with Dual-source CT (DSCT) coronary
angiography.
Methods 95 patients who were suspected coronary heart disease
performed dual-source CT coronary angiography examination, 30 MBs
of 24 cases was detected in 95 cases. The degree of stenosis, length,
plaque and left ventricular wall motion changes of MBs were analyzed.
Results MB was detected in 24 cases with incidence of 25.26% (24/95),
there were 30 mural coronary arterys and 17 MBs complicated by coronary
atherosclerosis (54.8%) in 24 cases, but No evidence of atherosclerosis
was found in the mural coronary artery. A significant difference statistically
was found between the extent of coronary artery wall stress and the
thickness of myocardial bridge (P<0.05); the more severe mural coronary
artery stenosis was, the more obvious the movement function damage of
the left ventricle was.
Conclusions DSCT could clearly show myocardial bridge and may judge
the morphological characteristic of MB-MCA, it can also provide heart
function information.
Keywords Angiography
CV015
Usefulness of Multidetector CT (MDCT) Evaluating
H y p e r t e n s i o n : C o r r e l a t i o n w i t h Tr a n s t h o r a c i c
Echocardiography
Dong Hun Kim¹, Eun Ha Suk², Hye-Sun Seo³
¹Department of Radiology, Soonchunhyang University Bucheon
Hospital, Korea
563
E-Poster
CH043
CT-Guided Core Biopsy for Lung Lesions – A Practical
Guide for Beginners
I-Chen Tsai
Taiwan
Methods Four patients (2 males and 2 females, 31-71 years old, median
age 55) were genetically diagnosed as BHD syndrome at our hospital,
including 2 family cases. The findings of chest CT examinations were
evaluated by two board certified radiologists.
Results Total number of cysts accounted for 710 in four patients (25-293,
mean 105). Cysts were round, oval or lobulated in shape. The lobulated
ones were larger than the round or oval cysts, with statistical significance
(p<0.01). A total of 187 cysts were distributed in the upper half of the lung
and 523 cysts were found in the lower half of the lungs. When the lungs
are divided into three zones from central to periphery in axial plane, a
total of 202 cysts were located in the inner zone, 336 in outer zone and
172 in subpleural zone. The subpleural cysts were larger than the cysts in
the inner or outer zones with statistical significance (p<0.01). There were
no other parenchymal abnormalities. In familial cases, the parents had
increased size and number of cysts than those of their children.
Conclusions The cysts of BHD syndrome are characterized as follows;
1) predominant distribution in the lower lung zone, 2) more likely to
distribute in the sub-pleural or outer zone of the lungs 3) varied sizes or
configuration, 4) no other parenchymal abnormality, and 5) increased size
and number of cysts with aging.
Keywords Lung, CT, Cysts, Genetic Defects
Others
from right lateral tracheal wall, within 2 cm of the tracheal bifurcation.
MDCT can depict the detail the course of trachea bronchus and the
lumen.
Methods Review the CT scans during 3 years (2007-2009) in our hospital
about 8000 cases.
Results There are thirteen cases of trachea bronchus. Six cases showed
trachea bronchus near bifurcation and supply entire RUL bronchus. Five
cases supply apical right upper lobe and three revealed trachea bronchus
over 10mm from bifurcation, one over 2cm, the other one about 3.5mm
from bifurcation. Two cases supply apical and anterior segment of RUL,
the orifice below the bifurcation 3 mm. One case accompanied lung CA
and the other one case had pneumonia.
Conclusions Trachea bronchus is insignificant in most cases. It could
have recurrent infection or bronchiectasis since the narrow orifice.
Accompanied malignancy is rare. Knowledge the course of trachea
bronchus, we can prevent the complication of endotrachea tube insertion
or guideline of bronchoscopic exam
Keywords Anatomy, Lung, Congenital, CT, Tracheobronchial Tree
Purpose To determine the diagnostic value of 64-MDCT angiography for
pre-operative assessment of anterolateral thigh (ALT) perforator flaps.
Methods 33 patients underwent reconstruction surgery using ALT flap
were included. All patients underwent pre-operative CT angiography
(CTA) for both thighs using a 64-MDCT scanner. Cutaneous reference
lines were made from anterior superior iliac spine (ASIS) to superolateral
border of patella prior to examinations. Axial images and threedimensional volume-rendering imaging were reviewed to determine the
origin, course, and cutaneous location of each perforator of ALT. The ALT
flaps with satisfactory perforators were subsequently harvested, which
served as reference standard. The size of each harvested perforator was
categorized as small (less than 0.5mm), medium (0.5-1.0mm) and large
(more than 1mm). In the first 15 patients, two radiologists reviewed the
images independently to evaluate the inter-observer variation with respect
to the presence, origin and course of ALT perforators.
Results A total of 81 perforators were obtained at surgery; CTA
accurately detected 68 (84.0%) perforators. The detection rate was
77.8% (14/18) in small, 81% (34/42) in medium, and 95.2% (20/21) in
large perforators. CTA accurately predicted the origin from transverse or
descending branches of lateral circumflex femoral artery in 67 (98.5%)
of 68 perforators. The musculocutaneous or septocutaneous courses
were accurately predicted in 54 (79.4%) of 68 perforators. The mean
distance between predicted and final cutaneous locations of perforators
were 0.81±0.69 cm in the axis parallel to the cutaneous reference lines,
and 0.94±1.05 cm in the axis perpendicular to the lines. Analysis for
inter-observer variation showed almost perfect agreement with respect
to the presence (Kappa value=0.838) and the origin (Kappa value=0.92)
of perforators. Substantial agreement was observed with respect to the
course of perforators (Kappa value=0.768).
Conclusions CTA is a useful technique for pre-operative mapping of ALT
perforator flaps.
Keywords Anatomy, Angiography, CT, Surgery
564
CV020
Congenital Left Ventricle-to-Pulmonary Artery Fistula
Yi-Shan Tsai¹, Wen-Pin Hung², Jieh-Neng Wang², Jing-Ming Wu²
¹Department of Radiology, National Cheng Kung University
Hospital, Taiwan
²Department of Pediatrics, National Cheng Kung University
Hospital, Taiwan
Purpose The purpose of this study was retrospectively to assess the
coronary bypass graft patency of more than 10-year long patients by 64
MDCT angiography
Methods All 9 patients (9 men, 0 women; mean age, 67.11 years; range,
53–79 years) had undergone coronary artery by pass graft (CABG)
surgery for CAD. They had undergone CABG surgery more than 10year long. (13.33 years; rang, 10-25 years) and were accepted 64 MDCT
during 2006.03 to 2009.02. The revascularization consisted of LIMA to
LAD or their branches in all 9 patients. The measured mean effective
diameter of LIMA graft was 4.49mm and that of native RIMA was 3.37
mm.
Methods The measured effective diameter of the LIMA graft (md: 4.49
mm) is significantly increased as compare to that of native RIMA (md: 3.37
mm).
Conclusions Follow-up of cononary graft patency can be accurately
determined by 64 MDCT angiography. The change of different graft
configuration with 64 MDCT angiography can predict the increase of IMA
diameter following myocardial perfusion demand.
Keywords CT, Grafts
CV023
Congenital Anomalies of Systemic Venous and Pulmonary
Vascular Systems
Jeong Nam Heo¹, Choong Ki Park1, Dong Woo Park1, Yo Won
Choi2, Seok Chol Jeon2
1
Department of Radiology, Hanyang University Guri Hospital,
Korea
2
Department of Radiology, Hanyang University Hospital, Korea
Purpose 1. To explain the embryology of the systemic and pulmonary
vascular systems in thorax. 2. To show congenital anomalies of venous
system in thorax with MDCT. 3. To describe the hemodynamic change in
each anomalies, if present.
Conclusions There are many congenital anomalies in systemic and
pulmonary vascular systems in the thorax. With development of MDCT
technique, we easily recognize the congenital anomalies of systemic
venous and pulmonary vascular systems. This exhibit shows the diverse
congenital anomalies which we encounter in daily practice. After the
review of this exhibit, it is possible to differentiate the diverse congenital
anomalies of the venous system in thorax.
Keywords Arteries, CT, Veins, Vena Cava
Purpose A rare case with congenital left ventricle-to-pulmonary artery
fistula was presented. This rare congenital cardiac Malformation has
never been reported in the literature.
Methods Image modalities of cardiac catheterization and cardiovascular
computed tomography scan were performed.
Results Cardiac catheterization which revealed two oxygen-saturation
step-ups, one at the right ventricle (from 62% to 85%) and the other at
the pulmonary artery (PA) (from 85% to 87%). An LV angiogram showed
two fistulas originated from the lateral wall of the LV and then joined
together to drain into the posterior-lateral side of the PA. An aortogram
showed normal pattern of coronary arteries. A cardiovascular computed
tomography scan also confirmed abnormal communication between the
LV and PA.
Conclusions Until now, only two cases had been reported due to acquired
etiologies such as aortic valve endocarditis and surgical treatment of
arotic regurgitation due to Behcet’s disease. This rare congenital form of
“Left Ventricle-to-Pulmonary Artery Fistula” has never been reported.
Keywords Heart
CV025
Colour Mapping in the Detection of Coronary Plaques and
Evaluation of Coronary Artery Stenosis
Zhonghua Sun1, Franky Jacobus Dimpudus2, Johanes Nugroho3,
Jeffrey Daniel Adipranoto3
1
2
Department of Radiology, Ramsay Health-Rumah Sakit
Surabaya Internasional, Indonesia
3
Department of Cardiology, Ramsay Health-Rumah Sakit
Surabaya Internasional, Indonesia
CV021
64 MDCT Angiography Assessment of More than 10Year Long Term Patent Mammary Artery Bypass: Initial
Experience
Tsai Huo-Hung 1, Tsai Tsung-Po 2, Tyan Yeu-Sheng 1, Yeh DaMien1, Ho Shang-Yun1
Purpose The purpose of the study was to demonstrate the potential
value of colour mapping technique for detection of coronary plaques due
to heavy calcification and evaluation of the coronary stenosis in patients
suspected of coronary artery disease.
Methods The proposed method was tested in three patients undergoing
64-slice CT angiography for diagnosis of coronary artery disease. The
colour mapping was generated on a GE workstation and it was based on
the curved planar reformatted images. Tracking vessel dots were placed
in the proximal and distal segments of each coronary artery, and the
software automatically produced a colour map with red colour assigned
to the calcified plaques and blue colour to the normal lumen. Assessment
of coronary stenosis was based on 2D axial, curved planar reformation
(CVR), maximum-intensity projection (MIP) visualizations, in comparison
with colour mapping and the standard of reference, coronary angiography.
Results Significant stenosis (>70%) was noticed in 6 coronary arteries
involving 3 left anterior descending arteries, 2 right coronary arteries
and one left circumflex visualized on 2D axial, CVR and MIP images.
An overestimation of the stenosis was found in 4 coronary arteries by
these 2D visualizations due to blooming artifacts resulting from the heavy
calcification. No significant stenosis (<50%) was confirmed by colour
mapping and angiography in two out of 4 coronary arteries, while in
the remaining two arteries, only 50% stenosis was visualized on colour
mapping and angiography compared to the 80% stenosis shown by 2D
images.
Conclusions Our preliminary study shows that the method of colour
mapping is as accurate as coronary angiography for detection of coronary
stenosis caused by heavily calcified plaques. Colour mapping could be
used as a complementary tool to conventional visualizations for detection
of coronary stenosis, especially in patients with heavy calcification in the
coronary arteries
Keywords CT, Heart, Image Manipulation/Reconstruction
CV028
Abdominal Mycotic Aneurysm: Role of Computed
Tomography
Sin-Yi Lyu1, Chen-Te Wu2, Yon-Cheong Wong2, Sheng-Yueh Yu3
1
Department of Diagnostic Radiology and Intervention, Chang
2
Department of Diagnostic Radiology and Intervention, RSROC,
Taiwan
3
Department of Cadiovascular Surgery, Chang Gung Memorial
Hospital, Taiwan
Purpose To characterize the imaging findings and demonstrate the
complication of mycotic abdominal aortic aneurysm from computed
tomography.
Methods We retrospectively reviewed the records of 20 patients (men 14;
women 6) with proven abdominal mycotic aneurysms and analyzed the
initial and following up computed tomography imaging findings.
Results These aneurysms were saccular in 18 (90%) and fusiform in
2 (10%). Maximal diameters were 5-10 cm in four patients (20%) and
less than 5 cm in sixteen patients (80%). The imaging features included
rim enhancement (n=19; 95%), aortic wall calcification (n=19; 95%),
and perifocal fat strandings (n=16, 75%). The blood or tissue cultures
yielded Salmonella infection in nine patients (45%) and Staphlococcus in
three patient (15%). Six patients (30 received operation and one of them
had thrombosed right common iliac artery. Fourteen patients received
operation (8 reconstruction with Hemashield graft, 5 reconstruction with
axillary-bifemoral bypass, 1 endovascular aortic repair). Three of them
showed graft thrombosis (). One showed recurrent mycotic aneurysm.
One showed ischemic colitis.
Conclusions Saccular aneurysm, rim enhancement with perifocal fat
stranding highly suggest mycotic aneurysm. The most common infection
pathogen was Salmonella.
Keywords Aneurysms, CT, Infection
CV029
A b d o m i n a l M y c o t i c A n e u r y s m s : C T- B a s e d
Clinicoradiological Grading and Correlation with Outcome
Ruey-Sheng Chang¹, Chao-Han Lai²
¹Department of Medical Imaging, Chia-Yi Christian Hospital,
Taiwan
²Department of Surgery, National Cheng Kung University, Taiwan
Purpose To evaluate the prognostic implications of radiologic findings
565
CV016
Pre-Operative mapping of anterolateral thigh perforator
flap using 64-Detector raw computed tomography
angiography
Chao-Shiang Li1, Wen-Chiung Lin2, Shyi-Gen Chen3, Tom Chen1,
Hsing-Yang Tu1
1
Department of Radiology, Renai Branch, Taipei City Hospital,
Taiwan
2
Department of Radiology,Tri-Service General Hospital, National
3
Department of Division of Plastic and Reconstructive Surgery,
Department of Surgery Tri-Service General Hospital, National
Purpose To investigate the effect of subtype of acute aortic dissection
(AD) on differential susceptibility of bilateral renal arteries (RA) by multislice CT.
Methods Source images (1 – 2.5 mm slice thickness) of multi-slice CT of
108 patients (age = 62±13 years, 75 men) of AD (type A, N = 57, intramural
hematoma type = 24) were retrospectively analyzed for the involvement
of right/left renal arteries by either intramural hematoma or false lumen.
We used Gaxotte’s (Gaxotte V. J Endovascular Therapy 2003; 10:719)
classification: Type I, no dissection extending into the branch; Type II,
dissection extending into branch; Type III, avulsion tear of branch from true
lumen. Type II and III together was defined as dissected RA.
Results For the total 216 RA, 149 (69%) were affected. 84 RA were
affected in type-A AD, in which 32 (38%) were dissected with a
predominance on left (N=23) over right (N=9) RA (P=0.002). There were
65 RA affected in type-B AD, in which 21 (32%) were dissected with a
balance between left (N=11) and right (N=10) RA (Chi-Square, P = 0.36).
On the other hand, there were 129 RA affected by false lumen, in which
48 (37%) were dissected with a predominance on left (N=30) over right
(17) RA (P = 0.007). 20 RA were affected by intramural hematoma, in
which 6 (30%) were dissected with a balance between left (N = 4) and
right RA (N = 2)(P = 0.31).
Conclusions In patients with acute AD, dissection of renal arteries is
more frequently occurred in the left side than the right side; however, the
difference is significant only in subtypes of type A or those with false lumen.
Keywords Kidney, Anatomy, Angiography, Aorta, Arteries
1
Division of Medical Imaging, Chung Shan Medical University
Hospital, Taiwan
2
Division of Cardiovascular Surgery, Chung Shan Medical
E-Poster
Purpose The goals of this exhibition are to explain CT techniques of
morphologic and functional analysis and to demonstrate various imagings
of MDCT for evaluating hypertension.
Methods 16-slices and 64-slices MDCT used in this study have a relative
high spatial resolution and a high contrast between the blood and other
tissues can be achieved after injection of contrast. Multiplanar reformation,
maximal intensity projection, 3-dimensional imagings, and functional
parameters measured by MDCT are used for evaluating hypertension.
Also, imagings of MDCT will be compared with those of transthoracic
echocardiography.
Results Cardiac MDCT provided superior image quality and accurate
data of functional analysis in evaluation of hypertension. Also, results of
MDCT were well correlated with those of transthoracic echocardiography.
Conclusions Cardiac MDCT is powerful and complementary imaging
modality to evaluate hypertension.
Keywords CT, Echocardiography, Heart
CV018
Differential Susceptibility of Bilateral Renal Arteries in Aortic
Dissection – A Multi-Slice CT Study
Wu Fu-Zong
RSROC, Taiwan
Others
²Department of Anesthesiology and Pain medicine, Asan Medical
³Department of Internal Medicine, Soonchunhyang University
Bucheon Hospital, Korea
Purpose To illustrate the imaging features of various congenital thoracic
venous abnormalities in adults. To outline the clinical implications for each
abnormality.
Methods The use of multislice CT and MR angiography provides
noninvasive imaging of the vascular system. Anatomy of thoracic veins is
complex but has been described in detail. Knowledge of thoracic venous
anatomy is important to recognize anatomic variants. We will show various
thoracic venous abnormalities in adults with their clinical impacts.
Results A variety of congenital abnormalities of thoracic veins including
the superior vena cava, brachiocephalic vein, pulmonary vein, azygos
and hemiazygos systems will be illustrated. Clinical implications of each
abnormality will also be discussed.
Conclusions The major teaching points of this exhibit are to understand
the different imaging features and clinical implications of congenital
thoracic venous abnormalities in adults.
Keywords Anatomy, Lung, MR, CT, Heart
CV032
Imaging of Post-Operation for Transposition of the Great
Arteries (d-TGA): Anatomy and Function
Tsun-Hou Chang1, Harold Litt2, Guo-Shu Huang1
1
Department of Radiology, Tri-Serive General Hospital, Taiwan
2
Department of Radiology, University of Pennsylvania School of
Medicine, United States
Purpose To evaluate d-TGA cases with Multi-detector rows CT (MDCT)
and MR imaging in cine, angiography and velocity mapping for detecting
late complications of post-operative follow-up.
Methods Thirty-two consecutive patients, from 2006 to 2009 in the
Hospital of University of Pennsylvania database, were studied with MDCT
or MRI for post-operative follow-up. Most of these patients also studied
with transesophageal echocardiography (TEE) for complimentary survey.
Results MDCT plays a role for patients who are contraindicated to receive
MRI, and illustrates very good anatomic images to evaluate post-operative
complications, such as baffle leakage, stenosis or obstruction. MRI
566
Purpose To review the clinical presentations and image findings in the
rare cases of vascular rings (the congenital malformation of aortic arch
including double aortic arch and right aortic arch associated with aberrant
left subclavian artery) in adults.
Methods From 2006 to 2009, we collected totally seven consecutive
adult cases with vascular rings which were incidentally diagnosed
based on multi-detector computed tomography (MDCT) findings. Six
cases had chest radiographs (CXR). Under the impressions other
than tracheoesophageal compression of the vascular rings, all of them
underwent MDCT examinations followed by image processing for
multiplanar reformatted images and three-dimensional volume rendered
(VR) images for better depictions of the trachea, the esophagus and
the vascular rings. We reviewed their clinical presentations, the initial
impressions on CXR and MDCT findings about the vascular anomalies.
Results Of the seven consecutive cases of vascular rings (five males and
two females with ages ranging from 20 to 86), only two patients recently
had mild dysphagia. The initial impressions of clinicians on CXR were
superior mediastinal mass (n=4) and right side aortic arch (n=4). The
findings from VR images could be categorized into four types: (1) right
aortic arch (RAoAr) associated with a Kommerell's diverticulum (KD),
an aberrant left subclavian artery (aLS) and a right descending aorta
(RDAo) (n=4); (2) a double aortic arch associated with a RDAo (n=1);
(3) RAoAr associated with KD, aLS and retroesophageal left descending
aorta (n=1); (4) AoAr associated with KD, aLS, RDAo and a left subaortic
brachiocephalic vein (n=1). The two symptomatic patients belonged to
type 3 and type 4 respectively.
Conclusions Conclusions Of the vascular rings in adults, the type 1 and
type 2 are asymptomatic. If symptomatic with dysphagia, the patients
may belong to type 3 or type 4. MDCT with VR images is promising in
diagnosis and depiction of vascular rings.
Keywords Anatomy, Aorta, Congenital, CT
CV036
Using 3D Half-Fourier FSE with Time-Spatial Labeling
Inversion Pulse Techniques Improve the Imaging Quality of
Non-Contrast-Enhanced MRA of Proximal Segments of Neck
Arteries
Hsin-Chieh Lin¹, Wei-Lun Huang 1, Wei-Hsing Li 1, See-Ying
Chiou1, Ming-Sheng Chern1, Chi-Hsin Lee, Kai-Chi Chen1, JennLung Su2
1
Department of Medical imaging, West Garden Hospital, Chinese
Taipei
2
Departmentof Biomedical Engineering, Chung Yuan Christian
University, Chinese Taipei
Purpose The disadvantages of TOF (time of flight) MRA failed to visualize
the proximal segments of neck arteries. This study aims to using noncontrast-enhanced MRA techniques with 3D Half-Fourier FSE with TimeSpatial Labeling Inversion Pulse (T-SLIP) techniques to improve the
imaging quality.
Methods Twenty five healthy adult (mean age 47.6y, range 16~74y) were
included in this study. We used ECG and respiratory gating synchronized
3D Half-Fourier FSE with (T-SLIP) techniques, the images were obtained
on diastolic phase during free breathing, The appropriate inversion time
airway.
Results A fistulous connection between the left pulmonary artery and
the innominate vein was incidentally shown on the three-dimensional
CT reconstruction imaging. The pulmonary arteries were mildly dilated
bilaterally. On the other hand, the CT scan provided no evidence of
external compression or vascular ring, besides mild left main bronchial
stenosis.
Conclusions On reviewing the previous literature, very little cases
were reported to have congenital fistulous connection between the left
pulmonary artery and innominate vein. The first case documented was
published in 1996, in an adult individual and also presented as incidental
finding. No such anomalous vascular connection had been demonstrated
in a child before.
CV037
Truncus Arteriosus
Son Phi Duong, Vu Tuan Nguyen, Hai Thanh Phan
Department of Cardiology, Vietnam
Purpose Truncus arteriosus is extremely uncommon and complex
congenital heart disease (present at birth) that occurs due to abnormal
development of the fetal heart during the first 8 weeks of pregnancy. It
occurs when the single great vessel fails to separate completely, leaving a
connection between the aorta and pulmonary artery. Our report presents
7 cases which represent four types of Truncus arteriosus. They were
suggested the diagnosis by Echocardiography afterward diagnosed and
classified clearly by MDCT-64.
Keywords Heart
CV038
Role of 64 Multi-Detector Computed Tomography in
Congenital Heart Diseases
Son Phi Duong, Vu Tuan Nguyen, Hai Thanh Phan
Department of Cardiology, Vietnam
CV033
Multi-Detector CT Diagnosis of Vascular Rings in Adults
Wing-Keung Cheung, Li-Pao Lin, Hsin-Yi Lai, Kao-Lan Wang
Department of Medical Imaging, Far Eastern Memorial Hospital,
Taiwan
and delay time parameters depends on ECG interval. No contrast medium
was administrated. We evaluated the imaging quality by 4-point scores (14), The point beyond 3 was defined as diagnostic value. The overall 175
neck arteries were evaluated by 2 radiologists.
Results The imaging quality was scoring, respectively, brachiocephalic
artery, bilateral common carotid artery, bilateral subclavian artery and
bilateral vertebra artry. The total means scores was 3.21 ± 0.68, the mean
diagnostic rate was 88.22 ± 0.14.
Conclusions Non-contrast-enhanced MRA with 3D Half-Fourier FSE and
T-SLIP techniques is able to improve the imaging quality of neck vessels
in proximal segments and also provide more information.
Keywords Angiography, Arteries, MR
E-Poster
CV031
Congenital Thoracic Venous Abnormalities in Adults:
Spectrum of Imaging Findings
Yon Mi Sung, SS Byun, JH Kim, HS Kim
Department of Radiology, Gil Hospital, Gachon University of
Medicine and Science, Korea
demonstrates not only good anatomic images, but also shows promising
functional data for further evaluation.
Conclusions MDCT and MRI are useful noninvasive methods of
investigating late complications of post-operative d-TGA patients
undergoing follow-up.
Keywords Arteries, MR, CT
Purpose To assess role of MDCT-64 in congenital heart diseases
diagnosis compare with operative result and interventional angiography .
Methods Since 09/09/2006 up to 09/10/2009 our center had 4000
patients scanned heart with contrast by MDCT-64. 95 patients with
complex congenital heart diseases: Complex Aortopulmonary collateral/
Pulmonary atresia with ventricular septal defect; Transposition of the great
arteries; Double-outlet ventricle; Tetralogy Fallot; Single atrial-ventricle;
Coarctation of the Aorta; Interruption of the Aorta; Truncus Arteriosus;
Aortopulmonary window; Alcapa syndrome; Aneurysm of Coronary
Artery… Most of operated cases demonstrated the exact diagnosis of
MDCT-64 in congenital heart diseases.
Conclusions MDCT-64 is the fast and non-invasive diagnosis method,
overcoming the limit of Echocardiography, providing the panorama and
useful informations prior to operate.
Keywords Heart
CV039
Congenital Pulmonary Artery to Innominate Vein Fistula in a
Child
Yen Ling Huang
Department of Radiology, Chung Gung Memorial Hospital,
Taiwan
Others
in patients with abdominal mycotic aneurysms and to propose a
clinicoradiological grading.
Methods We retrospectively reviewed consecutive 40 patients
undergoing surgery for mycotic aneurysms in the abdominal aorta or
iliac arteries. Based on the computed tomography (CT) findings, mycotic
aneurysms were categorized as follows: grade 1, periarterial soft-tissue
mass, stranding or fluid, with minimal arterial wall change; grade 2,
focal destruction at the lumen circumference; grade 3, “retroperitoneal
infectious complex;” and grade 4, presence of massive perianeurysmal
hemorrhage. Clinical profiles, surgical procedures and outcomes were
analyzed.
Results Forty-seven CT scans were available for review. Aneurysm
progression was shown in all six patients undergoing sequential CT
scans within 7 to 24 days. At the latest preoperative imaging, 8, 17,
10 and 5 mycotic aneurysms were categorized into grades 1, 2, 3 and
4, respectively. One (4%) in grades 1 and 2 required a concomitant
gastrointestinal procedure, versus 5 (33.3%) in grades 3 and 4 (P = .02).
The surgical mortality rate was 17.5%. The mortality rates were 0, 5.9%,
20% and 80% across the 4 grades (Cramer’s V coefficient = 0.65, P =
.002), indicating a strong association between the clinicoradiological
grading and mortality.
Conclusions The radiologic features of abdominal mycotic aneurysms
may not only be suggestive of the diagnosis, but also helpful in predicting
surgical complexity and outcomes.
Keywords Aneurysms, Aorta, CT, Surgery, Infection
Purpose Demonstration of a fistulous connection between the left
pulmonary artery and the left innominate vein in a child.
Methods An 1-year-3-month old girl, who was just discharged from local
clinics due to acute bronchopneumonia, was admitted to our hospital due
to fever flaring-up and persistent cough as well as bilateral white-out lung
fields on the chest radiography. The follow-up CXR a day after, however,
showed dramatic improvement. Since foreign body aspiration was highly
suspected, the bronchoscopy was arranged, which showed no evidence
of foreign body but circumferential lumen narrowing of the left main
bronchus. We performed chest CT to exclude vascular compression of the
567
ER011
Traumatic Chest Wall Herniation
Huai-Cheng Hsueh1, Chui-Mei Tiu2, Ming-Hsun Lee1, Tse-Kai
Tseng1
1
Department of Radiology, Lotung Poh-Ai Hospital, Taiwan
2
Department of Radiology, Taipei VGH, Taiwan
Purpose A 48 y/o male complained Lt chest wall and flank painful swelling
and ecchymosis due to falling down accident from one floor height. The
CXR showed fracture of Lt 9th and 10th ribs, then conservative treatment
is performed. After two weeks, focal swelling is still persisted, R/O focal
hematoma, but the fine-niddle aspiration is dry tapping. Chest CT scan
showed torn external abdominal oblique muscle and Lt 9-10th intercostal
muscle with mesentaric fat herniation.
Keywords Hernia
ER014
The Use of MR Arthrography in Acute Ankle Trauma: A Case
Report
Chi-Yin Ma
Department of Medical Imaging, Po-Jen General Hospital,
Taiwan
Purpose We report a case of acute ankle injury in which early
MR arthrography played a decisive role for treatment planning.
Methods A 44-year-old male was sent to our emergency room for
intractable left ankle pain and severe swelling after a fall. Since there was
no major torso injury, early surgery for suspected tendon rupture was
initially suggested by orthopedist after roentgenograms taken. With high
risk of ligamentous injuries and instability in moderate to severe ankle
trauma, we suggested MR arthrography which revealed no tendon rupture
but partial tear or tenosynovitis of the flexor hallucis and digitorum tendons
with tarsal tunnel syndrome, partial tear of the lateral collateral ligament
complex, chronic talocalcaneal osteoarthritis, and, unexpectedly, linear
fracture of the talus.
Results The surgery was undue after full discussion, and the medical
568
EX006
Variations in BOLD Response Latency Estimated from
Event-Related fMRI at 3T: Comparisons between GradientEcho and Spin-Echo
Mei Yu Yeh1, Changwei W Wu2, Wan-Chun Kuan3, Pei-Shan
Wei1, Yau-Yau Wai1, Wan Yung-Liang4, Ho-Ling Liu1
1
Graduate Institute of Medical Physics and Imaging Science,
2
University, Taiwan
3
Department of Environmental Science and Biomedical
Engineering, National Tsing Hua University, Taiwan
4
Division of Medical Imaging and Intervention, Chang Gung
algorithms are analyzed using T test. The results of T test for Roberts,
Sobel, and Canny are 0.704, 0.741, and 0.911.Canny algorithm generates
was found to has the most comparable result with manual depiction.
Conclusions Canny algorithm can reduce inaccuracy caused by human
intervention and shortening time of process significantly. It is a reliable
method to substitute for manual segmentation.
Keywords Anatomy, Angiography, Dissection
Purpose This study aimed to evaluate the performance of latency
estimation by different BOLD fMRI techniques, with two event-related
experiments at 3T.
Methods The first experiment evaluated the variations of hemodynamic
latency between voxels within the visual cortex and their relationship with
CNR for GRE, spin echo (SE) and diffusion-weighted SE (DWSE). The
second experiment used delayed visual stimuli between two hemifields
(delay time =0, 250 and 500 ms) to assess the temporal resolving power
of three acquisition conditions: GRE with TR=1000 ms, GRE with TR=500
ms and SE with TR=1000 ms. The results of experiment I showed the
earliest latency with DWSE (1.97 ± 0.33 ms) followed by SE (2.44 ± 0.31
ms) and then GRE (2.84 ± 0.72 ms), with significant differences found
between the DWSE and the other two (p<0.05). In general, latency
variations decreased as the contrast-to-noise ratio (CNR) increased for all
three techniques.
Results For experiment I, similar variations were found between GRE
and SE even when the later had lower CNR. For experiment II, significant
correlations were found between measured and preset stimulus delays
for subject-averaged data obtained from all three conditions (r^2=0.992,
0.990 and 0.958 for GRE with TR=1000, GRE with TR=500 and SE with
TR=1000, respectively ). The inter-subject variation of the measured
delay was found to be greatest with the GRE with TR=1000 (89~319 ms)
followed by the GRE with TR=500 (120~260 ms) and the smallest with the
SE with TR=1000 (71~152 ms).
Conclusions BOLD responses obtained from GRE exhibited greater
CNR but no compromised latency variations in the visual cortex. SE was
potentially capable of improving the performance of latency estimation,
however, no significant advantages were found due to its inferior
sensitivity at 3T.
Keywords MR, Hemodynamics/Flow Dynamics
Purpose We report a case of SMA dissecting aneurysm, misdiagnosed by
CT, diagnosed by angiogram and treated by stent inplantation.
Methods Abdominal CT, angiogram.
Results A 52years old female came to emergency with persistent
severe upper abdominal pain for 3 days, worse after intake of food. She
had history of hypertension and hyperlipidemia for 5 years and under
irregular control. Abdominal CT showed SMA thrombosis. After admission,
angiogram was done and showed dissecting aneurysm of SMA with
partial thrombosis of false lumen and compression of true lumen. We do
stent implantation and the patient recovered after close observation and
symptomatic treatment. Follow up CT showed patent true lumen.
Conclusions SMA dissecting aneurysm was misdiagnosed at emergency
CT and diagnosed by angiogram, we review the literatures of SMA
dissecting aneurysm to differentiate the thrombosis and dissecting of the
SMA.
Keywords Dissection, Stents
E-Poster
ER002
SMA Dissecting Aneurysm, A Case Report
Yi-Jie Ou Yang1, Jen-Dar Chen2, Chui-Mei Tiu2, Yi-Hong Chou2,
Teh-Chen Wang1, Teh-Chen Wang1
1
Department of Radiology, Taipei City Hospital Yang-Ming
Branch, The Radiological Society Of the Republic of China,
Taiwan
2
Department of Radiology, Taipei Veterans General Hospital;
School of Medicine, National Yang-Ming University, The
Radiological Society Of the Republic of China, Taiwan
treatment was focused on symptomatic relief of tarsal tunnel syndrome
and immobilization for fracture union.
Conclusions Ankle and foot injuries account for about 10% of emergency
room visits. MRI or MR arthrography mandates more clinical attention in
emergency settings if feasible.
Keywords Ankle, Arthrography, MR, Trauma
EX007
Evaluation of Automatic ROI Identify for Patients with Aortic
Dissection
Chia-Yuan Wu, Ming-Ju Chan, Shih-Kung Chou, Liang-Kuang
Chen
Department Diagnostic Radiology, Shin-Kong Wu Ho-Su
Others
Purpose Clinician depicted the area of aortic dissection manually to select
the suitable size of stent for intravascular treatment in past. However it’s
time-wasting and possible delay treatment opportunity. The purpose of
this research is to find out the best edge detection algorithm to shortening
the evaluation time and reduce the mortality.
Methods Ten patients with aortic dissection underwent three different
edge detection algorithms (namely Roberts algorithm, Sobel algorithm and
Canny algorithm) respectively to analyze the area of aortic dissection. The
results were compared with manual depiction to find out the best edge
detection algorithm.
Results 436 CT images were analyzed successfully in ten patients.
The area of aortic dissection obtained by three different edge detection
569
Purpose To evaluate chemical shift and diffusion-weighted MR imaging
using apparent diffusion coefficient (ADC) values for the characterization
of functioning and nonfunctioning adrenal adenomas.
Methods The study included 51 patients (25 women and 26 men) with 52
adrenal adenomas (four aldosteronomas, seven Cushing adenomas and
41 nonfunctioning adenomas) who underwent adrenal MRI examinations.
Chemical shift images were obtained by gradient echo sequence under
breath holding with the following parameters: 139/4.53, 2.40/1 (TR/TE
in-phase IP, out-of-phase OP/excitations); FA 90; slice thickness/gap
3.0 mm/0.6 mm. The signal intensity index (SII=[IP-OP]/IP × 100%) was
calculated. Diffusion-weighted images (DWIs) were performed using
echo planar imaging sequences under free breathing with the following
parameters: 3000/70/12 (TR/TE/excitations); echo train length 132; slice
thickness/gap 3.0 mm/0.6 mm and b-factor set at 50 and 800 sec/mm2.
We set the region of interest in the center of the adrenal mass, except for
cystic lesions and necrosis, and then measured the ADC value.
Results All 52 adrenal adenomas were demonstrated as high signal
intensity on DWIs. The diameter of the aldosteronomas (mean, 15.5 mm;
range, 15-17 mm) was smaller than that of the Cushing adenomas (mean,
34.9 mm; range, 19-51 mm) and nonfunctioning adenomas (mean, 21.5
mm; range, 15-47 mm). There was no difference in the mean ADC values
or mean SIIs among aldosteronomas (1.28 ± 0.27 × 10-3 mm2/s, 71.1 ±
14.6%), Cushing adenomas (1.09 ± 0.14 × 10-3 mm2/s, 53.8 ± 24.2%)
and nonfunctioning adrenal adenomas (1.06 ± 0.13 × 10-3 mm2/s, 65.5 ±
20.7%).
Conclusions ADC values and SIIs did not have diagnostic usefulness for
differentiating functioning and nonfunctioning adrenal adenomas.
Keywords Adrenal, MR
GU004
Endorectal Magnetic Resonance Imaging Staging of
Prostate Cancer: Utility of Diffusion Weighted Imaging (DWI)
and MR Spectroscopic Imaging (MRSI)
Jenny Ho¹, KS Tai1, WK Tso1, Michael Sun1, PC TAM2
1
China
2
Department of Surgery, Queen Mary Hospital, Hong Kong,
China
Purpose There are important treatment and prognostic implications in
distinguishing between organ-confined prostate cancer from that has
spread locally outside the capsule and that which has invaded the seminal
vesicles. Our retrospective study is to report the accuracy for the primary
tumour staging of prostate cancer with endorectal magnetic resonance
imaging (MRI), and to determine the role of DWI and MRSI in the
detection of tumour.
Methods From July 2007 to July 2009, 55 patients were referred for
endorectal MRI for pre-treatment evaluation of prostate cancer. Inclusion
criteria were TRUS biopsy-proven prostate cancer, minimum 4 weeks from
previous biopsy and radical retropubic prostatectomy within 6 months of
MRI. No patient had prior therapy or significant postbiopsy haemorrhage.
A total of 18 patients met all inclusion criteria. A 1.5T MR scanner was
employed with an endorectal/torso coil combination. The MRI protocol
included T1W and T2W scans of the prostate and pelvis. In addition
DWI and MRSI of the prostate were also obtained. The MR data were
evaluated on a General Electric Workstation using Functool v4.3 software.
Final histopathological report was used for correlation.
570
GU005
CT Findings of Renal Cell Carcinoma
Jongchul Kim
Department of Radiology, Cungnam National University Hospital,
Korea
Purpose To define and demonstrate the important CT [especially MDCT]
findings of the renal cell carcinoma (RCC) which is the most common
cancer of the kidney.
Methods Among 26,997 patients who received CT due to clinical suspicion
of abdominal disease in our hospital during recent 10 years, 5,916 patients
with available CT and final diagnosis of RCC (either proven by operation or
renal mass biopsy) were retrospectively analyzed by two radiologists.
Results CT findings of the RCC with various staging and unusual RCC
with difficult differentiation from other tumors will be discussed and
illustrated. RCC at CT usually is demonstrated as a renal mass with
variable density (depending on the presence of necrosis, hemorrhage,
or calcification) and inhomogeneous enhancement, and as a mass
causing adjacent focal renal contour bulging. Mass detectability is better
in nephrographic phase than corticomedullary phase. Approximately
5-10% of cases of RCC present as a mainly fluid-filled cystic mass with
or without solid portions. The presence and extent of venous invasion of
RCC is easily diagnosed on CT when images are obtained in a dedicated
protocol, particularly for scan delay time. CT angiography and CT
urography using MDCT seem to be useful to evaluate tumor thrombus in
renal veins or IVC or to rule out RCC invasion of pelvocalyceal systems or
proximal ureters.
Conclusions Familiarity with the spectrum of CT findings of RCC including
recurrent ones will allow the clinicians to consider appropriate treatment of
the patients and may eliminate the need for further imaging evaluation.
Keywords Kidney, CT
GU006
Imagings with Clinical Correlation of the Diagnosis of
Fournier Gangrene
Ming Pin Lin
Department of Radiology, Chi-Mei Medical Center Liouying
Campus, Chi-Mei Medical Center Liouying Campus, Attending
Staff, Taiwan
Purpose To retrospectively evaluate the usefulness of imagings and
clinical evaluation in the diagnosis of Fournier Gangrene.
Methods Fifteen patients who had undergone preoperative 14 CT, 1
sonography and who had surgical and or cytology proved Fournier
Gangrene.The patients included 14 men and 1 woman with mean age of
64 years (range, 34-88 years)
Results The prevalence of location was perianus (4 patients), perineal
(8 patients), genital regions (5 patients). Fascial thickening (10 patients),
fatty stranding (6 patients), subcunteneous emphysema (12 patients), fluid
collection (6 patients), abscess formation (8 patients). Mixed bacteria flora
3 species was (7 patients), 4 species (4 patients), 5 species (2 patients),
6 species (2 patients) and most commonly found bacteria was E.coli (11
patients), Klebsiella (7 patients), Streptococcus (6 patients), Enterococcus
imaging findings have some specific features. MSCT is a valuable and
necessary method in diagnosis of it and has high value in determination of
treatment plan and evaluation of prognosis.
Keywords Pelvis, CT, Uterus, Vena Cava
GU008
Roles of Radiological Imaging or Sonography in Different
Practice Guidelines for Acute Renal Colic by Urolithiasis
Chih-Cheng Lu
GU010
The Appearance of Lymphangioleiomyomatosis in MSCT
Dao-Ping Wang
Purpose Compared with other radiological tools, no radiation exposure is
noted in sonography. Assessment of the roles of radiological imaging and
sonography in different clinical practice guidelines (CPGs) for acute colic
events in urolithiasis was performed.
Methods The printed or online materials in CPGs for acute renal colic
related to ureteral stones by American College of Radiology (ACR),
European Association of Urology combined with American Urological
Association (EAU/AUA), and British National Health Service (NHS) were
reviewed.
Results The latest English versions of CPGs for acute colic of ACR, EAU/
AUA, and NHS were available in 2007, 2008, and 2009, respectively.
In ACR, the highest rating (scale 8) was non-enhanced computed
tomography (CT), sonography was suggested for patients in pregnancy,
in patients who were allergic to iodinated contrast, and in case with no
CT available. In EAU/AUA, the highest recommendation of diagnostic
imaging study was non-enhanced CT, followed by excretory urography
and sonography. Sonography was with level 2a for evidence, and grade B
for recommendation. CT was less suggested for follow-up after treatment
of radiopaque stones. In NHS, sonography was suggested for pregnant,
pediatric, and febrile patients. Sensitivities of sonography were not
as high as CT in stone detection. Sonography was useful to diagnose
hydronephrosis in people with complicated renal colic.
Conclusions In this limited review, varieties exist in different guidelines.
Sonography is a noninvasive tool but with limited usefulness based on
rating from different CPGs. However, that is quite different from our daily
practice. The study may do some help in establishing an official guideline
for evaluation of acute renal colic in Taiwan.
Keywords Acute, Kidney
GU009
Intravenous Leiomyomatosis: Diagnosis and Follow-Up with
MSCT
Cong Sun
Purpose To explore the clinical and image features of intravenous
leiomyomatosis, and evaluate the diagnostic and follow-up value of MSCT
on it.
Methods A retrospective study was performed in 3 cases with intravenous
leiomyomatosis and treated by surgery. All of them were female, and
had a history of hysterectomy. All cases were performed with MSCT
for diagnosis and follow-up. Two-dimensional and three-dimensional
reconstructions were performed in all cases by means of MPR (coronal,
sagittal oblique), CPR, MIP and VR. In the meantime, color doppler flow
imaging (CDFI) were also performed.
Results MSCT could display the panorama of the lesion. 3 cases could
be seen the lesion rooted from the iliac vein. 2 cases were showed with
intravenous leiomyomatosis extending through the inferior vena cava (IVC)
into the right cardiac cavities. And 1 case also had multiple rounded welldefined nodules in bilateral pulmonary. After surgery (3 months, 1 year
and 3 years, respectively), 3 cases were recurrence and accompanied by
collateral circulation. 2 cases with the subsequent development of diffuse
peritoneal leiomyomatosis.
Conclusions Intravenous leiomyomatosis is a rare disease, it often
extends through IVC into the right cardiac cavities, and its clinical and
P u r p o s e To e x p l o r e t h e c l i n i c a l a n d i m a g e f e a t u r e s o f
lymphangioleiomyomatosis (LAM), and evaluate the diagnostic value of
MSCT on it.
Methods A retrospective study was performed in 4 patients with
lymphangioleiomyomatosis. All cases were performed with MSCT in lung
and renal. 1 case was performed in head.
Results MSCT could display the panorama of the lesion. 3 patients
were showed with renal angiomyolipoma and pulmonary LAM. All have
pulmonary cysts at high-resolution CT, and the cysts are typically round.
Renal angiomyolipomas were shown in all cases, and 1 case violations of
retroperitoneal. 1 patient also had multiple rounded well-defined nodules
in the wall of bilateral ventricle.
Conclusions Lymphangioleiomyomatosis is a rare disease, and its
clinical and imaging findings have some specific features in MSCT. MSCT
is a valuable method in diagnosis of it.
Keywords Kidney, Lung, CT
GU011
Ureterovesical Stones Found in the Ultrasound and IVP
Studies
Yang Ching Chen¹, Tung Wei Cheng1, Te Chun Lee2, Jen Chung
Su2
1
Department of Radiology, Song Shan Armed Forces General
Hospital, Taiwan
2
Department of Urology, Song Shan Armed Forces General
Hospital, Taiwan
Purpose Evaluation of the necessity of sonography to confirm the
suspicious UVJ stones in the urinary bladder found in the IVP studies.
Methods From March 2007 to August 2009, 15 patients (14 men and
1 woman, 25 to 76 years old) with ureterovesical stone obviously
showed on sonography or IVP studies. All patients (100%) showed
UVJ stone on sonography. 13 patients (86%) showed UVJ stone on
IVP. 14 patients (93%) performed sonography had mild to marked
hydroureteronephrosis. 13 patients (86%) performed IVP had mild to
marked hydroureteronephrosis.
Results According to the literatures, sonography was a good method to
find the ureterovesical stones in the urinary bladder. An article showed
small stones at the ureterovesical junction were more accuately diagnosed
by sonography (79%) than by urography (68%). In our studies, it might
be compatible with their results that UVJ stones were more accuately
diagnosed by sonography (100%) than by urography (86%). When we
performed the IVP study, we did the sonography immediately when the
urinary bladder was distended by urine. It helped us more confirm the
stone was located at the UVJ, then ureteroscopy was unnecessary.
Conclusions Ultrasound was effective supplementary study to confirm
the suspicious UVJ stone in the urinary bladder found in the IVP study.
Keywords Bladder, Ultrasound
GU012
A Giant Adrenal Pseudocyst: A Case Report
Kwok-Wan Yeung1, I-Jen Tseng2
1
Department of Radiology, Fooying University Hospital, Taiwan
2
Department of Urology, Fooying University Hospital, Taiwan
571
Fumio Kotake1, Ritsuko Morikawa2, Ryota Nishio1, YoshikoTakahashi1,
Masataka Hoshina1, Kouichi Tokuue2
1
Department of Radiology, Tokyo Medical University, Ibaraki Medical
Center, Japan
2
Department of Radiology, Tokyo Medical University Hospital, Japan
(6patients), Pseudomonas (6patients) etc.
Conclusions CT plays an important role in diagnosis and in the
evaluation of disease extent for planning appropriate surgical treatment.
Keywords CT, Infection
E-Poster
GU003
Chemical shift and diffusion-Weighted MR imaging using
apparent diffusion coefficient values of functioning and
nonfunctioning adrenal adenomas
Results Median age was 67 years with a range 56-76 years. Median
prostate-specific antigen was 7.4 with a range of 2.5-16, and median
Gleason score was 6 with a range of 4-9. Sensitivity, specificity
and accuracy for detecting extraprostatic extension including both
extracapsular extension and seminal vesicle invasion were, 75%, 93%
and 89% respectively. The combination of MRSI and DWI with T2W image
improved tumour localization compared with T2W imaging alone, with
MRSI (sensitivity 78%) being more sensitive than DWI (sensitivity 31%) in
lesion detection.
Conclusions Endorectal MRI can reliably differentiate organ confined
(pT2) from locally invasive (pT3) prostate cancer. The combination of
DWI and MRSI with T2W imaging facilitate tumour localization, with MRSI
being more sensitive than DWI in lesion detection.
Keywords MR, Prostate, Staging
Others
Purpose 1. To identify and illustrate spectrum of various adrenal lesions
on CT and MRI. 2. To review the pathogenesis. 3. To describe and
illustrate the CT and MRI appearances of adrenal lesions. 4. To describe
advantages of additional MR sequences and contrast technique in the
differential diagnosis of adrenal lesions with a similar appearance.
Methods A diverse range of adrenal pathologies has similar radiological
appearance. Even simple incidentalomas can mimic neoplastic lesion
.At the same time, infective lesion can mimic malignancy. It is not always
possible to biopsy the lesion. Hence it is necessary to have certain
characteristic of lesions categorizing them as benign or malignant or
infective or incidentalomas noninvasively so that unnecessary intervention
can be avoided. This exhibit illustrates indications, technique, procedural
protocols for adrenal lesions and describes CT and MRI appearances of
these lesions.
Results Various adrenal lesions that we came across were: 1. Normal
Variants, pseudo-tumor, 2. Calcification, 3. Hyperplasia, 4. Adrenal
hemorrhage, 5 .Adrenal Cysts developmental, post traumatic, 6.
Tuberculosis, 7. Histoplasmosis, 8. Adenoma single and multiple, 9.
Adrenal cortical carcinoma, 10. Metastasis, 11. Pheochromocytoma, 12.
Neuroblastoma, 13. Ganglioneuroma.
Conclusions The major teaching points of this educational exhibit are:
1. Normal CT and MR anatomy of adrenal glands and imaging findings of
various adrenal lesions 2. Accurate CT characterization of different adrenal
pathologies based on early and delayed enhancement patterns 3. Aid of
chemical shift imaging (In phase and Out of phase) in characterization of
adrenal lesions with a similar radiological appearance.
Keywords Adrenal, MR, Neoplasms-Primary, CT
GU016
Differentiation of Histolopathology Pattern in Uterine
Adenocarcinoma: Role of Diffusion MR Imaging at 3T
Yu Ching Lin¹, Koon Kwan Ng1, Yi Che Chang Chien2, Yu-Ruei
572
GU022
The Presentation of Malignant Peripheral Nerve Sheath
Tumor at Sacral Area: A Case Report
Yang Wen Iuan
Department of Radiology of VGHTPE, VGHTPE, Taiwan
Purpose The malignant peripheral nerve sheath tumor (MPNST) is the
malignant counterpart to benign soft tissue tumors such as neurofibromas
and schwannomas. It is most common in the deep soft tissue, usually
in close proximity of a nerve trunk. The most common sites include the
sciatic nerve, brachial plexus, and sarcal plexus. The most common
symptom is pain which usually prompts a biopsy.
Methods In this case, this 21 male patient presented with the symptoms
with bil legs weakness and urine, stool incontinence for several months,
NE showed bilateral leg flaccid.
Results Ultrasonography showed one iso-echoic multilobulated soft tissue
mass with several cystic changes within. MRI showed iso-signal intensity
soft tissue mass in T1WI and many high signal intensity cystic content in
it. After contrast, this tumor only showed moderate contrast enhancement.
Conclusions The most commonly seen sarcomatous lesion with
cystic degeneration include chondroid tumor such as chondrosarcoma,
liposarcoma, synovial sarcoma and malignant peripheral nerve sheath
tumor. From the clinical symptoms and image presentation, we can
conclude the most preferable possibility of such lesions.
Keywords Neural Networks, Pelvis, Retroperitoneum, Spinal Cord
GU024
Is It Possible to Diagnose Tubal Cancer on CT?
Kie Hwan Kim, Sang Been Nam, Young Ju Chung, Byung Hee
Lee, Du Hwan Choe
Department of Radiology, Korea Cancer Center Hospital, Korea
Purpose To evaluate diagnostic accuracy of tubal cancer on CT.
GU026
Ultrasound Diagnosis of Round Ligament Varices Mimicking
Inguinal Hernias in Pregnancy: A Case Report
Sang Hee Cho¹, Jong Yeol Kim1, Kyung Hwan Byun1, Byung Ki
Kim1, Hyung Jo Yoon2
1
Department of Radiology, CHA Gumi Medical Center, CHA
University, Korea
2
Department of Radiology, Daegu Fatima Hospital, Korea
Purpose Round ligament varices during pregnancy are an important
differential diagnosis of inguinal hernia as they may cause similar
symptoms and clinical features, like inguinal hernia does. When
this condition is diagnosed correctly, unnecessary operation may be
prevented.
Methods We described a case of round ligament varices presenting during
pregnancy that was readily diagnosed with Doppler ultrasonography.
Results Doppler ultrasonographic findings of round ligament varices were
presented. The pathophysiology, clinical significance, and differential
diagnosis of them were discussed.
Conclusions When inguinal mass lesion was observed in pregnancy,
round ligament varices should be included in the differential diagnosis.
Keywords Pregnancy, Ultrasound, Hernia, Varices
GU030
MR Imaging Manifestation of Myxoid Adrenocortical
Neoplasms: A Case Report
Lao I-Ha, Tzeng Wen-Sheng
Department of Division of Diagnostic Radiology, Chi Mei Medical
Center, Yong Kang, Taiwan
Purpose Myxoid adrenocortical neoplasms are extremely rare and
to our knowledge, only about less than 30 cases have been reported
in the literature. Most of the literature which be reported focus on the
cytopathologic feature of myxoid adrenocortical neoplasms.
Methods We present a 65-year-old female of retroperitoneal tumor by
incidental finding. The songraphy showed hyopechoic mass lesion at left
suprarenal region measuring about 4.9cm in diameter. On MR imaging the
lesion arising from lateral limb of left adrenal gland exhibited low signal
intensity in T1WI and heterogenous high signal intensity in T2WI with fat
saturation. No significant change of signal intensity can be depicted in
chemical shift imaging. This lesion shows two component with different
enhancing sequence and all enhance well in the delayed phase after
administration of Gd-DTPA. The tumor was removed and the pathology
revealed Myxoid adrenal cortical adenoma.
Conclusions Myxoid changes in adrenal cortical neoplasms are rare
but half percentage of malignant potential is noted in current literature.
Because of prominent image feature of myxoid changes in MR imaging.
The usual clinical and image features can be applied to identify the myxoid
adrenocortical neoplasms and predicts the high possibility of malignancy.
Keywords Adrenal, MR
GU033
Case Report: Primary Carcinoid Tumor of Kidney
Chi-Lun Weng, Yung-Cheng Wang, Sen-Ping Lin
Department of Radiology, VS, Taiwan
Purpose To present a rare case of renal carcinoid tumor. The clinical
presentation, imaging finding of computed tomogram, pathologic features,
prognosis and treatment will be described.
Methods A 67-year-old woman had the history of hypertension under
regular medication. She received health examination on 98/5/20 and a
left renal tumor was found incidentally in the abdominal sonography. She
denied body weight loss, hematuria or flank pain. Only mild microcytic
anemia was noted. Her U/A was normal and renal function was within
normal limit.
Results The CT finding of our patient’s shows a left renal mass with some
calcification. After contrast medium administration, it isn’t enhanced
Conclusions We review the case and literature for renal carcinoid tumor.
There are no specific CT or MRI image findings to help differentiate
carcinoid tumor from other types of renal tumor.
Keywords Kidney
GU034
Malignant Lymphoma Presenting as Advanced Ovarian
Cancer
Mein-Kai Gueng, San-Kan Lee, Clayton Chi-Chang Chen
Taiwan
Purpose To evaluate sonographical and CT findings of ovary lymphoma
Methods A 28-year-old woman presented with signs and symptoms
suggestive of an advanced ovarian cancer who received ultrasound and
CT scan.
Results The transabdominal and intravaginal sonography revealed two
huge hypoechoic solid masses, one about 150X91X149 mm in size over
right ovary and another one about 114X110X81 mm over left ovary. CT
scan showed two huge heterogeneous enhanced masses about over
abdominopelvis with multiple paraaortic lymphadenopathies about 10-20
mm in size. The diagnosis of malignant lymphoma was established from
the biopsy specimen by lapascope.
Conclusions Lymphoma involving the ovaries is unusual and may cause
confusion for the clinician since its presentation might resemble much
more like frequent tumors. In general, the likelihood of malignancy of
ovary increases with increasing solid-tissue elements and thick septa.
When big solid mass is noted over ovary, lymphoma should including in
differential diagnosis.
Keywords Lymphoma, Ovaries
GU039
Hydroureteronephrosis Due to Ureteral Endometriosis
Der Yen Lin
Department of Radiology, Taiwan
Purpose Ureteral endometriosis is a rare disease, and it may mimic tumor
growth.
Methods A 49-year-old women was admitted with right upper abdominal
pain and fever. Abdominal sonography and CT were performed. PCN and
right laparoscopic nephroureterectomy were done.
573
Purpose Can DW (diffusion weighted) images assist in differentiating
histopathology of the uterine adenocarcinoma and also determine where
dose adenocarcinoma originated from cervix or endometrium?
Methods From 2006 to 2009, 93 patients with adenocarcinoma proven by
biopsy have undergone MRI (3-T MR scanner) in our institution and which
includes 34 cervical and 59 endometrial adeoncarcinoma are studied.
Histology differentiation pattern are divided into 39 well, 33 moderate and
21 poor. Cell types are classified as type I (endometroid and mucinous;
77 patients), type II (serous and clear cell; 8 patients) and Others
(adenosquamous and mixed; 7 patients). ADC is measured in all patients
and analyzed.
Results Mean apparent diffusion coefficient (ADC) value for histology
differentiation pattern are well (91.69 mm2/sec), moderate (85.58 mm2/
sec) and poor (80.1 mm2/sec). Which shows linear increment of ADC
value from poor to well. Mean ADC value for Cell Type I (88.07 mm2/sec),
type II (77.45 mm2/sec) and diagnostic accuracy for these two cell type
may reaches 87.06%. We obtained ADC value of 70 x 10-5 mm2/sec as a
cut off point for differentiating cervical and endometrial adenocarcinoma
with ADC > 70 x 10-5 mm2/se overall accuracy for diagnosing cervical
adenocarcinoma may nearly reach up to 100%.
Conclusions DWI is helpful in distinguishing uterine adenocarcinoma
originates from cervix or endometrium and it also has unique characteristic
in histopathology pattern of adenocarcinoma.
Keywords MR, Cervix, Pathology, Uterus
Methods CT findings of 12 patients with tubal cancer were evaluated
retrospectively. Histologically, 9 cases were serous adenocarcinoma, 1
case was carcinosarcoma, 1 case was borderline mucinous tumor, and
1 case was undifferentiated carcinoma. According to proportion of cystic
portion within the tumor, each case was divided into four categories: type I
was composed of more than 75% of cystic portion, type II was composed
of between 50% and 75% of cystic portion, type III was composed of
between 25% and 50% of cystic portion, and type IV had less than 25%
cystic portion. Diagnostic accuracy was evaluated for each type.
Results There were 1 serous carcinoma patient in type I, 4 serous
carcinoma patients in type II, 4 serous carcinoma patients and 1 mucinous
carcinoma patient in type III, and 2 carcinosarcoma patients and 1
undifferentiated carcinoma patient in type IV. In type I and II, diagnosis of
tubal cancer was easily made by dilated tubular cyst within irregular solid
mass. In type III, only 2 cases were suspected as tubal cancer. In type IV,
it was difficult to differentiate from other solid ovarian cancer due to scanty
cystic portion. However, the shape of solid mass was elongated, which
was different from other ovarian cancer.
Conclusions Diagnostic accuracy was dependent on the extent of cystic
portion. In most cases of serous carcinoma, it was easy to predict tubal
cancer. The larger the amount of cystic portion within the tumor, the
easier we can differentiate from other ovarian cancer. Even if the lesion is
composed mostly of solid mass, we can suspect tubal cancer based on its
elongated shape.
Keywords Fallopian Tubes
E-Poster
GU013
Radiology of Adrenal Lesions: A Pictorial Essay Depicting
CT and MR Characteristic of Adrenal Pathologies
Ameya Jagdish Baxi¹, Kishore Tourani1, Sripathi Vidyasagar2,
Thanugonda Nagendra1, Kishore Tourani1
1
India
2
Department of Hyderabad, Care Hospitals, Hyderabad, India
Cheng1, Gigin Lin1, Yeuh-Lin Lee1, Shu-Hang Ng1, Chyong-Huey
Lai3
1
Memorial Hospital, Linkou, Taiwan
2
Department of Pathology, Chang Gung Memorial Hospital,
Keelung, Taiwan
3
Department of Obstetrics and Gynecology, Chang Gung
Memorial Hospital, Keelung, Taiwan
Others
Purpose Adrenal pseuodocysts are rare and mostly asymptomatic,
but sometimes reach huge sizes, and cause size-related symptoms.
We present a case of a huge symptomatic adrenal pseudocyst with
characteristic imaging findings.
Methods A 56 year-old female patient suffered from right flank pain off
and on for three days. Chillness and fever up to 39.4°C were noted. Blood
analysis showed CRP=36.3 mg/dl, WBC=18390/μl, and urinalysis reveals
RBC=0-2/HPF and WBC=10-15/HPF. A series of imaging studies was
performed.
Results KUB demonstrated a huge radiopaque mass in right abdomen.
Sonography found a huge anechoic mass with a diameter of 24 cm, with
interior septation, wall thickening and with fluid-debris level, displacing
the right kidney posteriorly. Contrast-enhanced CT showed a cystic mass
with partially calcified septation and minimal wall thickening in the right
retroperitoneal cavity, causing posterior displacement of right kidney,
which is consistent with a huge right adrenal cyst. Laparotomy indicated
a huge right adrenal cystic mass with severe adhesion and acute
inflammation around the cyst. Pathological examination disclosed the cyst
having a wall composed of fibrous tissue with degenerative adrenal gland
on the outer wall. Dense infiltration of suppurative cells, abscess and
hemorrhage were seen. No lining epithelium is present. All of the above
findings were consistent with adrenal pseudocyst.
Conclusions Adrenal pseudocysts are rare and represent approximately
80% of cystic adrenal masses. Characteristic imaging features are
essential for diagnosis of this rare cyst.
Keywords Adrenal, CT, Ultrasound
GU043
Extratesticular Epidermoid Cyst Mimicking Enlarged Testis
Hao-Lun Kao, Hung-Wen Kao, Cheng-Kuang Chang, Chun-Wen
Chen, Kai-Hsiung Ko, Ching-Jiunn Wu, Cheng-Yu Chen, GuoShu Huang
Department of Radiology, Tri-Service General Hospital, National
Purpose Epidermoid cysts are benign simple epithelial tumors usually
appearing as hypoechoic lesions with scattered echogenic reflectors on
sonography. Herein, we present a 53-year-old man with an extratesticular
epidermoid cyst in the right scrotum which shows confusing sonographic
findings, normal-appearing echogenicity of the lesion and atrophied
testis, which lead to a diagnostic dilemma. With a variety of sonographic
574
HN001
3D MR Volumetric Case Control Study: The Posterior Fossa
CSF Space in Hemifacial Spasm
Ling Ling Chan
Hospital, Singapore
Purpose Hemifacial spasm (HFS) is widely believed to be due to
neurovascular compression (NVC), but etiological controversies remain.
We conducted a prospective case control MR volumetric study to
determine if a smaller posterior fossa cerebrospinal fluid (PF CSF) space is
a risk factor for HFS, and the clinical predictive factors of PF CSF volume.
Methods Patients clinically diagnosed to have HFS, and controls closely
matched for age, gender, race and hypertension were recruited. All
subjects underwent a standardized MR scan focussed over the posterior
fossa. The PF CSF volumes were measured on the high resolution 3D
constructive interference at steady state (CISS) image datasets using the
threshold tool in an image analysis software. The clinical demographics
were tabulated and analyzed, and volumes measured compared with a
paired student t test.
Results Mean age of 41 patients and 41 controls was 55 + 10 (40 to 78)
and 56 + 10 (40 to 77) years, and mean PF CSF volume 17303 + 3900
(10947 to 26951) and 19216 + 3912 (10996 to 30070) mm3 respectively.
The mean volume in the HFS group was 11.4% smaller than in the
controls (p = 0.015). A multivariate linear regression analysis with age,
gender, hypertension, HFS disease and control groups as independent
factors and PF CSF volume as the dependent factor revealed that a
small PF CSF volume was significantly associated with HFS (p = 0.01).
Younger subjects (p = 0.001) and women (p <0.0005) were also found to
be significant predictors.
Conclusions A small posterior fossa CSF space is a facilitating factor for
HFS, and could explain the strong Asian and female preponderance.
Keywords Orbit, CT, Eye
HN003
The Spread Pattern of Head and Neck Infections
Dongwoo Park
Department of Radiology, Hanyang University Guri Hospital, Korea
Purpose This study is aiming to analyze the pattern of spread and
complication of head and neck infections with reviewing their relevant
anatomy.
Methods The characteristic CT and/or MR imaging features of head
and neck infections with relevant clinical manifestations are analyzed
and exhibited. The route of spread and potential complication of head
and neck infections is evaluated and demonstrated. Relevant anatomy
pertaining to infections in the orbit, ear, paranasal sinuses, oral cavity
and neck is reviewed. All cases would be evaluated for the presence of
drainable collection, vascular involvement such as venous thrombosis or
carotid artery integrity, airway displacement and/or compression, orbital
and/or intracranial and/or spinal involvement.
Results Dental infections are the most common cause of deep neck
infections in adults, of which peri-apical abscess is the most common
source. Loose connective tissue layer of the scalp, orbital septum,
periorbita, valveless facial venous channels, mylohyoid line, buccinator
muscle insertion, buccopharyngeal gap, spaces crossing thoracic
inlet, pterygopalatine fossa, and a few skull foramina are the important
determinants for the pattern of spread or potential complication of head
and neck infections. Life-threatening infections have become less
common in the post-antibiotic era, but the delay in the diagnosis may lead
to fatal complications. Many imaging features of infections are similar to
those seen with neoplasms and post radiation changes. The correlation of
clinical and imaging findings is key.
Conclusions Head and neck infections are closely correlated with each
other due to the spatial contiguity and the communicable specific anatomic
routes. So that, accurate imaging interpretation, and the understanding of
regional anatomy and specific anatomic routes, patterns of spread, and
potential complications of head and neck infections are the essence.
Keywords Abscess, Anatomy, CT, Pharynx, Face, Infection
HN004
Cadaveric CT Head Scans- An Inside Tale on How It Can Be
Done
Yeo Chye Whatt Kenneth
Hospital, Singapore
Purpose Cadaveric CT head scans are a unpleasant but necessary
service provided by our department at Singapore General Hospital to
assist our clinical colleagues in their training and research purposes. A
standardized method must thus be formulated to achieve optimal yet fast
imaging of these fragile specimens.
Methods A Siemens 64-slice MSCT is used together with some commonly
found items present in any medical department to carry out the imaging
process. The preparation and teamwork required for efficient imaging will
be highlighted.
Results To date, about 200 cadaveric heads have been scanned by our
department, with an average of 10-20 heads being scanned each time.
Optimal images have been achieved and our clinical colleagues have
been very satisfied with the resultant scan image data.
Conclusions Cadaveric CT head scanning can be easily and efficiently
carried out if the highlighted procedural steps are adhered to.
Keywords CT
HN006
Histiocytosis-X
Heng-Long Hsiao
Department of Radiology, Changhua Hospital, Department of
Health, Executive Yuan, Taiwan
Purpose Pt’s with hepatosplenomegaly, lymphadenopathy, pulmonary
lesions, and, eventually, destructive osteolytic bone lesions then extensive
infiltration of the marrow often leads to anemia, thrombocytopenia, and
predisposition to recurrent infections such as otitis media and mastoiditis
and bingo. The course of untreated disease is rapidly fatal. Prognosis
are depended on the extent of the disease on organ involved with
lymphadenopathy and otitis media, skin, liver, spleen, lung, pituitary, skeleton
or hemopoietic system, or with significant anemia, or thrombocytopenia then
biopsy to find this unknown etiology disease and cure.
Methods Pt’s skull X ray, CXR and KUB, long bones axial skeleton. The
age range was from infant to adult are all examined.The sex ratio of male
to female was equal and than they were subdivided into three groups as
eosinophilic granuloma, Hand-Schuller-Christian disease, and LettererSiwe disease according to clinical and pathological outcome. Lucaia’s
modified schema used to predicate the outcome of treatment.
Results Histiocytosis X may affect almost any organ, hence the clinical
findings are extremely variable. The radiological findings consisted of
bony lesions and lung lesions involvement. Frequent involved sites of
bone was skull, with decreasing order of spine, femur, pelvis, humerus
and radius.CXR shows diffue nodular pattern in upper and mid zones 1-5
mm in size. Progress of disease leads to ring shadows honeycombing and
linear shadows are noted. After treatment and Lucaia’s modified schema
to predicate the outcome of curretage, radiotherapy chemotherpy result
with excellent correlation were noted.
Conclusions With advanced MRI and CT can let us find more lesions and
early detection, but it is too expensive and more radiation. So we still can
still rely on conventional X-ray to make diagnosis. We are still need to find
out the origin from immune or neoplasm; virus disease and can terminated
this disease forever by target therapy.
Keywords Skull
HN007
Comparison of Radiation Dose for Sinonasal Examination
between Multi-Detector CT and Digital Tomosynthesis with
Flat-Panel Detector Radiography
Haruhiko Machida¹, Toshiyuk Yuhara 1, Mieko Tamura 1, Eiko
Ueno 1, John M Sabo 2, Takako Mori 1, Shinji Abe 3, Tomokazu
575
Purpose To present MDCT findings of a uterine PEComa and review the
literature
Methods A 38 years old female had irregular menstruation for one year.
Biochemical evaluation revealed no significant abnormalities. The CEA,
CA 125 and CA 19-9 level were within normal limit. The ultrasonography
examination revealed a relative well-defined and mild hyperechoic mass
in posterior wall of the uterine corpus, measuring about 8.0x7.0x6.6 cm.
A contrast-enhanced MDCT scan of abdomen and pelvis with multiplanar
reconstruction was performed before and after intravenous administration
with an immediate post-contrast scan and a delayed scan.
Results The MDCT revealed a partially encapsulated mass in posterior
uterine wall with relative homogenous enhancement similar to adjacent
normal myometrum on both immediate and delayed post-contrast scans.
The patient received an exploratory laparotomy with intra-operative
biopsy and the pathological report of the frozen section suggested a
uterine sarcoma. She received a simple total hysterectomy with bilateral
salpingoophorectomy and bilateral pelvic lymphadenectomy 8 days later.
The final pathological diagnosis was a malignant sclerosing perivascular
epithelioid cell tumor (PEComa).
Conclusions Perivascular epithelioid tumor (PEComa) is a very rare
disease affecting various organs, most often the uterus. This tumor
displays a variety of histologic and clinical features. On imaging, uterine
PEComas typically appear as large, lobulated, heterogeneous soft tissue
masses with areas of necrosis and hemorrhage. Small tumors appear
fairly homogenous. Because the image findings are non-specific, uterine
PEComas are commonly misdiagnosed as leiomyomas before operation.
Therefore, a diagnosis of PEComa should be kept in mind when a welldefined leiomyomatous like uterine tumor is seen. MRI may be helpful
in differentiation typical leiomyomas from others. It is currently unknown
whether more advanced MRI techniques such as diffusion weighted
imaging, dynamic contrast enhancement and spectroscopy will be able to
differentiate leiomyoma from PEComa and other rare uterine neoplasms.
Further study is necessary.
Keywords CT, Uterus
E-Poster
GU041
Perivascular Epithelioid Cell Tumor (PEComa) of the Uterine
Corpus: MDCT Findings
Hui-Ling Hsu, Kuo-Luon Kung, Chia-Chien Chang, Hsien-Chang
Shen, Ying-Chi Tseng, Chi-Jen Chen, Jan-Wen Ku
Department of Radiology, Taipei Medical University – Shuang Ho
Hospital, Taiwan
presentations in extratesticular epidermoid cysts, magnetic resonance
(MR) imaging could play a complementary role in difficult cases.
Keywords MR, Cysts, Testes, Ultrasound
Others
Results Abdominal CT revealed soft tissue mass in right ureter with
dilatation of right proximal ureter and hydronephrosis, transitional
cell carcinoma of right ureter was impressed. The right laparoscopic
nephroureterectomy was performed and the pathology revealed ureteral
edometriosis.
Conclusions Ureteral endometriosis is a rare entity, it may mimic tumor
growth. In an obstructive uropathy in women, it should be included in the
differential diagnosis.
Keywords Kidney, CT, Ureters
HN008
Possibility of Ultrasound Diagnosis of Thyroid Cancer
D e l g e r e k h Ts e n d ¹ , K i m Yo u n g To n g ¹ , G o n c h i g s u r e n
Dagvasumberel², Lkhagvasuren Tserenkhuu³
¹Department of Radiology, National Cancer Center of Mongolia,
Mongolia,
²Department of Radiology, Health Sciences University of
Mongolia, Mongolia
³Director HSU of Mongolia, Health Sciences University of
Mongolia, Mongolia
Purpose Ultrasound diagnosis and differential diagnosis of the thyroid
cancer and it's recurrences.
Methods From 2004-2008 we have examined 225 consecutive patients
with thyroid disease at the State Central Hospital and National Cancer
Center of Mongolia.All patients were examined by US, color-Doppler
US and US guided fine needle aspiration biopsy (FNAB).The outcomes
of US study were compared with cytological and histological findings
retrospectively.
Results One hundred forty-seven of 225 patients (65,3%) detected
thyroid cancer, in 30 patients (13,3%) recurency of thyroid cancer, in 24
patients simple adenoma,in 24 patients AIT. At cytological evaluation,in
all 147 patients with diagnosed thyroid cancer were papillary in 89
(61%), folliculary in 44 (30%), and medullary in 5 (3,4%), anaplastic in
9 (6,1%) of cases. Us criteria and CFD examinations of thyroid cancers
were: without capsularity margin-90,3%, nonhomogeneous echo
structure-86,9%; hypoechoic-83,45%; irregular margin-82,1%;nonsmooth
margin-71,7%; abnormal shape-68,3%; with cystic component-36,5%;
microcalcification-24,8%; cervical LN one side if the metastasis-10,2%;
hypervascular-65%, hypovasculary-27,5%, avasculary-7,5%.
Conclusions We have defined main US signs indicating malignancy
of thyroid nodules.If 3 or more of these signs occurs,with involvement
of lymphatic nodules,thyroid cancer diagnosis have sensibility
85,3%,specificity 75,3% and accuracy 74,2%.
Keywords Thyroid
576
HN010
Comparison of Nodular Hyperplasia with Follicular
Neoplasm in Patients with Solid Thyroid Nodule Detected at
US
Purpose To compare the US findings of nodular hyperplasia with those of
follicular neoplasm in patients with solid thyroid nodule detected at US.
Methods To compare the US findings of nodular hyperplasia with those of
follicular neoplasm in patients with solid thyroid nodule detected at US.
Results 1. What are nodular hyperplasia and follicular neoplasm of the
thyroid? A. Clinical features B. Pathologic features: Gross/Microscopic
findings. 2. The US findings of nodular hyperplasia and follicular neoplasm
of the thyroid. 3. Proposed schematic illustration of the US findings. 4.
What are the differential points of their US findings between nodular
hyperplasia and follicular neoplasm. 5. Prognosis and therapy.
Conclusions In this pictorial assay, we compared the US findings of
nodular hyperplasia with those of follicular neoplasm in solid thyroid
nodules and proposed the schematic illustration of their US findings.
This comparison with its schematic illustration will be of help in the
accurate diagnosis and differentiation of nodular hyperplasia and follicular
neoplasm when we radiologists encounter solid nodules at thyroid US.
Keywords Thyroid, Ultrasound
HN011
Frontal Sinsusitis and the Relationship with Frontal Recess,
Concha Bullosa and Uncinate Process: Multidetector
Computed Tomography Assisted Study
Han Jong Kyu, Kim Yong Tong, Cho Seong Shik, Kim Sang Won
Department of Radiology, Soonchunhyang University Cheonan
Hospital, Korea
Purpose To assess frontal sinusitis and the relationship with frontal
recess, concha bullosa and uncinate process on MDCT.
Methods 276 patients (492 sides) with frontal sinusitis and no frontal
sinusitis were studied by MDCT. To evaluate prevalence of frontal sinusitis,
we investigated the presence of agger nasi cell, supraorbital ethmoid cell,
HN012
The Analysis of Frontal Recess and Concha Bullosa
Anatomical Variations on 3D Computed Tomography
Han Jong Kyu, Kim Yong Tong, Cho Seong Shik, Kim Sang Won
Department of Radiology, Soonchunhyang University Cheonan
Hospital, Korea
Purpose We aimed to review and assess the anatomical variations of the
frontal recess and concha bullosa on 3D CT.
Methods Frontal recess and concha bullosa anatomy and their variations
were studied with multidetector CT scans obtained in 492 sides of 276
patients. We investigated the presence of the agger nasi cell, supraorbital
ethmoid cell, suprabullar cell, frontal bullar cell, recessus terminalis,
interfrontal septal cell, and the types of frontal cells and concha bullosa.
At last, the relationship among agger nasi cell and frontal recess were
evaluated.
Results In this study, agger nasi cell were found in 84.5% of the patients,
and supraorbital ethmoid cell, suprabullar cell, frontal bullar cell, recessus
terminalis, interfrontal septal cell were in 18%, 64.6%, 17.5%, 62.4%,
20.3%. 65.2% of individuals had frontal cells (type I: 25%, type II: 6.9%,
type III: 10.1%, type IV: 2.8%) and 29.9% had concha bullosa (lamella:
15.6%, bullous: 5.1%, extensive: 8.9%). The incidence of recessus
terminalis increased in the absence of agger nasi cell (p<0.05) and that of
suprabullar cell increased in the presence of agger nasi cell (p<0.05).
Conclusions The anatomy and common variations that occurred in the
frontal recess and its related organs must be understood by radiologists
and edoscopic sinus surgeons.
Keywords Anatomy, Paranasal Sinuses, CT
HN015
The Frontal Recess Anatomy and Its’ Association with the
Development of Frontal Sinusitis Demonstrated Using
Computed Tomography Scan
Hsu-Huei Weng1, Ching-Feng Lien2, Wen-Hung Wang2, YuanHsiung Tsai1, Li-Sheng Hsu1, Shaner-Yeun Jao1
1
Hospital at Chiayi, Taiwan
2
Department of Otolaryngology-Head and Neck Surgery, Chang
Gung Memorial Hospital at Chiayi, Taiwan
Purpose To investigate the role of frontal recess cells in the development
of frontal sinusitis by means of computed tomography (CT) scans.
Methods We retrospectively reviewed a number of spiral CT images of
the sinuses between November 2007 and May 2009. Specific emphasis
on the various frontal recess cells was analyzed. Exclusion criteria
included previous sinus surgery, sinonasal polyposis, age younger than
18 years, head trauma/maxillofacial fracture, incomplete section (lack of
sagittal view), and malignancy. Logistic regression analyses were used
to compare the distribution of various frontal recess cells in patients with
frontal sinusitis versus patients without frontal sinusitis.
Results A total of 192 patients met the criteria and only 363 sides can be
distinguished. The prevalence of agger nasi cells, frontal cell type 1, type
2, type 3 and type 4, suprabullar cells (SBC), supraorbital ethmoid cells
(SOEC), frontal bullar cells, recessus terminalis (RT) and interfrontal sinus
septal cells was 89.0%, 21.5%, 10.5%, 7.7%, 0%, 39.1%, 7.7%, 6.3%,
43.8%, and 9.6%, respectively. The presence of suprabullar cells (OR
5.65; 2.55-12.55), supraorbital ethmoid cells (OR 7.16; 2.34-21.94), frontal
bullar cells (OR 3.71; 1.02-13.43), and recessus terminalis (OR 2.54;
1.35-4.79) revealed significant association in the development of frontal
sinusitis by multiple logistic regression models.
Conclusions The frontoethmoid cells that are located posteriorly and/
or posterolateral to the frontal recess (suprabullar cells, supraorbital
ethmoid cells and frontal bullar cells) may play a more important role
in the development of frontal sinusitis than those frontal recess cells
located anteriorly (agger nasi cells, frontal cell types 1-3). In addition, the
presence of recessus terminalis noted on CT images may signify a higher
occurence of frontal sinusitis. From an anatomic standpoint, the presence
of SOEC on CT images may indicate the highest odds of frontal sinusitis,
followed by the presence of SBC, FBC, and RT.
Keywords Paranasal Sinuses
HN016
Middle Ear Congenital Cholesteatoma (MECC) in Children:
High Resolution CT of Temporal Bone Findings and
Comparison with Otoscopic Examination
Jon-Kway Huang1, Min-Tsan Shu2, Sho-Jen Cheng1, Fei-Shih
Yang1
1
2
Department of Otolaryngology, Mackay Memorial Hospital,
Taiwan
Purpose To describe findings of MECC on high resolution CT (HRCT) of
temporal bone studies and otoscopic examinations.
Methods Retrospective review of 17 cases of MECC under the age of
15 years. All patients had HRCT of temporal bone studies and otoscopic
examinations. Clinical symptoms had hearing loss (n=6), asymptomatic
(n=9), otitis media with effusion (n=2). Final diagnosis was obtained from
surgery in all cases.
Results The morphology of the MECC can be classified as closed-type
(12 cases), open-type (3 cases) and mixed-type (2 cases). Grossly, the
closed-type has a well-defined margin, and the open-type has epithelial
plate without internal content. The mixed-type reveals soft tissue lesion
with adjacent debris deposition. On HRCT study, the closed-type reveals
a rounded or lobulated well-defined mass in the middle ear cavity; the
mixed-type shows ossicular chain destruction with an irregular soft tissue
shadow in the middle ear cavity and the open-type demonstrates ossicular
chain destruction only. Otoscopically, the closed-type shows a cyst behind
the tympanic membrane and the open-type reveals normal finding. The
mixed-type has variable appearance.
Conclusions Three types of MECC have been demonstrated, and the
closed-type (cyst) is the most common type. HRCT scan is useful in
defining the extent of the lesion and ossicular chain destruction. Further,
HRCT may correlate with the otoscopic finding to determine the type of
the lesion.
Keywords Neoplasms-Primary, Congenital, CT, Ear
HN018
Visual Defect Due to Chiasmal Compression by Tortuous
ACA
Yi-Shan Tsai, Hong-Ming Tsai
Department of Radiology, National Cheng Kung University,
Purpose A rare case with right-sided central and left nasal quadrantic
hemianopsia due to chiasmic compression by the A1 portion of the
577
Purpose 1. To evaluate the imaging findings of calcified thyroid lesions
detected at chest or neck CT. 2. To differentiate benign from malignant
lesion in the calcified thyroid lesions detected at chest or neck CT.
Methods The presence of calcification is the most significant
ultrasonographic finding in evaluating thyroid nodules because
calcifications are more frequently detected in papillary thyroid carcinoma
than in other thyroid lesions. To our knowledge, however, the significance
of CT features of calcifications in the thyroid glands has been not reported.
Results 1. The implications of calcifications between benign and
malignant thyroid lesions. 2. Imaging analysis of calcified thyroid lesions
at chest or neck CT: Categorization and schematic illustration. 3.
Correlation with the US and pathologic findings. 4. Suggested diagnostic
and therapeutic algorithm for calcified thyroid lesions detected at CT.
Conclusions In this pictorial assay, we evaluated the imaging findings of
the calcified thyroid lesions detected at chest or neck CT and proposed
the schematic illustration of their CT findings. This will be of help in making
a diagnostic and therapeutic plan when we radiologists encounter the
calcified thyroid lesions at chest or neck CT.
Keywords CT, Thyroid
suprabullar cell, frontal bullar cell, recessus terminalis, interfrontal septal
cell and pneumatization of frontal sinus, and evaluated frontal isthmus
diameter. The types of frontal cells, concha bullosa and uncinate process
were assessed. Differences were assessed using chi-square test and
Mann-Whitney test.
Results The incidence of frontal sinusitis increased in the presence of
supraorbital ethmoid cell, hyperpneumatization of frontal sinus, lamina
papyrcea insertion of uncinate process (p<0.05). The frontal ithmus
diameter of type 4 frontal cell were larger than those of other types
(p<0.05). However there was no significant difference in the incidence of
frontal sinusitis in type 4 frontal cell. Although its diameter was least, the
presence of type 1 frontal cell increased prevalence of frontal sinusitis
(p<0.05).
Conclusions MDCT is useful to evaluate the anatomical variations
of frontal recess and its related organs in frontal sinusitis patients. To
estimate the cause and prognosis of frontal sinusitis, we must evaluate
frontal recess, pneumatization of frontal sinus and the insertion pattern of
uncinate process on MDCT.
Keywords Paranasal Sinuses, CT
E-Poster
Purpose Although multi-detector CT (MDCT) is widely used for
diagnosing sinonasal diseases, radiation exposure, especially to the eye
lens, a particularly radiosensitive organ, is an issue that should be solved.
Digital tomosynthesis (DT) with flat-panel detector (FPD) radiography
is expected as a new alternative technology that allows volume data
acquisition with much less radiation dose. We investigated the feasibility
of DT radiography to reduce radiation dose for sinonasal examination
compared to MDCT using an anthropomorphic phantom.
Methods We scanned an Alderson-RANDO phantom covering frontal to
maxillary sinus using the clinically routine protocol by 64-detector CT (120
kV, 200 mAs, and 1.375 helical pitches) and DT radiography (80 kV, 1.0
mAs, 60 projections, 40 degree sweep, and posterior-anterior projection).
We measured the radiation dose of the internal organs including the
brain, submandibular and thyroid gland and on the surface at various
sites including the eyes during those scans using glass dosimeters. We
compared the radiation dose of those anatomies between both modalities.
Results Compared to MDCT, the dose measurements by DT radiography
were reduced to approximately 1/8, 1/12, 1/5, 1/17, and 1/293 in the brain
(MDCT vs. DT radiography: 14310.7 ± 2169.1 vs. 1772.3 ± 561.5 μGy),
submandibular (16952.7 ± 2344.4 vs. 1399.0 ± 83.9 μGy) and thyroid
gland (1231.1 ± 160.2 vs. 227.1 ± 90.5 μGy) and on the skin (20022.9 ±
9278.1 vs. 1160.0 ± 2118.4 μGy) and eye surface (32495.7 ± 2473.5 vs.
111.6 ± 6.0 μGy), respectively.
Conclusions DT with FPD radiography is useful for dramatically reducing
radiation exposure to various anatomies in the head and neck region,
especially the eye lens, compared to MDCT on sinonasal examination.
Keywords Paranasal Sinuses
HN009
Calcified Thyroid Lesions Detected at Chest or Neck
CT: Imaging-pathologic Correlation with Its Schematic
Illustration
Others
Numano3
1
Department of Radiology, Tokyo Women's Medical University
Medical Center East, Japan
2
Department of Diagnostic X-Ray and Emerging Technologies,
GE Healthcare, United States
3
Department of Radiology, Tokyo Metropolitan University, Japan
HN021
Sinonasal Polyps with Metaplastic Ossification: CT and MR
Imaging Findings
Hyung-Jin Kim¹, Yi Kyung Kim1, Jinna Kim2, Eunhee Kim1, Sung
Tae Kim1
1
D e p a r t m e n t o f R a d i o l o g y, S a m s u n g M e d i c a l C e n t e r,
Sungkyunkwan University School of Medicine, Korea
2
Korea
Purpose Metaplastic ossification (MO) is a rare event in sinonasal polyps.
The purpose of this study was to review the CT and MR imaging findings
of sinonasal polyps with MO.
Methods CT (n=5) and MR (n=3) images of 5 patients (4 men and
1 woman; mean age, 59 years; range, 47–77 years) with surgically
proved sinonasal polyps with OM were retrospectively reviewed, paying
particular attention to the location, size, shape, internal architecture, and
enhancement pattern of the lesion. The morphological characteristics of
578
Purpose Tracheostomy is one of the most commonly performed
procedures in the critically ill patient. Tracheostomy hemorrhage is a not
unusual complication but may be fatal. We present a case of tracheostomy
hemorrhage from thyroidea ima artery treated by endovascular
embolization, and review the literature.
Methods A 34 year-old male underwent tracheostomy due to pneumonia
with respiratory failure. However, poor nutrition and poor tracheostomy
condition were noted. Bleeding from tracheostomy was noted off and on.
About two months later, massive hemorrhage from tracheostomy was
noted. The esophagoscope revealed bleeding from the hypopharynx and
tracheostomy orifice. The digital subtraction angiography (DSA) revealed
pseudoaneurysm formation and contrast extravasations at the branches
of thyroidea ima artery just near the orifice of tracheostomy.
Results Endovascular embolization was performed smoothly and the
hemorrhage was controlled.
Conclusions Understanding not only the blood supplies of thyroid
gland but also the great vessels of the aortic arch and their variations is
important for both the diagnosis and endovascular treatment planning.
Endovascular embolization is an effective treatment for trachostomy
hemorrhage.
Keywords Angiography, Embolization, Thyroid, Hemorrhage, Interventional
HN025
Two Cases of Recurrent Extraventricular Supratentorial
Ependymoma in Childhood
I.H Rizuana, AH Hamzaini, S Radhika, A Sellymiah, S M
Swaminathan
Department of Radiology, Pusat Perubatan Universiti
Kebangsaan Malaysia, Malaysia
Purpose To highlight recurrent extraventricular supratentorial site as a
rare presentation of ependymoma. To illustrate the radiological findings
and review of the literature.
Methods In this paper, we describe two patients with supratentorial
extraventricular ependymoma. The first case is a 13-months old baby
boy presented with increasing head circumference, abnormal posture
and low GCS. The second patient is a 5 year old girl with known occipital
ependymoma.
Results Computed tomography (CT) of the brain in both patients
demonstrated a large well-defined cystic mass. In the first patient, the
mass was in the right frontoparietal lobe, measuring 9.5 x 8.0 cm with 1518 HU. It caused midline shift with compression of both lateral ventricles
(right more than left). There were areas of calcification at the superior
HN026
Dynamic CT in Evaluation of Pituitary Gland
Yu Chien Lo, Chao Chun, Lin Wu, Chung Shen
Department of Radiology, China Medical University Hoispital,
Taiwan
Purpose Using a 16 slice CT scan with multiple phase to evaluate the
pituitary gland instead of MRI in some special patients
Methods From 2006 to 2009, we collect 20 patients (all females, average
30.5 years old, ranged from 23 to 35 years old) that clinically suspected
pituitary microadenoma but could not tolerate the examination of MRI
(due to economic reason, pacemaker insertion, or claustrophobia) . All of
them were performed in a GE 16 slice CT scan. The patients were in head
down position to perform the coronal imaging. Six times of scan were
performed after contrast influed by using a power injector.
Results Five patients show a pituitary microadenoma clearly. One
patient shows pituitary hyperplasia clearly. Fourteen patients showed no
abnormal enhancement during whole course. All the patents stand the
whole procedure smoothly and result a good imaging quality.
Conclusions Although with some radiation, dynamic CT can provide
another choice to evaluate the pituitary gland in stead of MRI in some
cases and the imaging quality is batter than the MRI.
Keywords CT, Pituitary
HN029
Efficacy of HRUSG in Follow Up of Laryngeal CA-Boon for
Poor
Mithilesh Pratap¹, Sanjay Suman²
¹Department of Radidiagnosis, Patna Medical College and
Hospital, Patna, Bihar, India
²Department of Radidiagnosis, Indira Gandhi Intitute of Medical
Sciences, Patna, India
Purpose The purpose of our study is to prove the efficacy of HRUSG as
compared with CT for detection of extent/local invasion of the laryngeal
tumors.
Methods The present study consisted of 25 patients with confirmed
laryngeal Ca. the clinical assessment / DL of patients were carried out and
uniformly documented including the site, extent, laryngeal frame work,
extra laryngeal spread and cervical lymph nodes. The USG examination
was performed using Nemio-30 (TOSHIBA) color Doppler with L-12-14
MHz probes. CECT SCAN was performed on SOMATOMA AR-SP and
ASTEION TOSHIBA CT scan with 3D reconstruction. In operable tumors
the operated specimen was also examined. The results of CT/ DL /
Operated were compared to the result of HRUSG. The study was done in
double blind study design.
Results The study comprised of 25 male patients of laryngeal Ca with
average age of 55 years. As compared to CT & surgical specimen the
HRUSG was able to correctly identify the primary site of tumor in all cases
except in 3 cases of transglottic Ca, it failed to detect sub-glottic spread
which was clear in CT, cartilaginous involvement detection rate was 68%,
laryngeal involvement & local spread was detected in 77%, vocal cord
mobility was detected correctly in 92%, cervical nodal metastasis and
thyroid invasion was detected in 100% cases by HRUSG.
Conclusions Results of this study indicate that since HRUSG is easy to
perform, easily available, cost effective and radiation free; it can be used
as an alternative method for establishing the local extent of laryngeal
tumors and extra spreads as well as for recurrence in post radiotherapy
patients. It can be a boon to the patients and otolaryngeologists in the
poor Asian countries. It is cost effective and radiation free and can replace
costly and radiation causing CT scans in follow up of laryngeal ca.
Keywords Larynx, Ultrasound
HN030
Combined First and Second Branchial Cleft Cysts
Che-Ming Lin, Cheng-Hong Toh, Shu-Hang Ng, Koon-Kwan Ng
Department of Medical Imaging & Intervention; Department
of Medical Imaging and Radiological Sciences, Chang Gung
Memorial Hospital-Linkou Medical Center; Chang Gung
University, Taiwan
Purpose We herein present the imaging findings of a case with combined
first and second branchial cleft cysts.
Methods A 10 year-old girl has had palpable slow-growing non-tender
masses in her left neck for five years. On head and neck CT with and
without enhancement, two cystic masses were found in left submandibular
and left parotid regions respectively. The left submandibular mass was
posterolateral to submandibular gland, lateral to carotid space and
anteromedial to sternocleidomastoid muscle (SCM) and its location was
characteristics of a second branchial cleft cyst. The left parotid mass
extended from bony-cartilaginous external acoustic canal to angle of
mandible and its appearance was typical of a first branchial cleft cyst.
Methods Both masses were well-circumscribed, non-enhancing and have
hypodense internal. The patient underwent resection of the masses and
the pathology showed branchial cleft cysts.
Conclusions To the best our knowledge, combined first and second
branchial cleft cysts has never been reported in the literature.
Keywords Congenital, Cysts
HN031
A Rare Case of Extraocular Muscle Metastasis from
Hepatocellular Carcinoma
Allan Celi
Department of Radiology, Philippine Heart Center, Philippines
Purpose HCC metastasizing to the orbit is extremely rare. There has
been only 12 previous cases of HCC metastatic to the orbit cited in the
English-language literature, all with unilateral presentation and on further
inspection demonstrated brain and surrounding orbital wall involvement.
The purpose of the current report is to document a histologically confirmed
metastatic carcinoma to both orbits with no radiologic evidence of
surrounding osseous or brain metastasis, and upon CT scan examination,
was found to be restricted solely to a majority of the extraocular muscles.
In addition, the possibility of hepatocellular carcinoma metastasis to the
breasts, an equally uncommon occurrence, is likewise entertained.
Methods Case Report
Results CT scan of the head and orbits with intravenous contrast revealed
bilateral proptosis with multiple extraocular muscle belly swelling sparing
the right lateral rectus and left superior oblique muscles. Considerations
included Grave’s disease of the orbit and orbital lymphoma, but because
of the positive history of hepatocellular carcinoma, metastases was
considered as a differential diagnosis. Ultrasound guided fine needle
biopsy of the extraocular muscles, specifically the left lateral rectus muscle
immunohistochemically showed the tumor cells positively stained for AFP
consistent with metastatic HCC
Keywords This is a report on a 40-year-old woman with a history of
hepatocellular carcinoma with possible metastasis to the breast and
cervical lymph nodes, who presented with bilateral diplopia and painful
proptosis. Head scan revealed normal brain parenchyma. Orbital scan
579
Purpose To report a rare case of gaint pleomorphic adenoma occurring in
the parapharyngeal space with intracranial extension.
Methods A 69-year-old male patient presenting with right aural fullness
for months. Clinical examination showed a large submucosal mass
with a smooth surface compromising the right oro- and nasopharyngeal
airway. Surgical resection of the mass via preauricular infratemporal
subtemporal approach was performed. Histopathological examination
revealed pleomorphic adenoma. The patient then received postoperative
radiotherapy.
Results MRI shows a giant lobulated mass in the right parapharyngeal
space, about 7 cm in its largest dimension. The lesion appeared as
intermediate signal intensity on T1WI and hyperintensity on T2WI,
and exhibited strong contrast enhancement after intravenous contrast
administration. There was a cleavage plane with the deep lobe of the
right parotid gland. The mass displaced the right internal carotid artery
posteriorly with focal encasement. It also invaded the right central skull
base with geographic bony destruction of the right petrosal ridge, foramen
ovale, foramen spinosum, foramen lacerum, sphenoid sinus floor and
petrooccipital synchrondosis. Apart from little extension of the tumor to
the right sphenoid sinus, bulky intracranial extension to the right middle
cranial fossa with cavernous sinus involvement was noted.
Conclusions Parapharyngeal pleomorphic adenoma might present
with skull base destruction and intracranial extension. Recognition of
MRI findings was essential for the differential diagnosis and treatment
planning.
Keywords Metastases, MR, Brain/Brain Stem,Neoplasms-Primary,
Salivary Glands
HN023
Treatment of Tracheostomy Hemorrhage with Endovascular
Embolization of Thyroidea Ima Artery: Case Report and
Literature Review
Yu-Kun Tsui, Chien-Jen Lin, Te-Chang Wu, Wen-Sheng Tzeng
Department of Radiology, Chi Mei Medical Center, Taiwan
margin. Hyperdensities at inferior margins suggested haemorrhagic
(HU 53-45) component. The second patient had cystic mass in the right
occipital region causing mass effect and compressing the ipsilateral lateral
ventricle. MRI confirmed CT findings of a large predominantly cystic,
uniloculated, lobulated mass in the above mentioned region. Differentials
of supratentorial ependymoma, PNET and astroblastoma were given. The
children were treated surgically. Histopathological examination (HPE) of
the brain tissue was anaplastic ependymoma (WHO Grade III) in the first
case whereas the second patient had cellular ependymoma (WHO grade
II).
Conclusions Ependymoma is a slow growing rare glial tumour,
originating from the ventricular lining or central canal with poor outcome
despite aggressive treatment. Usual site in children is the posterior fossa.
These highly unusual cases illustrate an unpredictable supratentorial
extraventricular site of ependymoma in children.
Keywords MR, Brain/Brain Stem, Neoplasms-Primary, CT
E-Poster
HN019
Giant Parapharyngeal Pleomorphic Adenoma with
Intracranial Extension
Yen-Ling Lin, Shu-Hang Ng, En-Haw Wu, Yi-Ming Wu,
Memorial Hospital, Linkou Branch, Taiwan
MO on CT scans were documented as well.
Results All lesions were seen as lobulated (n=3), ovoid (n=1), or
dumbbell shaped (n=1) masses with a mean size of 3.3 cm (range, 2.2–
5.4 cm), located unilaterally in the posterior nasal cavity and nasopharynx
(n=2), posterior nasoethmoidal tract (n=2), and antrochoanal area (n=1).
Compared with the brain stem, all lesions demonstrated isoattenuation
on CT scans, iso- to hypointensity on T1-weighted MR images, and
hyperintensity on T2-weighted MR images. On contrast-enhanced MR
images, irregular peripheral enhancement was seen in 2 lesions and mild
to moderate diffuse enhancement in 1 lesion. On CT scans of all lesions,
there was centrally located MO, the shape of which was clustered small in
3, single nodular in 1, and large lobulated in 1.
Conclusions Although MO associated with sinonasal polyps is rare with
the pathogenesis still unknown, the diagnosis is highly suggested when
one sees a sinonasal mass with high signal intensity on T2-weighted MR
images, which contains central calcium-like depositions on CT scans.
Keywords MR, Paranasal Sinuses, CT, Inflammation
Others
anterior cerebral artery (ACA) was presented.
Methods Image modality of MRI including 3D FIESTA and MRA was
performed.
Results Image from 3D FIESTA showed tortuous left ACA indenting the
optic chiasm superiorly and distorting left side of optic chiasm before
looping anteriorly.
Conclusions Visual loss from compressive vascular lesions is relatively
infrequent clinical presentation and most cases are caused by saccular
aneurysm. It is in a manner analogous to the reported observations of
vascular tortuosity and vascular loops as a causative factor in some cases
of trigeminal neuralgia. The visual field defect in such cases is thought
to result from traction on small perforating vessels causing a chiasmal
infarction.
Keywords Eye
HN033
Langerhans Cell Histiocytosis of Lymph node: A Case
Report and Literature Review
Chang-Chu Tsu¹, Mu-Tai Liu1, Mu-Kuan Chen1, Chu-Ping Pi2,
Tong-Hao Chang1, Chih-Chieh Hsu1, Chao-Yuan Huang3, ChaoYuan Huang1
1
Department of Radiation Oncology, Changhua Christian
Hospital, Taiwan
2
Department of Otorhinolaryngology-Head and Neck Surgery,
Changhua Christian Hospital, Taiwan
3
Department of Oncology, National Taiwan University Hospital,
Taiwan
Purpose Langerhans cell histiocytosis (LCH) is a rare disease, involving
clonal proliferation of Langerhans cells, abnormal cells deriving from
bone marrow and capable of migrating from skin to lymph nodes. These
diseases are related to other forms of abnormal proliferation of white
blood cells, such as leukemias and lymphomas.
Methods A 43 year-old businessman without any systemic disease visited
our ENT OPD due to clinical manifestation of rapid growth of submental
mass. In our clinic, a right tonsil mass and a submental mass about
2x2cm were noted without pain, local heat, skin wound or erythema. With
the impression of right tonsil papilloma and submental lymphadenopathy,
a CT scan was recommended. The report showed solitary enlarged
submental node measured 1.7cm, showing isodense and homogenous
content. Afterward excisional biopsy was done at our OPD, and showed
a squamous cell papilloma in the right tonsil and Langerhans cell
histiocytosis of the submental lymph node.
Results Microscopically, there shows aggregate of tumor cells with
grooved, folded and indented nuclei, abundant slightly eosiniphilic
cytoplasm and fine chromatin admixed with eosinophils in subcapsular
sinus and cortex of lymph node. Eosinophilic abscess with central necrosis
and focal multinucleated giant cell are noted. Immunohistochemical stain
reveals CD21(-), S-100(+) and CD1a(+) in Langerhans cell. TB and PAS
580
Purpose Assessment of apparent diffusion coefficient as an early imagebased biomarker in the prediction of overall survival for patients with
hypopharynx cancer.
Methods 39 patients of hypopharynx cancer were included (Stage I to
III = 4 IVA = 23, IVB = 9,IVC = 3 ). Diffusion-weighted images from each
individual were acquired from a single-shot spin-echo echo-planar imaging
sequence, with the following parameterts: TR=8200 ms/TE=84 ms /b
value = 800 sec/mm2). ADC map was calculated from three orthogonal
directions. Regions of interest (ROIs) were carefully delineated from
the whole tumour volume in a non diffusion weighted image. The mean
and minimum values of ADC were calculated from each ROI. Receiver
operating characteristic (ROC) curve analysis was performed to identify
the optimal threshold using a binary classifier from a graphical plot of
sensitivity versus [1 –specificity].
Results By ROC curve analysis, the responding population were distinct
from the worst responding group, where the minimum ADC at baseline
increased (>0.22 mm2/sec). The survival probability at 15th month is 75%
in the high minimum ADC group and 30% in low. The change in minimum
tumor ADC was associated with 2-year survival (p<0.05), while mean ADC
is not correlated (p = 0.5).
Conclusions The result indicated that minimum ADC at baseline can
successful predict the patient survival and therefore can be a good
candidate as an image-based biomarker.
Keywords Pharynx
HN036
Buccal Mucosa Carcinoma Treated with Radical Surgery
and Postoperative Concurrent Chemoradiotherapy:
Prognostic Factor Analysis Buccal Mucosa Carcinoma
Treated with Radical Surgery and Postoperative Concurrent
Chemoradiotherapy: Prognostic Factor Analysis
Feng-Chun Hsu¹, Hon-Yi Lin1, Moon-sing Lee1, Shih-Kai Hung1,
Hsu-Chueh Ho2
1
Department of Radiation Oncology, Taiwan Society for
Therapeutic Radiology and Oncology, Taiwan
2
Department of Otolaryngology, Taiwan otolaryngological society,
Taiwan
Purpose To investigate prognostic factors in patients with buccal
cancer treated with radical surgery and postoperative concurrent
chemoradiotherapy (CCRT).
Methods We retrospectively reviewed 40 patients with buccal mucosa
carcinoma treated with radical surgery and postoperative CCRT between
August 2000 and June 2008. Of these, 4 stage I, 6 stage II, 1 stage III,
and 29 Stage IV were classified according to the AJCC criteria. Survivals
tumour extension to the infra-orbital fissure and beyond this, intracranial
extension.
Results Of the 78 patients, 10 had tumour extension to the infra-orbital
fissure detected by MRI. Both PET-CT and CECT detected the same 4
of the 10 (40%) patients with infra-orbital fissure extension. There were
6 patients whose infra-orbital fissure disease was detected only on
MRI but not on PET-CT or CECT. 8 of the 10 (80%) patients with infraorbital fissure disease also has intracranial disease. This highlights
the importance of the infraorbital fissure as a pathway for intracranial
extension of NPC.
Conclusions Although PET-CT has been shown to be more accurate in
detecting distant metastasis in the staging of NPC, it is less accurate in
the staging of local disease, in particular, with infra-orbital fissure disease.
Of the 3 modalities, MRI is superior in the detection of with infra-orbital
fissure disease due to its superior contrast resolution. PET-CT and CECT
detected only 40% of all patients infra-orbital fissure disease detected by
MRI.
Keywords Molecular Imaging, MR, Neoplasms-Primary, Comparative
Studies, CT
HN039
Percutaneous Intralesional Bleomycin Injection for the
Treatment of Orbital Lymphatic-venous Alformation (LVM)
Refractory to Surgery: Report of Two Cases
Chao-Yu Shen1, Ho-Fai Wong2, Ming-Chi Wu1, Yeu-Sheng Tyan1
1
Hospital, and School of Medicine, Chung Shan Medical
University; Taichung, Taiwan
2
Department of Neuroradiology, Chang Gung Memorial Hospital,
Chang Gung University, Taoyuan, Taiwan
HN041
Lingual Osseous Choristoma: Report of a Case
Hsien-Chang Shen, Ying-chi Tseng, Chi-Jen Chen, Jan-Wen Ku,
Hui-Ling Hsu, Kuo-Luon Kung, Chia-Chien Chang
Department of Radiology, Taipei Medical University–Shuang Ho
Hospital, Taiwan
Purpose Orbital LVM is rare and successful treatment of orbital LVM has
eluded the physician until now. We report two cases suffering from orbital
LVM refractory to surgery but have clinically improved and significant size
regression after percutaneous intralesion bleomycin injection.
Methods One 8-year-old male and one 27-year-old female who have
been diagnosed as left-sided orbital LVM. After diagnostic angiography
to rule out abnormal high flow arteriovenous shunting within the lesions,
fluoroscopic guided percutaneous intralesion bleomycin injection were
accomplished under general anesthesia.
Results Both patients have clinically improved and significant size
regression after fluoroscopic guided percutaneous intralesion bleomycin
injection in the follow up imaging study.
Conclusions Percutaneous bleomycin sclerotherapy for the treatment of
orbital LVM is relative safe and effective and can be used as one of the
treatment alternatives.
Keywords Percutaneous, Eye, Treatment Effects, Interventional
HN040
Comparison of the Efficacy of PET-CT, Conventional CT and
MRI in Detecting Extension of Nasopharyngeal Carcinoma
to the Infra-Orbital Fissure
James B K Khoo
Department of Oncologic Imaging, National Cancer Centre
Purpose Extension of nasopharyngeal carcinoma (NPC) to the infraorbital fissure is an important pathway for intracranial spread and
consequently, poor prognosis. This study aims at comparing the efficacy
of PET-CT, IV contrast-enhanced CT (CECT) and MRI in detecting
intracranial extension of NPC.
Methods 78 consecutive patients with recently diagnosed NPC underwent
staging workup with whole body PET-CT and MRI of the neck. The PETCT images were read by Nuclear Medicine Specialists. The CECT images
from the PET-CT study and the MRI images were read independently
by Diagnostic Radiologists. The images were examined for possible
Purpose To present a case of asymptomatic lingual osseous choristoma.
Methods A 40y/o female suffered from postnasal dripping and chronic
nasal obstruction for years. Under the impression of chronic paranasal
sinusitis and nasal polyps, sinus CT scan was performed.
Results CT scan showed pansinusitis and hypertrophic rhinitis on both
sides. An interest incidental finding was a small calcified nodule at midline
and posterior dorsum of tongue. The diagnosis of osteoma or oseeous
choristoma was made.
Conclusions There are many differential diagnosis for a lingual mass
included lingual thyroid, hyperplastic lingual tonsil or ectopic salivary gland
neoplasm. They are not easy to differentiate physically because the mass
are covered by normal mucosa of tongue. Only the osteoma or osseous
choristoma showed an unique finding of dense calcification of the mass.
Radiologist may make the diagnosis confidently with CT scan. Lingual
osseous choritoma shows a benign clinical hehavior and no malignant
transformation has been reported. The patient treated her symptom of
sinusitis and nasal obstruction but not the lingual mass.
Keywords CT, Tongue
Purpose Lymphoma is the second most common neoplasm in the head
and neck. There are 3 major imaging manifestations of lymphoma in this
area: 1) cervical lymphadenopathy, 2)extranodal lymphatic disease with
involvement of Waldeyer's ring, 3) extranodal extralymphatic disease,
such as involvement of the orbit, thyroid, salivary gland, sinonasal area
and larynx.
Methods Hodgkin lymphoma most commonly presents as cervical
lymphadenopathy alone. Extranodal involvement is rare, with an incidence
of approximately 4% to 5%. Conversely, non-Hodgkin lymphoma appears
as cervical lymphadenopathy with extranodal sites of disease in as many
as 23% to 30% of patients.
Results Contrast-enhanced CT of the neck, chest, abdomen and pelvis is
routinely performed for staging of lymphoma. The radiologic appearances
of lymphoma often overlap with many other pathologic entities, including
infectious, inflammatory, and neoplastic processes.
Conclusions In this exhibit, we will demonstrate various CT features of
lymphoma in the head and neck.
Keywords Lymphoma, CT
HN034
Minimum Apparent Diffusion Coefficient at Baseline Predict
Overall Survival for Patients with Hypopharynx Cancer
Yu-Hsuan Tasi¹, Yu-Chun Lin1, Tzu-Yen Kao2, Jiun-Jie Wang2,
Shu-Hang Ng1, Yu-Chun Lin1, Tzu-Yen Kao2
1
2
Department of Medical Imaging and Radiological Science,
were estimated by using Kaplan-Meier analysis. Potentially prognostic
factors were analyzed by using Cox proportional hazard models. Hazard
ratios were proved for effective size delineation.
Results The patient age ranged from 35 to 72 years (mean, 52.3 ± 9.3
years). The median follow-up time at analysis was 22.5 months (range, 4
- 87). For all patients, 3-year overall survival, disease-free survival, locoregional control, and distant metastasis-free survival rate were 75%, 44%,
48%, and 95%, respectively. For prognostic factors, the nodal (N) status
and extracapsular spread (ECS) were statistically significant in univariate
analysis. The 3-year overall survival, disease-free survival, and locoregional control rates by N(-) and N(+) status were 100%/40% (P<0.001),
56%/39% (P<0.001), and 56%/54%(P=0.013), respectively. The 3-year
overall survival and disease-free survival by ECS(-) and ECS(+) status
were 48%/33% (P<0.01) and 76%/33% (P=0.039), respectively.
Conclusions For patients treated with radical surgery and post-operative
CCRT, positive nodal status and extracapsular spread were poor
prognostic factors. For these patients, more effective treatment, such as
targeted therapy or additional adjuvant chemotherapy, may be needed.
Keywords Outcomes Analysis, Radiation Therapy/Oncology, Statistics
E-Poster
HN032
CT Imaging of Lymphoma in the Head and Neck
Wen-Pin Chen, Chun-Lin Huang, Joseph-Hang Leung
Department of Radiology, Chia-Yi Christian Hospital, Chinese
Taipei
stains are negative. Tc-99m MDP whole bone scan was also arranged with
no remarkable findings. Since single site, the infiltrated submental lymph
node, was involved, excision is the treatment of choice. Then prophylactic
radiation therapy with 1000cGy/5 fractions for the site was given in 200903. Until now, complete local control was attained.
Conclusions Treatment of LCH may include surgery, oral, topical
and intravenous medications and chemotherapy, or radiation therapy
depending on the site and extent of disease. As in our case, the patient
received surgical interventions and regional radiation therapy, due to
single site infiltration.
HN042
Adult Supraglottitis: An Uncommon Entity with Potentially
Misleading CT Findings
Thean Yean Kew¹, Jeevanan Jahendran²
¹Department of Radiation, University Kebangsaan Malaysia,
Malaysia
²Department of Otorhinolaryngology, University Kebangsaan
Malaysia, Malaysia
Purpose Supraglottitis is an uncommon condition with nonspecific
symptoms. We describe the case history and imaging findings of a patient
with clinically proven supraglottitis.
Methods A 71 year old woman presented with a 4 day history of sore
throat, odynophagia & hoarseness. Clinical examination revealed a
tender 4 x 4cm right sided neck node. Flexible laryngoscopy showed
oedematous arytenoids & epiglottitis, with normal vocal cord mobility.
Plain neck radiography showed marked thickening of the aryepiglottic
folds and epiglottis, with a steeple sign. The clinical impression was of
supraglottitis, with right level V lymphadenitis. She was stable without
airway compromise. CT was requested to exclude abscess formation. On
contrasted CT, there was symmetrical enlargement of the aryepiglottic
folds. The epiglottis was thickened, while the pre-epiglottic space was
581
Others
showed bilateral proptosis with multiple extraocular muscle belly swelling
with no apparent destruction of the orbital bone. A biopsy specimen of
the orbital tumor showed features of metastatic foci of hepatocellular
carcinoma. The tumor cells showed positive reaction against alphafetoprotein. There have been only 12 previous reported cases of
hepatocellular carcinoma metastatic to the orbit cited in the literature.
Keywords Liver, Metastases, Biopsy, Orbit, CT, Eye
Purpose The simultaneous presentation of aneurysmal subarachnoid
hemorrhage and occlusion of ipsilateral proximal internal carotid artery is
rare.
Methods A 62-year-old man experienced conscious change and vomiting
after falling down on the ground. An initial computed tomography
revealed massive subarachnoid hemorrhage. The computed tomography
angiography showed an occlusion of the proximal segment of right internal
carotid artery with patency of right ophthalmic artery. A 3mm aneurysm at
right supraclinoid internal carotid artery was also shown.
Results The patient was treated with craniotomy for clipping of the
ruptured aneurysm. Followed-up angiography confirmed an occlusion
of the right internal carotid artery proximal to the orifice of the right
ophthalmic artery with retrograde opacification of the right ophthalmic
artery by posterior communicating artery. Residual aneurysm was still
noted after clipping.
Conclusions This rare aneurysm probably developed as a result
of hemodynamic stress on the supraclinoid internal carotid artery
after occlusion of its proximal segment and/or secondary to chronic
hypertension. This case clearly demonstrates the diagnostic value of
computed tomography angiography to detect aneurysmal rupture even
under the circumstances of arterial occlusion.
Keywords Aneurysms, Angiography
HN044
R e c u r r e n t N a s o p h a r y n g e a l Tu m o u r M i m i c k i n g
Cerebellopontine Angle Meningioma - A Case Report
Fazalina Mohd Fadzilah, Kiew Siong Lau, Thean Yean Kew
Department of Radiology, Universiti Kebangsaan Malaysia
Medical Centre, Malaysia
Purpose Nasopharyngeal carcinoma is a relatively common malignancy
in Malaysia, especially among the Chinese male population. Base
of skull invasion and intracranial extension is a recognized entity
in NPC. However, posterior cranial fossa extension, specifically, to
cerebellopontine angle, is uncommon. We described a 46 year-old lady
with recurrent nasopharyngeal carcinoma, presenting with a mass at
cerebellopontine angle that mimicks meningioma radiologically. Debulking
582
Purpose 3D thin-section imaging is helpful for the detection of small
lesions, and we have developed 3D contrast-enhanced black-blood
imaging (CEBBI) for the evaluation of small oral cavity lesions. The
purpose of this study was to evaluate the usefulness of 3D CEBBI for
preoperative assessment of early tongue cancer, by comparing the
measured invasion depth on 3D CEBBI with those on 3D contrastenhanced T1-weighted gradient-echo sequence (SE MP RAGE) and by
correlating with histopathologic results.
Methods Ten patients, diagnosed with T1 or T2 oral tongue cancer
originating from the lateral border of the tongue, underwent preoperative
MR imaging with both 3D CEBBI and 3D contrast-enhanced SE MP
RAGE sequence, and received surgical excision as primary treatment.
The calculated tumor thickness on MR imaging and the invasion depth of
surgical specimen were compared.
Results All tongue cancers were detected on both MR sequences except
1 lesion on 3D contrast-enhanced SE MP RAGE. The average invasion
depths of the tumor were 11.5 mm in 3D CEBBI, 10.5 mm in 3D contrastenhanced SE MP RAGE, and 11.3 mm on histopathologic examination.
The relation coefficient of measured invasion depth on 3D CEBBI and
histopathologic depth was 0.848, and accuracy 87%, which showed
higher correlation compared with 3D contrast-enhanced SE MP RAGE.
Conclusions 3D CEBBI provides a satisfactory accuracy for detection of
the tumor and measurement of invasion depth in the preoperative imaging
evaluation of the patients with early tongue cancer.
Keywords MR, Tongue
IN002
Stent-Assisted Coiling of Wide-Necked Intracranial
Aneurysms
Lakshmi Sudha Prasanna Karanam1, Bhawna Dev2, Santhosh
Joseph3
1
2
3
Purpose To evaluate the angiographic results and clinical outcome of
patients treated with stent-assisted coiling by using a recently available
self-expandable intracranial stents
Methods In our study 29 patients with wide necked aneurysms were
included during the period from December 2005 and june 2008. 21 of them
were female and 8 male patients with a mean age of 48 years. Patients
having intracranial aneurysm (ruptured or unruptured) with a dome-toneck ratio <2 or neck length >4 mm were included. 20 of the 29 patients
presented with subarachnoid haemmorhage. Pre procedural workup with
CT, CTA, MR, MRA was done in all the patients. High resolution DSA was
done using Advantax LCN+ (GE Biplane system). Neuroform stent was
used in 15 patients, enterprise in 12 patients and Leo stent in one patient.
Following stent placement, coiling was done in all of the aneurysms.
Results In 28 of 29 cases, stent deployment across the neck of the
aneurysm was successful. Coiling was performed successfully in all the
aneurysms. In all aneurysms, immediate post treatment angiography
showed either total or satisfactory occlusion. The patients were followed
up at 3 months, 6months, 12 months and 18 months after the procedure.
Temporary deficits occured in 4 patients and permanent deficits in 2
patients. Recanalisation occured in one patient who was managed
conservatively. Death occured in 2 cases. Mortlaity of the study was 6 .4%
and morbidity was 6.4%.
Conclusions Stent assisted coiling is feasible and safe technique for the
treatment of therapeutically challenging wide neck aneurysms and can be
the procedure of choice.
Keywords Aneurysms, Embolization, Stents, Interventional
IN003
Direct Carotid Cavernous Fistulae-Various Presentations
and Treatment Approaches
Lakshmi Sudha Prasanna Karanam1, Bhawna Dav2, Santhosh
Joseph3
1
2
3
Purpose To discuss the clinical presentation and the efficacy of
endovascular management by various methods as the treatment option
for direct carotid cavernous fistulae.
Methods In our study 25 patients were included during the period from
04/02/2005 to 02/12/2008. 16 were male patients and 09 were female
patients with mean age of 37 years.25 patients presented with Type A
carotid fistulae of which 21patients had etiology of trauma. Majority of the
patients (21) presented with proptosis,the other symptoms being redeye
(19),diplopia (9), headache (13) and diminished vision (17).Pre procedural
workup with CT,CTA,MR,MRA was done in all the patients. High resolution
DSA was done using Advantax LCN+ (GE Biplane system). Embolisation
materials in the form of balloons were used in 15 patients and coils in 5
patients. Both balloons and coils were used in 3 patients.
Results Complete cure in the form of total reversion was achieved in
twenty one patients. Improvement with residual pathology was achieved
in two patients in whom there was complete clinical cure but angiogram
demonstrated small residual fistula. Procedure was abandoned because
of technical reasons in one patient. Spontaneous closure of the fistula
occurred in one patient. Complications in the form of inadvertent balloon
detachment occurred in two patients. Thus complete cure was seen in
84% of our patients which is in par with worldwide literature of 84-87%
success rate.
Conclusions Endovascular therapy is the treatment of choice in direct
carotid cavernous fistulae with goal of alleviation of the patients symptoms
and preservation of the parent vessel.
Keywords Balloon Insertions, Embolization, Interventional
IN007
Prospective, Correlative Study of Color Duplex Sonography
and Catheter Angiography in Peripheral Arterial Diseases
Amit Disawal, Jawahar Rathod, Kishor Taori, Nischal Kundargi
Purpose To compare the efficacy and accuracy of Color Duplex
sonography (CDS) to catheter angiography in patients with symptomatic
peripheral arterial disease
Methods No of patients: 71 (male 54, female 17), total no limbs 82 (71).
Age 11-72 yrs. Position of patient as per the artery to be examined. Color
Duplex Ultrasound: TOSHIBA ECCOOCEE US machine and ALOKA
PROSOUND 4000 real time duplex scanner. Transducer: 3.5 MHz -10
MHz Cathter Angiography: 500 mA X-ray machine with C-arm Image
Intensifier and DSA. Route: Femoral/Brachial artery, Seldinger method.
Results Accuracy of CDS compared to angiography in detection of
lesions in lower extremity arteries were 93%, 95% and 85% for aortoiliac,
femoro-popliteal and tibio-peroneal arteries respectively and for lesions in
upper extremity arterial segments were 93%, 93% and 93% in innominatesubclvian segment, axillo-brachial and radio-ulnar arteries respectively.
The end results of study shown sensitivity of 83%, specificity-96%
Accuracy-92%, positive predictive value-88% and negative predictive
value of 94% for CDS in comparison to catheter angiography in evaluation
of peripheral arterial diseases.The specificity (96%) and NPV (94%)
observed with CDS in evaluating the hemodynamically significant vascular
lesions were nearly equivalent to angiography.
Conclusions Color Duplex Sonography is a rapid, non-invasive and
relatively accurate modality for identification and localization of various
vascular lesions in peripheral arterial diseases. Hence, CDS can be used
as a screening modality for the patients with symptomatic peripheral
arterial diseases. CDS better characterize lesions (e.g. Plaque, Thrombus)
in comparison to angiography.
Keywords Angiography, Arteries, Ultrasound, Interventional
IN009
Congenital Vascular Variations Mimic Intracranial Aneurysm
on 3D Time-of-Flight Cerebral Magnetic Resonance
Angiography: Correlation with Catheter 3D Rotational
Angiography
Chao-Yu Shen, Yeu-Sheng Tyan, Ming-Chi Wu, Teng-Fu Tsao
Hospital, and School of Medicine, Chung Shan Medical
University; Taichung, Taiwan
Purpose 3D time-of-flight (TOF) MR angiography (MRA) is one of the
routine pulse sequence used for brain MRI evaluation to detect vascular
lesion but with limitation. We reported some situations of congenital
vascular variations that can mimic intracranial aneurysm on 3D TOF MRA
with 3D rotational angiography (3DRA) correlation.
Methods From September 2008 to September 2009, a total of 14 patients
with initially suspected intracranial aneurysm on the 3D TOF MRA
undertook catheter 3DRA for confirmation and therapeutic planning at
our institution. Two patients with fenestration of anterior communicating
artery (AcomA) and 2 patients with prominent infundibulum of
posterior communicating artery (PcomA) were overestimationed as
AcomA aneurysm and PcomA aneurysm on their 3D TOF MRA. We
compared both study modalities and discussed possible cause for the
misinterpretation.
Results A total of 19 aneurysms ( AcomA:4, PcomA:6, ICA:3, MCA:4 and
basilar artery:2) were suspected in the 14 patients on their 3D TOF MRA
studies, 15 aneurysms were confirmed by the further catheter 3DRA. Two
AcomA aneurysms and 2 PcomA aneurysms suspected on 3D TOF MRA
583
HN045
Accurate Prediction of Invasion Depth in Early Oral Tongue
Cancer: Correlation of Dedicated MR Imaging Sequence
with Pathology
Jinna Kim1, Jaeseok Park2, Eung Yeop Kim1, Seung-Koo Lee1,
Dong Ik Kim1, Eun Soo Kim1, Hyun Seok Choi1
1
Severance Hospital, Korea
2
Korea
E-Poster
HN043
Concurrent Aneurysmal Rupture of Right Supraclinoid
Internal Carotid Artery and Occlusion of Its Proximal
Segment: A Case Report
Bang-Bin Chen, Hong-Jen Shieh
Department of Medical Imaging and Radiology, National Taiwan
University Hospital, Yunlin Branch, Taiwan
surgery was performed, and histopathological examination revealed
undifferentiated carcinoma.
Keywords Metastases, MR, CT
Others
obscured by oedema. The retropharyngeal space was filled with oedema.
No abscess seen. The false vocal cords were thickened. The true vocal
cords were normal. Airway narrowing was noted, most severe at the level
of the thickened aryepiglottic folds. A right level V suppurative node was
seen. The patient was managed with IV Ceftriaxone. She was discharged
after 5 days on oral cefuroxime. No residual symptoms were detected on
follow up at 2 weeks.
Results Apparent increases in adult cases have been noted relative
to paediatric cases, most likely related to H influenzae immunisation.
CT is useful to document the presence of other conditions with similar
symptoms, or potential complications of supraglottitis. However, diagnosis
of supraglottitis is usually clinical. The CT findings clearly demonstrate the
oedematous swelling of supraglottic structures & obliteration of fat planes.
These findings are similar to those found in patients post-radiation, and
may also be misinterpreted as tumour. Correlation with plain radiography
and the clinical impression are therefore vital.
Conclusions CT correlates well with the laryngoscopic findings of
supraglottitis.
Keywords Larynx, CT, Inflammation
IN013
Onyx Embolisation of Cavernous Sinus Dural Arteriovenous
Fistulas
Cheng Kang Ong 1, Lily L Wang 2, Michelle T Ong 2, Mark A
Power3, Dang V Lam2, Ken Le2, Richard J Parkinson2, Jason D
Wenderoth1
1
Department of Interventional Neuroradiology, Prince of Wales
Hospital, Australia
2
Department of Medical Imaging, Prince of Wales Hospital,
Australia
3
Department of Medical Imaging, Liverpool Hospital, Australia
Purpose To describe case reports of treatment of ruptured vertebrobasilar
artery dissecting aneurysms.
Methods The clinical course, diagnostic imaging findings, treatment and
follow-up result of ruptured vertebrobasilar artery dissecting aneurysms
were described for five patients. The options of treatment are discussed,
followed by a review of current treatment modalities.
Results Of the five patients, two were treated by trapping via detachable
coil embolization, two by stent deployment with coiling, and one by
conservative management. Treatment was successful in all patients.
Ruptured dissecting aneurysms of the vertebrobasilar system have
a high risk for recurrent hemorrhage with a high mortality rate. They
can be managed by endovascular methods such as trapping, proximal
occlusion or stent placement. Under certain circumstances, conservative
management may be appropriate and the ruptured vertebrobasilar
dissections can heal spontaneously.
Conclusions Treatment of ruptured vertebrobasilar artery dissecting
aneurysms should be individualized based on location and configuration
of aneurysm, time of presentation, and clinical status of the patient.
Keywords Aneurysms, Embolization, Interventional
IN011
Hemodialysis Arteriovenous Shunt with Central Vein
Occlusion Mimic as Sigmoid Sinus Dural AV Fistula
Kuo Yu Chen, Shih Wei Hsu
Department of Radiology, Chang Gung, Kaohsiung Medical
Center, Taiwan
Purpose Brain edema caused by AV fistula of the cranial vessel is not
rare. We encountered an unusual case of brain edema with no obvious
cranial vessel fistula, but surprisingly result from retrograde arterialized
venous flow from an arteriovenous dialysis fistula of left forearm. The
diverting blood flow ran intracranially because of central venous occlusion
(CVO) and concurrent shunt overflow. Retrograde jugular venous flow can
be identified on angiography during late arterial phase after left subclavian
artery injection. The patient's signs and symptoms, including temporal
lobe edema and face swelling, resolved after fistula closure.
Methods Case report
Results Previous articles have reported the reversed high flow in venous
structure might cause different symptoms and signs among different
patients. It depends on two main factors. The first factor is venous
anatomy and its variation. Various symptoms and signs reported before
included mass effect in posterior fossa [5], arterialized blood flow in
cavernous sinus mimicking C-C fistula [10] and intracranial hypertension
[7].
Conclusions Venous flow in DAVF is grossly cephalocaudal direction
of the same side, instead of retrograde direction. This can be easily
differentiated by Doppler or angiography. MRA is not specific for
differentiate between DAVF and retrograde high-pressured flow of CVO,
because the turbulent flow inside veins are unevenly saturated by presaturation bands. So DAVF will be opacified even if their directions are
584
Purpose An increasing number of cavernous dural arteriovenous fistulas
(DAVFs) are now successfully treated with Onyx embolisation. We present
our experience in embolisation of cavernous sinus DAVFs using Onyx as
the sole embolic agent.
Methods Between February 2007 and June 2009, 11 cavernous sinus
DAVFs in 10 patients (1 patient had bilateral cavernous sinus DAVFs
which were treated on 2 separate sessions) were embolised with Onyx
at our institution. There were 6 females and 4 males, with a mean age
of 63.3 years (age range, 44-85 years). The clinical presentations,
angiographic features, endovascular embolisations, clinical and imaging
outcomes of these patients were reviewed retrospectively.
Results Ten of the 11 lesions were completely obliterated on the first
sessions of embolisation, while the other lesion was successfully treated
on the second attempt. The lesions were accessed via the ipsilateral
inferior petrosal sinus (n=5), the contralateral inferior petrosal sinus
and intercavernous sinus (n=1), the superior ophthalmic vein under
sonographic guidance (n=1) and direct percutaneous transorbital
puncture (n=5, including the lesion which was only partially embolised
on first attempt). Complications occurred in 4 patients and included
trigeminocardiac reflex (n=3) and periorbital haematoma (n=1), none of
which resulted in any permanent disability. At the last follow-up (range,
3–29 months), all patients had regained independent clinical status
although 1 patient still complained of persistent diplopia.
Conclusions Embolisation of cavernous sinus DAVFs using Onyx as the
sole embolic agent is effective and relatively safe. The cavernous sinus
may be accessed via several possible routes.
Keywords Embolization, Fistula
IN014
Recurrent Pain after Percutaneous Vertebroplasty
Chun-Han Liao, Chao-Chun Lin, Wu-Chung Shen, Yu-Chien Lo,
Yung-Jen Ho, Ming-Shiang Yang
RSROC, Taichung, Taiwan
Purpose Percutaneous vertebroplasty (PV) has been widely accepted
as the treatment for patients with symptomatic osteoporotic compression
fractures. Though the procedure relieves the pain from the compression
fracture, recurrent back pain after PV is common. However, recurrent pain
after percutaneous vertebroplasty is not rare with published incidence
ranged from 1.8-15.6%. The recurrent pain may lead to a substantially
diminished quality of life. Our goal is to identify specific reasons of
recurrent pain after PV and take care of the patients appropriately.
Methods We summarized the causes of recurrent pain after PV according
to the reviewed articles and our opinions based on our clinical database,
which comprises approximately 410 treatment levels in 300 unique
patients during our 4-year practice.
IN016
Under CT-Guided Extraoral Retromastoid Approach
Glossopharyngeal Nerve Block
Chih-Lin Chuang, Chih-Lin Chuang
Department of Radiology, Radiological Society Republic of
China, Taiwan
Purpose Glossopharyngeal nerve block is a simple technique that can
produce dramatic relief for patient suffering. Neurolytic block with chemical
neurolysis, pulse RF or thermodestruction has shown to provide long-term
relief for patients suffering from glossopharyngeal neuralgia and cancerreleated pain who have not responsed to more conservative treatments.
Methods Under CT guided glossopharyngeal nerve block was done by
extraoral retromastoid approach, advanced the needle into carotid space.
Neural ablations were done by chemical neurolysis with small qualities of
alcohol or thermodestruction with radiofrequency (RF).
Results Neurolytic block with chemical neurolysis or thermodestruction
has shown to provide long-term relief for patients suffering from
glossopharyngeal neuralgia and cancer-releated pain who have not
responsed to more conservative treatments.
Conclusions Glossopharyngeal nerve block is a simple technique that be
able to reproduce and dramatic relief for patients suffering.
Keywords Ablation Procedures, Anatomy, Pharynx, Tongue, Interventional
IN017
Embolization of Carotid Cavernous Fistulae by Transvenous
Approach through the Facial Vein and External Jugular Vein
Chao-Bao Luo
Department of Radiology, Taipei Veterans General Hospital and
National Yang-Ming University, School of Medicine, Taiwan
Purpose Trans-facial vein (FV) embolization of carotid-cavernous fistulas
(CCFs) via internal jugular vein is an alternative to those CCFs failed
to access by trans-inferior petrous sinus approach. FV termination to
external jugular vein (EJV) is uncommon. The purpose of this study is to
report our experiences of trans-FV embolization of CCFs via EJV.
Methods Over a 3-year period, a total of 45 CCFs were referred to
institute for transvascular embolization. Among these, 7 CCFs (direct type:
3, indirect: 4) were treated by trans-FV access via EJV because the facial
vein terminates in EJV. In two patients with direct CCFs, recurrent fistulas
were found after transarterial treatment. Trans-FV access was selected
because of occlusion (n=5), stenosis (n=1) or coil occlusion (n=1) of the
IPS. Trans-FV via superficial facial vein in 6, one through retromandibular
vein. Detachable coils were selected to embolize in all CCFs.
Results All CCFs were successfully accessed by trans-FV catheterization
via EJV; the fistulae were successful occluded by detachable coils on
immediate angiography. One direct CCF had a recurrence and was
managed by direct puncture of cavernous sinus with coil and liquid
adhesive embolization. One had temporary third cranial nerve palsy.
There was no significant peri-procedure complication or other recurrent or
residual fistula in an average of 9-month follow up.
Conclusions Knowledge of the various FV anatomies is crucial for transFV approach the CCFs. Trans-FV catheterization via EJV is a feasible
approach and provides a convenient alternative pathway for transvenous
embolization of CCFs when failure to access the fistulae via other venous
routes; and catheterization of the cavernous sinus via the FVand EJV is
usually successful in our limited case study.
Keywords Anatomy, AVM, Embolization, Interventional
IN018
Successful Endovascular Treatment of Intractable Epistaxis
Due to Ruptured Internal Carotid Artery Pseudoaneurysm
Secondary to Invasive Fungal Sinusitis
Shaner-Yeun Jao, Hsu-Huei Weng, Ho-Fai Wong, Wen-Hung
Wang, Yuan-Hsiung Tsai
Hospital, Taiwan
Purpose Mycotic pseudoaneurysm from the cavernous segment of the
internal carotid artery (ICA) secondary to an invasive aspergillus sinusitis
is rare. Surgical intervention with ICA ligation is generally accepted for
most mycotic aneurysms or pseudoaneurysms. When presented with
massive epistaxis due to a fungal aspergillus ICA invasion, mortality rates
are high
Methods We present the case of a 76-year-old male who developed
intractable epistaxis due to a mycotic pseudoaneurysm arising from the
cavernous segment of the right ICA.
Results The patient was successfully treated by endovascular
embolization at the orifice of the pseudoaneurysm followed by the total ICA
trapping technique using electrolytically Guglielmi detachable coils (GDC)
and injection of N-butyl-2-cyanoacrylate (n-BCA). The patient survived for
7 months but eventually died of urosepsis and cardiorespiratory failure.
Conclusions Endovascular embolization is a feasible and life-saving
approach for emergent management of massive intractable epistaxis
secondary to a complicated invasive fungal sinusitis.
Keywords Aneurysms, Arteries, Embolization
IN019
Effects of 60 Hz Electromagnetic Field Stimulation on
Astrogcyte
Ying-Chen Fang
Radiology Department, 455, Taiwan
Purpose Vertebroplasty is an effective treatment for pain reduction, and
kyphosis prevention in patients with osteoporotic compression fracture,
bony metastasis or benign bone tumors. For cases with osteonecrosis,
the pain sensation is aggregated by motion, especially between lying
down and sitting positions. Tenderness is less obvious in these cases. We
herein evaluate the outcome of osteonecrotic compression fracture to see
if there is difference between non-osteonecrotic group.
Methods Cases undergoing vertebroplasty in our institute were review
and separated into non-osteonecrotic and ostenecrotic groups. The
difference of age distribution, location, duration between insult to
treatment, and outcome measurement by comparing pre- and postvertebroplasty Visual Analogy Scale (VAS), anterior, middle, and posterior
vertebral body height, anterior wedge angle and kyphotic angle.
Results In patients who had compression fracture associating
ostenecrosis presenting with averay VAS reduction about 5 in the 1st
week better than cases without osteonecrosis. There is also better
improvement in anterior and middle vertebral body height, anterior wedge
angle and kyphotic angle in this group of patient.
Conclusions Vertebroplasty an effective treatment for compression
fracture. Especially in osteonecrotic cases, while obviously increasing
vertebral body height, and decreasing anterior wedge, and kyphotic angles
noted. For cases with vertebroplanae and osteonecrosis, vertebroplasty
can still be performed.
Keywords Outcomes Analysis, Spine, Vertebroplasty, Interventional
IN021
Management of Ruptured Proximal Arterial Aneurysm
Related with Brain Arteriovenous
Pakorn Jiarakongmun, Kittisak Unsrisong
Department of Radiology, Interventional Neuroradiologist,
Thailand
585
IN010
Treatment of Ruptured Vertebrobasilar Artery Dissecting
Aneurysms: A Report of Five Cases and Review of the
Literature
Jui-Hsun Fu¹, Shang-Chieh Li1, Ping-Hong Lai1, Kwo-Whei Lee2,
Wei-Liang Chen2
1
Department of Radiology, Kaohsiung Veterans General
Hospital, Taiwan
2
Department of Radiology, Changhua Christian Hospital, Taiwan
Results The common causes of recurrent pain after PV includes rib
Fracture, infection, nonunion bone-cement interface, new symptomatic
compression fracture, leakage, and idiopathic pain exacerbation. This
poster will introduce the 1) incidence 2) clinical symptoms 3) possible risk
factors 4) image finding 5) treatment and prognosis 6) prevention of these
recurrent pains.
Conclusions Recurrent pain after PV is induced by different etiologies.
Adequate prevention, evaluation and treatment are crucial for prognosis
and care of patients with PV.
Keywords Complications, Percutaneous, Spine, Treatment Effects,
Vertebroplasty
E-Poster
cephalocaudal. This phenomenon will be mistaken as cephalopedal
retrograde flow in veins like our reported case. This case reminds us any
hemodialysis patient with any congestive phenomenons or signs should
think about central vein occlusion. If we only concentrate in focal brain
symptoms or signs, or neglect past history of hemodialysis, the correct
diagnosis may be delayed.
Keywords Angiography
Others
turned to be fenestrations of AcomA and prominent infundibula of PcomA.
Conclusions Both fenestration of AcomA and prominent infundibulum
of PcomA are unusual congenital vascular variations which can mimic
intracranial aneurysm on 3D TOF MRA, catheter 3DRA can improve
visualization of these congenital vascular variations and make the
accurate diagnosis.
Keywords Aneurysms, Angiography, MR, Normal Variants, Congenital
Purpose We report our experiences in treatment of spinal fracture in
patients with malignant tumor.
Methods We treated spinal compression fracture with primary tumor in
other locations in 7 patients: one vertebroplasty for a patient with multiple
myeloma, one radiofrequency tumor ablation and vertebroplasty with
spinal metastasis from leiomyosarcoma of leg, two vertebroplasty for
osteoporotic vertebral fracture with avascular necrosis in one patient
with carcinoma of lung (biopsy in spinal lesion negative) and one patient
with adenocarcinoma from pancreas, one vertebroplasty and sacral
osteoplasty for cavity left after successful radiotherapy and chemotherapy
for prostatic carcinoma, one vertebroplasty for cavity left after successful
radiotherapy and chemotherapy for metastatic lesion from carcinoma of
lung, one kyphoplasty for spinal metastasis from carcinoma of lung during
a successful target therapy. These treatments were for pain control in
5 patients, for treatment of spinal metastasis and prevention of fraction
in 1 patient, for prevention of fracture in 1 patient. All these procedures
were performed in an angiographic suit under carful biplane fluoroscopic
monitoring.
Results These procedures were performed successfully without
complication. By using balloon inflation inside the vertebral body
(kyphoplasty), better filling of bone cement inside the vertebral body can
be achieved.
Conclusions Percutaneous vertebroplasty and kyphoplasty is helpful
in vertebral fracture for relief of pain, provide stability of the spine, and
prevention of vertebral fracture.
Keywords Spine, Vertebroplasty, Interventional
IN024
Spinal Intraosseous Epidural Arteriovenous Fistula with
Perimedullary Drainage Obliterated via Onyx Embolization
Chang-Hsien Ou 1, Ho-Fai Wong 2, Po-Lin Sun 1, Chen-Lung
Liang3, Li-Jen Yah1
586
IN025
Possibility of Ultrasound Diagnosis of Thyroid Cancer
Mei-Fang Liu1, Chung-Wei Lee2, Hon-Man Liu2, Chin-Hua Yang1,
Wai-Yee Au1, Sheng-Yih Sun1, Mei-Fang Liu1
1
Department of Radiology, Taoyuan General Hospital,
Department of Health, the Exeutive Yuan, Taiwan
2
Department of Medical Imaging , National Taiwan University
Hospital, Taiwan
Purpose To present a rare case of bilateral sigmoid sinus thrombosis with
concomitant dural arteriovenous fistulas.
Methods A 41-year-old female, with chronic headache for five years,
presented to our hospital with rapidly progressive dementia, unsteady
gait and change of behavior in recent one month. There was no
systemic illness of her in the past decades. Computerized tomographic
angiography of brain disclosed dural arteriovenous fistulas (dural AVFs)
at right posterior fossa with bilateral sigmoid sinus thrombosis. Multifocal
calcifications at bilateral subcortical cerebral white matter and deep gray
matter with diffuse brain swelling were also noted.
Results The patient was referred to a medical center for therapeutic
angiography, which reveals dural AVFs at right transverse sinus. It
received its blood supply from multiple branches of right internal and
external carotid arteries, draining through superior and inferior sagittal
sinuses, into bilateral cortical veins retrogradely. There was sinus
thrombosis of bilateral sigmoid and left transverse sinuses associated
with diffuse venous ectasia of bilateral cortical veins, cavernous sinuses,
superficial veins, perimedullary veins and perispinal veins. Transarterial
and transvenous embolizations were performed with detachable coils,
N-butyl cyanoacrylate (30%), followed by balloon dilatation of the
thrombosed sinus (right sigmoid sinus). Post-embolization angiography
showed a successful achievement with more than 80 % reduction of the
estimated shuting flow.
Conclusions Many studies have made effort to the diagnosis and
treatment of curable dementia to preserve patients’ functional status. New
IN026
Initial Experience in the Pipeline Embolization Device (PED)
in a Regional Teaching Hospital
Lau V1, Lee Raymand¹, Chan KH2, Leung KK3, Tso WK1
1
China
2
Department of Medicine, University of Hong Kong, Hong Kong,
China
3
Department of Surgery, University of Hong Kong, Hong Kong,
China
Purpose To evaluate the safety of placement of the Pipeline embolization
device for treatment of cerebral aneursyms.
Methods Prospective study including all consecutive patients treated with
PED from September 2008 up to November 2009 were included. The
underlying aneurysm size, location, procedural time, complication, length
of hospital stay were reviewed.
Results Between September 2008 and November 2009, 23 Pipeline
embolization devices (PED) (Chestnut Medical Technologies Inc., Menlo
Park, CA, USA) were placed in 17 consecutive patients with intracranial
cerebral aneurysms. There were 4 men and 13 women. Mean age of our
patients was 46.7 years old (range 32-76). All were unruptured anterior
circulation aneurysms except one ruptured dissecting vertebral artery
aneurysm. Aneurysm size ranged from 2.8mm up to 22mm. Two of the
aneurysms were reconstituted aneurysm after previous coiling with coil
compaction. One lobulated paraclinoid internal carotid aneurysm was
associated with a Spetzler-Martin Grade I frontal lobe arteriovenous
malformation. Glue embolization of the left frontal arteriovenous
malformation was performed in the same session. All procedures were
performed under general anesthesia. The mean procedural time was
132 minutes. No complication was reported in relation to the device
placement. Embolization of the left frontal arteriovenous malformation
was complicated with rupture requiring craniotomy, hematoma removal
and resection of the arteriovenous malformation. Excluding the
ruptured dissecting vertebral artery aneurysm and the ruptured frontal
arteriovenous malformation, the mean hospital stay was 3.9 days. We are
still collecting the long term follow-up result.
Conclusions Placement of the PED appears to be a safe and efficient
way in dealing with intracranial aneurysm. This flow directing device aims
at parent artery reconstruction which might laid down a new paradigm for
cerebral aneurysm treatment.
Keywords Aneurysms, Angiography
nterventional Radiology (IR)
IR006
Systemic Manifestations of Acute Arterial Thromboembolism
and Primary Role of Endovascular Thrombolysis as a Initial
Management
YoungKwon Cho, JinKoung An, YoonYoung Jung, KiWoong
Jung, SeungA Choi, ChangNeul Han
Department of Diagnostic Radiology, Eulji Medical Center, Eulji
University, Korea
Purpose Acute ischemia due to arterial thromboembolism is accounting
for 50 to 80% of atherosclerotic peripheral arterial disease and recently,
the incidence and mortality have been increased according to older, DM,
coagulopathy and arrhythmia. The aim of this exhibition is to demonstrate
the critical images and to suggest the role and efficacy of endovascular
thrombolysis after categorization according to origin, location and disease
period.
Methods From June 2006 to July 2009, 69 cases were included with
acute ischemia due to arterial thromboembolism and initially managed
with endovascular thrombolysis in a general hospital. We demonstrate
the typical features of acute thromboembolism on CT and MR and
conventional angiographic images during endovascular thrombolysis in
order to verify the role, success results and complications for support
organized categorization of systemic manifestation of acute arterial
thromboembolism in diagnosis and treatment.
Results Among 69 cases, 26 cases occured in cerebral arteries; 13 in
MCA, 9 in basilar artery, and 5 in multifocal arteries. Between them, 8
cases were successfully treated. The nine cases happened in visceral
arteries; 3 in celiac axis, 2 in SMA, 3 in renal artery and 1 in abdominal
aorta. And 8 cases were successfully treated. Two cases happened
in main pulmonary arteries, including one case of consequent vulky
thrombus at whole infrarenal IVC, which were all successfully treated.
18 cases occured in lower extremities, including one case of previous
involved in cerebral artery. Between them, 12 cases were successfully
treated. 13 cases occurred in upper extremites and nine cases were
successfully treated. Among 69 cases, 22 cases originated from
cardiogenic embolism and there were partially successful treatment in
seven, failed treatment in 16, and complications in seven.
Conclusions Familiarity with instructive images of multi-systemic
manifestations of acute thromboembolism and roles of endovascular
thrombolysis may great helpful in early diagnosis and treatment.
Keywords Ischemia/Infarction, Thrombolysis
Purpose To report a very rare case with spinal intraosseous epidural AV
fistula with perimedullary vein reflux causing myelopathy symptoms. With
Onyx embolization, the intraosseous fistula tracts are totally obliteration.
Methods A 57-year-old male with a history of T12 and L2 compressive
fracture with mild low back pain lasted for more than 1 year. An accident
took place few days before and acute deterioration of low back pain with
paresthesia, bilateral lower extremities paraparesis (Grade 2), urine and
feces incontinence are noted. Spinal MR imagings revealed hyperintensity
and edema of spinal cord with numerous abnormal dilated vessels
indicated spinal dural AV fistula with primedullary venous drainage. Spinal
angiography showed an epidural AV fistula fed via the left T12 lumbar
artery with intraosseous fistula tracts connecting to basivertebral vein and
draining to anterior internal (epidural) vertebral venous plexus than reflux
into the perimedullary veins. Embolization was performed by selective
catheterization from the left T12 lumbar artery into the fistula and 0.6ml
injection of Onyx over a period of 12 minutes. The proximal veous portion
and all the intraosseous fistula tracts are totally occluded.
Results The patient’s symptoms release just one day after embolization
and can walk via aids. Follow-up MR imagings 5 days later revealed
complete recovery of cord signal intensity and disappear of the abnormal
dilated vessels.
Conclusions Spinal epidural arteriovenous fistula is much rarer and only
few cases have been reported. The pathophysiological mechanism is not
clear and some causes such as neurofibromatosis, previous surgery or
trauma have been mentioned. Extradural AV fistula with perimedullary
reflux and intraosseous fistula course of this case may be extremely rare.
Keywords AVM, Spine, Fistula, Trauma, Interventional
and dramatic advances related to the diagnosis and treatment of cerebral
vascular anomalies have led to more precise classification schemas and
therapeutic approaches. There is rare literature report for dural AVF with
concomitant thrombosis of bilateral lateral sinuses. We present this rare
case of dural AVF with coincidental bilateral sigmoid sinus thrombosis with
clinical manifestations, image findings and treatment for the purpose of
early diagnosis and intervention of vasculsar dementia.
Keywords Angiography, AVM, CT, Dementia, Fistula, Interventional
E-Poster
IN023
Percutaneous Vertebroplasty and Kyphoplasty for Spine
Fracture of Patients with Malignant Tumor
Michael Mu Huo Teng, Hung-Ta Wu, Chao-Bao Luo, Feng-Chi
Chang, Wan-You Guo, Cheng-Yen Chang
Department of Radiology, Taipei Veterans General Hospital and
National Yang Ming University, Taiwan
1
Department of Radiology, E-Da Hospital, I-Shou University,
Taiwan
2
Taiwan
3
Department of Neurosurgery, E-Da Hospital, I-Shou University,
Taiwan
IR007
Catheter Refracture during Retrieval of Fractured Central
Venous Catheter Fragment
Sheng-Lung Hsu, Yuan-Hsiung Tsai, Hsu-Huei Weng, Bor-Yau
Yang
Hospital, Chiayi, Taiwan
Purpose Percutaneous retrieval of intravascular foreign bodies has
been proven to be a safe and effective procedure and the associated
complications are rare reported. Here we present two cases of the
catheter refracture and migration of fractured fragment into pulmonary
artery during percutaneous endovascular retrieval of a fractured central
venous catheter.
Methods Two patients encountered catheter refracture during retrieval
of a fractured central venous catheter with Basket retrieval device in our
hospital. The catheter fractured when we attempted to pull the catheter
back into the sheath. The refractured fragments drifted into right atrium
and pulmonary artery subsequently.
Results The refractured fragments of both patients were retrieved with
Snare retrieval device successfully.
Conclusions Extreme caution should be exercised while manipulating the
percutaneous endovascular retrieval of fractured central venous catheter,
especially with Basket retrieval device. For the risk of catheter refracture,
we recommend that the fractured catheter should be captured by the
587
Others
Purpose To review our experience with rare cases of ruptured arterial
aneurysm related with non-ruptured BAVMs in Ramathibodi hospital, in
term of natural history, pathophysiology, angioarchitectural risk, treatment
modalities and prognosis.
Methods We retrospectively review of case of non-ruptured BAVMs
with ruptured far proximal arterial aneurysm between October 2005 and
September 2009.
Results Three exceptional cases of ruptured arterial aneurysms of arterial
feeders of the non ruptured BAVMs include 36-year-old woman with
inferior left cerebellar AVMs with ruptured left PICA aneurysm, 47-yearold woman with righ temporal lobe AVMs with right MCA aneurysm and
65-year-old with left cerebellar AVMs with left AICA aneurysm, all present
with pure diffuse subarachnoid hemorrhage (SAH). 2/3 aneurysms
has been detected by noninvasive CECT of the brain. Endovascular
management of all aneurysm has been considered urgentlyand
successfully before curative management of the BAVMs. No recurrent
SAH is detected.
Conclusions Ruptured BAVMs usually present with intra-parenchymal
hemorrhage or mixed with SAH or SDH. Pure SAH related with BAVMs
is rare, and usually occur with present of ruptured flow related arterial
aneurysm. Noninvasive study i.e. CTA and MRA are recommoneded due
to their high sensitivity and specificity leading to urgent treatment of the
ruptured aneurysm, which carry more risk of recent recurrent bleeding or
SAH than BAVMs. Endovascular management including aneurysm coiling
or liquid adhesive (NBCA) are effective for preventing rerupture of these
flow related aneurysm with low complication.
IR011
Successful Tansarterial Catheterized Thrombolytic Therapy
for Acute Renal Infarct in a Preliminary Trial: A Case Report
at a Medical Center in Taipei County
Tsung-Po Hsu, Yu-Chiang Chen, Pei-Hui Chan, Kao-Lun Wang
Department of Medical Imaging Science, Far Eastern memorial
Hospital, Taiwan
Purpose Aggressive tansarterial catheterized thrombolytic therapy (TCTT)
for acute renal infarct is not commonly reported because of delayed
diagnosis in most cases. Here we report a case of acute left renal infarct
in a 68-year-old woman, who previously had coronary artery disease
and was found to have atrial fibrillation on arrival to our hospital. She
eventually received TCTT in our preliminary trial and got a successful
result. We describe the clinical course, the imaging findings and bring up
a brief discussion, so as to expect further technical improvement.
Methods We used percutaneous transarterial route and placed the
catheter tip within the left renal artery. Urokinase of total 560k units was
injected via the catheter according to the recommended manipulation,
followed by systemic administration of anticoagulants. And we evaluated
the clinical course and sequela.
Results Complete thrombolysis was successfully achieved, demonstrated
in the angiographic series 72 hours later. Finally the patient was smoothly
discharged and kept a constant dose of anticoagulants for prevention of
atrial-fibrillation related thromboembolism.
Conclusions Color-flowmetry sonography, enhanced computed
tomography, intravenous pyelography or angiography are helpful for
diagnosis of renal infarct. Generally speaking, intravenous administration
of thrombolytics is a current choice for renal infarct. In a fresh acute case,
however, TCTT may be considered for the first line of treatment.
Keywords Acute, Kidney, Embolism/Thrombosis, Thrombolysis,
Treatment Effects
588
IR017
Relationship between Costal Bone and Its Accompanying
Intercostal Artery: Analysis by MDCT
Tetsuya Minami
Department of Radiology, Kanazawa University Hospital, Japan
Purpose Intercostal artery injury is considered to be one of the major
complications in transthoracic puncture. So, we think it very important
to evaluate the pathway of intercostal artery. The purpose of this is to
analyze the relationship between costal bone and its accompanying
intercostal artery.
Methods 40 patients, who received thin-section contrast enhanced
thoracic CT from October to December, 2008 were subjected to the
study. Distance of intercostal arteries (5th to 11th) from inferior border of
upper costal bone was measured every one centimeter. In this study, we
analyzed only dorsal side pathway, because the way of intercostal artery
is more tortuous in this side. In addition, if patients had a surgical history
of thoracic cavity or thoracic aorta, and had a history of dissection of
thoracic aorta, they were excluded from the study.
Results The results demonstrated that a distance from costal bone
to intercostal artery was significantly longer within 6 cm from edge of
vertebral body, and the distance tended to be longer in lower rib than
upper rib.
Conclusions It seems possible that intercostal artery exist apart from
inferior border of costal bone within 6 cm from edge of vertebral body.
Therefore, we need to pay attention to puncture site selection, when a
target lesion exists in mediastinal side.
Keywords Anatomy, Lung, Interventional
Purpose To examine whether the use of C-arm computed tomography
(CT) during percutaneous nephrolithotomy increases the technical
success rate and decreases the procedure time. Puncture of a posterior
calyx would decrease the difficulty, risk of bleeding and procedure time.
Methods Between 2006 and 2008, we retrospectively review the data
of two groups of fifteen consecutive patients receiving percutaneous
nephrolithotomy due to staghorn stone. Before puncture on fluoroscopy,
the group 1 used only the IVU film as initial evaluation of the access. The
group 2 used the IVU film and multiplanar C-arm CT images reconstructed
from data acquired during a 180 degrees C-arm rotation. The desired
posterior calyceal stone to be punctured will be decided.
Results Two of 15 patients in the group 1 failed with success rate of
87%. The group 2 had 100% success rate. The mean procedure time was
significantly reduced in group 2 compared with the group 1 (45 min vs. 73
min, P<0.05). Among the group2, there were four patients were initially
difficult to approach due to relatively radiolucent stone. But the stones
were well seen in the 3D and MPR image of C-arm CT. All 15 patients in
group 2 had good 3D and MPR image, which were easy to decide the
posterior calyceal stone as puncture target.
Conclusions C-arm CT enables a good success rate and less procedure
time. Because it is reliable in confirming the location of posterior calyceal
stone to make a good puncture plan during percutaneous nephrolithomy.
Keywords Kidney, CT, Percutaneous
IR019
The Role of Interventional Radiology in the Management of
Pediatric Renal Trauma
Chien-Heng Lin¹, Wei-Ching Lin, Yung-Jen Ho²
¹Department of Pediatrics, Jen-Ai Hospital, Taichung, Taiwan
²Department of Radiology, China Medical University Hospital,
Taichung, Taiwan
Purpose Although interventional radiology has played an increasing
role in the management of adult trauma patients, little has been reported
its application in the pediatric renal trauma. This study analyzed the
indications, results, and complications for interventional radiology in
pediatric renal trauma patients.
Methods From February 2005 to August 2009, blunt renal trauma
pediatric patients (18 years or younger) admitted to our institute were
reviewed. Clinical data and computed tomographic (CT) findings were
reviewed. Outcomes and complications were also recorded.
Results Fourteen pediatric patients (12 boys and 2 girls) had renal
injury (11 right and 3 left; 1 grade 1, 2 grade 2, 5 grade 3, 4 grade 5, and
1 grade 5) and 6 of them underwent angiography because of contrast
medium extravasations at kidney found on CT. The average age and injury
severity sore was 13.4 ± 4.7 years (rang, 7-17 years) and 16.9 ± 8.1 (range,
9-29) respectively. No patients had bleeding tendency and 10 of them
presented with hematuria initially. Three of them underwent subsequent
transcatheter arterial embolization (TAE) and one underwent laparotomy
and splenectomy because of spleen hemorrhage. All patients had normal
renal function except one had renal vascular hypertension related trauma
directly at follow up. There was no mortality.
Conclusions Angiography was associated with minimal morbidity and
should be considered as a useful and safe diagnostic method for blunt
renal injured children. Arterial bleeding may produce massive hematoma
and TAE was a useful treatment for such cases to minimize renal
parenchymal damage.
Keywords CT, Embolization, Trauma, Interventional
IR020
Superselective Arterial Infusion Chemotherapy for Head and
Neck Cancers with 3Fr Sheath System
Seiji Iwamoto, Takahiro Taniwaki, Mitsuhiro Kinoshita, Yoichi
Otomi, Shoichiro Takao, Hideki Otsuka, Hiromu Nishitani
Department of Radiology, Tokushima University, Japan
Purpose In case of intervention with femoral artery approach, forced long
bed rest after the procedure is very much stressful for patients. In order
to shorten the forced bed rest period, we utilized 3Fr sheath system by
changing from 4Fr system at arterial infusion chemotherapy. We evaluated
the usefulness of the system.
Methods We tried arterial infusion chemotherapy with 3Fr system in
44 sessions, about 32% among all 138 sessions of arterial infusion
chemotherapy for head and neck cancer from August 2007 to May 2009.
We set the criteria for the usage of 3Fr system as follows. Criteria 1: The
second session in the same patient. We performed the first therapy by
4Fr system. If we could insert the sheath and operate catheter smoothly,
3Fr system was utilized for the second session. Criteria 2: Patients of 3rd
to 4th decade without evidence of arteriosclerosis. We used 3Fr system
even from the first time after having confirmed that there is no severe
arteriosclerosis nor tortuosity of the thoracic aorta on prior CT images.
Results In 1 session, 3Fr sheath insertion was difficult and we changed it
to 4Fr system. Other 43 sessions were accomplished by 3Fr system with
no problem. After the sheath withdrawal, it needed 7 minutes for manual
compression, and 1 hour for sandbag. All patients got free from bed rest in
2.5 hours. No delay of procedure period or complications were observed
in any session by changing to 3Fr system.
Conclusions Although 3Fr system is difficult to handle in comparison with
4Fr system, it is suitable and useful at the super-selective arterial infusion
chemotherapy for head and neck cancer in the shortening of forced
postoperative bed rest period if we select the cases with care.
Keywords Cervix, Interventional
IR021
Usefulness of Administration of Superparamagnetic
Iron Oxide Prior to Radiofrequency Liver Ablation; Early
Experience in Miniature Pigs
Suguru Kakite¹, Shinya Fujii1, Masahiko Koda2, Eiji Matsusue1,
Toshio Kaminou1, Toshihide Ogawa1, Masahiko Koda2
1
Department of Division of Radiology, Pathophysiological and
Therapeutic Science, Faculty of Medicine, Tottori University,
Japan
2
Department of Division of Medicine and Clinical Science,
Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori
University, Japan
P u r p o s e To e v a l u a t e t h e u s e f u l n e s s o f a d m i n i s t r a t i o n o f
superparamagnetic iron oxide (SPIO) for assessing the efficacy of
radiofrequency (RF) liver ablation.
Methods Nine RF liver ablations were performed in 3 miniature pigs.
Six of nine ablations were performed after administration of SPIO in 2
miniature pings (group A). Three of nine ablations were performed in the
other one miniature pig without administration of SPIO (group B). All pigs
were sacrificed 4 days after the procedure. Their harvested livers were
scanned with 1.5T MR system after fixation by 10% buffered formalin. The
MR images were precisely compared with histological specimens.
Results There was no histological difference in two groups. All ablated
liver lesions showed coagulation necrosis at the external layer. There
were no viable cells inside of coagulation necrosis. All ablated lesions had
hypo-intense rim on T2* weighted images. The rims of the group A were
thicker than those of group B (group A vs. group B: 3.42 vs. 2.19 mm). The
rims of the group B corresponded to congestion and hemorrhagic necrosis
area histologically. The rims of the group A corresponded to congestion,
hemorrhagic necrosis and coagulation necrosis areas. In group A, hypointense rim on T2* images reflected necrotic Kupffer cells that took up
SPIO before RF liver ablation.
Conclusions Administration of SPIO made it possible to precisely
evaluate ablated liver parenchyma by hypo-intense rim on T2* images.
This method is helpful for the evaluation of safety margin after RF ablation
for liver tumors.
Keywords Ablation Procedures, Liver, MR, Contrast Agents, Interventional
589
Purpose Dense packing is acknowledged the goal in endovascular
treatment of the intracranial aneurysm. Instead of attempting to achieve a
dense packing of the whole aneurysm, selective maximal packing for the
aneurymsal neck was achieved. The purpose of this study was to evaluate
the outcome of aneurysms treated by this method.
Methods From 2008 to 2009, eight patients with seven ruptured and
one unruptured aneurysms. All aneurysms with lobulated outline and
present of daughter sac were treated with selective embolization, coiling
was reduced for the daughter sac or the aneurysm fundus, but maximal
packing was achieved for the aneurysmal neck.
Results Seven aneurysms were shown to have complete occlusion on
angiograms obtained at the end of the procedure. Only one aneurysm
revealed the contrast stasis in lobulated daughter sac. The follow-up
studies show a stable complete occlusion and no rebleeding clinically.
Conclusions The selective embolization of the aneurysm seems to enable
a change in the concept of coiling, by reducing the amount of coils and
avoid perforation during manipulation of the coil within the daughter sac.
Keywords Aneurysms
Purpose To evaluate the technical feasibility in salvage of “mummy”
vascular accesses for hemodialysis. These vascular accesses were
occluded and had been abandoned for more than 3 months before their
resurrection. Technical success, clinical success, patency rates and
complications are reported.
Methods Between October 2008 and September 2009, endovascular
resurrection of a total of 17 mummy vascular accesses in 14 patients (8
females and 6 males) were attempted. There were 6 grafts in 4 patients
and 11 fistulas in 10 patients. The number of mummies aged older than
12 months is 88.2% (ranged from 12 months to 12 years).
Results The overall technical success rate is 76.5% (72.7% for fistula
and 83.3% for graft). The technical success rate for mummies aged
older than 12 months is 80.0%. The clinical success rate is 92.3%
one month after resurrection. There are 83.3% resurrected mummies
requiring re-intervention (13 episodes in 5 grafts in 3 patients and
15 episodes in 8 fistulas in 7 patients). The post-intervention primary
patency rates at 30 days, 60 days, 90 days, 180 days and 360 days
are 72.7±13.4%, 42.4±15.6%, 21.2±13.2%, 10.6±10% and 0%; the
post-intervention secondary patency rates are 90.0±9.5%, 90.0±9.5%,
90.0±9.5%, 78.8±13.4% and 78.8±13.4%. There were 2 episodes of
massive tear of access conduit vein during resurrection (n=1) and salvage
(n=1) procedures, which could not be managed by prolonged balloon
tamponade and were successfully controlled by NBCA tissue glue infusion
around venous leakage sites.
Conclusions For dialysis patients with very limited extremity veins for
further vascular access placement, resurrection of mummy access is a
safe and technically feasible procedure to prevent these patients from
catheter-dependent hemodialysis.
Keywords Angioplasty, Shunts, Fistula, Grafts, Veins, Interventional
IR018
Retrospective Comparsion of with and without the Help
of C-Arm Computed Tomography (CT) in Percutaneous
Nephrolithotomy
Chung-Ming Tsai1, Yeu-Sheng Tyan1, Horng-Rong Chang2
1
Hospital, Taiwan
2
Department of Nephrology, Chung Shan Medical University
Hospital, Taiwan
E-Poster
IR010
Selective Embolization of Intracranial Aneurysms with
Detachable Coils
Ming-Chi Wu1, Ho-Fai Wong2, Chao-Yu Shen1, Yeu-Sheng Tyan1
1
Hospital and Institute of Medicine, Chung Shan Medical
University, Taichung, Taiwan
2
Chang Gung University, Taoyuan, Taiwan
IR012
Resurrection of Mummy Vascular Accesses for Hemodialysis
Mei-Jui Weng1, Matt Chiung-Yu Chen2, Ping-Hong Lai1, HueiLung Liang1, Huay-Ben Pan1
1
Taiwan
2
Department of Radiology, Yuan's General Hospital, Taiwan
Others
device at its middle portion, and then grasped gently. Refracture may be
occurred with excessive force used during retrieval, especially when the
catheter is lodged into the sheath.
Keywords Angiography, Lung, Catheters, Complications, Technical
Aspects, Interventional
IR028
An Alternative Insertion Method of Peripherally Inserted
Central Catheters (PICC)
Cheng-kuang Chang¹, Wen-Chiung Lin1, Guo-Shu Huang2
1
Department of Radiology, Tri-Service General Hospital, Doctor,
Taiwan
2
Department of Radiology, Tri-Service General Hospital, Chief,
Taiwan
Purpose The objective of this study was to retrospectively evaluate the
feasibility of an alternative access to PICC insertion.
Methods In this observational and retrospective study, 27 patients
(8 males, 19 females; mean age 62.9 +/- 11.8 years) with difficulty in
upper arm PICC placement were included. A 4F, single-lumen PICC
was placed into the internal jugular (n=14) or subclavian vein (n=13)
by an interventional radiologist under the guidance of ultrasound and
fluoroscopy.
Results The placement of the PICC was technically successful in 27
(100.0%) patients. The mean duration of catheter usage was 38.5
(9~120) days via the internal jugular vein and 41.2 (2 - 178) days via the
subclavian vein with a total of 1074 catheter days. No procedure-related
complications were observed except one patient showed neuropathy
symptom immediately after subclavian vein puncture. Another patient
developed suspicious catheter-related sepsis after insertion for 3 months.
Otherwise, there is no other catheter-related complications been recorded.
Conclusions It is difficult to insert PICC through the peripheral veins
in the patients with multiple clinical conditions, such as upper limbs
contracture, thin peripheral veins and peripheral venous thrombosis.
Based on this study, implantation of PICC through internal jugular and
subclavian veins under the guidance of ultrasound and fluoroscopy by
an interventional radiologist provides a safe alternative access for the
patients with difficulty in peripheral insertion.
Keywords Ultrasound, Veins, Interventional
IR031
Can You Embolize by Microwire in Rabbit Renal Artery? Yes
or No
590
IR036
Y-90 Implantation: Technical Remarks and First Clinical
Results in Korea
Yun Hwan Joseph Kim¹, Cho Sung Bum1, Chung Hwan Hoon¹,
Seo Tae Seok², Seo Yeon Suk1, Cha In Ho², Choe Jae Gol³, Um
Soon Ho4
1
Department of Radiology, Korea University ANAM Hospital,
Korea
²Department of Radiology, Korea University GURO Hospital,
Korea
³Department of Nuclear Medicine, Korea University ANAM
Hospital, Korea
4
Department of Gastroenterology, Korea University ANAM
Hospital, Korea
Purpose To report our first clinical results concerning the toxicity and
clinical response after using Y-90 resin microspheres in patients with
unresectable HCCs.
Methods Data from 21 consecutive patients with 21 unresectable HCC
treated by radioembolization after interdisciplinary consensus conference
[from Dec. 2008 to Sept. 2009] were reviewed. Work-up included
dynamic liver CT, CTHA, PET-CT for screening, liver function tests, tumor
specific tests [AFP, PIVKA II] and 99mTc-MAA scan for assessment of
arteriovenous shunting after microcoil embolization of gastroduodenal
artey, right gastric artery and accessory left gastric artery.
Results In 21 patients, 23 procedures were performed, 19 single
procedures, 1 split primary treatment, and 1 repeated SIRT because
of progressive disease. There were no peri-interventional procedural
complications. Follow-up is 6.25+/-3.6 months [ range 1.3 to 9.7months
] with an overall mortality of 15% [3 of 20 patients. One patient follow-up
has been lost since 1 month later.]. One patient with single SIRT died from
IR037
Hybrid MR Angiography Compared with DSA in the
Diagnosis of Peripheral Arterial Disease
Chun-Chieh Wang¹, Huei-Lung Liang², Jer-Shyung Huang², YihHuie Lin², Huay-Ben Pan, Kuen-Huang Chen²
¹Department of Radiology, Longcyuan Veterans Hospital, Taiwan
²Department of Radiology, Kaohsiung Veterans General Hospital,
Taiwan
Purpose To prospectively determine the diagnostic performance of Hybrid
magnetic resonance angiography (MRA) in peripheral arterial disease
(PAD) of the lower extremity, including the pedal arteries, with digital
subtraction angiography (DSA) as the reference standard.
Methods Standard three-station chase-bolus and time resolved imaging
of contrast kinetics (TRICKS) MRA of pelvis and lower limb were
performed in 21 consecutive PAD patients (15 men, 6 women; mean
age, 73 years; range, 46–87 years). The mean examination time interval
between DSA and MRA was 1 day (range, 4 hours-3 days).For data
analysis, the arterial vascular system was divided into 32 segments. A
total of 672 arterial segments were analyzed for arterial stenosis by two
independent blinded readers using a four-point grading system (grade
1, <10% narrowing; grade 2, 10%–49% narrowing; grade 3, 50%–99%
narrowing; grade 4, occlusion). Sensitivity and specificity of hybrid
MRA for all vascular segments and segments below popliteal artery
were determined by characterization of significant stenoses (>50%) or
vessel occlusions; Interobserver agreements of significant stenosis, and
intermodality agreement were calculated by using k statistics.
Results Compared with conventional DSA, the sensitivity and specificity
of the hybrid MRA with regard to detection of hemodynamically significant
stenosis in all vascular segments were 92% and 97% for reader 1, and
89% and 92% for reader 2, respectively. As for vascular segments below
knee, the sensitivity and specificity were 98% and 95% for reader 1, and
94% and 88% for reader 2, respectively. Intermodality and interobserver
agreements of significant stenosis for both readers were excellent (k=0.84
– 0.90 and 0.84)
Conclusions Hybrid MRA is an accurate and reliable noninvasive
alternative to conventional DSA in the assessment of iliac and lower
extremity arteries in patients with PAD.
Keywords Angiography, Arteries, MR, Extremities, Interventional
IR038
Superselective Embolization for Lower Gastrointestinal
Bleeding: An Institutional Review over 12 Years
Hui-Chung Teng, Huei-Lung Liang, Yih-Huie Lin, Jer-Shyung
Huang, Huay-Ben Pan, Kuen-Huang Chen
Taiwan
Purpose To determine the outcomes of transcatheter embolotherapy in
the management of lower gastrointestinal (GI) bleeding in terms of efﬁcacy
rates, complications, recurrent bleeding rates, and 3-month motality.
Methods Between January 1996 and October 2008, 26 patients (18 men,
8 women; mean age 66.38 years) of lower GI bleeding were referred
to our department for angiographic control. Of them, 14 patients had
colorectal bleeding with failure of colonoscopic management. The rest of
12 patients had bleeding in small intestine. Only microcatheter can reach
beyond the marginal artery that embolotherapy be done. Microcoils were
the only embolizer used. Regional vascular spasm during manipulation
was regarded as a successful temporary embolization.
Results Three patients failed the embolotherapy and underwent surgical
resection. All the three patients died at 1, 7 and 25 days, respectively,
after operation. Three patients had vascular spasm but with successful
cease of bleeding. Twenty patients received superselective embolization
with microcoils at the level of either marginal artery or vasa recta artery.
Two patients of angiodysplasia had recurrent lower GI bleeding at 5 and
8 months after embolization. None patient rebled within the first 30 days.
Two patients (8.7%) had complicated with bowel gangrene. Eleven patients
(42%) died within 3 months after embolotherapy or surgical resection.
Conclusions Transcatheter embolotherapy to treat lower GI bleeding
is effective and safe with a relatively low rebleeding and ischemic
complication rates. The immediate clinical outcome is acceptable, but due
to poor clinical status of most of these patients, 3 month survival rate is
low. Transcatheter embolotherapy, other than surgical management, may
be regarded as the first line therapy in these multi-morbid patients.
Keywords Angiography, Arteries, Embolization, Hemorrhage,
Interventional
IR039
3D CT Visualizations of Endovascular Aneurysm Repair:
Current and Future Status
Zhonghua Sun
Purpose Endovascular aneurysm repair of abdominal aortic aneurysms
(AAA) has developed rapidly since its introduction in early 1990s. Despite
technical improvements and satisfactory mid-term results, long-term safety
or durability of the procedure still needs to be confirmed. The purpose of
the study was to provide an overview of the applications and diagnostic
value of 3D CT visualizations of endovascular aneurysm repair of AAA, as
well as explore the future directions so as to understand the advantages,
limitations and potential complications of the technology.
Methods A number of 3D visualizations were presented in the study
including surface shaded display, maximum-intensity projection, volume
rendering, virtual endoscopy and 3D stereoscopic views based on a group
of patients with AAA treated with suprarenal and fenestrated stent grafts.
Advantages and disadvantages of each visualization tool were discussed
when compared with routine 2D views including axial and multiplanar
reformations in the assessment of treatment outcomes of endovascular
repair.
Results 3D CT visualizations offer additional information when compared to
2D images for assessing stent graft repair of AAA. In addition, hemodynamic
effect of both suprarenal stents and fenestrated renal stents on the renal
arteries was demonstrated through flow analysis using computational fluid
dynamics with regard to the velocity changes, wall pressure, wall shear
stress observed in both pre-and post-stent grafting cases.
Conclusions Reliably recognizing the diagnostic value of each
reconstruction is of paramount importance for endovascular specialists
to effectively utilize CT angiography. A number of protocols are
recommended for following-up patients who are treated with stent grafts.
It is expected that these recommendations will improve the current followup procedures with the inclusion of various visualization tools.
Keywords Aneurysms, CT, Interventional
IR041
Inflammatory Myofibroblastic Tumor Treated with TAE – A
Case Report
Siu-Wan Hung
Taiwan
Purpose Inflammatory myofibroblastic tumor (IMT) of the liver is a benign
neoplasm formerly known as inflammatory pseudotumor. Involvement of
591
Purpose We are increasing cases in intracranial stening and some
increasing wire perforation in small arteries. How to solve the problem?
We embolized rabbit renal artery by microwire and RF generator. To
prospectively evaluate the tissue reaction, the embolic effects and
absorption of embolization effects of radiofrequency wire electrode
method to comparing with PVA embolization method on rabbit renal artery
(similar size in human M2).
Methods This experiement was performed in accordance with regulations
on the animal care and experimences. NewZealand white rabbits were
divided into two groups according to the materials [PVA, diameter 150-250
um (4 rabbits), and RF ablation (8 rabbits) by 0.018 inch Tefron coated
platinum Mandril guide Wire, Cook, Bjaeverskov, Denmark] used for
embolization of right renal artery. A rabbit from each group was sacrificed 3
days, 1 week, 2 weeks, 4 weeks after embolization Gross and microscopic
pathologic findings were examined with Hematoxylin and Eosin staining.
RF generator (RF3000, Boston Scientific Corporation,Boston,USA)
Results Gross pathologic findings were examined and swelling of
embolized kidney was observed 3days after embolization, where as
shrinkage of the kidney was consistently seen after 2weeks, with hard
consistency and nodular spaces being noted. At the histologic analysis
the PVA particles makes incomplete obstruction of the arterial lumen and
no vascularitis is noted at 3days later. The RF ablation shows full layer
necrosis with thrombus formation of after three days later. The 4weeks
later, PVA group shows no remarkable change and the RF group shows
no remarkable change and the RF group reveal generalized destruction of
architecture of artery with thrombolysis.
Conclusions Embaolization of radiofrequency wire electrode is a good
candidate for embolic method shows more cell destruction in rabbit in
comparision with PVA particle. We need long term follow up and safty
study of RF ablation method.
Keywords Embolization, Interventional
pulmonary complication after operation due to head trauma. Two patients
with single SIRT treatment died from hepatic insufficiency at 5 and 6
months, respectively, without remarkable progressive intrahepatic tumor
spread, possibly RILD as co-factor. Of the remaining patients, 1 presented
with progressive disease, 9 with stable disease, 6 with partial response
and 1 with complete response [by RECIST]. One patient with progressive
disease, two with partial response, and 4 with stable disease were treated
by combined TACE and RFA.
Conclusions Radioembolization with 90Y-loaded resin microspheres is
feasible in most patients with liver tumors. Despite of short-term period,
SIR-Spheres has a good antitumor effect to unresectable hepatic tumors.
Keywords Liver, Radionuclide Therapy, Embolization, Interventional
E-Poster
Purpose 1. This is a clinical audit. 2. To evalulate the efficacy of urgent
percutaneous cholecystotomy (PTC) for suspected acute cholecystitis in
patients with poor premorbidity, in terms of white cell count, liver function,
patient outcome etc. 3. Basic demographic data (age, sex, any DM/
premorbidity). 4. Assess approach of cholecystotomy (transhepatic or
transperitoneal with reference to CT images). 5. Assess clinical outcome
using less expensive non-locking catheter VS locking catheter.
Methods - retrospective review - audit of all PTC cases over a 2-yearperiod of time in an university based hospital - Patients' data: laboratory
results including WCC, LFT and bile culture, imaging findings, clinical
outcome (morbidity/motality) assessment using electronic patients' record
- Assessment of intra-, peri- procedural complications
Results Preliminary results show 1. PTC good in relieving acute
cholecystitis, as well as cholangitis should PTBD a techinically difficult
procedure confounded by mildly dilated biliary system. 2. Good
improvement on WCC, LFT and morbility. 3. Using cheaper non-locking
catheters with result as good as locking catheters. 4. Procedure related
complications only minimal.
Conclusions Percutaneous cholecystotomy is a safe and efficient method
in relieving acute cholecystitis in patients with poor premorbidity, as well
as safe temporizing method in relieving obstructed biliary system should
PTBD a technically difficult procedure. Procedure related complications
are minimal.
Keywords Gallbladder
Mi Nyong Choi, Dae Hyun Hwang, Kook Seon Kim, Jun Young
Jeon, Ik Won Kang, Eil Seong Lee
Department of Radiology, Hangang Sacred Heart Hospital of
Others
IR025
Clinical Audit of Efficacy of Percutaneous Cholecystotomy
in an Univerisity Hospital
Tong MP Mabel, HY Hung, CY Cheung, WY Hui and KT Wong
Department of Diagnostic Radiology and Organ Imaging, Prince
of Wales Hospital, The Chinese University of Hong Kong, Hong
Kong, China
IR046
Short and Long-Term Results of Balloon-Occluded
Retrograde Transvenous Obliteration for Esophageal and
Gastric Varices: A 10-Year Experience
Fumio Uchiyama¹, Satoru Murata 1 , Fumie Sugihara 1 , Jun
Watari2, Shinichirou Kumita1
1
2
Department of Radiology, Ebina General Hospital, Japan
Purpose Balloon-occluded retrograde transvenous obliteration (BRTO)
is a very useful treatment for gastric varices in terms of efficacy, safety,
and degree of invasiveness, and the recurrence rate of gastric varices has
been also reported to be 0%-10% after BRTO. Purpose of this study was
to retrospectively evaluate the effects of BRTO, especially on liver function
changes.
Methods Between April 1998 and March 2008, a total of eligible 34
patients (10 in the Child-Pugh A, 15 in the Child-Pugh B, 9 in the ChildPugh C) suffering with portal hypertension or liver cirrhosis underwent
B-RTO procedures at our institution to treat their esophageal and gastric
varices or hepatic encephalopathy. Of 34 patients, 23 had a HCV and one
had a HBV, and chronic alcohol ingestion in 5. Hepatic encephalopathy
was recognized in 16 patients. Written informed consent was obtained
and the study was approved by the hospital IRB. Changes in the ChildPugh score before and after the B-RTO procedure in each group were
statistically analyzed by means of (Wilcoxon's) signed rank test.
Results (1) Hepatic encephalopathy was improved in all 16 patients
(100 %). (2) The Child-Pugh score was not significantly improved both in
patients with the Child-Pugh A or B. However, 8 of 9 patients (89 %) with
the Child-Pugh C were significantly (P<0.01) improved after the B-RTO
procedures, and got the Child-Pugh B. There were no procedure-related
complication occurred.
Conclusions BRTO can effectively control hepatic encephalopathy, and
improve liver dysfunction in case of severe hepatic cirrhosis.
592
Purpose To evaluate the efficacy of percutaneous drainage in the
treatment of gallbladder empyema combined with liver abscess.
Methods Nine patients suffered from gallbladder empyema combined with
liver abscess in the past 3 years. Four of them received percutaneous
drainage of gallbladder empyema and subsequent drainage of liver
abscess, and five patients only received drainage of gallbladder
empyema. The clinical courses and CT scan image findings before
drainage were compared.
Results Table 1: Hospitalized days after drainage (H), C-reactive protein
level before (C0) and 1 week after drainage (C7), of patients received
drainage of gallbladder empyema and liver abscess (A) and patients only
received drainage of gallbladder empyema (B). H* C0 C7 A 14.5±2.1
29.1±3.7 5.7±2.5 B 17.2±2.9 27.9±3.9 6.3±3.3. Table 2: Gallbladder wall
thickness (G) and liver abscess size (L) of the two groups of patients in
millimeter. G L* A 6.3±1.2 62.8±19.5 B 6.1±2.5 23.6±11.4 Note: Data are
mean ± SD. *: P values < 0.05.
Conclusions Percutaneous drainage is a safe and effective nonsurgical
treatment for gallbladder empyema combined with liver abscess. If acute
cholecystitis induces a liver abscess more than 4cm in size, percutaneous
drainage of gallbladder empyema and liver abscess simultaneously will
reduce hospitalized days significantly.
Keywords Abscess, Liver, Percutaneous, Drainage, Gallbladder, Infection
IR054
The Importance of Computed Tomography Just before
Percutaneous Transhepatic Cholangiographic Drainage
Jui-Ying Lee¹, Wai-Man Choi1, Yung-Cheng Wang2
1
Department of Radiology, Sijihi Cathay General Hospital, Taiwan
2
Purpose Multislice computed tomography (CT) is usually the first
examination for evaluating the icteric patients. Gallstones and tumor
can be clearly shown on the CT images. In the patients with high serum
bilirubin level, percutaneous transhepatic cholangiographic drainage
(PTCD) is necessary for biliary drainage. PTCD is an invasive procedure
with risk of hemorrhage and severe pain. Besides, it needs a few days
to arrange the procedure in most radiologic departments. The gallstones
might be changed during this waiting period. Repeat non-enhanced CT
just before PTCD could offer precise diagnosis and possible change the
strategy of treatment.
Methods A 76 years-old man was admitted to our hospital because
of jaundice. The patient had several episodes of recurrent gallstones.
He had undergone left lobectomy of liver and cholecystectomy at other
hospital before this admission. The 1st abdominal CT at this admission
disclosed large gallstones in the distal common bile duct (CBD) and
marked dilatation of all bile ducts. The serum bilirubin level at the time
of admission was 6.6 mg/dl. It became 8.5 mg/dl three days later. PTCD
was arranged at the fourth day after admission. Non-enhanced CT was
repeated just before the procedure.
Results The 2nd CT showed absent gallstone and pneumobilia. The
calibers of the intrahepatic ducts were smaller. All the gallstones had
passed into the bowel loops. There was no obstructive lesion in the bile
ducts. PTCD was cancelled immediately. The serum bilirubin level fell to
normal slowly after two weeks.
Conclusions Our case suggests performance of the non-enhanced CT
just before PTCD, especially in the cases of CBD stones, could avoid
unnecessary invasive procedure.
Keywords Bile Ducts, CT, Percutaneous, Drainage, Interventional
Purpose To evaluate the effect of transarterial embolization (TAE) of renal
angiomyolipoma (AML).
Methods From 2002 July to 2009 Oct, 14 patients under the impression of
AML of kidney are treated by TAE. They are two male and twelve female
patients with age from 24 to 86 (Average: 48). The usage of material for
embolization is mainly gelfoam cubes. The before-TAE and post-TAE
follow-up CT are reviewed and their tumor volume are compared. The
tumor volume is divided into two parts: Angiomyoma (A) and Lipoma (L).
The effect of TAE is considered as volume of tumor before TAE divided by
volume of tumor post-TAE (Apre/ Apost and Lpre/ Lpost).
Results The ratio of Apre/ Apost is much smaller than Lpre/ Lpost.
Conclusions TAE is less effective for renal AML with larger fat
component.
Keywords Kidney, CT, Embolization, Interventional
IR052
Percutaneous Drainage of Gallbladder Empyema and Liver
Abscess to Treat Acute Cholecystitis Induced Liver Abscess
Cheng Chiang Huang
Department of Diagnostic Radiology, Kuo General Hospital,
Taiwan
IR055
Fluoroscopic Placement of Nasoenteric Tubes in Post
Gastroenteric Surgery Patients
Chien An Liu, Hsiou-Shan Tseng, Rheun-Chuan Lee, Cheng-Yen
Chang
Department of Radiology, Radiological Society Republic of
China, Taiwan
Purpose Nasoenteric tube feeding is an alternative to parenteral
intravenous nutritional support and is a preferred route of nutrition in
critically ill patients who are unable to tolerate oral feeding, suffered from
gastroparesis or delayed gastric emptying. This study is to describe our
technique and results with fluoroscopic placement of nasoenteric tubes in
post gastroenteric surgery patients
Methods From 2006 to 2009, 56 nasoenteric tubes were placed in 37
patients who received gastroenteric surgery at our hospital aged 32 to 92
years (mean, 71.6 years). 33 of 37 patients (89.2%) received gastroenteric
surgery. 4 patients (10.8%) received whipple operation. In every case, an
16-F feeding tube was inserted with fluoroscopically guided.
Results The tube was placed distal to the gastroenteric anastmosis for a
success rate of 94.6%. The rate of transferring to oral feeding was 54.5%.
The average retention time before the removal of tube to oral feeding was
24.8 days.
Conclusions Fluoroscopically guided placement of a nasoenteric tube is
with highly successful rate . In addition, it is also effective in providing a
temporary nutrition support before relief of postoperative gastroparesis.
Keywords Stomach
IR058
Effects on IVC Diameters in Normal Subjects with
Respiration
Mark Ten¹, Teh Hui Seong²
¹Department of Diagnostic Radiolgoy, MBBS, FRCR, M.MED,
Singapore
²Department of Diagnostic Radiology, Alexandra Hospital,
Singapore
E-Poster
IR042
Renal Angiomyolipoma Treated with TAE
Yu-Ching Cheng
Taiwan
Keywords Angiography, Liver, Cirrhosis, Embolization, Varices,
Interventional
Purpose To evaluate the degree of change on the sonographric AP
diameter of the IVC in normal patients with respiration
Methods The descriptive study was conducted from 1/5/2008 to 1/8/2008.
The AP diameters of the intra-hepatic segment of the IVC were taken in
a subxiphoid position, with patients in supine position. Diameters were
taken with patients in full inspiration as well as rest.
Results There were a total of 125 patients evaluated, with 80 males and
45 females. The average age was of 49, with a range of 18 to 88 years.
The average diameter of the IVC at rest for all the patients was 2.36 cm
with a range of 1.25 to 4.62 cm. The IVC on inspiration for all the patients
was 1.91 cm with a range of 0.83 to 3.39 cm. The average difference in
diameter is 0.46 cm. The average diameter of the IVC for males as rest
was 2.48 cm, with a range from 1.25 to 4.62 cm. The average diameter of
the IVC at inspiration is 2.00, with a range 0.83 to 2.00 cm. The average
difference in diameter is 0.48 cm. The average diameter of the IVC for
females at rest was 2.16 cm, with a range 1.32 to 3.37. The average
diameter on inspiration was 1.74 cm with a range of 1.05 to 2.57. The
average difference in diameter is 0.41 cm.
Conclusions IVC diameters can vary about 0.4 to 0.5 cm in healthy
subjects from rest to deep inspiration. Results are similar in males and
females. IVC diameters have been evaluated in sick patients in other
studies, but they can also vary in healthy patients. This variation in
diameter has implication in therapeutic decisions or when interventional
procedures like retrievable IVC filters are performed, even in normal
patients.
Keywords Vena Cava
Others
the liver is extremely rare. Although its histopathologic nature is benign,
it may difficult to differentiate this benign entity from a malignant tumor
because of its tendency to local invasion and recur. We present a case
of a 16-year-old patient with IMT of omentum treated with twice excision
and chemotherapy but with recurrence in left lobe of liver. We are going
to present the result of repeated TAE of an Inflammatory Myofibroblastic
Tumor case. The result and literatures are discussed.
Methods Repeated performed with four times TAE and follow-up with CT
images.
Results No evidence of local recurrent with a 6 month follow-up.
Conclusions TAE is an effective treatment for IMT.
Keywords Liver, Omentum, Embolization, Treatment Effects,
Inflammation, Interventional
593
MS002
Imaging of Peripheral Nerve Sheath Tumours
Daniel Weng Yew Chee¹, Wilfred CG Peh²
¹Department of Diangositc Radiology, Tan Tock Seng Hospital,
Singapore
²Department of Diagnostic Radiology, Alexandra Hospital,
Singapore
Purpose Learning Objective: This poster on the imaging features of
peripheral nerve sheath tumours (PNSTs) emphasizes the characteristic
signs and distinguishing features of PNSTs on imaging. ABSTRACT:
Peripheral nerve sheath tumours may be benign or malignant. Benign
PNSTs include neurofibroma and schwannoma. All neurogenic tumours
share certain common imaging features, and this is related to its common
neurogenic origin; suggested by a fusiform-shaped soft tissue mass
with tapered ends, the target sign, atrophy of the muscles supplied by
the involved nerve and the “split-fat” sign. When the parent nerve is
identified, an eccentrically-located tumour suggests a schwannoma, while
a centrally-located soft tissue mass suggests a neurofibroma. On T2weighted magnetic resonance (MR) images, neurogenic tumours may
show a high signal intensity in the periphery and low signal intensity
in the central region, producing the magnetic resonance target sign.
This sign strongly suggests a neurogenic neoplasm and may be seen
in neurofibromas, schwannomas and malignant PNSTs. Such a mass
with associated muscular fatty atrophy in a typical nerve distribution is
indicative of a PNST. Muscle atrophy is not commonly seen in other soft
tissue tumours. The split-fat sign represents a rim of fat surrounding the
tumour. This sign is not specific for PNSTs but rather suggests that the
tumour originates in the intermuscular space, in which neurogenic tumours
are the most frequent cause. This sign is more common in benign PNSTs
and lesions arising from large nerves.
Methods NIL
Results NIL
Conclusions Imaging has an important role in the detection of neurogenic
tumors. MR imaging in particular, allows a more confident diagnosis of
594
Purpose To evaluate the stage of skeletal eosinophilic granuloma (EG) using
the gadolinium-DTPA enhanced magnetic resonance imaging (Gd-MRI).
Methods The Gd-MRI findings were retrospectively correlated to
histopathologic phases in 17 patients with a histopathologically proven
diagnosis of EG by curettage biopsy. There were 10 female and 7
male patients, age range 1-36 years, mean age 8.5 years. There were
classified into 'initial stage' with full hyperintensity lesion, 'middle stage'
with peripheral hyperintensity and central low intensity, and 'last stage'
with reduced intensity on the Gd-MRI, and correlated with 'first phase' with
proliferation of various cells, 'second or third phase' with cells intermingled
with multinuclear giant cells or foam cells, and 'last phase' with decreased
cellularity on the histopathology, retrospectively.
Results The stages of EG using the Gd-MRI findings correlated well
with the phases on the histopathology, and the concordance and the
discordance rates were in 94.1% (16/17) and 5.9% (1/17), respectively.
Conclusions Gd-MRI is accurate to determine the stages of skeletal EG.
Keywords Marrow, MR, Staging
MS005
Epithelioid Hemangioendothelioma of Tibial Distal
Metaphysis: A Case Report
Yu-Chiang Chen
Department of Medical Imaging Science, Far-Eastern Memorial
Hospital, Taiwan
Purpose Here we present a case of epithelioid hemangioendothelioma
arising from tibial distal metaphysis in a 36-year-old woman.
Methods We provide the X-ray, MRI and histopathological pictures,
describe the imaging characteristics and discuss the differential diagnosis.
Results A lucent osteolytic lesion is located at the left tibial distal
metaphysis with sclerotic rims and ossified periosteal reaction. In MRI
series, it reveals a lobulated hypervascular mass lesion accompanied
by surrounding bone marrow edema and cortical disruption. In Tc-99m
bone scan series, it reveals a prominent hot area. This patient eventually
received neoplasm excision. Epithelioid hemangioendothelioma was
proven under histopathological interpretation.
Conclusions Vascular tumors originating from the bone constitute
an infrequent group of skeletal nsoplasm. Also epithelioid
hemangioendothelioma is a rare endothelial vascular neoplasm first
identified and described in soft tissues in 1982 by Weiss and Enzinger. It
is defined as an intermediate-grade malignant vascular neoplasm with the
behavior between epithelioid hemangioma and angiosarcoma. So it may
be considered while we provide a list of differential diagnosis.
Keywords Ankle, Long Bones, MR, CT
MS006
Sonographic Diagnosis of Posterior Interosseous Nerve
Syndrome from Occult Ganglion Cyst with MRI Correlation
(Case Report) Koakait Vivitmongkonchai, M.D. Faculty of
Medicine, Thammasat University, Thailand
Koakait Vivitmongkonchai
Yu-Chung Hung, Ya-Tin Jan, Fei-Shih Yang
Purpose To report a case of posterior interosseous nerve syndrome
caused by occult ganglion cyst diagnosed with real-time ultrasound.
Methods A 24 year-old man presented with gradually progressive
weakness of extension of his right fingers and abduction of right thumb for
six weeks. Physical examination and electromyography were suggestive
of posterior interosseous nerve syndrome. Real-time ultrasound was
performed using 5-13 MHz broadband linear array probe (Siemens
Ultrasound, Memphis, TN) to localized and characterize posterior
interosseous nerve entrapment. MRI was subsequently done to confirm
the diagnosis.
Results Sonography revealed a deep-seated anechoic cystic lesion
extending from anterior aspect of distal right radio-capitellar joint down
along radial tunnel to proximal supinator muscle between superficial
and deep head associated with evidence of enlargement and decreased
echogenicity of deep branch of radial nerve. The findings are suggestive
of posterior interosseous nerve compression by a ganglion cyst. MRI
confirmed the presence of ganglion cyst with enlargement, increased
T2 signal intensity and enhancement of deep branch of radial nerve. In
addition; MRI demonstrated partial atrophy with typical denervation signal
intensity change of muscles innervated by posterior interosseous nerve.
Conclusions Ultrasound is a good screening diagnostic imaging
investigation of possible posterior interosseous nerve syndrome due to its
availability, low cost, high spatial resolution and flexible control of imaging
plane orientation.
Keywords Cysts, Ultrasound
Purpose To evaluate the effectiveness of MRI in diagnosing subungual
glomus tumor.
Methods From 2002-11 to 2009-09, 10 cases of clinically suspicious
subungual glomus tumor, aged from 19-45 years old (mean: 39) and
all are female, were prospectively studied with MR examination before
surgery. Two of the patients underwent sonographic examination.
Seven patients had plain radiography study. The MR examinations were
performed at two 1.5 Tesla units ( Twin Speed; GE Medical Systems,
Milwaukee, Wis. and Sonata; Siemens AG, Germany, Erlangen ) using
axial T1WI and T2WI, coronal T1WI, coronal and sagittal PDWI with
fat suppression and post contrast medium injection axial and coronal
T1WI with fat suppression, One patient had received additional dynamic
contrast medium study. All cases had surgery and pathologically proved to
be glomus tumor.
Results All the ten cases can be precisely diagnosed in MR examinations.
The MR examination showed slightly hypointensive to slightly
hyperintensive on a T1-weighted image, and hyperintensive on a T2weighted image. The tumor signal is close to that of the dermis of the nail
bed in our groups The T1-weighted image after injection of gadolinium
shows a strongly intense signal. Prominent vessel connects the tumor
was another typical MR imaging finding.
Conclusions MR imaging features of subungual glomus tumor are unique
and specific. It is feasible for diagnosing not only the existence but also
the exact locations and sizes of these tumors preoperatively.
Keywords MR
MS007
Brodie’s Abscess of the Femursimulating Osteoid Osteoma:
A Rare Case Report
Kuo-Chang Chen, Liang-Kuang Chen, Hsu-Yi Chen
Department of Diagnostic and Interventional Radiology, Shin
Kong Wu Ho-Su Memorial Hospital, Taiwan
MS0013
The Carpal Height Ratio: It’s Difference between Men and
Women
Yung-Cheng Wang
Purpose Subacute osteomyelitis (Brodie’s abscess) is a diagnostic
challenge and may be indistinguishable with other benign or malignant
bone lesions. As much as 90% of the cases are initially misdiagnosed,
with a mean delay of 3 months to correct diagnosis. Fifty percent of
the cases are wrongly suspected to be of tumoral origin. It occurs most
frequently at the tubular bones in the lower extremities, especially the
tibia, with staphylococcus aureus to be the most common pathologic
organism.
Methods This 60 years old female came to our orthopedic clinic
for chronic right thigh pain. Plain radiography of right hip shows
subtrochanteric fracture and a small oval-shaped radiolucent nidus.
Subsequent CT study demonstrated a well-defined nidus with rim sclerosis
and poorly demarcated cortical edema at subtrochanteric region of right
femur. Under the impression of osteoid osteoma with pathological fracture,
ORIF was done and purulent content was found during the operation.
Results The histopathological examination showed necrotic bone
trabeculae and granulation tissue with plasma cell infiltration, consistent
with subacute osteomyelitis.
Conclusions Discrimination between Brodie’s abscess and osteoid
osteoma may be difficult in imaging study. The inner aspect of the nidus
is smooth in osteoid osteoma in contrast to osteomyelitis. The cardinal
signs of subacute and chronic osteomyelitis include draining sinus
tracts, deformity, instability and local signs of impaired vascularity. Grey
et al have described a penumbra sign on T1-weighted MRI scans in
subacute osteomyelitis. Other findings suggestive of Brodie’s abscess
include elevated ESR (more than 40 mm/h) and double density sign on
scintigraphic study. This case reemphasises the old dictum “culture every
tumor and biopsy every infection”.
Keywords Abscess, Long Bones, Extremities, Infection
MS009
Subungual Glomus Tumor – Emphasis on MR Imaging
Purpose The purpose of this study is to discover if there is a significant
difference in carpal height ratio between men and women aged 20 to 50.
Methods We retrospectively reviewed 261 cases of normal plain wrist
radiographs and measured the carpal height ratio by Picture Achieving
and Communication System (PACS). Each case was then stratified by
gender and age (20-29, 30-39, 40-50).
Results The mean carpal height ratio was 0.52 ± 0.03 for men (range:
0.43-0.59), 0.50 ± 0.03 for women (range: 0.43-0.57) and 0.51 ± 0.03 if
gender was disregarded (range: 0.43-0.59). The difference in the ratios of
between male and female was statistically significant (p<0.01). However,
there was no significant difference (p=0.13) in each age group of men and
women.
Conclusions We recommend using gender specific norms, i.e. 0.52 ± 0.03
for men and 0.50 ± 0.03 for women respectively to calculate carpal height
ratio and define carpal collapse. Without gender specification, there might
be over diagnosis of carpal collapse in women, more investigation may be
needed to look into any possible racial difference as our study is based on
a homogenous ethnic Chinese population.
Keywords Joints
MS0014
Comparison of Radiological Evaluation in Flatfoot
Huan-Chu Lo, Wen-Cheng Chu
Department of Radiology, Armed Forece Tao-Yuan General
Hospital, Taiwan
Purpose The purpose of this study was to evaluate the correlation
between the arch angle and other radiographic parameters. Moreover,
we tried to find a radiographic parameter which was able to enhance the
flatfoot diagnosis.
Methods In this study, 87 lateral weight-bearing radiographies were
obtained from the military recruits. Five radiographic measurements,
including a calcaneal-fifth metatarsal angle (arch angle), a medial arch
595
Purpose Lisfranc injury may be subtle and difficult to recognize. Up to
20% of Lisfranc injuries may be missed, and overlooked Lisfranc injury
may predispose the patient to chronic pain and disability. The purpose of
this study is to help participants to 1. Understand the anatomy of the foot
2. Establish a simple systematic method of assessing a foot radiograph 3.
Improve the radiological diagnosis of Lisfranc injury
Methods 17 participants, comprising of 10 junior orthopaedics doctors
and 7 junior casualty officers were recruited for the study. Each participant
took part in a pre-study survey which comprise of a questionnaire
regarding the understanding of foot anatomy and radiography; and
picture quiz containing of a set of 12 foot radiographs which could be
normal, Lisfranc injury or other bony pathology. A set of lecture notes on
anatomy and radiographic evaluation of foot, and Lisfranc injury were
then distributed for the participants to study at their own leisure before a
post study survey is performed. Each participant was given another set
of 12 foot radiographs (similar to pre-study quizzes) to analyse and a
questionnaire on beneficial of the learning session to complete.
Results Diagnostic accuracy improved after the learning session. The
proportions of correct diagnosis of Lisfranc injury increase from 53% to
92%. 59% felt the learning session to be very beneficial and 41% found
the session useful.
Conclusions This study has demonstrated the effectiveness of a simple
learning tool in improving radiological diagnosis of Lisfranc injury.
Keywords Joints, Education, Foot
MS004
Contrast-Enhanced MRI for the Staging of Skeletal
Esosinophilic Granuloma
Tae Yong Moon¹, In Sook Lee1, Jongmin Lee2 Jeung Il Kim3
1
Korea
2
Department of Radiology, Kyung Pook National University
Hospital, Korea
3
Department of Orthopedic Surgery, Pusan National University
Hospital, Korea
Department of Radiology, Faculty of Medicine, Thammasat
University, Thailand
E-Poster
MS001
How Can We Improve the Radiological Diagnosis of Lisfranc
Injury?
Leesien Yap
Department of Radiology, Leeds General Infirmary, United
Kingdom
neurogenic tumors. MR imaging is now a readily available tool in most
institutions and is well established as the imaging modality of choice.
Others
Purpose The purpose of this exhibit is to describe MR and US features of
variable lipomatous tumors as a periarticular soft tissue mass.
Methods Related plain radiographic, and MR and US imaging features
will be discussed.
Results We describe MR and US features of variable lipomatous tumors
as a periarticular soft tissue mass, including lipoma, lipoma arborescence,
angiomyxolipoma, lipoblastoma, and liposarcoma.
Conclusions MRI and US are an important diagnostic tool for the
assessment of these conditions.
Keywords MR, Ultrasound
MS017
High Resoultional Ultrasonographic Findings of Nerve
Entrapment Syndromes
I Yang, YJ Oh, JY Woo, AY Jung, HS Hong, SY Chung
Purpose The purpose of this exhibit is to describe high resoultional
ultrasonographic imaging findings of various nerve entrapment syndrome
of extremities.
Methods MRI and US are an important diagnostic tool for the assessment
of these conditions.
Results We describe high resoultional ultrasonographic imaging findings
of various nerve entrapment syndrome of extremities; suprascapular
nerve entrapment syndrome, tarsal tunnel syndrome, and carpal tunnel
syndrome.
Conclusions High resolution US is an important diagnostic tool for the
assessment of those conditions.
Keywords MR, Ultrasound
MS019
Unusual Presentation of the Osseous Tumor and PseudoTumor of Ankle and Foot
Hui-Yi Chen, Po-Pang Tsai, Yung-Fang Chen, Yung-Jen Ho, WuChung Shen
RSROC, Taiwan
Purpose This article discusses the unusual primary osseous neoplasms
and pseudo-tumor that affect the foot and ankle.
596
Purpose To explore the clinical value of post-processing techniques of
multi-slice spiral CT (MSCT) in orbital fracture.
Methods Thirty-six patients with orbital fractures subjected to MSCT
reformatted images and CT axial images were retrospectively reviewed.
They were classified into 3 grades based on the utility of the advanced
MSCT reformatted images: the grade A group ( substantial new
information was obtained) , the grade B group (confirmatory with improved
visualization and understanding of the orbital fracture) , and the grade C
group (no added useful information was obtained) .
Results There were 15 fractures (11 cases) in grade A , 40 fractures (25
cases) in grade B , and 109 fractures (25 cases) in grade C. 109 fractures
were shown by CT axial images,and 164 fractures by MSCT reformatted
images.Fractures were located in the medial wall of orbit in 24 cases, in
the side wall of orbit in 12 cases , in the superior wall of orbit in 5 cases ,
in the inferior wall of orbit in 12 cases, in the optic canal in 6 cases , in the
prefrontal bone of von Bardeleben in 6 cases , in the palatine bone in 2
cases,in the nasolacrimal duct in 1 cases.
Conclusions MSCT reformatted images can clearly reveal the whole and
detail the osteoporosis structure of the orbital fracture and obtain more
useful information not presented on CT axial images.
Keywords Orbit, CT, Eye, Trauma
MS028
Charateristic Radiologic Findings of Adult Skeletal
Langcrhans Cell Histiocytosis; Emphasis on MR Findings
In Sook Lee¹, Yeon Joo Jeong1, Jong Woon Song2, Kyung Jin
Suh3
1
Korea
2
Department of Radiology, Inje University Pusan Paik Hospital,
Korea
3
Department of Radiology Dongguk University Gyungju Hospital,
Korea
Purpose To evaluate the charateristic radiologic findings of adult skeletal
Langcrhans cell histiocytosis (LCH), emphasizing on MR findings.
Methods The study was institutional review board approved. Plain
radiographs, CT and MR images of seven patients (4 men, 3 women;
mean age, 35 years) with pathologically proven LCH were retrospectively
reviewed by consensus of two experienced radiologists. Analysis of image
MS029
Cases Report: Images of Chondrosarcoma at Rare Location
with Tumor Thrombus Extension in Adolescents
Chueh-Jung Hsieh, Hui-Yi Chen, Yung-Jen Ho, Wu-Chung Shen
Taiwan
Purpose Analysis of image pattern of chondrosarcoma at rare location
with tumor thrombus extension in adolescents.
Methods We collect two cases of chondrosarcoma arising from left iliac
bones and left calcaneus with tumor thrombus extension in adolescents at
clinical practice and analyze the image presentation.
Results The image pattern of the chondrosarcoma at rare location with
tumor thrombus extension in adolescents.
Conclusions Similar case report of the chondrosarcoma at rare location
with tumor thrombus extension in adolescents is few. In clinical practice,
the radiologist should have acknowledge about the images pattern and
make the diagnosis.
Keywords Ankle, Pelvis
MS032
Chronic Distal Biceps Brachii Tendon Injury: Clinical and
Imaging Features
Shoichiro Takao 1 , Hideki Otsuka 2 , Junji Ueno 1 , Tetsuji
Yamaguchi3, Masataka Uetani3, Hiromu Nishitani2
1
Department of Radiologic Science and Technology, Division of
Health Sciences Institute of Health Biosciences the University of
Tokushima, Japan
2
Department of Radiology, the University of Tokushima Faculty of
Medicine, Japan
3
Department of Radiology, Nagasaki University of Medicine,
Japan
Purpose To illustrate the imaging features of chronic distal biceps brachii
tendon injury. To discuss the mechanism of this injury based on the clinical
and imaging features.
Methods Four cases of the radiologically and/or surgically proven distal
biceps brachii tendon injury were reviewed. Patients were 69 to 84 years
old and gender was 1 male and 3 females. They complained pain of the
forearm (3 patients), swelling of the elbow (2 patients), mass of the elbow
(2 patients) and dullness of the upper arm (1 patient). Imaging features
on plain radiography, CT and MRI including radial tuberosity hypertrophy,
irregular contour of the tendon and cubital bursitis were assessed.
Relation between the radial tuberosity and the distal biceps brachii tendon
during supination and pronation of the elbow was demonstrated on MRI of
a normal volunteer.
Results Plain radiography showed hypertrophy (spur-like projection)
of the radial tuberosity in all cases. On MRI, the distal biceps brachii
tendon showed irregular contour and abnormal signal within the tendon
accompanied by cubital bursitis in all cases. Rotation of the radial
tuberosity from medial to a posterior direction was seen from supination to
pronation of the elbow on MRI of a normal volunteer; this movement may
be associated with tension and friction stress to the distal biceps brachii
tendon/ cubital bursa complex.
Conclusions As clinical findings are nonspecific, imaging diagnosis of
chronic distal biceps brachii tendon injury is important for management of
the patients. A hypertrophic change of the radial tuberosity is suggestive
and MR imaging findings are diagnostic for this lesion.
Keywords Joints, MR, Elbow
MS040
Fracture, X-Ray Reporting
Pramod Lonikar
Department of Radiology, Shri Tirupati Diagnostic Centre, India
Purpose To know art of reporting of trauma X-rays. Most trauma X-rays
are primarily seen by orthopaedists, and are reported by radiologists
lateron for the sake of medicolegal or insurance issues.
Methods In reporting of trauma X-rays five thing should be included
-name and part of bone involved, type of fracture, group geometry and
features in terms of displacement, angulation.
Results Improvement in quality of reporting of trauma x rays, helps
clinician.
Conclusions Scientific reporting of trauma X-rays will help radiologists to
retain X- ray work.
Keywords Conventional Radiography
MS041
The Role of MRI in Osteoarthritis of the Hip
Bakhtiyor Akhmedov, Marat Khodjibekov
Department of Radiology, Tashkent Medical Academy,
Uzbekistan
Purpose To improve the diagnosis of hip osteoarthritis using MRI.
Methods Seventy patients (86 joints) with hip osteoarthritis, stages I
(13), II (31) and III (42) underwent routine AP roentgenography and
MRI (Magnetom Open Viva, Siemens), 0.2 Tesla in T1 and T2 spinecho sequences in standard coronal and axial planes. The control group
included 20 healthy subjects (40 joints) undergone only MRI.
Results Characteristic signs of osteoarthritis revealed by MRI were
degeneration of the articular cartilage and labrum, subchondral sclerosis,
subchondral cysts, osteophytosis, disorders of joint configuration
(subluxation) and synovitis. The most early sign of osteoarthritis,
degeneration of the labrum, characterized by increase of its signal
intensity and deformation was found in 7 patients with stage I of the
disease. Roengenography failed to detect the early changes of the labrum.
Degeneration of the articular cartilage was revealed in 79 (91.8%) of joints
in MRI and 82 (95.3%) in X-ray films. Subchondral sclerosis was noted
in 44 (51.2%) in MRI and in 68 (79.1%) cases in roentgenography. MRI
was superior to X-ray in detecting subchondral cysts – 42 (48.8%) and
32 (37.2%) of cases б respectively. Small osteophytes were better seen
in roengenography (80.6%) while severe osteophytosis accompanied by
disorders of joint configuration (subluxation) in MRI. Synovitis by MRI was
detected in 32.3% of cases.
Conclusions MRI in standard T1 and T2 spin-echo sequences improved
visualization of labrum degeneration, subchondral cysts, subluxation and
synovitis.
Keywords Hip
MS042
Sonography Imaging of Thrombosed Persistent Median
Artery in Carpal Tunnel Region
597
MS022
The Diagnostic Value of Post-processing Technique of
Multiple Slice Spiral CT in Orbital Fracture
Wanly Bi
findings included as follows; the presence and the pattern of cortical
destruction, adjacent edema, bone remodeling, the lesion location, the
margin of soft tissue mass (well or ill-defined) by cortical disruption, and
enhancement degree (mild, moderate, well).
Results The sites of adult skeletal LCH of this study were femur (n =2),
knee joint (n=2), humerus (n=2), skull and facial bones (n=2), spine (n
=2), and pelvic bone (n =2). Four patients had lesion involvement more
than two sites. Cortical destruction was seen in seven patients and
adjacent edema was presented in three patients. Characteristically, treein-bud appearances (cortical extension of intramedullary lesion with
nodular shape) on MR images were five patients. Bone remodeling or
cortical thickening occurred in six patients. Extruded soft tissue mass
through cortical disruption showed well-definend margin in six patients
and ill-defined margin in one patient. All seven patients revealed well
enhancement about lesions. Within the bony structure, two patients have
clerotic rim and one patient showed punch out appearance.
Conclusions Cortical destruction with well-defined soft tissue mass, bone
remodeling, and tree-in-bud appearance were the most common imaging
features of adult skeletal LCH. These imaging findings may be helpful for
differentiating LCH from malignant tumors including metastasis in adult.
E-Poster
MS016
Radiologic Features of Lipomatous Tumors as a Periarticular
Soft Tissue Mass
I Yang, HS Ko, JY Woo, AY Jung, HS Hong, SY Chung
Methods Despite the fact that practically any entity can occur in the foot
in rare cases, taken together the 8 different lesions make up for the vast
majority of unusually tumors and tumor-like lesions of the ankle and foot.
It is based on the analysis of the lesion's X-ray morphology and location,
the patient's age, and in certain entities, the MR morphology.
Results Among the 8 cases, benign bone tumors are in 4 cases,
including chondromyxoid fibroma, gaint cell tumor, osteoid osteoma and
osteochondroma. Primary malignant bone tumors are in 2 cases, including
chondrosarcoam and multiple myeloma. Pseudo-tumors are in 2 cases.
The patients consisted with 4 male and 4 female and the age was ranged
from 1 to 65 years.
Conclusions The bones of the foot and ankle are affected by a variant
spectrum of mass-forming tumors or tumor-like lesion; however, such
lesions arise with an incidence that is unique to this site. As an uncommon
location for primary bone tumors, lesions within the foot and ankle are
subject to misdiagnosis. This article describes the uncommon tumors and
tumor-like lesions of the ankle and foot, emphasizing their characteristic
radiologic and MR imaging features to aid in appropriate patient.
Keywords Ankle, MR, Foot
Others
angle (MAA), a calcaneal pitch angle (CP), a talus angle (TA) and a talofirst metatarsal angle (TFM), were obtained to evaluate the osseous
structure in flatfoot. The criterion for judging flatfoot was defined as the
arch angle ≥ 165 degree. Two statistic methods, the Pearson correlation
and the kappa statistic, were used to find the correlation coefficient and
the degree of association between the arch angle and other parameters,
respectively. The receiver operating characteristic (ROC) curve was also
obtained to assess the diagnostic accuracy of a test, and to compare the
usefulness of different tests.
Results The CP was the most correlated to arch angle negatively
(p<0.001, r= -0.881) and the greatest area under ROC curve (0.982). In
addition, this angle was measuring easily and there were few effects on
artificial disturbance and image quality. The kappa test exhibited excellent
agreement (kappa score = 0.827) related to the arch angle on the premise
that the CP ≤ 11° was defined as a flatfoot.
Conclusions The CP could improve the diagnosis of the flatfoot as an
auxiliary parameter when the arch angle was not easily defined.
Keywords Foot
MS050
Therapeutic Effect of Low Energy Shockwave-Treated Major
Muscle Injury
Chung-Cheng Huang¹, Ching-Jen Wang²
¹Department of Diagnostic Radiology, Radiological Society of the
ROC, Taiwan
²Department of Orthopedic Surgery, Orthopedic Society of ROC,
Taiwan
MS045
MR Imaging Features of Cystic Lesions around the Knee Joint
Sun Joo Lee1, Hye Jung Choo2, Myung Hee Kim1, Yeong Mi
Park1, Ji Sung Park1, Choong Ki Eun1
1
Department of Radiology, Inje University, Busan Paik Hospital,
Korea
2
Department of Radiology, Inje University College of Medicine,
Busan Paik Hospital, Korea
Purpose 1. To illustrate the MRI appearance of cystic lesions and solid
tumors mimicking cyst. 2. To explain the clinical features and significance
of these lesions. 3. To review the anatomy of normal bursa and joint
recess of the knee.
Methods We reviewed 700 MRI of the knee performed at Inje University
Hospital during the past 3 years.
Results A wide variety of cystic lesions may be encountered during
routine MR imaging of the knee. Many lesions produce clinical features
suggestive of internal derangement of the knee. Cystic lesions around
the knee were classified as follows; bursitis (prepatellar, superficial
and deep infrapatellar, suprapatellar, medial collateral ligament, pes
anserine, lateral collateral ligament-biceps femoris and gastrocnemiussemimembranosus), fluid collection in joint recess, meniscal cysts,
intraarticular and extraarticular ganglia, intraosseous cysts at the insertion
of the cruciate ligaments, subchondral cysts, and solid tumors mimicking
cyst (schwannoma, intramuscular myxoma, myxoid liposarcoma, and
synovial sarcoma).
Conclusions MR imaging is the most appropriate imaging technique to
depict characterization of cystic lesions, their anatomic relationships and
combined intra-articular lesions A correct MR diagnosis is needed to avoid
unnecessary arthroscopy and to guide specific therapy.
Keywords Knee, MR, Cysts
MS049
Acromion Osteolysis and Fracture Following Hook Plate
Fixation for Acromioclavicular Joint Dislocation: A Case
Report
Chun-Yu Lin, Chia-Ling Chiang, Kun-Huang Chen
Department of Radiology, KaohSiung Veterans General Hospital,
RSROC, Taiwan
Purpose The hook plate has been introduced as a new immobilization
device for unstable distal clavicle fracture (Neer type II) and displaced
acromioclvicular joint dislocation (Rockwood type III to VI). It provides
a normal rotation movement between the clavicle and the scapula in
addition to firm fixation for fracture healing and acromioclavicular joint
reduction. With more clinical experiences, however, various complications
of hook plate have been recently reported. We present a case complicated
with progressive osteolysis and acromial fracture after hook plate
application. To our knowledge, this complication has not been illustrated in
598
Purpose The study aimed to clarify the therapeutic outcome of the novel
extracorporeal shockwave therapy (ESWT) on the mayor injury of the
skeletal muscle.
Methods The major laceration injury was created in the vastus lateralis
muscles in rabbits. In ESWT group, 24 thighs received lower energy
ESWT at the 1 week after surgery. Another 24 thighs without ESWT were
denoted as control group. Fatty infiltration and highest first pass slope
were monitored by magnetic resonance imaging (MRI) at 2-wk, 4-wk,
6-wk and 8-wk after ESWT. The corresponding resected specimens
were subjected to histopathological (hematoxylin and eosin, and Masson
Trichrome stains) and immunohistochemical (CD31) examinations in
parallel at the same time points with MRI examination. The Mann-Whitney
U test was used to asses the values of all numeric data.
Results Whereas significant increase of first pass slope values in the
ESWT group at 2-wk, longer term effect did not subsequently reveal
significant difference in the two groups. The number of microvessels was
also comparable in the both groups. There was a propensity in increase
of regenerating myofibers, increase of fatty infiltration and reduction of
fibrous tissue at the injured muscle of the both groups over time. Among
the ESWT group, our data mostly exhibited more regenerative myofibers
and lesser magnitude of the fatty infiltration and fibrous tissue formation
in the injured muscle. Regardless of slightly better beneficial effects in
the ESWT group, the differences between the two groups still remained
insignificant in promoting myofiber regeneration, impeding fatty infiltration
and reducing fibrous formation during muscle healing.
Conclusions Lower energy ESWT in the major injury of skeletal muscles
exerted only slight beneficial effects. The ultimate result did not prove
significant improvement in the muscle healing.
Keywords Animal Investigations, Experimental Investigations, Trauma
MS051
Assessment of Area of Achilles Tendon in Diabetics by High
Resolution Ultrasound
Palle Lalitha¹, M C Reddy Balaji²
¹General Department, Focus Diagnostics, India
Purpose To study the effect of diabetes on the Achilles tendon in
asymptomatic diabetic patients.
Methods A prospective cross sectional case control study was performed.
Eighty patients suffering from Diabetes were included in the study. Only
patients who were asymptomatic and did not show clinical or sonographic
features of Achilles tendinoses were included in the study. Forty control
patients in the same age group were also studied. High resolution
Ultrasound was performed on all the patients in the prone position with
the leg hanging from the edge of the bed. The area of the Achilles tendon
was measured at the mid point between the musculo-tendinous junction
and insertion on the calcaneum. The measurements of the diabetic and
non-diabetic control group were compared. Measuring the thickness of the
Achilles tendon was not preferred, due to a lot of variation in the shape of
the tendons.
Results The mean area of the Achilles tendon in diabetic patients was 0.65
± 0.05, which was significantly greater than the control group.
Conclusions Diabetes has a debilitating effect on the tendons. This effect
increases with the duration of diabetes.
Keywords Physiological Studies, Tendons, Ultrasound
Purpose The purpose of this study was to describe the sonographic
features of musculoskeletal liposarcoma.
Methods Over a 10-year period, 20 patients with histologically proven
musculoskeletal liposarcomas had been examined with gray-scale
and color Doppler ultrasound at our institution. These images were
retrospectively reviewed and analyzed.
Results Of the 20 liposarcomas, 7 were well-differentiated liposarcomas,
12 were myxoid liposarcomas, and 1 was mixed-type liposarcoma. These
liposarcomas predominantly affected the lower extremity, particularly the
thigh. The longest diameters of these lesions were ranging from 3 cm to
32.7 cm (Mean: 15.3 cm). Almost all liposarcomas (90%) appeared as
heterogeneous masses at grey-scale ultrasound, while only two welldifferentiated liposarcomas (10%) appeared as relatively homogeneous
masses. The presence of homogeneous hyperechoic foci suggesting fat
component was only found in 6 liposarcomas (30%). The margins of these
lesions were partly infiltrating in 13 cases and completely well-defined
in 7 cases. Parallel echogenic lines, which were typical for lipomatous
tumors, were present in all cases of well-differentiated liposarcomas, but
were not present on myxoid liposarcomas. In 9 cases (75%) of myxoid
liposarcomas, there were homogeneous hypoechoic areas, which may be
presumed as myxoid component. CDUS revealed increased vascularity in
all liposarcomas. The flow signals were significantly higher in the myxoid
liposarcomas than well-differentiated liposarcomas.
Conclusions The majority of liposarcomas appear as heterogenous
masses with partly infiltrative margins and increased vascularity. The
presence of parallel echogenic lines within the tumor is suggestive of the
diagnosis of well-differentiated liposarcoma. Most myxoid liposarcomas
consist of homogeneous hypoechoic regions, which may be presumed as
myxoid matrix.
Keywords Neoplasms-Primary, Extremities, Ultrasound
MS056
Sensitivity and Specificity of Ultrasound in the Recognition
of Anterior Cruciate Ligament Tears
Palle Lalitha
General Department, Focus Diagnostics, India
Purpose To Evaluate the Anterior Cruciate Ligament (ACL) by Ultrasound
and to assess the Sensitivity and Specificity of Ultrasound in the
recognition of Anterior Cruciate Ligament Tears.
Methods All the patients referred to our center for MRI knee were
included in the study. An ultrasound of the knee was performed before
the MRI and a diagnosis regarding ACL appearance was made on the
ultrasound. After the ultrasound, MRI of the knee was performed and ACL
was evaluated. Then a comparison of ultrasound and MRI appearance
was made. Doubtful appearance of ACL was confirmed by arthroscopy.
Sensitivity and Specificity of Ultrasound in the recognition of Anterior
Cruciate Ligament Tears was then calculated.
Results Ultrasound was found to be fairly sensitive in the detection of
ACL tears. Significant correlation was found between the ultrasound and
MRI appearance of ACL tears, however there are a few limitations to this
technique.
Conclusions Ultrasound is fairly sensitive in the detection of ACL injury. It
cab be used as an initial screening modality.
Keywords Ligaments, Ultrasound
MS058
The Differential MR Imaging Features between Gouty
Arthritis and Septic Arthritis in Knee and Ankle
Sun Young Lee, Myung Jin Shin, Sang Hoon Lee, Hye Woon
Chung
Department of Radiology, Radiologist, Korea
Purpose Objective: Gouty arthritis, which frequently present with acute
monoarticular inflammation, may be confused with septic arthritis because
of many overlapping clinical and radiologic features. The aim of this study
was to find out the differential MR imaging (MRI) features between acute
gouty arthritis and septic arthritis in knee and ankle.
Methods We compared MRI findings of 18 gouty arthritis with those of
29 septic arthritis. Of 18 patients with gouty arthritis, 15 have knee joint
involvement and 3 have ankle joint involvement. Of 29 patients with
septic arthritis, 23 and 6 patients have knee and ankle joint involvement,
respectively. We evaluated synovial enhancement pattern, bone erosion,
osteomyelitis (OM), T2 low signal intensity lesion in joint space. Especially
in ankle we evaluated combined lateral malleolar bursitis.
Results T2 low signal intensity in affected joint without osteomyelitis is
most distinct finding of goury arthritis. (10 of 18 patient, 55%, p<0.029)
In contrast, OM was found in 18 of 29 patients (62%) with only septic
arthritis. On MR imaging, overlapping features found in both gouty and
pyogenic arthritis such as irregular synovial enhancement, joint effusion,
extraarticular soft tissue change. In patients with ankle involvement, lateral
malleolar bursitis was found in 2 of 3 patients (67%) with gouty arthritis,
but in none of 6 patients (0%) with septic arthritis.
Conclusions Although MR findings of acute gouty arthritis showed many
similar features with septic arthritis, there were some distinct features of
gouty arthritis including T2 low signal intensity withtout of osteomyelitis in
all joints and lateral malleolar bursitis in ankle joint unlikely septic arthritis.
Keywords Infection, Inflammation
MS059
Sensitivity and Specificity of Ultrasound in the Recognition
of Posterior Cruciate Ligament Injury
Palle Lalitha¹, M.Ch Reddy Balaji²
¹General Department, India
Purpose To Evaluate the Posterior Cruciate Ligament (PCL) by
Ultrasound and to assess the Sensitivity and Specificity of Ultrasound in
the recognition of Posterior Cruciate Ligament Tears.
Methods All the patients referred to our center for Magnetic Resonance
Imaging(MRI) of knee were included in the study. This prospective study
included hundred patients. An ultrasound of the knee was performed
before the MRI and a diagnosis regarding PCL appearance was made
on the ultrasound. After the ultrasound, MRI of the knee was performed
and PCL was evaluated. Then a comparison of ultrasound and MRI
appearance was made. Sensitivity and Specificity of Ultrasound in the
recognition of Posterior Cruciate Ligament Tears was then calculated.
Results Ultrasound was found to be fairly sensitive in the detection of
PCL tears. Significant correlation was found between the ultrasound and
MRI appearance of PCL injury.
Conclusions Ultrasound is fairly sensitive in the detection of PCL injury. It
can be used as an initial screening modality.
Keywords Ultrasound
MS060
Work-Related Musculoskeletal Disorders among Medical
Staff in a Radiology Department
Cheng-kuang Chang, Chun Wen Chen, Kai-Hsiung Ko, Hao-Lun
Kao, Hung-Wen Kao, Ching-Jiunn Wu, Chih-Wei Wang, GuoShu Huang
Purpose The aim was to investigate the association between
musculoskeletal disorders (MSD) and work-related risk factors in the
medical staff in a single radiology department.
Methods The study was conducted in a radiology department with 107
staff members. A self-administered, modified Nordic Musculoskeletal
599
Purpose To present two cases of persistent median artery (PMA)
association with carpal tunnel syndrome. One of the patients had
thrombosis of PMA.
Methods Findings of ultrasonography and color Doppler ultrasonography
are evaluated.
Results Ultrasound showed separation of median nerve with persistent
median artery in bilateral carpal tunnel region. One patient was associated
with focal thrombosis in the persistent median artery.
Conclusions A persistent median artery, usually related to median nerve
variations such as high division or a bifid nerve, is a possible cause of
carpal tunnel syndrome. Acute carpal tunnel syndrome has been reported
secondary to thrombosis of persistent median artery. Ultrasound is
important for confirming the diagnosis.
Keywords Arteries, Ultrasound, Wrist
MS054
Musculoskeletal Liposarcomas: Sonographic Appearance
Ming-Hsun Lee1, Hong-Jen Chiou2, Huai-Cheng Hsueh1, Tse-Kai
Tseng1, Chui-Mei Tiu2, Yi-Hong Chou2
1
Department of Radiology, Lotung Poh-Ai Hospital, Taiwan
2
Taiwan
E-Poster
English literature.
Keywords Shoulder
Others
Ying-Yue Jhang, Hong-Jen Chiou
Taiwan
Purpose Spontaneous osteonecrosis of the knee (SONK) is a poorly
understood entity which has been hypothesized to be associated with
meniscal pathology. This issue however, remains controversial. The
purpose of the study was to evaluate the incidence of meniscal pathology
in patients with SONK and from that, attempt to establish a relationship
between the two entities.
through 31 June 2009 were retrospectively reviewed by two MSK
radiologists for the presence of SONK and associated meniscal pathology.
The demographic data, the location and type of meniscal tear, meniscal
root involvement, and associated meniscal extrusion were recorded.
Results A total of 32 SONK lesions of the femoral condyle were identified
(M/F=20/12; age range 27-79; mean 48). 20 out of the 32 (63%) SONK
lesions involved the medial compartment, while others were laterally
located. Meniscal tears were seen in 22 patients, accounting for 69% of
SONK lesions. Among these, there were 13(60%) medial meniscal tears,
7 (32%) lateral tears and 2 tears involving both the medial and lateral
compartments. Only 8 (36%) SONK lesions had a meniscal tear on the
ipsilateral side. 8 (36%) out of 22 tears were radial tears, 10 (45%) were
longitudinal tears and the rest (19%) were complex/bucket-handle tears.
20/22 (90%) of the tears involved the body and/or posterior horn and there
were 6 radial tears involving the posterior root, all of them associated with
meniscal extrusion.
Conclusions Meniscal tears are common in patients with SONK, the
majority located at the medial side involving the body and posterior horn
of the meniscus. No specific type of meniscal tear was more susceptible
to SONK. The cause and effect of the two entities, however, was not
conclusive and further study is warranted.
Keywords Knee, MR
600
Purpose The purpose of this study was to analyze the type and the
frequency of incidental colorectal tumors detected by F-18 FDG PET/CT
(FDG PET/CT) performed for patients with various malignant tumors.
Methods One thousand two hundred and eighteen consecutive patients
with malignancies, who underwent FDG PET/CT (1360 times), were
retrospectively reviewed. Incidental colorectal tumors which were newly
detected were examined, excluding primary lesions, recurrences and
metastatic lesions. Incidental tumors without FDG uptake, which were
detected by only CT, were also excluded. Diagnoses were made by
pathological and/or colonoscopic findings, in addition to radiological
findings. FDG PET/CT was performed using a Siemens Biograph 16.
FDG was purchased via a delivery system. All patients fasted for at least
6 hours before PET/CT. Sixty minutes after intravenous administration of
FDG, all patients were positioned supine on the imaging table with their
arms by their sides. Whole-body PET/CT was acquired for each patient
from the top of the skull to the middle of the thigh.
Results Incidental tumors were detected in 47 patients (3.9%) out
of 1218. Colorectal tumors were detected in 18 (38.3%) out of 47
with incidental tumors. Out of 18 with colorectal tumors, six patients
(33.3%) had cancers. Maximum standardized uptake values (SUVmax)
were 15.1±7.3 (mean±SD) and 9.2±4.6 in cancers and benign polyps,
respectively. There was no significant difference between malignant and
benign lesions. The SUVmax of cancers was significantly higher (P<0.05)
than that of the physiological focal uptake (6.5±2.1, n=8).
Conclusions Incidental colorectal lesions were frequently detected by
FDG PET/CT in patients with malignancies. Since physiological FDG
uptake appears in the colorectal region, abnormal findings in this region
on PET/CT images should be carefully evaluated.
Keywords Large Bowel, Neoplasms-Primary
NM002
How to Manage RI Venography in Pre-Orthopedic Surgery
Patients
Kaori Terazawa, Hideki Otsuka, Yoichi Otomi, Naomi Morita,
Hiromu Nishitani
Department of Radiology, Tokushima University Hospital, Japan
Purpose The preoperative evaluation of venous thromboembolism (VTE)
is important to avoid complications, because VTE is often induced by
orthopedic surgery. We focused on radioisotope venography (RIV) using
99mTc-macroaggregated human serum albumin (99mTc-MAA), examining
orthopedic patients.
Methods We conducted 34 examinations in 33 patients who were referred
for RIV and lung perfusion scintigraphy for the pre-orthopedic operative
evaluation of VTE. Two board-certificated (one nuclear medicine boardcertificated) radiologists interpreted the images based on the following:
1) flow defect of lower extremities, 2) interruption of flow, 3) irregular or
asymmetric filling of the deep vein (low flow), 4) presence of collateral
vessels, 5) abnormal RI retention on delayed-phase image. Scoring was
based on a 5-point scale, and more than 2 points was considered VTEpositive.
Results Abnormal findings were noted in 27 of the 34 examinations
performed in the 33 patients and normal findings in the other 7
examinations. According to the RI score, 21 patients were classified into
the VTE-positive group and 12 into the VTE-negative group. Pulmonary
perfusion scintigraphy was positive for pulmonary thromboembolism (PTE)
in 5 of the 21 patients in the VTE-positive group and 3 of the 12 in the
VTE-negative group.
Conclusions Many patients showed no definite clinical symptoms, and,
therefore, the percentage of patients with latent VTE or PTE may be
NM006
Relationship between FDG Uptake and the Pathological Risk
Category in Gastrointestinal Stromal Tumors
Yoichi Otomi, Hideki Otsuka, Naomi Morita, Kaori Terazawa,
Hiromu Nishitani
Department of Radiology, Graduate School of Medicine,
University of Tokushima, Japan
Purpose To evaluate 18F-fluorodeoxyglucose (FDG) uptake and the
pathological risk category of gastrointestinal stromal tumors (GISTs), and
to investigate the possibility of determining the pathological risk category
by positron emission tomography/computed tomography (PET/CT). To
discuss the potential roles of PET/CT in GIST, such as determination of
risk category prior to therapy and postoperative or post-chemotherapy
follow-up.
Methods We undertook 25 PET/CT studies in 17 patients (11 male, six
female, 44–85 years old) with GISTs.
Results All eight lesions imaged before treatment were FDG-positive on
PET/CT. Five of these eight primary lesions were categorized as high
risk, and showed intense FDG uptake with maximum standardized uptake
value (SUVmax) of 8.0, 8.8, 10.0, 14.3 and 15.0. The other three primary
lesions were categorized as low or intermediate risk, and showed much
lower FDG uptake (low risk: SUVmax of 2.2 and 3.0; intermediate risk:
SUVmax 3.3). Recurrent tumors were also shown as FDG-positive.
Conclusions Primary GISTs and recurrent tumors can be detected by PET/
CT. GISTs are FDG-positive, with a varying degree of uptake. FDG uptake
and pathological risk category appear to be related. Our study suggests that
the degree of FDG uptake is a useful indicator of risk category.
Keywords Large Bowel, Duodenum, Small Bowel, Stomach
indicates high metabolism and malignant potential. In our cases, higher
FDG uptake and much hyperintensity on DWI were found in the GIST
of high risk patient compared with the low and intermediate risk ones. It
could be considered that the GIST of pathologically high risk patient had
a high glucose metabolism and high cellularity. Since 18F-FDG PET/
CT could evaluate the glucose metabolism and DWI the cellularity of the
GISTs, not only 18F-FDG PET/CT but also DWI may be useful tools for
determining the risk category for GISTs.
Keywords Small Bowel, Stomach
NM008
FDG Uptake in the Anterior Mediastinum; Thymic or Non
Thymic? Benign or Malignant?
Hideki Otsuka1, Yoichi Otomi2, Seiji Iwamoto2, Shoichiro Takao2,
Naomi Morita 2, Kaori Terazawa 2, Masafumi Harada 1, Hiromu
Nishitani1
1
2
Purpose Fluorodeoxyglucose (FDG) uptake in the anterior mediastinum
is associated with various conditions including thymic tumors (thymoma,
thymic cancer), teratoma, lymphoma, metastasis, sarcoidosis and
germ cell tumors. Physiologic thymus uptake can be seen in patients
aged around 40 years. Thymic hyperplasia is often demonstrated in the
patients after chemotherapy. FDG-PET demonstrates both metabolic
activity and disease distribution. Morphologic images by CT can show the
size and shape of a lesion, necrotic or cystic changes, and calcification
and fat components. A PET/CT system can obtain both metabolic and
morphologic images in a single session. We reviewed FDG uptake in the
anterior mediastinum. Maximum standardized uptake values; thymoma
(2.7 – 11.2), thymic cancer (4.8 - 13), mature teratoma (3.2), carcinoid
(4.4), york sac tumor (23, 18), MFH (9.4), thymic hyperplasia (2 - 3.2),
and sarcoidosis (4.9 - 13). Normal physiologic thymus uptake, thymic
hyperplasia and most benign tumors showed slight to moderate FDG
uptake, whereas most malignant tumors showed high FDG uptake. As
FDG-PET/CT can evaluate primary lesions as well as metastasis and
dissemination, it is a useful modality for therapy monitoring.
Keywords Molecular Imaging
NM007
Comparison between DWI and FDG-PET for Determining
GIST Risk Category
Yoichi Otomi, Hideki Otsuka, Naomi Morita, Kaori Terazawa,
Hiromu Nishitani
Purpose Gastrointestinal stromal tumors (GISTs), while relatively rare
as they represent less than 3% of all gastrointestinal neoplasms, are
the most common mesenchymal tumor of the gastrointestinal tract.
Approximately 70% of all GISTs are found in the stomach, 20% originate
from the small intestine, while 10% are found elsewhere. We present
3 cases of GIST and discuss diffusion-weighted imaging (DWI) and
18F-fluorodeoxyglucose positron emission tomography (18F-FDG
PET/CT) findings. We investigate the possibility of determining the risk
category pathologically by tumor size and the number of mitotic cells.
Methods We retrospectively reviewed medical records of patients
pathologically diagnosed with a GIST. Magnetic resonance Imaging (MRI)
and 18F-FDG PET/CT were performed on the 3 patients (2 women) prior
to therapy.
Results The primary tumor was located in the stomach in 2 patients and
in the small intestine in 1. GIST of the high risk category patient showed
intense FDG uptake with a maximum standardized uptake value (SUVmax)
of 8.8 on 18F-FDG PET/CT. The GISTs of low and intermediate risk
patients showed lower FDG uptake (SUVmax 3.0 and 3.3, respectively).
On DWI, the GIST of high risk patient showed much higher intensity than
those of low and intermediate risk ones.
Conclusions It is reported that a high rate of FDG uptake in a GIST
NM009
Bone SPECT Correlating to CT Finding in Skull Base
Invasion of Nasopharyngeal Carcinoma
Chih-Feng Chen1, Yu-Erh Huang2, Yu-Jie Huang3, Chun-Chung
Lui1, Yu-Chang Li4
1
Department of Radiology, KH-CGMH, Taiwan
2
Department of Nuclear Medicine, KH-CGMH, Taiwan
3
Department of Radiation Oncology, KH-CGMH, Taiwan
4
Department of Radiology, E-Da Hospital, I-Shou University,
Taiwan
Purpose Skull base invasion is an important factor for patients’ outcomes
with nasopharyngeal carcinoma (NPC). Previous articles had reported that
bone single photon emission computed tomography (SPECT) was more
sensitive in detecting skull base invasion than computed tomography (CT).
However, the discrepancy between them was also frequently disputed. The
goal of this study is using a semiquantitative analysis to help recognize
skull base bone invasion. Methods: Sixty-eight NPC patients (with 126
skull base lesions) were sorted out as SPECT-positive (SPECT-P) and
received further semiquantitative analysis. An objective quotient, the lesionto-temporal ratio (LTR), was used. It was based on the tracer uptake ratio
between the skull base lesion and the membranous temporal bone. The
LTR values of all SPECT-P lesions were divided into CT-negative (CT-N)
and CT-positive (CT-P) groups for subsequent statistics.
Methods Using CT as a reference, we correlated semiquantitative values
(LTR) of bone SPECT with it.
Results Among all SPECT-P lesions, 68% (86/126) could be identified
601
NM001
Incidental Colorectal Tumors Detected By F-18 FDG PET/CT
in Patients with Malignant Tumors
Eiji Ohtake, Tsuyoshi Kawano
Division of Nuclear Medicine, Kanagawa Cancer Center,
Yokohama, Japan
higher than estimated. In orthopedic surgery, many patients have chronic
inflammatory disease such as RA as an underlying disease. After the
operation, the promotion of inflammatory responses due to surgery and
limitations in body movement according to the surgical area occur, which
may further increase the risk of VTE. The preoperative identification of
patients with VTE or PTE is useful for perioperative management and the
evaluation of preventive measures against postoperative VTE.
Keywords Lung, Embolism/Thrombosis, Veins
E-Poster
MS062
Incidence of Meniscal Pathology in Patients with
Spontaneous Osteonecrosis of the Knee
Hung Lit Chow1, Julian C.Y. Fong2, Godfrey K.F. Tam1
1
China
2
Department of Radiology, Princess of Margaret Hospital, Hong
Kong, China
Others
Questionnaire was used to determine work practices, work descriptions,
prolonged postures and movements, and body pain. Ninety-seven
questionnaires (93.3% response) were returned for analysis.
Results The majority of respondents (77.3%) reported at least one
episode of body pain during the previous year. Less than half (44.3%)
of respondents were able to have time off during work shifts, and 42.3%
worked more than eight hours per shift. Pain in the neck or shoulder
(61.9%) was the most common complaint. There was a lower incidence
of body pain for staff members who could arrange at least some time off
during the work shift than for staff unable to do so.
Conclusions MSD among staff in the radiology department were related
to work posture and movement. Time off taken during a work shift
appeared to be a protective factor lowering the incidence of pain in all
parts of the body.
Keywords Occupational/Environmental Hazards, Complications, Health
Policy and Practice
NM012
FDG-PET/CT Findings of Extranodal Lymphoma
Takahiro Taniwaki, Hideki Otsuka, Yoichi Otomi, Naomi Morita,
Kaori Terazawa, Seiji Iwamoto, Shoichiro Takao, Hiromu
Nishitani
Purpose FDG-PET/CT can play a very important role in diagnosis,
staging and restaging of lymphoma. FDG uptake varies according to the
pathological type of lymphoma. Diffuse large B-cell lymphoma, the most
common type of non Hodgkin lymphoma, shows very high FDG uptake
whereas follicular- or mucosa-associated lymphoid tissue lymphoma
(MALT) demonstrates slight to moderate uptake. Lymphoma may involve
both lymph nodes and extranodal organs, such as the digestive tract or
bones. Here, we investigated the findings and utility of FDG-PET/CT for
extranodal lymphoma.
Methods Seven patients with extranodal lymphoma were included in this
study (bone, 3; adrenal glands, 2; kidney, 1; uterus, 1). One hour after
injecting FDG (3.7 MBq/kg body weight), PET/CT was performed using
a hybrid PET/CT scanner. The degree of FDG uptake was determined
as standardized uptake value (SUVmax). Distribution of the disease and
other findings were also evaluated.
Results SUVmax was 5.3–7.7 for Hodgkin’s lymphoma of bone, 4.8 for
diffused large B-cell lymphoma of bone, 11 for B-cell lymphoma (unknown
background) of bone, 11.7 for Hodgkin’s lymphoma of bilateral adrenal
glands, 23 for diffused large B-cell lymphoma of bilateral adrenal glands,
10.8 for suspected marginal zone B-cell lymphoma of kidney, and 38.8
for diffused large B-cell lymphoma of the uterus. Three patients showed
node and extranodal organ involvement and four patients only showed
extranodal organ involvement.
Conclusions FDG-PET/CT is useful for diagnosis, staging and restaging
of lymphoma.
Keywords Kidney, Adrenal, Lymphoma, Uterus
602
Purpose To assess disease specific alterations in diffusion anisotropy and
diffusivity of cerebral white matter and determine regional differences in
fiber tract integrity between patients with Alzheimer’s disease, vascular
dementia, frontotemporal dementia and age-sex matched controls.
Methods Ten patients each with Alzheimer’s, vascular and frontotemporal
dementia and ten normal controls underwent diffusion tensor imaging
(DTI) on a 3 Tesla MR scanner. The imaging protocol included high
resolution 3D T1W imaging (3D SPGR), T2W FSE and EPI based tensor
encoded diffusion weighted scans. The mean apparent diffusion coefficient
(ADC) and fractional anisotropy (FA) values of several lobar white matter
regions and corpus callosum were calculated using Functool software.
The corpus callosum was segregated into anterior and posterior regions
(anterior 25% and posterior 25% of the callosum). FA and ADC values
were calculated for all the 40 patients including controls. The student t
test was used to compare the values between the control subjects and
between the different subgroups of demented patients.
Results Significant differences were found in the ADC and FA values
of demented patients and controls. Values of diffusion anisotropy were
significantly lower for patients with Alzheimer’s disease than for controls.
In patients with frontotemporal and vascular dementia, anterior white
matter FA values tended to be lower than those of the posterior white
matter whereas posterior white matter was more severely affected in
Alzheimer’s dementia.
Conclusions These results indicate that there are significant changes in
white matter microstructural integrity in dementias with a characteristic
topographical distribution of the abnormal diffusion indices in various
dementia subtypes. White matter integrity is critical to cognitive functions.
Using DTI on a 3 Tesla scanner it is possible to precisely assess the
pattern and severity of white matter disruption in the early stages of
dementia and aid in the differential diagnosis of dementias.
Keywords MR, Brain/Brain Stem, Dementia
NR003
Imaging of the Hypothalamus: From Normal Anatomy,
Pathophysiology to Various Pathologic Conditions
Ming-Tsung Chuang, Chia-Hsin Lu, Yih-Sheng Liu, Hong-Ming
Tsai, Shirley Kuo
Department of Diagnostic Radiology, National Cheng-Kung
Purpose 1.To demonstrate the normal anatomy of the hypothalamus
using illustrative schema and MRI images for correlation. 2. To review
the pathophysiology of the hypothalamus. 3.To show various pathologic
conditions based on the characteristic anatomic location and different
disease category.
Methods 1. Use illustrative schema and MRI images to show the normal
anatomy of hypothalamus and adjacent structures, including optic chiasm,
tuber cinereum, infundibular stalk, mammillary body. 2.Spectrum of various
hypothalamic lesions based on anatomic location and disease category, from
congenital, neoplasm, vascular, inflammatory to granulomatous diseases.
Results Summary tables of pathologic conditions and imaging features
based on anatomic location.
Conclusions The main teaching points of the exhibit are:1)to understand
the normal anatomy of hypothalamus.2)to learn the pathophysiology of the
hypothalamus.3)to show various pathologic conditions based on anatomic
locations and disease category. To be familiar with these knowledge will
enhance our ability for better diagnostic accuracy.
Keywords Anatomy
NR005
Bone Marrow Perfusion Magnetic Resonance Imaging
in Patients with Osteoporotic Vertebral Compression
Fractures: Peak Enhancement Ratio Is an Independent
Purpose To prospectively investigate relationships between (i)
intraosseous vacuum phenomena and (ii) bone marrow perfusion by
dynamic contrast-enhanced magnetic resonance images (DCE-MRI) in
patient with osteoporotic vertebral compression fracture.
Methods Forty-three subjects referred for evaluation of vertebral
compression fracture underwent DCE-MRI from T8 to sacrum. Bone
marrow perfusion by measuring the DCE-MRI time-intensity curve pixel
by pixel from non-injured vertebrae was developed using 2 distinct
parameters: peak enhancement ratio (PER) to indicate tissue blood
perfusion and enhancement slope to reflect vascularity. The contrast and
noncontrast area of the injured vertebrae were calculated. Multiple logistic
regression was used to evaluate the relationships between baseline
clinical factors, parameters of DCE-MRI and presence of intraosseous
cleft or not in injured vertebrae.
Results Thirty-one injured vertebrae (72%) had intraosseous cleft.
The cleft group showed significantly lower PER (p =0.001) and lesser
enhanced area ratio (p =0.049) than the no cleft group. Lower PER of
the non-injured vertebrae was associated with higher noncontrast area
ratio of the injured vertebrae (γ = -0.362, p=0.017). Multivariate logistic
regression analysis identified lower PER (hazard ratio, 0.000; 95%
confidence interval, 0.000-0.096; p=0.009) as an independent predictor
for intraosseous vacuum phenomena. The sensitivity and specificity of a
PER of less than 0.57 for intraosseous cleft formation were 81% and 83%,
respectively.
Conclusions Our findings provide evidence that decrease bone marrow
perfusion measured by DCE-MRI can predict present of intraosseous
vacuum phenomena in osteoporotic compression fracture.Clinically, DCEMRI may help to select high-risk patients for tailored antiosteoporotic
therapy.
Keywords MR, Contrast Agents, Spine
NR006
Arterial Spin-Labeling in Routine Clinical Practice: A
Preliminary Experience of 200 Cases
Tai-Yuan Chen, Tai-Ching Wu, Te-Chang Wu, Chien-Jen Lin
Purpose Arterial spin-labeling (ASL) is an MR perfusion method for
the quantitative measure of CBF which takes advantage of the freely
diffusible property of arterial water. We describe our experience with a
heterogeneous collection of 200 ASL perfusion cases.
Methods All ASL perfusion imaging examinations were performed on a
clinical 1.5T MR imaging unit with a transmit/receive head coil, using a
second version of quantitative perfusion imaging by means of a single
subtraction with the addition of thin-section periodic saturation (Q2TIPS).
In the past four months, 200 pulsed ASL cases were performed as a
component of routine clinical brain MR evaluation. These ASL studies
were analyzed with respect to overall image quality and patterns of
perfusion on final gray-scale DICOM images and color Joint Photographic
Experts Group (JPEG) CBF maps.
Results We identified the various patterns of perfusion on the basis
of a retrospective analysis. ASL is capable of accurately depicting
various states of both hypoperfusion and hyperperfusion. We described
various causes of focal and global hypoperfusion, including acute and
chronic cerebral ischemia, transient ischemic attack, encephalomalacia,
hydrocephalus, hematoma, intratumoral or non-tumoral cyst, among
others. ASL is also sensitive to pathologic states manifesting as focal,
regional, and global hyperperfusion including brain tumors and vascular
malformations as well as seizures in the ictal phase, postanoxia
vasodilatation, hypercapnia, among others.
Conclusions ASL perfusion imaging can be implemented successfully in
a routine clinical neuroimaging protocol and can accurately demonstrate
alterations in brain perfusion.
NR007
MR Imaging of Posterior Reversible Encephalopathy
Syndrome (PRES): Utility of Diffusion Weighted Imaging
(DWI)
Jenny Ho, K S Tai, W K TSO
Department of Radiology, Queen Mary Hospital Hong Kong,
China
Purpose PRES is often unsuspected by clinicians and radiologists may
be the first to suggest this diagnosis. Our goal was to describe the MRI
findings in our PRES patients and to determine the value and prognostic
significance of restricted diffusion detected on DWI.
Methods Retrospective review of brain MRI at our institution from March
2007 to March 2009 revealed 5 consecutive patients with confirmed
diagnosis of PRES. All patients have normal follow up MRI and full clinical
recovery. Our MRI protocol included T1W, T2W, FLAIR, DWI and postgadolinium sequences. Proton MR spectroscopy was obtained in two
patients. Two neuroradiologists independently studied the MRI images of
each patient. They recorded the location and signal characteristic of each
lesion. The most sensitive pulse sequence in lesion detection was noted.
Results The regions of brain involved were the parietooccipital lobes (n =
5), temporal lobe (n = 2), thalamus (n=2) and frontal (n = 1) lobes. Bilateral
occipital lobes involvement was the commonest findings (n=4). Cortical
gray and subcortical white matter edema was present in all patients. Two
patients demonstrated mild contrast enhancement in the affected areas.
Areas of restricted diffusion suggestive of cytotoxic edema were present in
3 patients. No residual abnormality is detected in the areas with restricted
diffusion on subsequent follow up imaging. MRS performed in two patients
revealed normal spectrums. DWI was the most sensitive sequence
depicting the largest number and extent of lesions.
Conclusions The most common MRI finding was T2W hyperintense
lesions at bilateral occipital cortical gray and subcortical white matter. DWI
was the most sensitive sequence depicting the largest number and extent
of lesions. Restricted diffusion occurred in significant proportion of our
patients, is completely reversible and is not necessarily associated with
poor outcome.
Keywords MR, Brain/Brain Stem, Imaging Sequences
NR008
MR Imaging of Spontaneous Spinal Epidural Haematoma
(SSEH)
Jenny Ho, W K Tso, K S Tai
Department of Radiology, Queen Mary Hospital Hong Kong,
China
Purpose SSEH is an uncommon cause of spinal cord compression
requiring emergency surgical intervention. Early recognition, accurate
diagnosis and rapid treatment may result in decreased morbidity and
improved patient outcome. Our goal was to describe the MR imaging
findings of SSEH and determine the role of MRI in the management of this
condition.
Methods Retrospective review of 960 urgent MRI examinations of
the spine performed at our institution in a three years period from
March 2006 to March 2009 revealed 3 consecutive patients with SSEH
confirmed by operative findings. After urgent decompressive surgery
one patient had complete recovery, one with mild residual neurological
deficits that gradually improved after rehabilitation, while one suffered
permanent deficit. No cause was found in these patients at operation to
account for the haemorrhage. MRI with T1W, T2W and post-gadolinium
sequences were performed in all patients using a 1.5T MR scanner. Two
neuroradiologists independently reviewed the MRI findings and recorded
the location of lesions and the signal characteristic of detected lesions.
Results Patients were of age 28, 54 and 79 year old (mean age 54)
respectively. M:F= 1:2. All presented with neck/back pain followed by
symptoms of acute cord compression. No history of trauma or bleeding
tendency. Two patients had lower cervical (C6-7) haematoma, the other
at lower thoracic spine (T8-9). All posteriorly located. The extent ranged
from 1-3 vertebral segments. The spinal epidural haematomas showed
T1W isointense and hyperintense signal on T2W images. No contrast
603
Purpose Clinical History: A 55 years old male, referred from the health
care center department for physical check up. Non-specific past medical
history but with smoking dependency.
Methods PET/CT scan finding: There is an abnormal focal FDG uptake
in the lower esophagus region, the PET/CT fusion image confirm the
lower third esophageal anatomic site. That may be due to inflammation or
physiological uptake.
Results Physical check up results: Follow up endoscopic examination
and showed gastroesophageal reflux disorder (GERD), biopsy was taken
and the pathological report come out to be- “Barrett`s Esophagitis”.
Conclusions Discussion When GERD without medical treatment,
the inflammatory process will keep persistent, It will induced Barrett`s
esophagitis. In Barrett's esophagitis, the normal esophageal squamous
cells will turn into a type of cell called “specialized columnar cells”. This
situation will increase esophageal cancer probability. The rate is more than
normal group 20 times equivalent to 0.5% per year. PET/CT scan may be
an alternative check up method for Barrett`s Esophagitis early detection.
Keywords Endoscopy, Inflammation
NR002
Quantitative Diffusion Tensor Imaging and Tractography of
the Dementias on 3 Tesla MRI
Rima Kumari
Department of Neuroradiology, Institute of Human Behavior and
Allied Sciences (IHBAS), India
Predictor for Intraosseous Vacuum Phenomena
Wei-Che Lin, Hsiu-Ling Chen, Yu-Fan Cheng, Chun-Chung Lui
E-Poster
NM011
Case Presentation: Barrett`s Esophagitis: Serendipity
Finding of PET/CT
Hui-Ping Chen, Sheng-Ping Changlai
Department of Nuclear Medicine, Lin Shin Hospital, Taiwan
Neuroradiology (NR)
Others
in CT (CT-P group), whereas other 32% (40/126) couldn’t (CT-N group).
The LTR values of the two groups had statistically significant difference
(p<0.01). The sensitivity and specificity of LTR values for CT results can
both reach 90% when using a LTR threshold 3.80.
Conclusions If we use CT as the reference, a threshold value can be
obtained by semiquantitative analysis of SPECT with sensitivity and
specificity. In another point of view, if a lesion with a tracer uptake ratio (LTR
value) is higher than the threshold, it will have a high positive predictive
value (PPV) for predicting the existence of bone erosion in CT.
Keywords CT, Radiation Therapy/Oncology, Skull
NR011
MR Imaging Findings of Baastrup’s Disease: Intervertebral
Discs, Facet Joints and Ligamentum Flavums
Woo-Mok Byun
Department of Diagnostic Radiology, College of Medicine,
Yeungnam University, Korea
Purpose To know MRI findings of intervertebral discs, facet joints and
ligamentum flavums related with spinal instability in Baastrup’s disease.
Methods The study group consisted of 32 patients with Baastrup’s
disease underging routine spine MR imaging. Disc degeneration and
anular tears at same level of Baastrup’s disease were evaluated on MRI.
Thickness and signal intensity of ligamentum flavum on axial T2-weighted
images was evaluated at the same level of interspinous arthritis. The
degree of facet joint osteoarthritis (OA) was rated on an ordinal scale. A
facet joint effusion was measured on the axial T2 images.
Results Lumbar interspinous bursitis was present at 38 levels in 32
patients. Mutilevels of lumbar interspinous bursitis were 19% (6 of 32
patients). All cases had disc degeneration. There were circumferential
entire anular tears in 87% (33 of 38 levels). Anular tears with periannular
enhancement by the inflammation were seen on 12 cases. Facet joint
effusion was present at 27 of 38 levels (71%). Facet osteoarthritis was
present at 35 levels. Hyperintense ligamentum flavum with hypertrophy
on T2-weighted images was detected at 18 of 38 levels (47%). Canal
stenosis was noted in 63% (24 of 38 levels). Posterior epidural cyst was
present at 7 cases.
Conclusions Anular tears, facet joint change, and ligamentum flavum
hypertrophy related with spinal instability in Baastrup's disease are common.
Keywords MR, Spine
604
NR013
Subclinical Central Nervous System Complication of
Ankylosing Spondylitis: Evaluation with Conventional MR
Imaging and 1H MR Spectroscopy
Teng-Fu Tsao1, Ruei-Jin Kang2, Da-Min Yeh1, Yeu-Sheng Tyan1 ,
James Cheng-Chung Wei3
1
Hospital, Taiwan
2
National Chi Nan University, Taiwan
3
Division of Allergy, Immunology and Rheumatology, Chung
Shan Medical University Hospital
Purpose To prospectively assess the subclinical central nervous system
complication of ankylosing spondylitis (AS) at conventional magnetic
resonance (MR) imaging and 1H MR spectroscopy.
Methods Seventeen AS cases (case group) without clinical symptom
or sign of central nervous system lesion and 16 subjects matched for
age and sex (control group) underwent conventional MR imaging and
proton (hydrogen 1) MR spectroscopy in the corpus striatum and the
parietooccipital white matter of brain. Institutional review board approval
for this study was obtained, and written informed consent was obtained
from each subject or his or her family.
Results There were two cases (11.8%) with small old cerebral lacunal
infarctions, two cases (11.8%) with subluxation of atlantoaxial joint, and
one case (5.9%) with mild brain atrophy in AS group. There was no
significant abnormality in the control group. From proton MR spectroscopy
in the corpus striatum, AS cases disappeared the positive correlation
between the N-acetylaspartate–to-creatine (NAA/Cr) ratio, which reflects
functional neuronal mass, and choline-to-creatine (Cho/Cr) ratio, which
reflects active cellular turnover and membrane metabolism (r = 0.388, p
NR014
Analyses of White Matter Anatomy and Tract-Specific
Quantification by Tract Probability Maps in Carbon
Monoxide Intoxication
Wei-Che Lin1, Chun-Yi Lo2, Hsiu-Ling Chen1, Chih-Hsueh Wang2,
Ai-Ling Hsu3, Ching-Po Lin2
1
2
Institute of Biomedical Imaging and Radiological Sciences,
National Yang Ming University, Taiwan
3
Division of Allergy, Immunology and Rheumatology, Chung
Shan Medical University Hospital, Taiwan
Purpose To investigate white matter (WM) tract injury in patient with
carbon monoxide (CO) intoxication by using atlas based probabilistic
maps.
Methods We enroll 17 patients with CO intoxication and 22 sex- and
age-matched healthy volunteers. A WM parcellation atlas based on
probabilistic maps of 6 major fiber tracts was created from the diffusion
tensor imaging (DTI). Using these probabilistic maps, tract-specific
quantification of mean diffusivity (MD) and fractional anisotropy (FA),
including the axial (λ ||) and radial (λ⊥) diffusivity, were performed. The
parameters of DTI from different fiber tracts in different groups were
compared. Repeat studies were performed in 8 patients after 3 months of
follow-up to look for any interval change in parameters of DTI.
Results In patient with CO intoxication, FA decrease and MD, axial (λ ||)
and radial (λ⊥) diffusivity increased significantly in the anterior thalamic
radiation, cingulum, cortitospinal tract, inferior fronto-occipital fasciculus,
superior longitudinal fasciculus and uncinate fasciculus in comparison
with the corresponding fibers of healthy controls. Repeat studies in the 8
patients showed significantly increase of MD, axial (λ ||) and radial (λ⊥)
diffusivity. FA of all fiber tracts was not significantly different from that in
controls.
Conclusions CO intoxication may cause decline in parameters of DTI
indicating microstructural WM pathology. Atlas based probabilistic maps
allows efficient initial screening and longitudinal evaluation of the status of
individual WM tract after CO intoxication.
Keywords MR, Brain/Brain Stem, Trauma
NR015
Crossed Cerebellar Diaschisis Due to Intracranial Hematoma
in Basal Ganglia or Thalamus: Assessment with Diffusion
Tensor MR Imaging
Hahun Song, Yi-Kyung Kim
Department of Radiology, Cheju Halla Hospital, Korea
Purpose Diaschisis refers to a functional impairment occurring remotely
from the site of a brain lesion, which is anatomically connected by fiber
tracts. The purpose of our study was to evaluate whether diffusion tensor
MR imaging (DTI) might provide evidence of crossed cerebellar diaschisis
(CCD) in patients with unilateral deep-seated hematoma without cortical
structural abnormality.
Methods Fourteen patients (9 men, 5 women; mean age 56.4 years) with
unilateral hypertensive intracerebral hemorrhage strictly confined either
to the basal ganglia or thalamus were evaluated by DTI. Nine psychiatric
patients without structural abnormality on MRI were included as control
subjects. For the evaluation of pontocerebellar fibers, the fractional
anisotrophy (FA) of the bilateral middle cerebellar peduncle (MCP) in both
patient and control groups was measured. Changes of FA values in the
MCP were compared.
Results In patients with a intracranial hematoma in basal ganglia or
thalamus, MCP of the contralesional side showed an FA value of 0.6812+0.0174, which was significantly lower than that of the ipsilateral side MCP
(0.7201+-0.0174) (one tail paired t test, p =.0009).
Conclusions DTI can visualize CCD in patients with subcortical
hematoma without cortical structural abnormality. This suggested that
CCD can develop regardless of interruption of the corticocerebellar tract,
which is the pricipal pathway of CCD.
NR017
The Value of PROPELLER FLAIR in the Brain in Comparison
with Standard FLAIR
Masayuki Maeda, Nobuyoshi Matsushima, Kan Takeda
Department of Radiology, Mie University School of Medicine,
Japan
Purpose The aim of our exhibition was to evaluate clinical usefulness
and limitations of Periodically Rotated Overlapping ParallEL Lines with
Enhanced Reconstruction (PROPELLER) FLAIR in comparison with
standard FLAIR.
Methods Consecutive 73 patients who gave consent were included in a
prospective comparison of PROPELLER and standard FLAIR sequences.
All examinations were performed at 1.5 T with comparison of standard T2weighted FLAIR to PROPELLER T2-weighted FLAIR in the axial image
orientation. Imaging protocols were matched for spatial resolution, with
data evaluation by 2 experienced neuroradiologists. Image data were
compared qualitatively and quantitatively regarding various image artifacts
and overall image quality (conspicuity and detection).
Results Qualitatively, PROPELLER FLAIR showed less motion, CSF flow,
metal, and pulsation artifacts than the standard FLAIR. Quantitatively,
prepontine CSF/pons contrast was significantly higher in PROPELLER
than standard FLAIR (p<0.01), indicating less CSF artifacts in
PROPELLER. On the other hand, lesion contrast was significantly lower
in PROPELLER than the standard FLAIR (p<0.01).
Conclusions PROPELLER FLAIR appears advantageous particularly
in uncontrollable children or emergent patients despite of lower lesion
contrast.
Keywords Artifacts, MR, Brain/Brain Stem
NR019
CT Analysis of Eyeball Rupture
Wei-Hsin Yuan1, Wan-You Guo2, Hui-Chen Hsu3, Michael MuHuo Teng2, Chao-Bao Luo2, Feng-Chi Chang2
1
Division of Radiology, Taipei Municipal Gan-Dau Hospital-T.
V.G.H., Taipei, Taiwan, Taiwan
2
Taipei, Taiwan
3
Department of Medical Imaging, Taiwan Adventist Hospital,
Taipei, Taiwan
Purpose This study aimed to evaluate the computed tomography (CT)
features and frequency of eyeball rupture in patients with acute eyeball
trauma.
Methods The study consisted of 42 patients with 42 surgically proven
eyeball ruptures. Two radiologists, without the knowledge of patients’
surgical outcomes, analyzed the contour, size and content of each eyeball
and adjacent structures around the eyes to pattern on CT scans based on
a consensus.
Results Twenty-two (52%) of the 42 ruptured eyeballs showed irregular
605
Purpose 1. To review the embryology of corpus callosum. 2. To
demonstrate the normal anatomy of the corpus callosum using schematic
illustration and MRI images. 3. To review the pathophysiology and show
various pathologic conditions based on different disease category.
Methods Content Organization 1.Embryology 2.Normal anatomy
and imaging of corpus callosum. 3.Developmental abnormalities:
agenesis,hypogenesis,lipoma. 4. White matter disorders: MS, ADEM,
adrenoleukodystrophy, Marchiafava-Bignami disease PML. 5.Infarct.
Results 6.Inflammatory/infectious conditions: encephalitis,aspergillosis,a
bscess. 7. Vascular:AVM. 8. Trauma:diffuse axonal injury. 9. Neoplasms:
GBM, lymphoma, metastasis. 10. Intoxication: metronidazole, antiepileptic
drug. 11. Miscellaneous: Shunting tube injury, osmotic demyelination.
Conclusions 1. To review the embryology and normal anatomy of the
corpus callosum using schematic illustration and MRI. 2. To review the
pathophysiology and various pathologic conditions based on different
disease category using modern MRI techniques,including MRS, SWI
(susceptibility-weighted images), DTI (diffusing tensor images) and FT
(fiber tractography). 3. Summary tables with imaging key features for
differential diagnosis of pathologic conditions of corpus callosum.
Keywords MR, Brain/Brain Stem, CT
Purpose The primitive persistent hypoglossal artery is the rare artery, but
secondary common carotid-vertebrobasilar anastomosis. The purpose
of this paper is to review a large number of MRA to check the incidence
of PHA, the degree of hypoplasia or aplasia of vertebral arteries, and to
show how to make a diagnosis of PHA on MRA or MRI.
Methods MRA of continuous 16,415 cases between October 2005 and
September 2008 were evaluated using two 1.5T systems and one 1.0T
system. Stereoscopic view of 12 sets of MRA was evaluated by two
neuroradiologists using 9 Megabyte monitor.
Results The incidence of PHA is 0.037% (6 cases) in this study. The
bilateral intracranial vertebral arteries were aplastic in all cases. Two cases
of 3DCTA demonstrated bilateral vertebral arteries ending as muscle
branches and not entering intracranial region. This finding has never been
reported yet. One of the cases demonstrated the symptom caused by
PHA. A 25-year-old man with right PHA, a professional wrestler, presented
severe vertigo when he turned his head to left side because of temporary
suppression of right common carotid artery by developed muscles. The
key points to diagnose PHA on MRA and MRI were; the flow-void is
detected in one side of hypoglossal canal in T2-weighted axial images,
the flow-voids due to vertebral arteries are not detected in the foramen
magnum, the parallel artery to ipsilateral internal carotid artery is detected
in the lateral view of MRA, and the C-shaped or reverse C-shaped artery
si shown in the base view of MRA.
Conclusions The incidence of PHA is the similar with the previous reports
demonstrated by conventional angiography. The PHA itself does not
usually present clinical symptoms, but the awareness for its anatomical
features is important for neuroradiologists and neurosurgeons before
surgical procedure.
Keywords Anatomy, MR, Brain/Brain Stem, Normal Variants
= 0.124) compared to the correlation in the control subjects (r = 0.593, p
= 0.0253). The positive correlation was maintained in the parietooccipital
white matter in both AS cases (r = 0.570, p = 0.0168) and control subjects
(r = 0.762p = 0.0016). The ratio of NAA/Cr and Cho/Cr themselves in both
locations, however, did not show significant difference in both groups.
Conclusions Conventional MR imaging detected occult brain and upper
cervical spinal lesions in AS cases. Proton MR spectroscopy revealed
the loss of the correlation between functional neuronal mass and active
cellular turnover in corpus striatum in AS cases. This result may suggest
the potential involvement of central nervous system in AS patient even
though who has not clinical symptom or sign.
Keywords Ischemia/Infarction, MR, Brain/Brain Stem, Spine
E-Poster
NR010
Imaging of the Corpus Callosum: From Embryology, Normal
Anatomy, and Pathophysiology to Various Pathologic
Conditions
Hsueh-Li Kuo, Ming-Tsung Chuang, Chia-Hsing Lu, Yih-Sheng
Liu, Hong-Ming Tsai
Department of Diagnostic Radiology, National Cheng Kung
NR012
Six Cases of Persistent Primitive Hypoglossal Artery (PHA)
among 16,415 Cases of MRI and MRA Series in Three Years
Eri O’uchi¹, Yasutaka Kawamura 1, Yoichi Kikuchi 1, Michihiro,
Tanaka2, Toshihiro O'uchi1
¹Department of Radiology, Kameda Medical Center, Japan
²Department of Neurosurgery, Kameda Medical Center, Japan
Others
enhancement was demonstrated. No spinal cord vascular malformation,
tumour or syrinx was detected.
Conclusions Spontaneous spinal epidural haematomas demonstrate
T1W isointense and T2W hyperintense signal without contrast
enhancement. MRI is the modality of choice in pre-operative imaging
diagnosis. Urgent MRI permits early diagnosis of this uncommon disease,
allowing timely intervention and thus ensures better patient outcome.
Keywords Acute, Spine
Purpose To evaluate the appearances of intraspinal dermoid ruptured
into the central spinal canal, as well as the MRI diagnosis and differential
diagnosis.
Methods Eleven cases of intraspinal dermoid ruptured into the central
spinal canal were reviewed. Six cases underwent whole spine MRI scan,
2 cases with thoracic and lumbar spine MRI, as well as 3 cases only with
lumbar spine MRI.
Results Free fat droplets within spinal cord central canal demonstrated
high signal intensity on T1WI, slight declined signal intensity on T2WI, and
extremely low signal on fat suppression sequence. Among 11 cases, 2
cases broke into neighboring central spinal canal of the dermoid, 3 cases
scattered within thoracic spinal cord central canal, 4 cases discontinuously
distributed in the whole spinal cord central canal, 2 cases showed
continuous distribution.
Conclusions Intraspinal dermoid ruptured in the central spinal canal had
specific appearance on MR imaging, when a dermoid tumor is suspected,
MRI of the entire spine were recommended to detect possible leakage of
fat within central spinal canal.
Keywords MR, Spinal Cord
NR021
MR Imaging of Ruptured Spinal Dermoid Tumors with
Spread of Fatty Droplets in the Central Spinal Canal and/or
Spinal Subarachnoidal Space
Yong Zhang, Jingliang Cheng
Department of Radiology, The First Affiliated Hospital of
Zhengzhou University, China
Purpose To evaluate the appearances of intraspinal dermoid ruptured into
the central spinal canal and/or spinal subarachnoidal space, as well as the
MRI diagnosis and differential diagnosis.
Methods 12 cases of ruptured intraspinal dermoid were reviewed. All of
the 12 patients in our series, 8 patients had undergone whole spine MR
examination, 2 patients had been scanned thoracic and lumbar spine
segment, the remaining two patients were only examined lumbar spine
segment.
Results In our series of twelve cases, four spinal dermoid located at
606
Purpose 1.Describe the relevant imaging anatomy of the craniovertebral
junction. 2. Identify the common neogrowth involving the CVJ. 3. Discuss
potential pitfalls and mimics that can be mistaken for neogrowths.
Methods Background: The craniovertebral junction (CVJ) is the complex
articulation comprised of the clivus, foramen magnum and upper
two cervical vertebrae. It is the potential site of a variety of radiologic
diagnoses and misdiagnoses. Neoplasms that arise within the CVJ consist
of osseous tumors, extensions from soft tissue that surround the region,
and those from nervous system structures. These often involve and
encase important neurovascular structures, such as the vertebrobasilar
system and lower cranial nerves.
Results Imaging findings: The most common intradural extramedullary
tumors are meningiomas, neuromas, and rarely dermoid tumors,
lipomas, arachnoid cysts, paragangliomas and intradural extraosseous
chordomas. Intramedullary tumors at the cervicomedullary junction include
astrocytomas, ependymomas, and cerebellar region tumors. Chordomas,
chondromas, chondrosarcomas, and metastases are common extradural
intraosseous tumors. Each lesion has a different growth pattern, with
different bony destruction and neurovascular structures involvement. A
variety of nonneoplastic lesions may be found at this region. Infectious
processes include osteomyelitis and several granulomatous processes.
Tuberculosis involves this area with tuberculous abscesses both ventral
and dorsal to the spinal canal. Noninfectious inflammatory processes,
such as rheumatoid arthritis, CPPD, may compress the neural tissues
following the deposition of the collagenous material.
Conclusions Knowledge of the pathologic features of these tumors and
how these features are reflected in their imaging appearances may help
radiologists differentiate them.
Keywords MR, Brain/Brain Stem, Neoplasms-Primary, Spine,
Inflammation
NR024
Ultrasonographic Findings in Hypoxic Ischaemic
Encephalopathy and Usefulness of Resistive Index and
MRI for Prognostication and Outcome of Non-Cystic
Purpose 1. To study neurosonographic features of hypoxic ischaemic
encephalopathy (HIE) in neonates and compare them with MRI. 2. To
study correlation between resistive index (RI) and outcome of these
babies.
Methods Fourty one neonates (GA 35 weeks or more) admitted in
NICE Institute for Newborn, with clinical suspicion of HIE underwent
neurosonogram using GE Volusion-I on day of admission and follow-up was
done after a week. We evaluated neurosonographic features of HIE and
measured RI in middle cerebral and anterior cerebral arteries. Correlation
was then attempted between RI values and patient outcome. Seven
patients underwent MRI brain using 1.5 Tesla and findings were compared.
Results Thirty six babies with HIE showed bilateral increased
periventricular and subcortical white matter echogenicity with involvement
of basal ganglia. Of them, 28 babies showed RI in normal range
(0.56 - 0.64). These babies were discharged with normal neurological
examination. Five babies showed RI < 0.45, out of which 4 (80%)
did not survive. Remaining 3 babies revealed RI > 0.88 with diastolic
reversal in one. Latter did not survive, and remaining 2 had poor
neurological outcome. MRI done in 7 cases revealed similar features as
neurosonogram, and did not add any further to patient care.
Conclusions Neurosonogram is an effective and inexpensive modality to
diagnose brain changes in HIE. Resistive index estimation in intracranial
arteries has shown good correlation with immediate neurological outcome
of infants. Subjecting a subgroup of cohort to expensive MRI brain may
not contribute to patient care or short-term outcome prediction. This
presentation emphasizes role of neurosonogram and Resistive Index as a
prognostication tool in cystic and non-cystic periventricular leucomalacia
in premature and term neonates with hypoxic ischemic encephalopathy.
Keywords MR, Brain/Brain Stem, Ultrasound
NR025
A Pictorial Essay of Sellar and Parasellar Lesions: Our
Experience
Ameya Jagdish Baxi, Kishore Tourani, Belman Murali,
Thanugonda Nagendra, Sripathi Vidyasagar
Department of Radiodiagnosis, Care Hospitals, Hyderabad, India
Purpose 1. To identify and illustrate spectrum of Sellar and Parasellar
lesions on CT and MRI. 2. To review the pathogenesis.
Methods A diverse range of sellar and parasellar lesions have a similar
radiological appearance. Even simple hyperplasia can mimic neoplastic
lesion .At the same time, infective lesion can mimic malignancy.It is
necessary to have certain characteristic of lesions categorizing them
as benign or malignant or infective pathology noninvasively so that
unnecessary intervention can be avoided. Patients with sellar and parasellar
lesions who came for CT and MRI scanning were included in this study.
Results : Various sellar and parasellar lesions that we came across
were: 1. Normal anatomy and Variants, 2. hyperplasia, 3. pitutary
microadenoma, 4. pitutary macroadenoma hemorrhage, 5. pitutary
microadenoma with apoplexy, 6. craniopharyngioma, 7. tuberculosis,
8. sarcoidosis, 9. empty sella, 10. metastasis, 11. meningioma, 12.
lymphoma, 13. astrocytoma, 14. germ cell tumor, 15. hypophysitis, 16.
diabetes inscipidus, 17. meningitis.
Conclusions This exhibit illustrates normal anatomy and characteristic CT
and MRI findings of various sellar and parasellar lesions with emphasis on
radiological differentiatiation of these lesions from each other.
Keywords MR, Skull
NR027
Lesions of the Corpus Callosum: MR Imaging and
Differential Considerations in Adults and Children with
Spectroscopy Corelation
Thanugonda Nagendra, Kishore Tourani
Department of Radiodaignosis, Care Hospitals, Hyderabad, India
Purpose 1. To study involvement of corpus callosum in various
brain pathologies. 2. To characterize these lesions radiologically with
spectroscopy correlation and metabolite changes. 3. To assess disease
outcome in such patients.
Methods This is a retrospective study done in Care hospital from 1st of
February, 2006 to 31st August, 2009 using 1.5 Tesla MRI. All patients who
underwent Brain MRI during this period were studied for corpus callosum
involvement. We used standard Axial DWI, ADC, Pre and post contrast T1,
T2, FLAIR & Hemo , Coronal FLAIR, Sagittal T2 and FLAIR sequences.
In addition, we also did single section 2D multivoxel spectroscopy was
performed using chemical shift imaging techniques at the level of selected
image.
Results The pathologies we came across were acute and chronic infarcts,
diffuse axonal injury, ADEM, Vasculitis, multiple sclerosis, infections,
tumor, extra pontine myelinolysis, tumor infiltration, lymphoma and
radiation necrosis .While DWI and ADC sequences were most informative
for characterizing acute and chronic infarcts, FLAIR was most useful
for identifying rest of the pathologies. T1 contrast differentiated edema
from tumor infiltration where as spectroscopy differentiated normal from
pathological tissue.
Conclusions Corpus callosum is the major commissural pathway
between brain hemispheres. It plays an integral role in relaying sensory,
motor, and cognitive information between two hemispheres. Magnetic
Resonance Imaging is an effective modality to study corpus callosum and
its involvement in various diseases. MRS may be helpful to demonstrate
metabolite levels and ratios of lesions, and complements conventional MR
imaging.
Keywords Abscess, Acute, MR
NR028
Congenital Anomalies Associated with MoyaMoya Disease
Hsin-Hui Huang
Department of Medical Imaging, Chung-Shan Medical University
Hospital, Taiwan
Purpose We report a case of MoyaMoya disease combined with
encephalocele and suspicious Morning Glory syndrome which
demonstrated by several imaging modalities including multi-detector
computed tomography, brain magnetic resonance images, and carotid
arteriography.
Conclusions MoyaMoya disease is a rare cerebrovascular disorder of
unknown etiology. It can be associated with several underlying congenital
conditions. Carefully review the imaging and keep these congenital
abnormalities in mind can help us to identify the final diagnosis.
Keywords Angiography, MR, Brain/Brain Stem, CT, Skull, Eye
NR029
Differential Diagnosis of Non-Ischemic Hyperintense Signals
on Diffusion MRI: Our Experience
Thanugonda Nagendra, Kishore Tourani, Ravuri Power
Purpose 1. To study and review the pathologies causing hyperintense
signals on DWI sequence in MRI. 2. To study the mechanism of
hyperintensity in each lesions each. 3. To differentiate between them
using additional MR sequences.
Methods Patients undergoing MRI (1.5 t Magneton Sonata) study in Care
Hospitals Hyderabad from Feb 2004 to August 2009 were included in this
study. We used b values within the range of around 1000 to 2000 s/mm2
taking into account both SNR and diffusion weighting of water molecules.
In addition, we also did Axial, Coronal and Sagittal T1, T2, FLAIR, DWI,
ADC, Hemo and postcontrast T1 sequences using standard TR and TE
factors.
607
NR023
Tumors and Tumorlike Lesions of the Craniovertebral
Junction
Sheng-Che Hung¹, Yao-Liang Chen1, Wan-You Guo2, GuangMing Yang3, Cheng-Hsien Wu4
1
Department of Diagnostic Imaging and Intervention, ChangGung Memorial Hospital, Linkou, Taiwan
2
Department of Radiology, Veterans General Hospital, Taiwan
3
Memorial Hospital, Xiamen, Taiwan
4
Department of Diagnostic Radiology, National Cheng Kung
Periventricular Leucomalacia in Neonates
Ameya Jagdish Baxi1, Ashok Mittal2, Belman Murali1, Sripathi
Vidyasagar1, Kishore Tourani1, Thanugonda Nagendra1
1
2
Department of Neonatology, Nice Institute of the Newborn, India
E-Poster
NR020
MRI Diagnosis of Intraspinal Dermoid Ruptured into Central
Spinal Canal
Yong Zhang, Jingliang Cheng
Department of Radiology, The First Affiliated Hospital of
Zhengzhou University, China
the level of L1-2, four at T12-L1, two at L3-4, and two at L2-3. Free fat
droplets within spinal cord central canal and/or spinal subarachnoidal
space demonstrated high signal intensity on T1WI, slight declined signal
intensity on T2WI, and extremely low signal on fat suppression sequence.
Ten cases of spinal dermoid ruptured into central spinal canal in our series
(case 1-case 10), among which, two cases broke into neighboring central
spinal canal of the dermoid (case 1 and case 3), two cases showed
scattered distribution (case 2 and case 4); four cases distributed in the
whole spinal cord central canal (case 5-case 8); one case presented
as strip shape (case 9) and the last one as strip shape (case 10). Case
11 were spinal dermoid ruptured into central spinal canal and spinal
subarachnoidal space, as well as case 12 were only ruptured into spinal
subarachnoidal space.
Conclusions Intraspinal dermoid ruptured in the central spinal canal and/
or spinal subarachnoidal space had specific appearance on MR imaging,
when a dermoid tumor is suspected, MRI of the entire spine were
recommended to detect possible leakage of fat within central spinal canal.
Keywords MR, Spinal Cord
Others
contours on CT scans. Of the 22, 16 (38%) shrank and 6 (14%) grew
in size. Among the 42 ruptured eyeballs, 19 (45%) had lens dislocation
or destruction, 20 (48%) had intraocular hemorrhage, 8 (19%) showed
intraocular gas, 6 (14%) had intraocular foreign bodies, and 12 (29%)
had shallow anterior chambers on CT scans. The mean anterior-posterior
diameter loss (1.6, 0.9-2.2 mm at 95% confidence interval) of anterior
chamber was significantly greater than zero based on a paired t-test
(P<0.001). Twenty-eight (67%) of the 42 ruptured eyeballs had at least
two of the above-mentioned abnormal CT features. Moreover, orbital
fractures and periorbital soft tissue swelling never occurred alone. Night
lesions (21%) consisted of single abnormal CT feature: one intraocular
hemorrhage (2%); one lens dislocation (2%); one size reduction (2%); two
periorbital soft tissue swelling (5%) and four shallow anterior chambers
(10%). Seven (17%) eyeball ruptures were not diagnosed correctly presurgically on CT scans: 5 (12%) showed no obvious abnormal findings,
and two (5%) presented only periorbital soft tissue swelling. There was no
false positive rate.
Conclusions The sensitivity and specificity of CT scans for the detection
of eyeball rupture were 83% and 100%, respectively. Most of the eyeball
ruptures (67%) had at least two abnormal CT features. Shallow anterior
chamber is a useful single CT feature for evaluating eyeball rupture at
cornea.
Keywords Acute, Eye
NR031
Pictorial Reports of Three Cases of Reversible Posterior
Leukoencephalopathy Syndrome (RPLS)
Hillary Ka Ying Tam, Phoenix Pui Yan Lui, Chi Kong Kam, Sai
Chung Ho, Yee Na Tam
Department of Radiology, North District Hospital, Hong Kong,
Hong Kong, China
Purpose To highlight the typical and atypical features of reversible
posterior leukoencephalopathy syndrome (RPLS) and its clinical
significance.
Methods Cases with non-contrast CT brain performed within period
1.4.2009 to 30.6.2009 were reviewed and three cases with imaging
features of reversible posterior leukoencephalopathy syndrome were
selected. Follow up images including CT and MRI were reviewed.
Related literature search is performed via OVID using keywords
"reversible posterior leukoencephalopathy syndrome" and "hypertensive
encephalopathy". Typical and atypical imaging features of RPLS are
highlighted and presented as a pictorial essay.
Results The three cases presented with age ranged from 25 to 54
years old. Two of them are with history of chronic renal disease and
hypertension. They all presented with increased systemic blood pressure.
They had clinical symptoms of headache, generalized weakness, blurring
of vision or convulsion. Two of the cases illustrated typical features of
supratentorial occipital involvement and supratentorial together with
posterior cranial fossa involvement, respectively. The remaining case
illustrated the atypical features of central variant of RPLS. Despite the
extensive imaging findings, all patients show no neurological deficits.
608
Purpose We report a case of extradural meningioma in thoracic spine
with pre-operative impression of metastasis.
Methods A 69 y/o female has complained of numbness and weakness
of bilateral legs for about two months. She has had right sciatic pain for
20 years and had regular follow up at outpatient department. She has
felt abnormal sensation of both legs since 2 months ago, in addition,
progressive numbness and weakness gradually developed.
Results MRI of cervicothoracic spine with and without contrast
enhancement revealed an extradural, dumbbell shape t u m o r
(1.2*0.8*3.5 cm) at T4/T5 level, more on the right. The mass lesion
disclosed homogeneous hypointense on bothT1WI and T2WI and good
enhancement after contrast injection on T1WI. Metastatic mass or
neurogenic tumor was impressed. After surgical removal of the tumor,
pathological diagnosis of extradural meningioma was confirmed.
Conclusions Meningioma is one of the most common spinal tumors,
and most are of the intradural type. Spinal epidural meningiomas are
rare lesions which account for only 2.7-10% of all spinal meningioma.
Extradural meningiomas are more common in younger patients and are
more invasive and aggressive than the usual intradual type. Extradural
spinal mass could generally be considered as metastatic lesion or
neurogenic tumor. According to the patient’s age, metastatic lesion was
considered first. We report this case in order to emphasize the importance
of tissue-proof which guides the plan of treatment.
Keywords Spine
NR034
Anatomical Organization of the Blind's Brain: Combined
VBM and DTI Analysis
Zhi Wang 1, William Barre 2, Tim Dyrby 2, Olaf Paulson 2, Ron
Kupers2, Maurice Ptito3, Cheng Zhou1
1
2
Department of MR, Denmark Research Center for Magnetic
Resonance, Denmark
3
Department of MR, Denmark Research Center for Magnetic
Resonance, Canada
Purpose To explore the whole brain grey and white matter organization in
a large cohort of CB individuals compared to NS controls using Diffusion
Tensor Imaging (DTI) and tractography (DTT).
Methods 13 CB and 13 NS were scanned in this experiment. T1WI, T2WI,
and DWI (61 directions; b=1200 s/mm2) were acquired on a Siemens 3T
scanner. T1 and T2 images were segmented using the vbm5 toolbox in
SPM5. DARTEL was used for high dimensional intersubject registration.
The diffusion tensor was fitted using the RESTORE algorithm.Randomize
(FSL) was used for analyzing TBSS data. Significance levels: p=0.01,
FWE-corrected; Covariates: age, gender, weight, height and intracranial
volume.
Results All structures belonging to the visual system show significant
volume reductions.All components of the Retino-geniculo-striate system
NR035
Image Fusion of Functional Magnetic Resonance Imaging
and Diffusion Tensor Imaging
Zhi Wang¹, Yue Guo1, Min Chen1, Hong Gao1, Zhuang Cui2, Fei
Sun3, Cheng Zhou1
1
2
Department of Neurosurgery, Beijing Hospital, China
3
Department of Research and Developing, General Electronics
Corporation, China
Purpose To develop an image fusion software (fDf, fMRI/DTI fusion) which
can overlap the structural, functional MRI (fMRI) and Diffusion Tensor
Imaging simultaneously for preoperational evaluation of tumor patients’.
Methods fMRI with bilateral hands grasp movement and DTI were
performed using GE 1.5T magnetic resonance system on 10 subjects (5
healthy volunteers and 5 patients with brain tumor, of which 3 metastases,
1 cavernous hemangioma and 1 glioma). All data were input to the
personal computer and off-line postprocessing of fMRI and DTI data was
performed using SPM5 and Volume-One software package to visualize
the activated functional cortex areas and corticospinal tracts. fDf is used
to import the fMRI and structural images to Volume-One to show them
simultaneously.
Results Brain functional activation maps and diffusion tensor fiber
tracking images were obtained in all five healthy volunteers and four
patients except one who suffered from left hemiplegia. The functional
activation maps and the fiber tracking images are successfully fused by
the fDf software, where the activations areas and the white matter fiber
are displayed together. The fusion images of healthy volunteers showed
the hand motion areas and corresponding corticospinal tracts, while that of
the patients display the relationship of the eloquent cortex and peritumoral
fiber tracts, which are useful in guiding the treatments for the surgeons
and radiotherapists.
Conclusions All the results confirmed that the image fusion software
worked well for all the data. The neurosurgeons and radiotherapists
considered the software were very helpful for preoperative planning.
Keywords MR, Brain/Brain Stem, Computer Applications
Methods Institutional review board approved this prospective study, and
all informed consents were obtained. A total of 84 subjects were enrolled.
All subjects went through a detailed clinical history and comprehensive
neuropsychological tests, which include neuropsychological assessment,
mini-mental state examination, cognitive abilities screening instrument,
neuropsychiatric inventory and clinical dementia rating. The diagnostic
criteria were based on the National Institute of Neurologic, Communicative
Disorders and Stroke-AD and Related Disorders Association. All subjects
underwent MRI examination using a 3T scanner, including 30 patients
with probable AD, 24 with MCI, and 30 with normal cognitive function. Two
neuroradiologists rated the images independently by a medial temporal
lobe atrophy score (MTA score). The probability of medial temporal lobe
atrophy was rated by a five-point (0 to 4) scoring system according to
Scheltens et al. Ratings of 2-4 were considered to be positive results for
medial temporal lobe atrophy.
Results Twenty three (76.6%) out of 30 probable AD patients had scores
ranging from 2 to 4, 8 (33.3%) of 24 MCI patients had scores of 2-4,
while 27 (90%) of 30 control subjects had scores of 0 or 1. None of the
normal controls had a score of 4, whereas only one probable AD patient
had a score of 0. The average MTA scores of AD, MCI and normal were
2.80 (S.D. 1.30), 1.10 (S.D. 1.08), and 0.43 (S.D. 0.69) respectively. The
differences between groups were statistically significant (p<0.0001).
Conclusions For clinical practice, visual ratings on MR images acquired
at 3 Tesla provide a useful and rapid assessment of medial temporal lobe
atrophy.
Keywords MR, Dementia
NR042
Intracranial Aneurysm Detection with 4-Channel
Multidetector CT Angiography: Thin-Slab Maximum Intensity
Projection (MIP) versus Volume Rendering (VR)
Te-Chang Wu, Yu-Kun Tsui, Chien-Ren Lin, Tai-Ching Wu, TaiYuan Chen, Wen-Tseng Tzeng
Department of Radiology, Chi-Mei Foundation Hospital, Taiwan
NR039
Visual Rating of Medial Temporal Lobe Atrophy in Probable
Alzheimer’s Disease, Mild Cognitive Impairment and Normal
Aging: Evaluation with 3T MR Imaging
Yauyau Wai 1, Wen-Chuin Hsu 2, Hao-Li Liu 3, Jiun-Jie Wang 4,
Hon-Chung Fung2, Shu-Hang Ng2
1
Department of Medical Imaging & Intervention, Chang Gung
2
Department of Medical Imaging & Neurology, Chang Gung
3
Taiwan
4
Purpose To compare the aneurysm detection rate between thin-slab MIP
and VR images in 4-channel multidetector CT angiography.
Methods From June, 2007 to May, 2009, total 158 consecutive patients
underwent four-section CT angiography in the ER of our hospital. Most
indications are severe explosive headache and SAH in the plain CT
presumed to be aneurysm rupture. The inclusion criteria are intracranial
aneurysm or other hemorrhagic vascular anomalies confirmed by surgery
or CTA consensus by two neuroradiologists [T.C.W and Y.K.T]. CT
angiography and digital subtraction angiography results were evaluated
independently with 2D MIP and 3D VR images separately.
Results Total 124 patients are included, 84 patients of which had 101
aneurysms and 30 patients of which had other vascular anomalies. Five
aneurysms are missed by CT angiography, all of which are less than
3 mm. Six aneurysms were not confirmed by using digital subtraction
angiography, four of which are at MCA bifurcation. The sensitivity,
specificity and accuracy of CTA for all aneurysms were 0.95, 0.87 and
0.92 respectively. The sensitivity for detecting aneurysm <=3 mm and
>3 mm are 0.75 and 1.00 respectively. The sensitivity of MIP and VR
images for all aneurysms was 0.93 and 0.77, respectively. In aneurysms
>3 mm, all of them were detected by MIP images but 14 aneurysm were
not detected by VR images. In aneurysms <=3 mm, seven and night
aneurysms were not detected by MIP images and VR images respectively.
Overall, MIP images detected 16 aneurysms more than VR images if each
reformation images utilized separately.
Conclusions Four-slice CT angiography has high sensitivity and accuracy
for aneurysm detection, especially for aneurysm >3 mm. MIP images, that
is easily got and less reformation limitation in the four-slice CT is more
robust than VR images for aneurysm detection.
Keywords Aneurysms, Angiography, Brain/Brain Stem, CT, Image
Manipulation/Reconstruction, Interventional
Purpose To prospectively evaluate whether visual assessment of medial
temporal lobe atrophy on 3T MR images could distinguish patients with
probable Alzheimer’s disease (AD), from mild cognitive impairment (MCI)
and normal age-matched subjects.
NR044
Isolated Intracranial Rosai Dorfman Disease with Unusual
“Hamburger-Like” Imaging Appearance – Case Report
609
Purpose To demonstrate unusual MRI findings of hypertensive
encephalopathy
Methods A 46-year-old man with chronic hypertension presented with
acute double vision. Arterial blood pressure was 188/125 at admission.
Brain MRI showed hyperintensities in cerebral periventricular region and
pons on T2-weighted and fluid-attenuated inversion recovery (FLAIR)
images. Laboratory examinations and renal echo were unremarkable.
Results The patient's symptom resolved completely in a few days after
control of blood pressure. Complete resolution of the periventricular and
pontine hyperintensities in follow-up MRI one month later confirmed the
diagnosis of acute hypertensive encephalopathy.
Conclusions Acute hypertensive encephalopathy involving cerebral
periventricular region and brainstem without accompanying cerebral
cortical and subcortical lesions is rare. To be familiar with this unusual
imaging finding helps make a correct diagnosis.
Keywords Acute, MR, Brain/Brain Stem, Hypertension
NR033
Extradural Meningioma in Thoracic Spine: A Case Report
Ching-Wen Huang
Department of Radiology, Shin Kong Wu Ho-Su Memorial
Hospital, Taiwan
including optic nerve, chiasm, lateral geniculate nucleus, optic radiations
and visual cortex were reduced. In the Non-visual areas changes were
observed in the posterior hippocampus and parts of the frontal and
temporal lobes. However, we did not observe any areas with increased
densities of grey and/or white matter.
Conclusions We show for the first time large reductions in the midbrain
visual structures. Our VBM data however did not confirm the enlargement
of the fronto-occipital and the supra-longitudinal fasciculi previously
reported. Our ongoing DTI analysis may still confirm earlier findings.
Keywords MR, Brain/Brain Stem, Congenital
E-Poster
NR030
Atypical MRI Findings of Hypertensive Encephalopathy
Fan Yang-Kai
All the cases showed rapid clinical improvement after blood pressure
stabilization. The later two cases with follow up scans performed and
reversibility was demonstrated.
Conclusions -Atypical imaging manifestations of RPLS are indeed more
common than previously perceived. Radiologists should be aware of the
atypical patterns of RPLS. -Clinical correlation with blood pressure and
physical findings is crucial in exclusion of other sinister entities. Prompt
recognition of the imaging patterns of RPLS facilitates proper treatment
and avoids unnecessary investigations. -Reversibility is a defining feature
of reversible posterior leukoencephalopathy syndrome. Follow up imaging
is recommended whenever necessary for confirmation of the diagnosis.
Keywords Brain/Brain Stem, Hypertension
Others
Results Other than acute infarcts, we came across different pathologies
like granulomas (mostly tuberculomas and cysticercosis), abscess, Acute
hematoma, Multiple sclerosis and demyelination, Encephalitis, Vasculitis,
Central pontine myelinosis, Reversible posterior leukoencephalopathy
and tumors like Central neurocytoma ,Lymphomas, Epidermoid,
Medulloblastoma, Atypical meningiomas and Hemangiopericytoma. MR
Spectroscopy also helped to differentiate these lesions.
Conclusions Diffusion-weighted imaging is a widely used MRI technique
with rapid acquisition time. A hyperintense signal on DWI is very
sensitive to detect acute cerebral ischemia but is not specific, i.e. not
every hyperintensity on DWI is an ischemic stroke. Consequently, DWI
with high intensity signals, commonly called positive DWI, is sometimes
misinterpreted as infarcts and leads to incorrect medical management. In
this exhibit, we briefly discuss some of the essential, technical aspects of
DWI and report various clinical scenarios and their differentiation, which
may lead to positive DWI findings but are not ischemic strokes.
Keywords Abscess, Acute, Lymphoma, MR
NR045
Neuroimagings of Semantic Dementia
Noriko Kitamura¹, Hitoshi Terada1, Terumitsu Hasebe1, Seigo
Nakano2, Mizuki Oka3, Ryuji Sakakibara4, Hideo Morita1
1
Department of Radiology, Toho University Sakura Medical
Center, Japan
2
Department of Internal Medicine, Clinical Pharmacology Center,
Honjo Clinic, Japan
3
Department of Psychiatry, Sakurgaoka Memorial Hospital,
Japan
4
Department of Neurology, Toho University Sakura Medical
Center, Japan
Purpose Semantic dementia (SD) is a unique frontotemporal lobar
degeneration (FTLD) characterized by the loss of meaning or knowledge
for words and objects. Converging evidence from neuropathologic,
neuroradiologic, and neuropsychological studies has indicated that SD is
associated with atrophy in the anterior temporal lobes. Rare studies have
used statistical analysis to assess atrophy to examine functional changes
in SD.
Methods We used MR imaging and voxel-based morphometry to assess
atrophy, and single photon emission tomography (SPECT) and statistical
parametric mapping to examine functional changes in two cases of SD.
Results MR imaging in both cases showed left temporal lobe atrophy
without any ischemic changes. The voxel-based specific regional analysis
system (VSRAD) showed tissue loss especially in the anterior temporal
cortex and the anterior hippocampal region. SPECT demonstrated
temporal lobe involvement. Statistical analysis showed decreases of
cerebral blood flow in a specific region, tip of the temporal lobe.
Conclusions The main alterations concerned the left temporal lobe,
in accordance with the striking impairment of semantic memory in SD
patients. Hypoperfusion was more extensive than grey matter loss in both
temporal lobes. While SPECT is more sensitive than MRI, there is striking
concordance between morphological and functional abnormalities, which
610
Purpose Though 3T magnetic resonance scanner is getting more and
more popular, 1.5T MRI is still used by the majority on clinical purpose for
most medical center all over the world until now. We performed a motortask experiment in this study to proof if 1.5T MRI provides well enough
spatial resolution on brain functional research.
Methods Totally five healthy young right-handed subjects (21±1 years)
were enrolled for this study, four were acquired with standard resolution
(64x64) on T2* EPI functional scan and the fifth subject were acquired
both standard and high resolution (64x128). A standard block-design
with totally 40 phases (2 rests, 2 stimulations) were used for functional
scan, all subjects performed three different motor tasks (finger, wrist, and
elbow). Functional data were analyzed by SPM2.
Results Both st

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