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C Electronic Poster Sessions (EPS) ......... 338

Abdominal Viscera (Solid Organs) ............. 343GI Tract ....................................................... 363Breast ......................................................... 380Cardiac ....................................................... 391Chest .......................................................... 401Computer Applications ............................... 417Contrast Media ........................................... 421Molecular Imaging ...................................... 425Genitourinary.............................................. 426Head and Neck........................................... 440Interventional Radiology ............................. 449Musculoskeletal .......................................... 462Neuro ......................................................... 483Pediatric ..................................................... 505Physics in Radiology .................................. 516Radiographers ............................................ 522Vascular ..................................................... 524ECR Research Grant Winners ................... 536

Scientific andEducational Exhibits

This icon indicates an exhibit scheduledfor an electronic poster session (EPS)

in one of the EPOS theatres on the second level.

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FFFFFridaridaridaridaridayyyyy, Mar, Mar, Mar, Mar, Marccccch 5, 2004h 5, 2004h 5, 2004h 5, 2004h 5, 2004

13:15 - 14:00 Abbey

EPS 03CardiacModerator:V.E. Sinitsyn; Moscow/RU

C-238The value of magnetic resonance imaging in the assessment of adultpatients with corrected transposition of the great arteriesS. Shine, E. Kavanagh, C. Cantwell, K. Walsh, A.E. Wood, J.G. Murray;Dublin/IE

C-246Positron emission tomography and 13N-ammonia application to evaluatemyocardial blood flow in the asymptomatic patients with coronary arterycalcificationD.V. Ryzkhova, I.E. Itskovich, L.A. Tyutin, L.A. Kofal; St. Petersburg/RU

C-248One-year CT evaluation of pulmonary veins following percutaneouscryoablation in patients treated for atrial fibrillationB. Ghaye1, D. Szapiro1, C. Timmermans2, L.-M. Rodriguez2, H.-F. Tse3,C. Geller4, G. Ayers2, R.F. Dondelinger1; 1Liège/BE, 2Maastricht/NL,3Hong Kong/CN, 4Magdeburg/DE

C-249Myocardial delayed enhancement on MRI: Its prognostic significance inpatients with congestive heart failure due to nonischemic dilatedcardiomyopathyH. Saito, H. Otani, T. Ishibashi, A. Sato, K. Takase, T. Matsuhashi, T. Yamada,S. Takahashi; Sendai/JP

C-269Multi-detector row CT for the assessment of atrial septal defect andpulmonary venous drainage in adultsG. Morgan-Hughes, A. Marshall, C. Roobottom; Plymouth/UK

13:15 - 14:00 Empire

EPS 05Computer ApplicationsModerator:E. Bellon; Leuven/BE

C-360PACS: Ergonomic considerationsC.L. Arnoldus, C.J. Zylak, M. Flynn; Detroit, MI/US

C-367Web computed radiography: A solution for X-ray examinations in AfricaD.J. Gardeur1, E.H. Niang2; 1Paris/FR, 2Dakar/SN

C-369Clinical validation of a tele-operated mobile ultrasound scanner using alight weight robot (OTELO project)R. Gilabert1, M. Vannoni1, F. Courreges2, C. Delgorge2, C. Novales2,G. Poisson2, P. Vieyres2, C. Bru1; 1Barcelona/ES, 2Bourges/FR

C-372Performance assessment of a wavelet contrast enhancement method indense parenchyma based on simulated lesionsS. Skiadopoulos, L. Costaridou, P. Sakellaropoulos, C. Kalogeropoulou,E. Likaki, G. Panayiotakis; Patras/GR

C-373Estimating the arterial compliance in early stages of atherosclerosis:Evaluation of a new index on the curve-fitted Doppler sonogramsN. Erdogan, S. Kara, F. Dirgenali, M. Okandan; Kayseri/TR

13:15 - 14:00 Old Vic

EPS 01bGastrointestinal TractModerator:A.Z. Ginai; Rotterdam/NL

C-102Detection of T-stage in cardiac cancer: Comparing MR to multislice CTZ. Pan, H. Zhang, H. Ling, B. Ding, K. Chen; Shanghai/CN

C-121Diagnosis and staging of colorectal carcinomas using multislice CTcolonography (MSCTC): Pictorial essay with pathologic correlationR. Iannaccone, A. Laghi, C. Catalano, A. Lamazza, F. Mangiapane, S. Trenna,D. Marin, A. Schillaci, R. Passariello; Rome/IT

C-145Small bowel sonography in celiac disease after oral administration ofsonographic contrast mediumP. Mirk, R. Foschi, I. De Vitis, L. Guidi, A. Vecchioli-Scaldazza, P. Marano;Rome/IT

C-156A pictorial review of out of hours CT abdomen and pelvis performed foracute abdominal pain: A personal experience of what a trainee radiologist isup againstC. Tam, D. Nicholson; Manchester/UK

C-172Suspected bile duct leaks after laparoscopic cholecystectomy: Role ofmangafodipir-enhanced MR cholangiographyM. Aduna1, J. Larena1, D. Martin1, B. Martínez de Guereñu2, J. Alústiza3;1Bilbao/ES, 2Vitoria/ES, 3Donosti/ES

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Scientific Exhibits - Electronic Poster Sessions

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SaSaSaSaSaturturturturturdadadadadayyyyy, Mar, Mar, Mar, Mar, Marccccch 6, 2004h 6, 2004h 6, 2004h 6, 2004h 6, 2004

13:00 - 13:45 Abbey

EPS 02BreastModerator:R. Given-Wilson; London/UK

C-192Image quality of commercially available digital mammography systemscompared by contrast-detail analysisT.D. Geertse, R.E. van Engen, L.J. Oostveen, R. Visser, M.A.O. Thijssen;Nijmegen/NL

C-209Breast ultrasound: An evaluation of the use of frequency-modulated(CHIRP) signal pulsesS.S.S. Tan, B.P. Tan, G.K.L. Wansaicheong, B.K. Chong; Singapore/SG

C-230The importance of radiological imaging of mammary implants aftersimulation of recreational diving conditionsI.O.J. Verslegers, S. Van Poucke, B. Stockman, W. Tjalma, M. Van Goethem,A. De Schepper, P.M. Parizel; Antwerp/BE

C-231Resection of non-palpable breast cancer using 3D imaging created bymultislice helical CT: A new interventional technique to design resectionlines in breast preserving surgeryK. Oda, T. Kubota, H. Satake, A. Sawaki, T. Ishigaki, Y. Nimura; Nagoya/JP

C-232European breast screening performance: Does case volume matter?H.J. Scott1, A.G. Gale1, D. Wooding1, D. Walter2; 1Derby/UK, 2Augsburg/DE

13:00 - 13:45 Empire

EPS 09Interventional RadiologyModerator:J. Lammer; Vienna/AT

C-521Percutaneous islet cell transplantation for type I diabetes: Technique andindicationsR.D. Garcia-Monaco, R. Lambertini, S. Hyon, C. Ceballos, P. Argibay;Buenos Aires/AR

C-532Effect of vessel size on creation of pulmonary radiofrequency lesions insheep: Assessment of the "heat sink" effectK. Steinke1, K.S. Haghighi2, K.K. Hazratwala2, D.L. Morris2; 1Basle/CH,2Sydney/AU

C-555In-vivo transcatheter implantation of a new aortic stent-valve for thetemporary relief of acute aortic insufficiencyM. Hashimoto1, T. Kaminou1, P. Haage2, Y. Ohuchi1, K. Nakamura1, K. Sugiura1,Y. Noishiki3, R.W. Günther2, T. Ogawa1; 1Yonago/JP, 2Aachen/DE,3Yokohama/JP

C-557A comparative study of transjugular intrahepatic portosystemic shunt andtranscatheter sclerotherapy for gastric varicesT. Ninoi1, K. Nakamura1, N. Nishida1, Y. Sakai1, T. Kitayama1, M. Hamuro1,R. Yamada1, Y. Inoue1, T. Kaminou2; 1Osaka/JP, 2Yonago/JP

C-558Interest of portal vein embolization combined with two-stage hepatectomyin treatment of colorectal liver metastasesM. Greget, N. Pfleger, P. Briggs, E. Blonde, F. Veillon, D. Jaeck; Strasbourg/FR

13:00 - 13:45 Old Vic

EPS 01aAbdominal Viscera (Solid Organs)Moderator:P.K. Prassopoulos; Alexandroupolis/GR

C-007Will prospective respiratory gating (PACE) round off breath-hold in MRCP?E. de Kerviler1, A.-M. Zagdanski1, M. Allez1, P. Bourrier1, A. Stemmer2, J. Frija1;1Paris/FR, 2Erlangen/DE

C-008Magnetic resonance pancreatography versus endoscopic ultrasonographyin suspected common bile duct lithiasis: A prospective, comparative studyB. Delorme1, C. Aube1, T. Yset2, P. Burtin1, J. Lebigot1, P. Pessaux1,C. Gondry-Jouet1, J. Boyer1, C. Caron-Poitreau1; 1Angers/FR, 2Amiens/FR

C-034Proton MR spectroscopy and diffusion-weighted MR imaging at 3.0 T for thediagnosis and monitoring of therapeutic effect on hepatocellular carcinomabefore and after chemoembolizationC.-Y. Chen, G.-C. Liu, Y.-T. Kuo, T.-S. Jaw; Kaohsiung/TW

C-036Conventional and Doppler ultrasonography as control methods forabstinence in alcoholic liver cirrhosis patientsO.Y. Chipov, V.E. Syutkin, I.O. Ivanikov; Moscow/RU

C-066Acute pancreatitis: Value of MRI and MRCPJ. Elias Jr, M.N. Simão, V.F. Muglia, A.C. Santos, J.S. Santos, C.S. Trad;Ribeirao Preto/BR

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13:00 - 13:45 Abbey

EPS 11NeuroModerator:P. Brennan; Dublin/IE

C-707MRI of the brain in inherited neurometabolic disorders: A pictorial reviewS.P. Prabhu, S.A. Barnard, N. Stoodley, S.A. Renowden; Bristol/UK

C-766Axial DW-EPI study of biexponential water diffusion in human cervicalspinal cordA. Jasinski1, B. Tomasz1, M. Konopka2, P. Pieniazek2, M. Hartel2, T. Skorka1,W.P. Weglarz1; 1Krakow/PL, 2Katowice/PL

C-769Imaging of the craniocervical junction: Development, normal anatomy andpathological statesJ. Rimola, A. Carvajal, A. Rovira Gols, M. Zauner, P. Bermúdez, A. Massuet;Sabadell/ES

C-783Preoperative mapping of eloquent white matter using diffusion tensorimagingC.V. Salvan, A. Aralasmak, J.L. Ulmer, R.W. Prost, E.A. DeYoe, L. Hacein-Bey,D.L. Daniels, H.G. Krouwer, W.M. Mueller; Milwaukee, WI/US

C-784High resolution MR neurography application in patients with cervicalradiculopathyZ. Erdem, O. Erdem, F. Cagavi, M. Kalayci, S. Gündogdu, B. Acikgoz;Zonguldak/TR

13:00 - 13:45 Empire

EPS 15VascularModerator:D. Vorwerk; Ingolstadt/DE

C-8994D visualisation of cardiovascular pathologies: Computational fluiddynamics (CFD) utilizing isotropic CT-angiography datasetsT. Frauenfelder, E. Boutsianis, T. Boehm, N. Teodorovic, B. Marincek,S. Wildermuth; Zürich/CH

C-900Contrast-enhanced MR venography of the central veinsC.J. Johnston, J. Mc Cann, E. Laffan, J.F.M. Meaney; Dublin/IE

C-915Endovascular stent-graft placement for treatment of thoracic aorticaneurysmsM. Fernández -Velilla, G. Garzón, I. Acitores, F. Ibáñez, L. Riera; Madrid/ES

C-924An evaluation of internal carotid artery and cerebral blood flow volumeusing color duplex sonography in patients with vertebral artery hypoplasiaM. Acar, B. Degirmenci, A. Yucel, R. Albayrak; Afyon/TR

C-942MRA evaluation of renovascular hypertension: PAT optimized 3D contrastenhanced, phase-contrast, and time-of-flight MR angiography using 12-channel phased array body coilÖ. Özsarlak, P.M. Parizel; Antwerp/BE

13:00 - 13:45 Old Vic

EPS 04ChestModerator:C. Schaefer-Prokop; Vienna/AT

C-291Smoking-related interstitial lung diseases: Radiologic-pathologiccorrelationA. Hidalgo, T. Franquet, A. Giménez, R. Pineda, M. Madrid; Barcelona/ES

C-292The spectrum of CT appearances in pulmonary amyloidosisA. Aylwin, P. Gishen, A. Nicholson, S. Copley; London/UK

C-313The chest radiological appearances of severe acute respiratory syndrome(SARS): Analysis of 54 casesT. Yu, Y. Zhang, W. Li, N. Ye, Y. Cai, Q. Xu; Tianjin/CN

C-325Simulated low radiation dose CT angiography of pulmonary arteriesD. Tack1, V. De Maertelaer2, C. Suess3, P. Muller4, P. Scillia2, W. Petit2,P. Gevenois2; 1Baudour/BE, 2Brussels/BE, 3Forchheim/DE, 4Charleroi/BE

C-339Pulmonary hypertension: CT of the chest in pulmonary veno-occlusivediseaseA. Resten, S. Maître, M. Humbert, F. Capron, G. Simonneau, D. Musset;Clamart/FR

16:00 - 17:30 Abbey

EPS R&EECR Research Grant WinnersModerator:N. Gourtsoyiannis; Iraklion/GR

C-955Optimized techniques for the labeling of human natural killer cells with ironoxide contrast agentsH.E. Daldrup-Link, G. Piontek, M. Rudelius, C. Uherek, J. Schlegel,E. Rummeny; Munich/DE

C-956Which temporal frame rate is necessary in quantitative dynamic ³He-MRI?C. Heussel1, A. Dahmen1, F. Lehmann1, M. Salerno2, K.K. Gast1,H.-U. Kauczor1, J.P.I. Mugler2, E.E. de Lange2, W. Schreiber1; 1Mainz/DE,2Charlottesville, VA/US

C-957Anatomical and functional premotor correlations in supplementary motorarea lesionA. Krainik1, G. Marrelec1, H. Duffau1, P. Cornu1, L. Capelle1, A.-.L. Boch1,J.-.F. Mangin2, D. Le Bihan2, C. Marsault1, J. Chiras1, H. Benali1, S. Lehéricy1;1Paris/FR, 2Orsay/FR

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Scientific Exhibits - Electronic Poster Sessions

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C-958The use of internet filters to build a radiology education and teachingresourceP. Davison, J. Revell, M.R. Rees; Bristol/UK

C-959Single breath-hold subtraction: Novel approach to diagnosing pulmonaryembolism by multi-slice CT (work-in-progress)J.E. Wildberger1, A.H. Mahnken1, H. Ditt2, M.U. Niethammer2, E. Spüntrup1,E. Klotz2, R.W. Günther1; 1Aachen/DE, 2Forchheim/DE

C-960Assessment of the angioarchitecture and hemodynamic characteristics ofcerebral AVMs by contrast enhanced static and non enhanced dynamic MRangiographyM. Essig; Heidelberg/DE

C-961Diagnostic investigations in relation to determination of paramagneticcentres and free radicals in the model of testicular tumor metastasesM. Kekelidze, F. Todua; Tbilisi/GE

C-962Diagnostic accuracy of Gadolinium-enhanced MR-angiography vs. contrast-enhanced helical CT in the diagnosis of pulmonary embolism in thepresence of lung infiltrate: An animal studyT. Franquet, S.E. Kalloger, A. Oikonomou, S.L. MacDonald, E.M. Baile,R.J. Mayo; Barcelona/ES

MondaMondaMondaMondaMondayyyyy, Mar, Mar, Mar, Mar, Marccccch 8, 2004h 8, 2004h 8, 2004h 8, 2004h 8, 2004

13:00 - 13:45 Abbey

EPS 12PediatricModerator:A. Duncan; Bristol/UK

C-802Spinal ultrasound in newbornsM. Torres, S. Dieguez, M. Rasero, M.M. Miralles, C. Serrano; Madrid/ES

C-804Neck masses in infants and children: A pictorial reviewJ.R.A. Turkington, A. Paterson, L.E. Sweeney, G. Thornbury; Belfast/UK

C-807Misinterpretation of trauma films by radiographersD.W. Pilling, H.S. Lloyd; Liverpool/UK

C-824Optic nerve ultrasound in assessment of raised intracranial pressure: Itsrole in clinical practiceL.C. Bamford, A. Paterson, G. Cran, J. Turner, S. McKinstry, P. Flynn,L.E. Sweeney; Belfast/UK

C-825Magnetic resonance urography in the diagnostic work-up of infants andsmall childrenG.I. Kirova, M. Minkov, T. Georgieva, G. Hadjidekov; Sofia/BG

13:00 - 13:45 Empire

EPS 13Physics in RadiologyModerator:T.G. Maris; Iraklion/GR

C-861Practical experience with the application of the "Digital addendum of theEuropean protocol for quality assurance in mammography"H. Bosmans1, F. Rogge1, A.-K. Carton1, K. Young2, R. van Engen3,M. Thijssen3, G. Marchal1; 1Leuven/BE, 2Guildford/UK, 3Nijmegen/NL

C-864Adventures in non medical radiographyA.A. Alhajeri, D. McKenna, B. Tuohy, C. Roche, P. McCarthy; Galway/IE

C-868Potential of phase contrast in X-ray imagingP. Monnin1, R. Meuli1, J. Hoszowska2, J.-F. Valley1, F.R. Verdun1;1Lausanne/CH, 2Grenoble/FR

C-872RF-induced artifacts due to aneurysm clips in MRT at 3.0 TU.A. Lauer, H. Graf, F. Schick, C.D. Claussen; Tübingen/DE

C-874Follow-up of patients subjected to high skin radiation dose as aconsequence of repeated interventional cardiology proceduresR. Padovani, G. Bernardi, E. Quai, M. Signor, H. Toh; Udine/IT

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13:00 - 13:45 Old Vic

EPS 08Head and NeckModerator:R. Maroldi; Brescia/IT

C-477Imaging strategies, evaluation, and management of congenitalneurosensorial hearing lossM. de Juan-Delago, J. Ruscalleda Nadal, C. Meda Bolunya,L. San Roman Manzanera, E. Guardia Mas, C. Castaño Duque; Barcelona/ES

C-478The diagnostic value of diffusion coefficient in the characterization ofparotid tumorsA. Kalai, F. Petit, Y.K. Maratos, F. Guerfala, N. Bely, P. Halimi; Paris/FR

C-486MRI of the inner ear structures: 1.5 T versus 3.0 TH. Graf, F. Schick, C.D. Claussen, M.D. Seemann; Tübingen/DE

C-489Digital radiography density measurements in differentiation of periapicalgranulomas and radicular cystsI.K. Rozylo-Kalinowska; Lublin/PL

C-507Neck imaging with MR to determine needle angles and safe depths for localanaesthesia in interscalene brachial plexus nerve blocksR.N. Patel, A.M. Sardesai, M.J. Herrick, A.K. Dixon; Cambridge/UK

16:00 - 16:45 Abbey

EPS 07GenitourinaryModerator:G. Heinz-Peer; Vienna/AT

C-404MRI atlas of post surgical appearances for pelvic floor dysfunctionM. Pouquet1, B. Caire-Gana1, J. Villeval2, Y. Aubard1, J. Rouanet2,A.J.M. Maubon1; 1Limoges/FR, 2Montpellier/FR

C-405Postpartum uterus: What is normal? What is pathological? Evaluation withultrasound and CTI. Escape, J. Martinez, F. Bastart, L. Ortega, C. Solduga; Barcelona/ES

C-422Radiologic-pathologic correlation of different macroscopic and microscopiccomponents in solid and cystic renal tumoursE. Quaia, M. Belgrano, L. Calderan, S. Cernic, G. Tona, R. Pozzi Mucelli;Trieste/IT

C-443Color Doppler ultrasonography in scrotal traumaL. Rocher, A. Giuria, A. Miquel, P. Eschwege, S. Droupy, M. Bléry, Y. Menu; LeKremlin-Bicêtre/FR

C-466Reduction of ionising radiation exposure to patients due to new imagingtechnology for medical diagnostics of the urinary tract: A retrospectivestudy covering 20 years in a Norwegian referral hospitalA. Nyquist1, I. Børretzen2, H. Olerud2, B. Bjørnarå1, T. Gudmundsen1;1Drammen/NO, 2Oslo/NO

16:00 - 16:45 Empire

EPS 10MusculoskeletalModerator:K. Bohndorf; Augsburg/DE

C-597Morphology of the scaphoid nonunion in high resolution helical multislicecomputed tomographyG.P. Christopoulos, R. Schmitt, G. Coblenz, S. Froehner, M. Wagner,H. Brunner, K.-H. Kalb, H. Krimmer; Bad Neustadt a. d. Saale/DE

C-598Whole-body MRI for detection skeletal metastases in cancer patients and inbenign pathology of bonesJ. Barcelo1, J. Vilanova1, M. Villalon1, M. Figueres2, E. Riera1, A. Rubio1;1Girona/ES, 2Palamos/ES

C-602Multiple myeloma: Predictive value of MRI of the spine and 99Tc MIBIscintigraphy in the diagnosis and therapyJ. Nekula, M. Myslivecek, J. Bacovský, V. Šcudla, D. Horák; Olomouc/CZ

C-622MR imaging features of foot involvement in ankylosing spondylitis patientsZ. Erdem, S. Sarikaya, O. Erdem, S. Ozdolap, S. Gundogdu; Zonguldak/TR

C-678A new method for radio frequency of lumbar disc in treatment of chroniclow back painN. Azulay1, M. Forgerit2, A. Moumouh1, E. Alava3, P. Vandermarq1, J.-P. Tasu1;1Poitiers/FR, 2Niort/FR, 3Barcelona/ES

16:00 - 16:45 Old Vic

EPS 06Contrast Media/Molecular ImagingModerator:P. Reimer; Karlsruhe/DE

C-380Clinical impact of liver specific contrast agents in liver imagingA. Ba-Ssalamah, M. Uffmann, S. Mehrain, S. Schweighofer, W. Schima;Vienna/AT

C-381Doppler rescue: A review of the use of ultrasound microbubble contrastagents in the visualisation of the large vesselsK. Satchithananda, M.E.K. Sellars, S.M. Ryan, P.S. Sidhu; London/UK

C-388Optimized IV contrast administration protocols for diagnostic PET/CTimagingT. Beyer, G. Antoch, S. Rosenbaum, L. Freudenberg, T. Fehlings, J. Stattaus;Essen/DE

C-400Quantitative 3D-reslicing essentially improves comparison of histologicalimages with radiological dataF.M.A. Kiessling, M. Le-Huu, T. Kunert, M. Thorn, S. Vosseler, K. Schmidt,W. Semmler, H.-P. Meinzer, N. Fusenig; Heidelberg/DE

C-401Monitoring of tumor response to anti-angiogenic treatment by iron oxideenhanced MRIT. Persigehl, L. Matuszewski, A. Wall, R. Bieker, T. Kessler, W. Berdel,W. Heindel, R. Mesters, C. Bremer; Münster/DE

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Scientific and Educational Exhibits

C 343B D E FA G

Abdominal Viscera (Solid Organs)

Biliary tract

C-001Portal biliopathy: Imaging featuresS. Kim, J. Lee, S. Shin, C. Kim, T. Noon, S. Lee; Pusan/KR

Learning Objects: To illustrate the imaging features of portal biliopathy.Background: Portal biliopathy is a recent terminology used to describe abnor-malities of the biliary tracts in patients with portal hypertension. We analyzedhelical CT scans of 23 patients selected by the following criteria: Portoportal col-laterals and biliary abnormality. Other imaging studies including magnetic reso-nance cholangiopancreatography (MRCP) and cholangiography (5 patients) wereperformed. In this exhibit, we illustrate the clinical features and the cause of por-toportal collaterals, and abnormality of the biliary tract such as wall thickening,upstream dilatation with stenosis, and irregularity of bile ducts.Imaging Findings: Most patients with portal biliopathy were asymptomatic. How-ever some patients (4/23) had mild obstructive jaundice. The portoportal collater-als were caused by the compression of extrahepatic portal vein (2/23), idiopathicportal hypertension (2/23) and extrahepatic portal vein thrombosis (19/23). Por-toportal collaterals depicted on the CT scans were 23 paracholedochal veins and16 epicholeodochal veins. The extrahepatic bile duct walls were thickened in 16patients and were irregular in 22 patients. 6 patients had upstream bile duct dila-tation with stenosis caused by portoportal collaterals and fibrosis.Conclusion: Portal biliopathy is caused by extrahepatic portal vein occlusion oridiopathic portal hypertension. The irregularities of ductal walls are mainly due toparacholedochal veins. The thickened walls of extrahepatic bile ducts containingenhanced epicholedochal veins distinguish portal biliopathy from the biliary ma-lignancy such as cholangiocarcinoma.

C-002CT angiography of gall bladder lesions: Radiologic and histopathologiccorrelationM. Terada, M. Sato, M. Kimura, H. Tanihata, N. Kawai, K. Yamada;Wakayama/JP

Learning Objectives: To illustrate CT angiography (CTA) features of gallbladderlesions. To evaluate the usefulness of mucosal enhancement patterns for differ-entiation of gallbladder carcinoma from benign gallbladder lesions.Background: The prognosis of patients with gallbladder carcinoma is still poor. Itis sometimes difficult to distinguish gallbladder carcinoma, especially the typewith thickened wall, from benign lesions such as chronic cholecystitis (CC), xan-thogranulomatous cholecystitis (XGC) and adenomyomatous hyperplasia (AMH).We retrospectively reviewed CTA and pathologic findings in 20 patients with clin-ically suspected gallbladder tumorous lesion. The definitive diagnosis was histo-logically confirmed after surgery in all cases (12 carcinomas, 4 CC, 2 XGC, 2AMH).Imaging Findings: Of 12 gallbladder carcinomas, intraluminal polypoid growthwas seen in 2, both of which were well-differentiated papillary adenocarcinomaon histopathology and showed marked radiate enhancement on CTA. Massiveintraluminal growth with mural invasion was seen in 2 (1 well-differentiated tubu-lar adenocarcinoma, 1 poorly-differentiated adenocarcinoma) and showed mod-erate irregular enhancement and focal lack of mucosal rim-enhancement on CTA.Thickened wall type carcinoma was seen in 8 (7 poorly-differentiated adenocar-cinoma, 1 endocrine carcinoma), which showed lack of mucosal rim-enhance-ment in all (focal 6, diffuse 2). Of 8 benign lesions, mucosal rim-enhancementwas smoothly delineated in 6 (all CC, 1 XGC, 1 AMH) and irregularly delineatedin 2 (1 XGC, 1 AMH). Intraluminal non-enhancing nodules were seen in 4 (1/12carcinoma, 1/2 XGC, 2/2 AMH).Conclusion: It seems that CTA findings, especially mucosal enhancement pat-terns, might help to distinguish gallbladder carcinoma from benign lesions withthickened wall.

C-003Virtual endoscopy (VE) of the biliary tract using 16-slice multidetector-rowCT (MDCT)J.-Y. Oh, K.-J. Nam, J.-C. Choi, J.-H. Cho, K.-N. Lee; Pusan/KR

Learning Objectives: To evaluate virtual endoscopic (VE) findings of the normalbiliary tract and variable biliary diseases.Background: Choledocoscopy is a difficult and invasive procedure in used toevaluate biliary disease. VE using MDCT is non-invasive and easily feasible in all

cases with excellent image quality. We will describe the virtual endoscopic find-ings of variable biliary diseases.Procedure Details: We performed MDCT in seventeen patients who had hadPTBD performed due to biliary obstruction. MDCT was performed after contrastinjection through the PTBD tube. Imaging parameters were: 16 x 0.75 mm colli-mation; 6.0 mm slice thickness; 120 kVp; 114 effective mAs and 1 mm recon-struction interval. VE images were reconstructed using a volume renderingtechnique and analyzed by two independent radiologists.Imaging Findings: VE depicted all stones greater than 3 mm in all five cases.Tumoral stenosis presented irregular and asymmetrical narrowing on endolumi-nal view in seven out of nine cases. Regular smooth tapering was seen in threecases of benign stenosis.Conclusion: VE of biliary tract seems to be the good modality to evaluate theendoluminal morphology of biliary disease.

C-004Contrast-enhanced MR cholangiography: A new technique to evaluate thebiliary treeM. Sánchez, J. Ayuso, M. Pagés, T. Caralt, C. Ayuso; Barcelona/ES

Learning Objective: To illustrate the technique, benefits and limitations of thecontrast-enhanced Magnetic Resonance Cholangiography (CEMRC) with man-gfodipir trisodium in several applications. To describe our results based on a se-ries of 86 patients.Background: Contrast-enhanced MR cholangiography with IV mangafodipir triso-dium is a recently developed technique. Mangafodipir trisodium (MnDPDP) is ahepatobiliary MR contrast agent that is administered intravenously and is excret-ed primarily via the biliary system. We describe this technique with the mostsuitable indications. We explain the limits of CEMRC and their advantages anddisavantages compared to conventional T2 weighted MR cholangiography.Procedure Details: In our centre 86 patients (29 liver living donor candidates, 17bile ducts leaks, 8 Caroli disease, 19 bilio-enteric anastomoses and 11 miscella-neous) underwent magnetic resonance cholangiography (MRC) with single-shotfast spin-echo (SSFSE) without contrast, and fast spoiled gradient-echo (FSP-GRE) 3D T1W after mangafodipir administration. The main limitation to this con-trast is biliary stasis that reduces its excretion, not being useful in dilated ducts orcholestasic patients.Conclusion: We show that MRC T1 weighted with Mangafodipir trisodium im-proved traditional SSFSE in selected patients. This technique can especially fa-cilitate the definition of the anatomy in nonobstructed biliary systems and canprovide functional information in bile duct leaks and bilio-enteric anastomoses.

C-005CT and MRI findings of peribiliary cystsG. Brancatelli1, R. Baron2, V. Vilgrain3, Y. Menu4, L. Grazioli5, F. Sorrentino1,L. Maruzzelli1, M. Midiri1, R. Lagalla1; 1Palermo/IT, 2Chicago, IL/US, 3Clichy/FR,4Paris/FR, 5Brescia/IT

Learning Objectives: To recognize the CT and MR imaging findings of peribil-iary cysts.Background: Peribiliary cysts are the result of cystic dilatation of periductal glandsof the bile ducts, and are exclusively seen in the hepatic hilum and larger portaltracts, and have a diameter ranging from 2 to 20 mm. In this exhibit we will showmultiple examples of peribiliary cysts at helical CT and 1.5 T MR imaging.Imaging Findings: Apart from the peculiar intrahepatic distribution on both sidesof the portal vein, peribiliary cysts show the typical imaging findings of liver cysts,and are exclusively found in the cirrhotic liver.Conclusion: Knowledge of the imaging findings of peribiliary cysts is importantto differentiate them from potential mimics such as diffuse or local dilatation ofthe bile ducts, von Meyenburg complex, cholangitis and periportal collar.

C-006Multislice CT cholangiography using thin-slab minimal intensity projectionand multiplanar reformatted image in evaluation of biliary abnormalities:Preliminary experience and an illustrative reviewH. Kim, S. Park, S. Park, H. Shin, S. Park, H. Kim, Y. Kim, W. Bae, I. Kim;Cheonan/KR

Purpose: To evaluate the diagnostic efficacy of multislice CT cholangiography(CTC) using thin-slab minimal intensity projection (MinIP) and multiplanar refor-matted (MPR) image in evaluating the biliary abnormalities.Methods and Materials: We prospectively evaluated 35 patients with suspectedbiliary tract abnormality using CTC with thin-slab MinIP and MPR. The final diag-

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noses of the patients were intra- or extrahepatic duct stone (n = 16), hilar cholan-giocarcinoma (n = 3), extrahepatic bile duct cancer (n = 3), bile duct dilatation byan extrinsic cause (n = 5), ampulla of Vater cancer (n = 3), choledochal cyst (n = 1),and non-specific extrahepatic bile duct dilatation (n = 4). CT was performed us-ing multi-detector row CT (1.25 mm collimation; 13.5 mm/rotation table speed;pitch 1.35; 0.8 sec rotation time; 1.25 mm reconstruction interval), 70 secondsafter contrast material injection (150 mL, 3 mL/s). Biliary contrast material wasnot used. Using a workstation, CTC with thin-slab MinIP (4-15 mm) and MPRimage in a coronal oblique plane was obtained. The diagnostic efficacy was eval-uated and the CTC was compared with the gold standard techniques of endo-scopic retrograde cholangiography, magnetic resonance cholangiography, orpercutaneous transhepatic cholangiography.Results: CTC correctly diagnosed all biliary abnormalities except in two patientswith common bile duct stones. The correspondence between the CTC and thegold standard techniques was 88% (14 of 16 patients) in bile duct stones, and94.3% (33 of 35 patients) in overall.Conclusion: Multislice CTC using thin-slab MinIP and MPR image is an effectivediagnostic tool in the evaluation of the biliary tract abnormality.

C-007Will prospective respiratory gating (PACE) round off breath-hold in MRCP?E. de Kerviler1, A.-M. Zagdanski1, M. Allez1, P. Bourrier1, A. Stemmer2, J. Frija1;1Paris/FR, 2Erlangen/DE

Purpose: To compare breathhold MRCP techniques with respiratory triggeredsequences using the PACE (prospective acquisition correction with navigatorechoes) technique.Material and Methods: MRCP imaging was performed in 20 patients with ob-structive jaundice using a single thick-slice breathhold RARE sequence, a mult-islice breath-hold HASTE sequence and a "work in progress" 3D-free-breathingsequence developed by Siemens. This sequence is a heavily T2-weighted (TE/TR = 670 ms/1xrespiratory cycle, restore magnetisation pulse), high-resolution(1.5 mm-thick slices, 384 matrix, voxel size = 1 x 1 x 1.5 mm3) 3D-TSE turbo spinecho sequence using the PACE technique for respiratory triggering. Ductal dila-tation, level and cause of obstruction were analysed.Results: In all cases, the 3D-free-breathing sequence was superior to the breath-hold sequences in terms of spatial resolution, without significant motion artifacts.As a result, the distal bile ducts and the pancreatic duct were always better dem-onstrated with the 3D sequence than with the breath-hold sequences. MIP re-constructions allow analysis of the entire biliary tree with different projections.The duration of the 3D sequence (3 to 5 minutes depending on patients' respira-tion) was comparable to the overall duration of the RARE sequence, which re-quires several slice positioning to explore the entire biliary tree. Lastly, theT2-weighted HASTE sequences better demonstrated pancreatic tumors than theother sequences.Conclusions: The new 3D-free-breathing sequence using PACE is robust andespecially useful in uncooperative patients. This sequence has now replaced allthe breath-hold heavily T2-weighted sequences in our protocol. HASTE and oth-er less T2-weighted sequences remain useful in case of extrinsic compressionas they demonstrate anatomical structures.

C-008Magnetic resonance pancreatography versus endoscopic ultrasonographyin suspected common bile duct lithiasis: A prospective, comparative studyB. Delorme1, C. Aube1, T. Yset2, P. Burtin1, J. Lebigot1, P. Pessaux1,C. Gondry-Jouet1, J. Boyer1, C. Caron-Poitreau1; 1Angers/FR, 2Amiens/FR

Purpose: To compare the accuracy of MR cholangiopancreatography (MRCP)and endoscopic ultrasonography (EUS) for the diagnosis of common bile ductstones (CBS) in patients with mild to moderate clinical suspicion of CBS.Materials and Methods: 45 patients were prospectively enrolled. Inclusion crite-ria included acute pancreatitis, subclinical jaundice, and clinical features of CBSmigration. Radial EUS and MRCP with SSFSE technique were performed at 48hours maximum interval. The gold standard diagnosis was obtained with: a) En-doscopic retrograde cholangiopancreatography (n = 20) or intraoperative cholan-giography (n = 14) if EUS and/or MRCP were abnormal, b) clinical and biochemicalfollow-up (n = 11) if the EUS and MRCP were normal.Results: The definitive diagnosis was CBS in 16 patients, malignant obstructionin 4, and another biliary disease in 2 (lithiasis migration aspect with papilla oede-ma); 23 were considered free of biliary disease. The sensitivity and specificity ofMRCP was, respectively, 90.5 and 87.5% for etiologic diagnosis, and 87.5 and96.6% for the detection of CBS. The corresponding values for EUS were 86.4and 91.3% for etiologic diagnosis and 93.8 and 96.6% for the depiction of choledo-

cholithiasis. The difference in accuracies between both techniques was not sig-nificantly different.Conclusion: In cases of poor to moderate suspicion of choledocholithiasis, ac-curacies of both EUS and MRCP are similar. Because MRCP is a non invasivetechnique, it may be preferred for this indication.

C-009The role of multiphasic helical computed tomography in malignantobstructive jaundiceU. Ozkan, M.E. Inal, E. Akgul, F. Binokay, M. Celiktas, G. Soker, S. Soyupak,E. Aksungur; Adana/TR

Purpose: The aim of this study was to determine the value of multiphasic helicalcomputed tomography (MHCT) in the detection of obstruction level, proximal ductalextension and the etiology of the tumor in cases with malignant obstructive jaun-dice.Material and Methods: A total of 96 cases were included in the study. The caseswere presumed to be malignant by clinical evaluation and ultrasonographic ex-amination. All cases underwent MHCT with 5-7 mm collimation and percutane-ous transhepatic cholangiography (PTC). The level of obstruction, proximal ductalextension of the tumor and the origin of the tumor were evaluated by MHCT. Theresults of the MHCT were compared with those of PTC, which is accepted as thegold-standard method. In 72 (75%) cases, diagnosis was established on the ba-sis of clinical and radiological findings, while in 24 (25%) cases it was estab-lished by clinical, radiological and histopathological findings.Results: The level of the obstruction was accurately detected by MHCT in 90%of the cases. The ductal extension of the tumor was accurately detected by MHCTin 68% of the cases when compared to PTC. The organ/structure from which thetumor originated, according to the PTC findings, was accurately detected by MHCTin 87% of the cases.Conclusion: MHCT is effective in detecting the obstruction level and, the organor structure from which the tumor originated. But CT is not effective in detectingthe proximal ductal invasion of tumor, so cannot replace PTC.

C-010Correlation between Mn-DPDP- enhanced MR cholangiography andintraoperative cholangiography in the evaluation of living liver donorsJ.R. Ayuso, C. Ayuso, C. de Juan, T.M. De Caralt, E. Bombuy,J.C. Garcia-Valdecasas; Barcelona/ES

Purpose: To evaluate the ability of Mn-DPDP-enhanced MRC in the evaluationof biliary anatomy of adult living liver donors correlating these findings with thoseobtained with intraoperative cholangiography.Methods and Materials: Twenty adult living liver donors were evaluated withpresurgical Mn-DPDP-enhanced MRC and intraoperative cholangiography. Axialand coronal volumetric 3D T1-weighted FSPGR sequences were obtained 20 min.after the IV injection of 0.5 mL/kg of Mn-DPDP.Results: Only 6 donors had a normal biliary branching pattern at operative cholan-giography (type A). Six had a trifurcation (type B). Four had a right posterior duct(RPD) draining into the common duct (CD) (type C). One had a RPD draininginto the left duct (type D), one had two aberrant left ducts draining into the CDand into the right anterior duct (RAD) (type E), and 2 had a cystic duct draininginto an aberrant RPD that joined to the CD (type F). MR cholangiography corre-lated with intraoperative findings in 15 (75%) of 20 donors. MR failed to depict thecomplex anatomy of the type E pattern. One exam failed to identify the drainageregion of the cystic duct (type F), but clearly showed the aberrant RPD. In threeinstances operative cholangiography showed a type B pattern, but MR clearlydefined a unique right duct in two of them.Conclusion: Contrast enhanced MR cholangiography is accurate to depict thecentral hepatic biliary duct anatomy and can be used preoperatively for surgicalplanning.

C-011Anomalous pancreaticobiliary junction: Diagnostic value of multislice CTS. Itoh, H. Satake, Y. Mori, T. Ishigaki; Nagoya/JP

Purpose: To assess the diagnostic capabilities of multislice CT in patients withan anomalous pancreaticobiliary junction (PBJ).Materials and Methods: This study included 7 patients with an anomalous PBJand 25 with a normal PBJ. Contrast material was injected at 0.08 mL/kg bodyweight/sec over 30 sec, and multiphase contrast-enhanced CT of the pancreato-biliary region was performed using a multislice CT scanner. Multiplanar reformat-ted (MPR) images covering the pancreatic parenchyma were generated with

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0.5 mm thickness at 0.5 mm intervals from pancreatic phase axial images recon-structed with 0.5 mm or 1 mm thickness at 0.5 mm intervals using a 260 mm fieldof view. The visualization and location of the confluence of the pancreatic andbiliary ducts were determined using the MPR images combined with axial imag-es of 0.5 mm or 1 mm thickness. In patients with an anomalous PBJ, the diag-nostic capabilities of CT for associated pancreatobiliary diseases were alsoassessed.Results: The duct confluence was depicted in 7 and 24 patients with an anoma-lous PBJ and a normal PBJ, respectively. In all patients with an anomalous PBJ,it was demonstrated that the pancreatic and biliary ducts joined within the pan-creatic parenchyma. This finding was seen in no patients with a normal PBJ. CTallowed the detection of congenital choledochal cyst (n = 5), bile duct carcinoma(n = 3), and adenomyomatosis of the gallbladder (n = 1) in all patients, but failedto detect bile duct stone (n = 2).Conclusion: Multislice CT can accurately identify the location of the confluenceof the pancreatic and biliary ducts, which is useful for diagnosing an anomalousPBJ.

C-012Magnetic resonance cholangio-pancreatography (MRCP) using a new free-breathing navigator triggered acquisition technique (PACE-TSE)P. Asbach, C. Klessen, R. Kirsch, B. Hamm, M. Taupitz; Berlin/DE

Purpose: To evaluate a new free-breathing navigator triggered T2-TSE sequence(PACE-TSE) for magnetic resonance cholangio-pancreatography (MRCP) in com-parison to the established standard breath-hold MRCP technique.Materials and Methods: Prospective evaluation of 30 consecutive patients re-ferred to our clinic for MRCP. All patients were examined at 1.5 T (Siemens Mag-netom Quantum) using the following sequences: PACE (= Prospective AcquisitionCorrection)-TSE MRCP (work-in-progress sequence,384 x 384 matrix, coronalslice orientation, TR 1910 ms, TE 832 ms, 40 slices, 1.5 mm thick), breath-holdMRCP based on the HASTE sequence (256 x 256 matrix, coronal slice orienta-tion, TR ∞, TE 1100 ms, 1 slice, 80 mm thick). Three independent abdominal MRIexperienced radiologists reviewed all images and evaluated depiction of ductalstructures of the intra- and extrahepatic bile ducts and the pancreatic duct on a 5-point scale. In addition, frequency of artifacts was noted.Results: Mean examination time of the PACE-TSE was 6.2 minutes. The depic-tion of ductal structures was significantly better (p < .05) using the PACE-TSEsequence compared to the standard MRCP sequence. Frequency of artifactswas on the same level as on the standard sequence.Conclusions: For MRCP the PACE-TSE sequence significantly improves imagequality and recognition of anatomical details compared to standard breath-holdHASTE technique.

C-013Sensitivity and specificity of transabdominal ultrasound in detectingcommon bile duct (CBD) stones in post cholecystectomy patientsS. Nair, P. Kumar, A.E.A. Joseph, M. Knight; London/UK

Purpose: Endoscopic retrograde cholangiopancreateography (ERCP) is an es-tablished modality for retrieval of CBD stones. This study assesses the sensitivityand specificity of abdominal ultrasound (TUS) in determining CBD stones in pa-tients with prior cholecystectomy.Methods: Retrospective review of 165 patients with prior cholecystectomy un-dergoing ERCP for suspected CBD stones.Results: 165 patients (52 male and 113 female) with a mean age of 65.3 years(range 23-92). All patients had pre-procedural TUS by one operator (AEAJ) onthe same day as the ERCP and the ERCP was performed by single surgeon(MJK).TUS was able to detect CBD stones in 79 patients and in the remaining 86 pa-tients no stones were detected. However, with ERCP, stones were retrieved from111 patients in total with the remaining 54 having no stones. Amongst the 79patients reported as positive for CBD stones by TUS, 70 were confirmed to haveCBD stone by ERCP. However, of the 86 patients reported as being negative forCBD calculi by TUS a further 41 were identified to have CBD stones during ERCP.Therefore, in patients with prior cholecystectomy, TUS has a sensitivity of 63%and specificity 83% in detecting CBD stones. The positive and negative predic-tive value were 0.88 and 0.52.Conclusion: Routine use of TUS in patients with prior cholecystectomy suspect-ed of CBD calculi is of limited value as a screening tool. However its specificityand the positive predictive value is high for it to be used as a tool to refute othersuspected diagnoses.

C-014Multidetector CT cholangiography without biliary contrast agentadministration in patients with biliary tract obstructionP. Boraschi, F. Donati, R. Gigoni, M.C. Cossu, A. Volpi, M. Femia, F. Falaschi;Pisa/IT

Purpose: To optimize the protocol for multidetector CT cholangiography (CTC)without biliary contrast agent administration, and to assess the ability of the tech-nique for detecting the site and cause of biliary obstruction.Methods and Materials: A series of eighteen patients with biliary system dilata-tion on ultrasound were studied with a four row CT scanner (Somatom Plus 4Volume Zoom; Siemens, Erlangen, Germany), using the following parameters:Collimation, 1 mm; slice width, 1 mm; reconstruction interval, 0.5 mm. A non-ion-ic contrast medium (Visipaque 320, Amersham Health) was infused intravenous-ly at a rate of 4-5 mL/sec; two scans of the upper abdomen were obtained at20-25 (arterial phase) and 75-80 seconds (venous phase) after starting contrastmedium injection. Multiplanar volume reconstructions, curved planar reforma-tions, and volume rendering images were performed using data sets of venousphase. In all patients CTC findings were correlated with surgery, MR cholangiog-raphy, endoscopic retrograde cholangiography, percutaneous transhepatic cholan-giography and/or imaging follow-up.Results: Patients were affected by cholangiocarcinoma (n = 8), choledocolithia-sis (n = 4), ampullary tumor (n = 1), Caroli's disease (n = 1), and pancreatic can-cer (n = 4). In 13 out of 18 patients CTC correctly assessed the site and cause ofbiliary obstruction; 3 out of 4 cases of common bile duct stones were missed onCTC. Vascular infiltration was also correctly diagnosed on CT in 3 patients withcholangiocarcinoma.Conclusion: Multidetector CT cholangiography without contrast agent adminis-tration seems to be an alternative non-invasive diagnostic modality in the evalu-ation of patients with biliary obstruction, particularly when MR cholangiographyis contraindicated or not available.

C-015Standard size and shape of the normal bile duct: Overview of a newparameter using magnetic resonance cholangiography (MRC)Y. Kitagawa1, M. Ogawa2, N. Hayakawa2, H. Yamamoto2, Y. Katono2,T. Matsunaga2, J. Kamiya2, K. Oda2, Y. Nimura2; 1Obu/JP, 2Nagoya/JP

Purpose: Limited studies have focused on the setting of standard size of thebiliary tract. Magnetic resonance cholangiography (MRC) is a non-invasive mo-dality for the precise examination of the biliary tract. Moreover, MRC provides 3Dimages and cross-sections of the bile duct. The aim of this study is to elucidatethe standard size and shape of the bile duct using this modality.Methods and Materials: In 50 cases with normal bile ducts, the area and diam-eter of the bile duct was measured by a 1.5 T MR system using a 3D T2W half-Fourier single-shot turbo spin-echo (HASTE) sequence, prospectively. The imagevoxel was 1.0 x 0.9 x 1.0 mm. The following sites were measured; upper borderof pancreas (A), common hepatic duct (B), left hepatic duct (C) and right hepaticduct (D).Results: The measured areas (mm2) were 49.1 ± 15.9 in A, 53.6 ± 19.5 in B,37.0 ± 12.6 in C and 37.1 ± 14.3 in D, respectively. There was positive corelationbetween the area and age. The diameters (mm) were 7.8 ± 1.4 in A, 8.1 ± 1.5 inB, 6.7 ± 1.4 in C and 6.8 ± 1.3 in D, respectively. The ratio of A to B was 1:1.1, Ato C was 1:0.76 and A to D was 1:0.83.Conclusion: MRC provided useful parameters to define standard size and shapeof bile ducts without invasive techniques. These data are useful for diagnosis ofdilatation and strictures of the extrahepatic bile duct.

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Liver

C-016Fibrocystic hepatobiliary diseases: CT and MRI findingsG. Brancatelli1, V. Vilgrain2, M. Federle3, Y. Menu4, M.-P. Vullierme2, D. Marin5,M. Midiri1, M. De Maria1, R. Lagalla1; 1Palermo/IT, 2Clichy/FR, 3Pittsburgh,PA/US, 4Paris/FR, 5Rome/IT

Learning Objectives:1. To review a multimodality imaging approach to those diseases caused by duc-tal plate malformations.2. To understand the pathologic characteristics of congenital fibrocystic hepato-biliary abnormalities and correlate them with the imaging findings.Background: Fibrocystic hepatobiliary diseases are congenital disorders, char-acterized by persistence or lack of remodelling of the embryonic ductal plate. Thelevel at which malformation in the ductal plate develops determines the clinicaldisorder: Congenital hepatic fibrosis/ Autosomal recessive polycystic disease;small intrahepatic ducts: Autosomal dominant polycystic disease; intermediateintrahepatic ducts: Caroli's syndrome; large intrahepatic bile ducts: Choledochalcysts; extrahepatic bile duct. In addition, bile ducts microhamartomas (von Mey-enburgh complexes) are considered to be part of the spectrum of ductal platemalformations.Imaging Findings: In this exhibit we will show the helical CT and state of the artMR imaging findings in the diseases that belong to the family of ductal platemalformation. We will also show appropriate pathologic correlation.Conclusion: The members of this family of diseases can be found in variouscombinations. Their clinical importance is related to portal hypertension, cholan-gitis or mass effect. CT and MR imaging are able to show a typical pattern foreach of these diseases.

C-017A pictorial review of pitfalls of diagnosis of focal liver lesions followingenhancement with super paramagnetic iron oxide (SPIO)M.P. Callaway, J. Virjee; Bristol/UK

Learning Objectives: Magnetic resonance imaging of the liver following the ad-ministration of super paramagnetic iron oxide has been reported as the mostsensitive non-invasive method of identifying liver metastasis. In addition Kupfercell uptake of iron oxide with reduction of the signal on T2 weighting is very im-portant in the differentiation of focal nodular hyperplasia from other benign liverdiseases. This pictorial review demonstrates some of the pitfalls of interpretationof focal abnormalities following the administration of SPIO. The examples aresupported by pathological correlation.Background: Several recent studies have concluded that post-SPIO magneticresonance imaging of the liver is the most sensitive method of identifying meta-static disease to the liver. The particles are trapped by the reticulo-endothelialcells because of their size (between 45-60 nm), and so lesions with little or noKupfer cells do not take up SPIO and remain unchanged, while the surroundingliver is reduced on T2-weighting. However, sometimes pitfalls can be encoun-tered which mimic types of both benign and metastatic disease. In this reviewexamples of atypical haemangioma appearing as metastatic deposits, diffusefibrosis post chemotherapy and focal nodular hyperplasia with little uptake ofSPIO are presented. All examples have pathological correlation.Procedure Details: All patients received the standard dose of SPIO (Endorem,Laboratoire Guerbet) calculated on weight and administered intravenously in 5%dextrose solution over 30 minutes. Imaging was performed using gradient echosequences using a Siemens 1.5 Tesla Symphony MR scanner. Pathological cor-relation was obtained either following surgery or post biopsy.

C-018Fusion of the medial scissurae plane with the ligamentum teres plane:A liver anatomic variation that must be known by radiologistsO. Lucidarme, E. Savier, J. Taboury, M. Cadi, P. Malzy, P.A. Grenier,L. Hannoun; Paris/FR

Learning Objectives: To describe an anatomic variation of the liver, which con-sists of the presence of the gallbladder bed (the medial plane) being in the line ofthe ligamentum teres. To outline the importance of its recognition before hepato-biliary surgery. To propose an original hypothesis to explain this abnormality.Background: This variation (mainly described in Asian countries) was discov-ered in 7 patients among 1720 who underwent a preoperative liver exploration.

We will display the surgical photographs, ultrasound cine-loops (US), multidetec-tor CT (MDCT) with 3D reconstructions, magnetic resonance cholangiographies(MRCP), conventional cholangiographies and arteriography, which were obtainedin 2, 7, 3, 2, 4 and 1 case respectively.Imaging Findings: Fusion of these hepatic planes can be defined as follows: (1)Juxtaposition of the ligamentum teres and the gallbladder; (2) stereotyped portalvein branching with a right posterior branch, left branches, and a main medialbranch terminated by the ligamentum teres; (3) two main hepatic veins; (4) lackof the horizontal part of the left bile duct. US and MDCT were most accurate inrevealing this abnormality. A persistence of the right, instead of the left umbilicalvein has been hypothesized, but we rather consider this abnormality as the resultof default in development of the central part of the liver leading to the persistenceof only one plane including both the gallbladder and the ligamentum teres.Conclusion: US and MDCT can easily detect this "fusion of planes". When un-noticed, this variation may lead to serious complications during hepato-biliarysurgery.

C-019Hepatic perfusion disorders: Tips and tricks using MDCTA.-S. Rangheard, B. Bessoud, A. Lesavre, L. Rocher, Y. Menu;Le Kremlin-Bicêtre/FR

Learning Objectives: To illustrate hepatic perfusion disorders, understand theirmechanism and consequences. To be able to accurately differentiate on MDCTperfusion disorders from tumour changes, especially when they are associatedin the same patient like HCC or metastatic disease.Background: Diffuse diseases, benign conditions and malignant tumours arecommonly associated with changes in arterial, portal or hepatic vein flow, induc-ing many false positives and negatives in tumour detection and staging. Mecha-nism could be compression, thrombosis or fistulae. MDCT shows more commonlythese images, but also provides more tools (image processing) for analysis.Imaging Findings: Obstruction of a portal branch, either proximal or intrahepat-ic, induces an automatic increase of arterial flow explaining early parenchymaenhancement. Subcapsular arterio-portal fistulae are very common, especiallywith MDCT and sometimes misleading for hypervascular tumours. Obstruction ofthe hepatic veins induces a delayed contrast wash-out of the liver parenchymaleading to persistent patchy enhancement. Peliotic changes are especially mis-leading; they are diffuse or focal, and may be associated with tumours. Theseperfusion disorders will be illustrated. Importance of MIP analysis and multipla-nar reformatting to identify volumic shape of the image, and vessels' precise anat-omy will be detailed. A simple method to classify arterial, portal or hepatic disordersand their clinical implications will be presented.Conclusion: Knowledge of the hepatic perfusion disorders is essential to avoidvery common pitfalls in liver MDCT imaging. Better understanding will result inless false positive and false negative rates, and increased confidence in tumourdetection and staging.

C-020Harmonic, contrast-specific ultrasound of non-cystic focal lesions of theliver: A pictorial essayA. Nunziata1, O. Catalano2, M. Mattace Raso2, B. Cusati2, A. Siani2; 1Naples/IT,2Pozzuoli/IT

Learning Objective: To illustrate the contrast-specific appearance of a wide spec-trum of liver focal lesions and to correlate the images shown with the related CTand MRI features.Background: We use a low-mechanical index (0.07 in mean), continuous-mode,harmonic, contrast-specific technology named contrast tuned imaging (CnTI,Esaote, Italy). We employ a second-generation, sulfur-exafluoride based, micro-bubble contrast agent (SonoVue, Bracco, Italy). The contrast agent, at a volumeof 2.4 or 4.8 mL, is injected through a peripheral vein and a 20 G needle.Imaging Findings: Several focal liver lesions are shown during the various phasesof enhancement: Hemangioma, adenoma, focal nodular hyperplasia, dysplasicnodule, hepatocellular carcinoma, cholangiocellular carcinoma, hypovascular andhypervascular metastasis, lymphoma, amoebic, pyogenic, and micotic abscess,focal steatosis, and skip areas in a steatotic liver. Tumor cases are also illustratedbefore and after percutaneous ablation and transcatheter chemoembolization.Conclusion: SonoVue-enhanced ultrasound can identify several features of fo-cal hepatic lesions. Radiologists should be aware of the typical and atypical ap-pearance of these lesions in order to optimize proper characterization and toavoid interpretative pitfalls.

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C-021How to reach the sonographic diagnosis of focal liver lesions using asimple algorithm: A DVD-Rom based teaching file with US image and videodatabaseP.S. Zoumpoulis, K. Pahou, I. Bechrakis, A. Delladetsima, E. Tako, D. Leli, S.Kiriazi, I. Vafiadis; Athens/GR

Learning Objectives:- To teach a trainee how to describe the main US characteristics of a focal liverlesion.- To show the way to facilitate diagnosis imaging through correct algorithms.- To help comparison of an US image of diagnostic difficulty with galleries ofsimilar US images with proven diagnosis.Background: The purpose of this DVD Rom is to suggest diagnostic algorithmsin order to characterize focal liver lesions starting from an ultrasound image andits main morphologic and hemodynamic sonographic features.Procedure Details: The user can start using this teaching file by describing theUS characteristics of a focal liver lesion that he has difficulty in characterizing(i.e.: Unilocular, hypoechoic, hypovascular liver lesion). The system guides himthrough a specific algorithm of all possible hypoechoic and hypovascular liverlesions (i.e.: cyst, echinococcal cyst, atypical hemangioma, metastasis). A largecollection of classified US images (galleries) and videos in each diagnostic cate-gory are available for comparison with the users' images. The users' image canalso be linked to the contents of corresponding interesting cases, which are briefcase reports with clinical, biochemical, imaging and pathological data.Conclusion: The user can be aided in the differential diagnosis of a liver lesionby comparing it to other "similar" sonographic images, which are available ingalleries, videos as well as interesting cases.

C-022MRI features of intrahepatic cholangiocarcinomaA. Luna1, R. Ribes2, J. Vida2, E. Ramon3, E. Feliu4, M. Buzzi5; 1Jaen/ES,2Cordoba/ES, 3Madrid/ES, 4Alicante/ES, 5Buenos Aires/AR

Learning Objectives: To review the different patterns of intrahepatic cholangi-ocarcinoma evaluated with MRI. To describe MR features that may differentiateintrahepatic cholangiocarcinoma from other diffuse hepatic masses.Background: Although intrahepatic cholangiocarcinoma represents the secondmost common primary intrahepatic mass, there are no published large seriesdescribing their MRI findings. It usually appears in a non-cirrhotic liver as a dif-fuse mass, but a nodular pattern is also possible. In imaging studies, it can bedifficult to differentiate from diffuse hepatocarcinoma and desmoplastic metas-tases.Procedure Details: We retrospectively reviewed 41 patients with biopsy provenintrahepatic cholangiocarcinoma studied with MRI. Our protocol includes T1-weighted, T2-weighted or Haste sequence, STIR sequence, a dynamic enhancedseries, 2D HASTE thick slice cholangiography and 3D fat-saturated TSE T2-weighted cholangiography. Most commonly, intrahepatic cholangiocarcinomapresents as a large mass, hypointense on T1-weighted images and moderatelyhyperintense on T2-weighted images. They enhance in a variable grade on thearterial phase with greater delayed enhancement. Features that may help to es-tablish a presurgical diagnosis are: Areas of central fibrosis, dilatation of intrahe-patic biliary tree, hepatic capsular retraction and progressive centripetalenhancement. Differential features from diffuse hepatocarcinoma, large metas-tasis and other diffuse hepatic masses are shown.Conclusion: MRI helps to characterize presurgically intrahepatic cholangiocar-cinoma.

C-023Complications of pyogenic hepatic abscesses: CT and clinical featuresD. Yang, H. Kim, J. Kang, C. Park, T. Seo, H. Kim, W. Jin, H. Hwang;Incheon/KR

Learning Objectives: To describe the CT and clinical findings of the variouscomplications of pyogenic hepatic abscesses.Background: Early diagnosis and prompt therapy are essential to reducing themorbidity and mortality associated with a pyogenic hepatic abscess. The mortal-ity rate is increased when the hepatic abscess extends into the chest, peritonealcavity, or pericardial cavity. However, reports of complications in pyogenic hepat-ic abscess are rare and the imaging appearance has been studied in only a smallnumber of patients. In this exhibit, we will describe the CT and clinical findings ofthe various complications of pyogenic hepatic abscesses. The CT and clinicalfindings of 81 patients who had a confirmed pyogenic hepatic abscess were an-alyzed retrospectively.

Imaging Findings: Of the 81 patients, 21 cases of various complications fromthe pyogenic hepatic abscesses were encountered in 17 patients (21%). Twotypes of complications were observed in four patients. These complications in-cluded rupture into the pericardial cavity (n = 1), pleuropulmonary complications(n = 11), rupture into the gastrointestinal tract (n = 1), rupture into the peritonealcavity (n = 3), rupture into the retroperitoneum (n = 1), vascular complications(n = 3), and biliary complications (n = 1).Conclusion: A knowledge of these complications is important for an early diag-nosis and the appropriate management.

C-024Contrast pulse sequences (CPS) imaging of focal liver disease usingSonoVue, a perfluorocarbon microbubble ultrasound contrast agentE. Leen, P. Ceccotti, P. Horgan; Glasgow/UK

Learning Objectives: To describe the imaging sequence and limitations in thedetection and characterisation of focal lesions with CPS. To illustrate the kineticprofile of SonoVue within aorta, hepatic vessels and liver to optimise scans forthese applications. To illustrate CPS enhancement patterns compared with thoseof CT and MR of the corresponding lesions.Background: CPS is a novel mode based on the processing of non-linear sig-nals in the fundamental frequency band with improved sensitivity and specificityto contrast agent depiction. As a result, its advent has led to a need for re-evalu-ation of the temporal enhancement characteristics of normal liver and focal liverdisease.Procedure: CPS imaging with SonoVue was performed in 120 patients with focalliver disease using the Acuson Sequoia with continuous low MI imging. Plannedstandardised scanning through the liver to ascertain complete organ coverageduring the vascular and late phases of the contrast administration is required fordetection. For characterisation, various scanning techniques with optimal use ofcontrast doses can be applied to demonstrate the altered vascular morphologyand differential enhancement or perfusion relative to the normal liver at specificphases. In 20 patients we assessed the kinetic profile of SonoVue within theaorta, hepatic artery, portal vein and liver tissue quantitatively, to allow for opti-mised scanning. Comparison of CPS enhancement patterns and dynamics aremade with optimised MD-CT and MR studies.Conclusion: CPS improved the detection and characterisation of liver lesionsand the enhancement characteristics highly correlated with those of MD-CT andMR.

C-025Atypical liver hemangiomas: Contrast-enhancement patterns at pulse-inversion UST.V. Bartolotta, M. Midiri, M. Galia, G. Mamone, A. Carcione, R. Lagalla;Palermo/IT

Learning Objectives: To illustrate the contrast-enhancement patterns of hepatichemangiomas (HE) assessed as atypical at baseline ultrasound (US).Background: In about 20-40% of cases HE do not show ultrasonographic typicalfeatures (homogeneous, hyperechoic mass with well-defined margins and poste-rior acoustic enhancement), thus making the correct diagnosis a difficult task.Recently, the introduction of contrast-specific US techniques, such as pulse-in-version, has lead to a better depiction of both macro and microvascularization ofhepatic tumors.Twenty-five patients with 28 HE confirmed at helical CT whichappeared not typical at baseline US underwent pulse-inversion US after Levo-vist® administration. Selected images (obtained at baseline and respectively 25-30 s, 55-60 s and 240 s after Levovist® injection) were sequentially reviewed todetermine echogenicity time changes of HE in comparison with adjacent liverparenchyma.Imaging Findings: 16/28 (57%) of HE showed a peripheral globular enhance-ment with a progressive centripetal fill-in, which was complete in 12/16 HE andincomplete in 4/16 HE. 4/28 (14%) showed a homogeneous early enhancementthat lasted throughout the vascular phase. 8/28 (29%) HE showed a rim-like en-hancement with a progressive centripetal fill-in. Deeply located HE, and HE withincomplete fill-in could still represent a challenging diagnosis. In the former casethe signal-to-noise ratio is often unfavourable whereas in the latter the half-life ofcurrently used contrast agents does not allow very late scans.Conclusion: CEUS allows the demonstration of typical contrast-enhancementpatterns in most of HEs indeterminate at baseline US, thus providing useful cluesfor characterization of these lesions.

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C-026Benign and malignant conditions in hepatic capsular retractionG. Brancatelli1, M.P. Federle2, A. Blachar3, V. Vilgrain4, Y. Menu5, L. Maruzzelli1,M. Midiri1, M. De Maria1, R. Lagalla1; 1Palermo/IT, 2Pittsburgh, PA/US,3Tel Aviv/IL, 4Clichy/FR, 5Paris/FR

Learning Objectives: To recognize the most common primary and secondaryconditions associated with capsular retraction of the liver.Background: Although capsular retraction has been most commonly describedin association with malignant conditions, in our experience we have observed itwith a diverse spectrum of benign and malignant etiologies.Imaging Findings: We have observed capsular retraction in primary malignantneoplasms (epithelioid hemangioendothelioma, hepatocellular carcinoma, cholan-giocarcinoma), secondary malignant neoplasms before and after treatment, andhepatic hemangioma, especially in cirrhotic livers. Other etiologies include con-fluent fibrosis in cirrhotic livers, chronic biliary obstruction (as can be seen inprimary sclerosing cholangitis), and traumatic hepatic injury (iatrogenic and non-iatrogenic).Conclusion: Because several recent studies have incorrectly reported hepaticcapsular retraction as a specific sign of hepatic malignancy, it is important tounderstand the imaging appearances of the various etiologies associated withthis sign to avoid misdiagnosis that may adversely affect the therapeutic approach.

C-027Causes of false positive interpretation for hepatocellular carcinoma incirrhosisG. Brancatelli1, R. Baron2, V. Vilgrain3, Y. Menu4, G. Runza1, A. Campisi1,M. Midiri1, M. De Maria1, R. Lagalla1; 1Palermo/IT, 2Chicago, IL/US, 3Clichy/FR,4Paris/FR

Learning Objectives: To recognize the most common causes of false positivediagnosis for hepatocellular carcinoma in the cirrhotic liver.Background: The distortion of liver parenchyma in the cirrhotic process can it-self create pseudotumors. Coincidental lesions in the liver, such as hemangioma,cysts, and focal nodular hyperplasia, can occasionally simulate more significanttumors, although their imaging characteristics usually allow an accurate diagno-sis. In this exhibit we will show the most common causes of false positive inter-pretation for HCC in end stage cirrhotic liver disease.Imaging Findings: Hyperdense regenerative nodules, dysplastic nodules, he-mangiomas, fibrosis, peliosis, THADs and arteriovenous fistulas are potentialcauses of false positive interpretation for hepatocellular carcinoma in the cirrhot-ic liver.Conclusion: In screening a large transplantation population, approximately 8%of patients will have findings suggestive of a false-positive diagnosis of hepato-cellular carcinoma.

C-028Contrast-enhanced ultrasonography in the characterization of benign focalhepatic lesions: Spectrum of findingsT.V. Bartolotta, M. Midiri, M. Galia, A. Carcione, M. De Maria, R. Lagalla;Palermo/IT

Learning Objectives: To illustrate the contrast-enhancement patterns of focalhepatic lesions at contrast-enhanced US (CEUS).Background: Gray-scale US is a low-specificity technique in the differential di-agnosis of hepatic tumors. More recently, newer US techniques were introducedwhich are extremely sensitive to non-linear response of microbubble-based UScontrast agents. We describe CEUS findings of both typical and atypical heman-gioma, focal nodular hyperplasia (FNH), adenoma, angiomyolipoma, solitarynecrotic nodule (SNN), intrahepatic extramedullary hematopoiesis (IEH), focalsteatosis and skip-area of the liver.Imaging Findings: Cavernous hemangioma may show a peripheral globularenhancement with a progressive centripetal fill-in, which can be complete (typi-cally) or incomplete (atypically) when hemorrhagic necrosis, scarring, or myxo-matous changes occur. A rim-like enhancement with a progressive centripetalfill-in may be observed. Capillary hemangiomas frequently show a homogeneousearly enhancement that lasts throughout the vascular phase. FNH are highly hy-pervascular tumors with a strong enhancement in the arterial phase. An unen-hancing central scar may be present. Adenomas are supplied by the hepaticartery and they exhibit early enhancement, but usually less intense than FNHand often heterogeneous. Angiomyolipoma is a rare hypervascular tumor withlarge intratumoral vessels, often punctate or curved. SNN is a very rare pseudo-tumoral mass, probably an end-stage of a long-standing focal disease, which

exhibit lack of vascularization. IEH may show early enhancement in the arterialphase. Focal fatty liver and fat-sparing areas usually become isoechoic to sur-rounding hepatic parenchyma in the late phase.Conclusion: CEUS may provide useful clues for the characterization of focalhepatic benign lesions.

C-029Spectrum of cystic liver lesions on CT and MR imagingG. Brancatelli1, V. Vilgrain2, P. Ros3, K. Mortele3, M.P. Federle4, C. Del Frate5,Y. Menu6, M. Midiri1, R. Lagalla1; 1Palermo/IT, 2Clichy/FR, 3Boston, MA/US,4Pittsburgh, PA/US, 5Udine/IT, 6Paris/FR

Learning Objectives: To understand the CT and MR imaging findings of cysticliver lesions.Background: In some cases it is difficult to characterize hepatic cysts with imag-ing criteria alone. However certain cystic focal liver lesions have classic CT andMR imaging characteristics. In this exhibit we will show the imaging findings insimple noncomplicated and complicated hepatic cysts, polycystic liver disease,biliary cystadenoma and cystadenocarcinoma, hydatic disease, hepatic abscess,biliary hamartomas, Caroli's disease and choledochal cysts.Imaging Findings: CT and MR imaging findings to recognize are the size of thelesion; the presence and thickness of a wall; the presence of septa, calcifications,or internal nodules; the enhancement pattern; the MR cholangiographic appear-ance.Conclusions: The spectrum of cystic liver lesions as studied with helical CT and1.5 T MR imaging is presented.

C-030Focal confluent fibrosis: Findings at CT and MRI in the cirrhotic liverG. Brancatelli1, R. Baron2, V. Vilgrain3, Y. Menu4, S. Pardo1, L. Maruzzelli1,M. Midiri1, M. De Maria1, R. Lagalla1; 1Palermo/IT, 2Chicago, IL/US, 3Clichy/FR,4Paris/FR

Learning Objectives: To recognize the imaging findings of focal confluent fibro-sis in cirrhotic liver.Background: Fibrosis is always present with cirrhosis. When the fibrosis is con-centrated focally, a finding often referred to as focal confluent fibrosis, it can cre-ate mass lesions that simulate tumors at imaging. Such lesions occur commonlyin patients with long-standing cirrhosis who need transplantation (up to one-thirdof patients).Imaging Findings: These lesions are often wedge-shaped, radiating from theporta hepatis, are widest at the capsular surface, and are most common in theanterior and medial segments of the liver but can be present anywhere in the liver.The associated parenchymal atrophy with capsular retraction over the lesion is acommon, reliable finding in helping to differentiate it from hepatocellular carcino-ma. At MR imaging, fibrosis always has high signal intensity on T2-weighted im-ages, similar to the appearance of malignancy. While usually hypoattenuating orisoattenuating relative to adjacent liver tissue on unenhanced and contrast-en-hanced CT scans, focal areas of vascular enhancement within portions of theselesions can simulate tumor.Conclusion: When characteristic findings and location are present, focal conflu-ent fibrosis can be differentiated from hepatocellular carcinoma. Focal areas ofvascular enhancement must be recognized as such and not misinterpreted astumor.

C-031Evaluation with MRI of hydatid cysts in the liver: Range of appearancesA. Luna1, R. Ribes2, J. Vida2, M. Buzzi3 E. Feliu4, P. Caro5; 1Jaen/ES, 2Cordoba/ES,3Buenos Aires/AR, 4Alicante/ES, 5Cádiz/ES

Purpose: To review the different features of hydatid cyst in the liver evaluatedwith MRI. To be alert of hydatid cyst as a potential pitfall in MRI studies.Background: Hydatid cysts of the liver are frequent in Mediterranean countries.Due to MRI capabilities, in many institutions, MRI is the first imaging study in theevaluation of patients with suspicion of liver disease, most commonly in patientswith a known malignancy to rule out metastases, without any other previous im-aging study. The heterogeneous and variable appearance of hydatid cysts makesthem a potential pitfall on MRI studies.Procedure Details: We retrospectively reviewed patients with hydatid cysts inthe liver studied with MRI. Special attention was dedicated to their appearanceon T1-weighted, T2-weighted and post-contrast sequences. All the studies wereperformed in a 1.5 T magnet. Correlation with available ultrasound, CT and path-ologic studies was performed. The presence of a capsulated complex heteroge-

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neous mass, with solid and cystic components, hypointense areas on T1 and T2-weighted images should raise the suspicion of a hydatid cyst. But the presenta-tions of echinococcal cysts are multiple, and they may also present as an almosthomogeneous cyst, a predominantly solid mass, a completely hypointense masson T1 and T2-weighted images. Besides this different patterns of enhancementhave been demonstrated.Conclusion: Hydatid cyst of the liver may present with multiple different featureson MRI studies, it not being possible to establish a diagnostic pattern for theircharacterization. Radiologist's should be alert to this diagnosis, mainly in casesof a hepatic heterogeneous mass.

C-032Liver adenoma: A spectrum of imaging findings with radiologic-histopathologic correlationB. Boukobza, C. Guettier, D. Azoulay, J. Coumbaras, R. Adam, D. Samuel,D. Castaing, M.-F. Bellin; Villejuif/FR

Learning Objectives: To become familiar with the broad spectrum of CT and MRcharacteristics of liver adenomas. To correlate the pathologic characteristics, in-cluding immunolabeling, with the imaging findings. To discuss the key elementsto be included in the differential diagnosis and to provide examples of them.Background: Because of the risk of hemorrhage and malignant transformation,hepatocellular adenomas must be identified and treated promptly. In this exhibitwe will illustrate the imaging features with corresponding immunostaining pat-terns. 21 patients with liver adenoma were evaluated in our department with ul-trasonography, CT and MRI prior to surgery. 7 patients had multiple lesions[multiple adenomas (n = 4), focal nodular hyperplasia (n = 4), angioma (n = 1)].We visually compared the imaging features (size and number of lesions, homo-geneity, vascularization, presence of fat, capsule) with the histopathologicallydetected lesions and the results of CD 34 and smooth muscle actine immunos-taining.Imaging Findings: The degree of attenuation or signal intensity relative to un-derlying liver on CT or MR images depends on the composition of the tumor(hemorrhagic, fatty and hepatocellular components) and of the liver, as well ason the phase of contrast material enhancement. The following imaging findingsare suggestive of the diagnosis of liver adenoma in a noncirrhotic liver: A solid,heterogeneous and hypervascularized lesion, with a fatty component, and a hy-perintense and heterogeneous lesion on both T1- and T2-weighted MR images.Conclusion: Liver adenomas have a wide variety of appearances, with no spe-cific characteristics. Their heterogeneity is reflected by their numerous histologiccomponents.

C-033Quantitative assessment of the contrast behavior of typical focal hepaticlesions before and after the administration of Gd-DTPA andsuperparamagnetic iron oxide (SPIO) particlesT. Schwarzlmueller, C. Zech, S.O. Schoenberg, T. Helmberger, M.F. Reiser;Munich/DE

Purpose: The purpose of this study was the quantitative comparison of Gd-chelate- and SPIO-enhanced MRI regarding specific contrast phenomena in fo-cal hepatic lesions.Methods: On a 1.5 Tesla magnet, 453 (Gd-DTPA) versus 463 patients (SPIO)were studied pre- and post-contrast administration. In both groups the lesion-to-liver-contrast ratio (L/L) for 229 and 238 lesions (45/102 hepatocellular carcino-mas, 90/92 metastases, 69/23 hemangiomas, 25/22 hepatocellular adenomasand focal nodular hyperplasias) was calculated before and after contrast admin-istration.Results: In the Gd-group, post-contrast administration there was a significant(p < 0.05) positive change of the L/L on T1W images, only in hypervascularizedmetastases (-19 ± 15 to 6 ± 23) and hemangiomas (-16 ± 20 to 9 ± 26) that wasparalleled by the L/L changes on T1W imaging in the SPIO-group (-25 ± 29 to6 ± 24 and -15 ± 20 to 18 ± 43), without a significant difference between the Gd-DTPA- and SPIO-enhanced group. SPIO L/L on T1W images changed signifi-cantly in HCC's in cirrhotic livers (-7 ± 24 to 21 ± 71), in hypovascularizedmetastases (-19 ± 24 to 11 ± 30), HCA's and FNH's (-6 ± 21 to 21 ± 26), whileon T2W imaging only in HCC's in non-cirrhotic liver (10 ± 14 to 21 ± 17) and inboth hypo- and hypervascularized metastases (16 ± 19 to 27 ± 25 and 20 ± 20to 33 ± 30) a significant L/L increase was seen.Conclusion: The combination of slight parenchymal signal loss and vascularsignal increase in SPIO-enhanced T1W imaging allowed the superior depictionof vascular information as in hypervascularized metastases, hemangiomas, be-nign hepatocellular lesions, and HCC's in cirrhosis. This vascular information with

interpretation of SPIO-enhanced T1W and T2W images may enhance the diag-nostic efficacy of SPIO-enhanced MRI.

C-034Proton MR spectroscopy and diffusion-weighted MR imaging at 3.0 T for thediagnosis and monitoring of therapeutic effect on hepatocellular carcinomabefore and after chemoembolizationC.-Y. Chen, G.-C. Liu, Y.-T. Kuo, T.-S. Jaw; Kaohsiung/TW

Purpose: To evaluate the therapeutic effect of patients with a large HCC beforeand after TACE by 1H-MRS and ADC value with DW MRI.Material and Methods: Thirty patients with large HCC (> 3 cm) were examinedwith single-voxel (2 x 2 x 3 cm3) MRS (Probe-P) using a body coil; and spin-echoecho-planar sequence (b, 0 and 500 sec/mm2) MRI on a 3.0 T MR scanner (SignaVH/I, GE). Twelve of the 30 HCCs reviewed before and after TACE. We also ex-amined 10 normal liver patients using the same protocol. The absolute concen-tration of choline was measured by external phantom replacement method at3.2 ppm. ADCs were calculated for all lesions with commercially available soft-ware on an imaging workstation (Functool & AW 4.0; GE). Student's t-test wasused to compare the data. Paired t-test was used for comparing the choline changeof HCCs before and after TACE.Results: The mean choline concentrations for HCC and normal liver are3.23 mm ± 3.19, 0.20 mm ± 0.28. ADCs for HCC and normal liver are 1.70 x 10-

3 mm2/sec ± 0.31, 1.63 x 10-3 mm2/sec ± 0.41. No significant difference on ADCexists between HCC and normal controls (p > .05). There is a significant increasein choline concentration in HCC as compared to normal liver (p < .01). The meancholine concentration for the 12 HCCs post-TACE decreased from 3.9 mm ± 0.94to 0.65 mm ± 0.29 (p < .01). The mean ADC for 12 HCCs post-TACE increasedfrom 1.64 x 10-3 mm2/sec ± 0.11 to 2.18 x 10-3 mm2/sec ± 0.10 (p < .01).Conclusion: 1. DW MRI is useless, and 1H-MRS is useful in the diagnosis ofHCC. 2. Absolute choline concentration on 1H-MRS and ADC value could beuseful methods for monitoring therapeutic response to TACE for HCC.

C-035Computer aided preoperative segmental localization of liver tumors:Clinical evaluation with inter-observer study from 230 lesionsA. Osorio1, P.-J. Valette2, A. Mihalcea2, J. Atif1, X. Ripoche1; 1Orsay/FR,2Lyon/FR

Purpose: A new PC based software has been developed to generate the hepaticsegments of the anatomic Couinaud model.Methods and Materials: The method consists of extracting the envelope of theliver using an active contours algorithm. In order to find out the different hepaticsegments, the user has to specify eight points on a number of CT slices: theright, middle and left hepatic veins, the right and left portal veins, the left lobe tip,the deep ligament venosum, the superficial ligament venosum and the inferiorvena cava. Using a cubic line interpolation and an active contours method, the3D reconstruction of the segments is computed and their volumes calculated. Alesion designation gives it's volume, the main associated hepatic segment andeventually other affected segments.Results: A senior (taken as a gold standard) and a junior radiologist have ana-lyzed sixty CT scans of patients with focal hepatic lesions. The requested timeand the performance of the junior radiologist to describe the segmental localiza-tion of the hepatic tumors have been measured with and without the developedsoftware. The number of targets, in each case, varied between 1 and 10 lesions.Thirteen patients have already had an hepatectomy and 43 patients had severalportal or hepatic vein anatomic variations.Conclusions: The software leads to a drastic decrease in the interpretation time,consuming about 35%, and the proportion of the localization errors are reducedfrom 19% to 9%.

C-036Conventional and Doppler ultrasonography as control methods forabstinence in alcoholic liver cirrhosis patientsO.Y. Chipov, V.E. Syutkin, I.O. Ivanikov; Moscow/RU

Laboratory tests (MCV, GGTP activity, ratio of GGTP and ASTP, ALTP) comprisethe traditional methods for control of abstinence in alcoholic liver cirrhosis pa-tients. In addition we investigated ultrasonography parameters (a-p size of rightliver lobe, spleen late, presence of collaterals, diameter and blood flow velocity inthe portal vein, hepatic artery resistive index) in 21 alcoholic liver cirrhosis pa-tients (group 1). All patients were similar by age, Child score, values of laboratoryand ultrasonography tests. After 11-14 months we studied all patients again: 11

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were in prolonged abstinence (group 2), other 10 – hard abused patients (group 3).Results: Values of GGTP and a-p size of right liver lobe decreased in group 2and had not significantly changed in group 3 as compared with group 1 (146 ± 154,606 ± 406 vs. 599 ± 435 p = .014, p = .968; 13.5 ± 1.5, 17.4 ± 2.2 vs. 17.6 ± 2.5,p = .0003, p = .507). Hepatic artery resistive index increased in group 2 and hadnot significantly changed in group 3 as compared with group 1 (0.72 ± 0.04,0.59 ± 0.05 vs. 0.63 ± 0.07, p = .0001, p = .144). There were no difference in theother ultrasonography parameters and MCV.Conclusion: The addition of ultrasonography indices to the traditional laboratorytests significantly improves control of prolonged abstinence in alcoholic liver cir-rhosis patients. The high value of hepatic artery resistive index (> 0.70), absenceof hepatomegaly and low GGTP activity are typical for prolonged abstinence.Low RI, significant enlargement of the right liver lobe and high GGTP activity aretypical for abused patients.

C-037Evaluation of the diagnostic efficacy of FDG-PET in patients with focalhepatic lesions: Comparison with SPIO enhanced MRIY. Nakagami, N. Takahashi, T. Oka, A. Abe, M. Ito, T. Hara, A. Suzuki,T. Kawano, T. Inoue; Yokohama City, Kanagawa/JP

Purpose: The aim of this study was to compare the diagnostic efficacy of fluo-rine-18 deoxyglucose (FDG) positron emission tomography (PET) for the detec-tion and diagnostic accuracy of focal liver lesions, with superparamagnetic ironoxide (SPIO) enhanced MRI.Methods and Materials: Twenty-four patients (14 men and 10 women, meanage 61.4 years) were examined by SPIO-MRI and FDG-PET. All patients werealso examined by intravenous contrast-enhanced spiral or multi-detector row CT(CECT).Results: There were a total of 43 confirmed focal hepatic lesions; 31 metastaticcancers in 16 patients and 12 hepatocellular carcinomas (HCCs) in 8 patients.Final diagnosis was established by operation in 22 cases, by biopsy in 13 cases,and by progression of disease on follow-up examination in the other 8 cases. Thesensitivity of FDG-PET for HCC detection was almost equal to CECT, but that ofFDG-PET for metastatic cancer detection, especially cancers smaller than 1 cmin size, was significantly superior to CECT. That of FDG-PET for HCC detection,especially cancers smaller than 1 cm in size, was significantly inferior to CECT.The sensitivity of FDG-PET for metastatic cancer detection was almost equal tothat of SPIO-MRI, but the specificity of for metastatic cancer detection was signif-icantly superior to that of SPIO-MRI because SPIO-MRI produced a higher inci-dence of false-positive findings.Conclusion: FDG-PET could take the place of SPIO-MRI as a non-invasive ex-cellent modality to determine the distribution of hepatic lesions preoperatively.FDG-PET could also be a useful modality to follow liver metastasis postopera-tively.

C-038The dynamics of ultrasonography (US) and laboratory signs of acutealcoholic hepatitis (AAH) in patients with liver cirrhosis (LC)V.E. Syutkin, O.Y. Chipov, I.O. Ivanikov; Moscow/RU

Purpose: To reveal the early and late US and laboratory signs for diagnosis ofAAH in patients with LC.Methods and Materials: We studied 80 patients with alcoholic LC: 33 patientswith AAH (abstinence from alcohol less than 10 days (group 1)), 29 patients withAAH (abstinence 11-50 days (group 2)), 18 patients in prolonged abstinence(more then 50 days) served as a control group (3)). The size of the right lobe ofliver (RL), resistive index in hepatic artery (RI), GGTP activity, MCV, WBC andband neutrophils (BN) were measured in all patients.Results: Values of GGTP decreased (609 ± 389, 356 ± 195, 94 ± 76, p = .0001),and RI increased (0.59 ± 0.06, 0.62 ± 0.08, 0.73 ± 0.05, p < 0.0001) for groups1,2,3 respectively. There was no significant difference between groups 1 and 2 inRL (17.3 ± 2.2 cm; 15.9 ± 2.1 cm), MCV (96.9 ± 11fl; 99.2 ± 6.9fl), BN (8 ± 6%;10 ± 6%). In group 3 all these tests normalized. In group 1 WBC was lower(7.6 ± 2.3) than in group 2 (14.1 ± 10.8, p < 0.05).Conclusion: Low RI is an early diagnostic sign of AAH in patients with LC andhigh WBC is a late one. The decrease of GGTP activity remains important for allAAH stages. RL, MCV and BN remain high and did not change significantly in thefirst 50 days of abstinence.

C-039Quantitative hepatic arterial flow measurement by xenon CTY. Kodama, T. Shimizu, A. Sawada, Y. Sakuhara, D. Abo, K. Miyasaka;Sapporo/JP

Purpose: To evaluate the accuracy of hepatic arterial blood flow by xenon CT forcomparison with ultrasound transit time flow meter (UTTFM).Materials and Methods: This study was approved by the animal care and usecommittee of our institute. Ten female adult beagle dogs were used. The probe ofthe UTTFM was attached to the dogs PHA surgically. Xenon CT was performedfor 9 minutes, (25% Xenon inhalation for 4 minutes and monitoring for 5 minutes.)In 7 dogs, xenon CT was repeated under surgically induced proximal proper he-patic artery (PHA) stenosis following a normal xenon CT. Following this, xenonCT was again repeated after surgically induced proximal portal vein (PV) steno-sis. Quantitative hepatic arterial flow by xenon CT and UTTFM were reportedrespectively. Mean value and standard deviation were shown for the normal ses-sion, PHA stenosis session, PV stenosis session, and all session respectively.We assess whether these were correlated or not by using regression analysis.Results: In the normal session, quantitative hepatic arterial flow by xenon CTand UTTFM were 46.2 ± 13.2 and 49.9 ± 15.1 respectively. In the PHA stenosissession, 27.0 ± 8.6 and 17.0 ± 8.1. In PV stenosis session, 61.1 ± 24.8 and60.3 ± 19.4. In all sessions, 45.0 ± 20.6 and 43.3 ± 22.8. (All units are mL/min/100 g). Quantitative hepatic arterial flow by xenon CT correlated with that byUTTFM significantly using regression analysis, in the normal session(r = 0.905565, p = 0.0003) and all session (r = 0.858681, p < 0.0001).Conclusions: Hepatic arterial flow by xenon CT reflects the change of hepaticarterial flow. Quantitative arterial flow by xenon CT was correlated with that byUTTFM significantly.

C-040Contrast-specific ultrasound (CS-US) of liver lesions: Significance of portal-phase hypoechogenicityM. Mattace Raso1, O. Catalano1, A. Nunziata2, B. Cusati1, A. Siani1;1Pozzuoli/IT, 2Naples/IT

Purpose: A hypoechoic (hypovascular) lesion during the portal-sinusoidal phaseof CS-US imaging of the liver is usually considered diagnostic for metastasis inclinical practice. Our purpose was to statistically assess the prevalence and sig-nificance of these hypoechoic liver lesions.Material and Methods: We retrospectively evaluated the contrast-specific UShepatic studies of 221 consecutive patients evaluated in a 1-year period (March2002-February 2003) for different non-traumatic clinical questions. A continuous-mode, low-mechanical index US technology was employed (Contrast Tuned Im-aging, Esaote, Italy). A sulfur exafluoride-based microbubble contrast agent wasinjected (SonoVue, Bracco, Italy).Results: Hypoechoic liver lesions were identified in 60 patients (31 women and29 men, aged 22-81 years, mean 57 years). Eleven subjects with > 10 lesionsand 4 subjects without a confirmed diagnosis were excluded. Fourty five patientswith 116 hypoechoic lesions had a final diagnosis (CT and/ or MRI-correlation in30 cases, US follow-up in 8, and needle-aspiration in 7). Patients showed 1-10focal lesions (mean, 3 lesions). Diagnosis was metastasis (95 lesions/ 30 pa-tients), abscess (13 lesions/ 8 patients), lymphoma (3 lesions/ 2 patients), intra-hepatic cholangiocellular carcinoma (2 lesions/ 2 patients), thrombosedhemangioma (1 lesion/ 1 patient), dysplastic nodule in cirrhosis (1 lesion/ pa-tient), and direct infiltration from gallbladder carcinoma (1 lesion/ 1 patient).Conclusion: Excluding abscess, that shows other typical features, a hypoechoicliver lesion at venous-phase CS-US imaging is diagnostic for non-hepatocellularmalignancy and particularly for metastasis (even in the absence of a known ext-rahepatic tumor). No benign lesion appears as hypoechoic during portal-sinusoi-dal phase of liver opacification.

C-041Liver cirrhosis: Evaluation of haemodynamic changes using an ultrasoundcontrast agentG. Argalia, T. Abbattista, G. Giuseppetti; Ancona/IT

Purpose: Liver cirrhosis is associated with haemodynamic changes. Using ultra-sound c.a. (Levovist), we measured and compared Doppler signal arrival, andpeak enhancement times in the hepatic vein of patients with cirrhosis, chronicliver disease and in healthy subjects.Methods and Materials: We examined 40 subjects (n = 12 with cirrhosis, n = 16with chronic liver disease and n = 12 healthy subjects) In the first group therewere 6 patients with Child stage A, 1 patient with B and 5 patients with C. The

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signal was recorded starting 20 seconds before contrast infusion until 2 minutesafter its end. The software of the ultrasound machine automatically sampled time-intensity values.Results: Arrival times were significantly shorter (p < 0.001) in cirrhotic than non-cirrhotic livers (chronic liver disease + controls) and in patients with Child stageC compared with A. Differences in peak enhancement were weakly significantbetween cirrhotic and chronic patients (p < 0.04) and highly significant betweenthe former and controls (p 0.05). Finally, cirrhotic patients had arrival times con-sistently shorter than 17 seconds. Automatic time-intensity curve analysis mademeasurements objective and conceptual error systematic, thus identifiable.Conclusion: Analysis of the passage of Levovist at the hepatic vein can thusbecome a non-invasive, well-tolerated and cost-effective diagnostic and monitor-ing tool in a large number of patients with liver disease.

C-042Non-specificity of the peritumoral ring of fat sparing surrounding tumors inliver steatosisL. Marti-Bonmati, F. Peñaloza, E. Villarreal, C. Soto, M. Martínez; Valencia/ES

Purpose: To evaluate the relationship between peritumoral fat sparing ring (PFSR)surrounding liver lesions on MR images and the nature (benign-malignant) ofthese tumors.Methods and Materials: We reviewed the MR imaging examinations of 128 con-secutive patients with an institutionally confirmed liver tumor diagnosis. Withinthe standard liver MR protocol, an axial double echo T1-weighted GRE (TE 2.3and 4.6 ms, 235 x 512 matrix), and a dynamic T1-weighted GRE (TE 1.3 ms,258 x 512 matrix) in the early arterial, portal, equilibrium and late phases werealways acquired. The presence and degree of liver steatosis, cirrhosis, PFSRand contrast-enhanced rings were recorded.Results: PFSR was observed in 21 patients. There was a statistical correlationbetween the degree of steatosis and the presence of PFSR. However, there wasnot a correlation between the presence of cirrhosis and the presence of a PFSR.A sparing area distal to the lesions was seen in 18% of the cases, being statisti-cally associated to a complete PFSR. Although most PFSR did not enhance withGd, 4 cases of PFSR were seen as a peritumoral contrast-enhanced ring, match-ing both areas. PFSR was seen both in benign (hemangiomas) and malignant(metastasis, HCC) tumors.Conclusion: PFSR may be caused by direct compression of the adjacent hepat-ic parenchyma by the lesion and arterioportal shunts. These rings match therings observed after contrast injection in metastatic tumors. However, and al-though frequently seen in patients with malignant tumors, PFSR can be alsoseen with benign tumors.

C-043Influence of overheating on local depression of liver function evaluated byscintigraphy, post contrast MRI and after the fusion of functional andmorphological imagesM. Studniarek, M. Nowakowski, M. Retkowski, W. Adamonis, D. Studniarek,T. Bandurski; Gdansk/PL

Purpose: To find and measure the hypothetic zone of penumbra in liver paren-chyma after RF ablation.Methods and Materials: Five patients were studied after RF ablation. SPECT ofthe liver (99mTc sulphur colloid) and MRI studies were performed. Superimposi-tion (fusion) of liver images from SPECT and MRI was made using Corel PhotoPaint 9. Correct magnification of slices before fusion was based on anatomicallandmarks e.g. liver/spleen external borders and shape of their hilar. Hypoactivezones were measured and compared with diameter of coagulated foci. In twomini-pig livers 16 foci of thermal coagulation were induced. T1-weighted imageswere then obtained after i.v. injections of Gd-hepatotropic c.m. and 99mTc-sul-phur colloid. After killing the animals, autoradiograms of resected and sliced liv-ers were received. Diameters of thermocoagulated foci were compared to thesize of liver afunction zones obtained at MRI and scintigraphy.Results: In patients the size of coagulated spheres at the end of treatment meas-ured 14-26 mm of diameter. The hypoactive zones surrounding, and including RFablated tumour were 20-25 mm larger than thermally coagulated ones. In piglivers the mean size of coagulation measured 12.5 mm, whilst that of non-en-hanced foci was 17.5 mm. On autoradiographic images the mean diameter ofhypoactive foci measured 22 mm.Conclusion: The zones of liver afunction evaluated by MR, SPECT and autora-diograms are significantly larger than the diameter of coagulated foci. The de-pression of liver function after RF ablation is more significant than it is supposedto be before and during therapy.

C-044withdrawn by authors

C-045Iron liver quantification by MRIJ. Elias Jr, A.A.O. Carneiro, A.L.C. Martinelli, D.B. Araújo, O. Baffa;Ribeirao Preto/BR

Purpose: To evaluate the clinical MRI utility to quantify liver iron deposits in non-blood transfused and transfused patients.Methods: MRI was performed in a group of 10 non-blood transfused patientsand in 13 polytransfused patients. T2 MRI images were acquired using multi-slice single-spin-echo (SSE), single slice multi-spin-echo and gradient-recalled-echo (GRE) techniques conducted on a 1.5 T scanner. The logarithm of thebrightness and transversal relaxation time (R2 = 1/T2) were obtained. This R2value was determined by curve fitting to the signal intensity (SI) of SSE imagesas a function of the spin-echo time (TE). Seven SSE images with different TEswere used. All patients also had the hepatic iron concentration (HIC) evaluatedby Magnetic Susceptometry (MS).Results: The SI in the first-echo imaging by MSE presented the best correlationwith HIC by MS (97%). The SI of the image by GRE sequence showed a correla-tion of 89% with HIC. The R2 value also presented a good correlation (93%),however with a long time of sequence acquisition (~30 minutes). Although withthe lowest correlation, MRI by GRE sequences is an attractive technique to eval-uated HIC because of its fast acquisition (~ 15 seconds), allowing the patient tohold their breath during the acquisition.Conclusion: MRI is a good non-invasive technique to evaluate liver iron over-load, able to evaluate iron as high as 40 mg/g of dry tissue.

C-046Use of dual-contrast magnetic resonance imaging in staging of hepato-cellular carcinoma: Comparison with arterio-portal CT, spiral CT, andhepato-cellular MRI contrast mediumP. D'Andrea, M. Favat, F. Schiavon; Belluno/IT

Purpose: This study aimed to verify whether the use of D-C MRI, performed bysequential administration of SPIO (Endorem Guerbet) and Gd-BOPTA (Multi-hance Bracco), improved the capability of MRI in detecting small hepatocellularcarcinoma (HCC) in comparison to both CT imaging, and dynamic or delayedMRI with Gd-BOPTA only.Materials and Methods: We evaluated 47 patients with a diagnosis of HCC, forwhom either surgical or mini-invasive therapy was already planned. In order todetect further lesions, a first group of 21 patients was examinated by S-CT, AP-CT and dynamic and delayed MRI with Gd-BOPTA. A second group of 26 pa-tients was then examined by S-CT and D-C MRI in combined sequence as follows:First we perform FFE T2 sequences after SPIO administration, then dynamicFFE T1 B H sequences after Gd-BOPTA administration. Statistical analysis wasperformed by Wilcoxon test and intra-class correlation.Results: In the first group we could detect 74 lesions: the most sensitive was theAP-CT, with a mean of 2.47 lesions/patient while S-CT revealed 96% of them,dynamic Gd-BOPTA MRI 88% and delayed Gd-BOPTA MRI 80%. In the secondgroup, by D-C MRI during dynamic sequences we could detect 83 lesions, with amean of 2.63 lesions/patient, while S-CT showed only 91%of them. No severeadverse reactions were observed in our series.Conlusions: Results in our study showed that D-C MRI could improve the MRIsensitivity and conspicuity of lesions in staging of HCC, in comparison with bothhepato-cellular contrast medium MRI and CT imaging.

C-047Hepatocellular carcinoma detection and characterization: Gd-BOPTA-enhanced magnetic resonance imaging (MRI) versus tetraphasic multislice-spiral computed tomography (CT)I. Sansoni, A. Laghi, D. Marin, M. Celestre, P. Foti, F. Iafrate, C. Miglio,R. Passariello; Rome/IT

Purpose: The aim of our study was to prospectively compare the diagnostic ac-curacy of tetraphasic mutlislice-spiral CT and Gd-BOPTA-enhanced MRI in de-tecting and characterizating hepatocellular carcinoma.Method and Materials: Sixty patients with chronic hepatitis were referred for CTand MRI evaluation of the liver. CT was performed using a 4-slice multidetectorscanner. A tetraphasic acquisition protocol (unenhanced, arterial, portal venousand equilibrium phases) was obtained following dynamic injection of iodated non-

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ionic contrast medium. MR study was performed on a 1.5 T scanner using thefollowing acquisition protocol: pre-contrast T2w HASTE and T1w FLASH; dynamiccontrast-enhanced T1w FLASH acquired at the arterial, portal and equilibriumphases; delayed (60 min) T1w FLASH hepato-biliary phase. CT and MRI wereblindly evaluated for the presence, number and characterisation of lesions. Im-age data were compared with histopathology and/or follow-up.Results: Multislice spiral CT detected 52/56 hypervascular focal liver lesions(25 ≥ 2 cm, 27 < 2 cm). Gd-BOPTA-enhanced magnetic resonance imaging de-tected 51/56 lesions (27 ≥ 2 cm, 24 < 2 cm). No statistically significant difference(p > 0.05) was observed in lesion identification. Lesion characterization was cor-rect in 39 cases at multislice CT and in 52 cases at MRI. A statistically significantdifference between CT and MR was observed for characterization of lesionssmaller than 2 cm.Conclusions: No statistically-significant difference between multislice-spiral CTand Gd-BOPTA-enhanced MRI was observed in terms of lesion detection rate,independently of lesion size. Gd-BOPTA MRI provided additional clues for lesioncharacterization, if lesions smaller than 2 cm are considered.

C-048Mn-DPDP enhanced MRI in the detection of liver metastasesF. Örs, M. Kocaoglu, N. Bulakbasi, C. Tayfun, I. Somuncu, M. Yildirim;Ankara/TR

Introduction: The aim of this study is to compare contrast enhanced MRI withMn-DPDP, triphase helical CT and T2-weighted sequences in the detection andcharacterization of liver metastases.Material and Method: Thirty-two patients who had an unknown primary malig-nancy and suspicious focal liver lesion on US and CT examinations, underwenttriphase helical CT, noncontrast MRI and contrast Mn-DPDP- enhanced MRI.The lesions were subdivided according to their dimensions as equal to or smallerthan 5 mm, between 5-10 mm and greater than 10 mm. Histopathological diag-nosis of all lesions were confirmed by preoperative biopsy and follow-up, or intra-operative biopsy.Results: Liver metastases were detected in 13 of 32 patients of whom all weresuspicious. Contrast enhanced MRI with Mn-DPDP detected 123 metastases in13 patients. The number of the lesions equal to, or smaller than 5 mm; between5-10 mm; equal to or greater than 10 mm were 55, 35 and 33 respectively. Ahundred metastases were detected on T2-weighted images. The number of theselesions according to their dimensions were 39, 29, 32. Eighty-six metastaseswere detected with dynamic liver CT and their numbers according to their dimen-sions were 21, 24 and 21. Finally contrast enhanced MRI with Mn-DPDP detect-ed more metastases than T2- weighted images with a ratio of 41% and triphasehelical CT with a ratio of 161%.Conclusion: Contrast enhanced MRI with Mn–DPDP is superior to T2-weightedimages and triphase helical CT in detecting lesions smaller than 5 mm., but thissuperiority is statistically insignificant.

C-049Pyogenic liver abscess: Harmonic, contrast-specific ultrasound (US)findingsM. Mattace Raso1, O. Catalano1, A. Nunziata2, V. Molese1, A. Siani1;1Pozzuoli/IT, 2Ercolano/IT

Purpose: To illustrate the appearance of pyogenic liver abscess as shown duringreal-time, contrast-specific, harmonic US imaging.Material and Methods: We retrospectively evaluated the contrast-specific USfeatures of 8 cases of aspiration-confirmed liver abscess. There were 5 womenand 3 men, aged 25-78 years.A continuous-mode, low-mechanical index US technology was employed (Con-trast Tuned Imaging, Esaote, Italy). A second-generation, sulfur-exafluoride based,microbubble contrast agent was injected I.V. (SonoVue, Bracco, Italy). All studieswere correlated with the CT findings.Results: The following findings were categorized in 13 abscesses (1-6 abscess/patient, mean 1.6). Arterial-phase rim enhancement (13/13), arterial vessels run-ning along the margin of the abscess (11/13), small arterioles within the internalsepta (8/13), dense and persistent septal enhancement (13/13), absent microcir-culation within the internal fluid/ necrotic components (13/13), peri-abscess tran-sitory arterial-phase hypervascularity (perifocal hyperemia - 3/13). Largerabscesses showed partial peripheral septa, while thin but complete septa couldbe identified in smaller abscesses, with an overall appearance of honeycombing.Conclusion: To our knowledge, the contrast-specific US findings in pyogenicliver abscess have still not been described. This new tool identifies typical fea-tures, including: Arterial-phase rim enhancement; arterial vessels running along

the margin of the abscess or the internal septa; dense and persistent septal en-hancement; absent microcirculation within the internal fluid/necrotic components;peri-abscess transient arterial-phase hypervascularity. Radiologists should beaware of the typical and atypical appearance of hepatic pyogenic abscess asshown at contrast-specific US imaging.

C-050Precise image fusion of PET and CT of the liverJ.A. van Dalen, W. Vogel, H. Huisman, W.J.G. Oyen, J.O. Barentsz;Nijmegen/NL

Purpose: Diagnostic and surgical strategies could benefit from precise localiza-tion of liver malignancies via PET-CT image fusion. However, fusion uncertain-ties occur due to: 1. Protocol differences in data-acquisition, and: 2. The limitedPET resolution and its moderate visualization of liver tissue. A new method wasinvestigated that minimizes the uncertainties well beyond the typical uncertain-ties of 1 cm obtained by commonly available methods.Methods and Materials: User indicated boundaries of the liver and the mutualinformation fusion method were used. By restricting fusion to the liver region andby acquiring the CT scan during unforced expiration breathold, fusion was opti-mized. Hence, dependency on differences in position, orientation and shape ofthe liver were minimized. PET and CT images of 10 patients with liver metastasiswere fused by 4 operators and repeated up to 4 times. A comparison with manu-ally aligning the images was also made.Results: In total, 70 fusions were performed. A precision measurement of 2-3 mm (3 times smaller than for the manual results) was obtained, independent ofthe operator and the position in the liver. Visual judgement showed that our fusionresults were significantly better (p < 0.05) than the manual results. No systemat-ic fusion bias was observed. A Wilcoxon test showed that the distribution of thepaired difference of our results and the manual results has a mean value consist-ent with zero.Conclusion: By restriction to the liver region, and using comparable breathingprotocols during the scans, precise PET-CT fusion of the liver was obtained.

C-051Real time characterization of focal liver lesions using SonoVue, a newultrasound contrast agentC. Nicolau, V. Catalá, R. Vilana, L. Bianchi, R. Gilabert, C. Brú; Barcelona/ES

Purpose: To evaluate the ultrasonographic characterization of focal liver lesions(FLL) during the vascular phase of SonoVue.Materials and Methods: One hundred and thirty five FLL's characterized eitherby fine needle biopsy (n = 95) or dynamic CT /MRI (n = 40) were studied. Finaldiagnoses were: 25 metastases, 66 hepatocellular carcinomas (HCC), 8 focalnodular hyperplasias (FNH), 2 cholangiocarcinomas, 11 regenerating nodules,15haemangiomas, 1 solitary fibrous tumor, 5 focal fatty changes, 2 hydatic cysts.After a baseline US (Sequoia 512, Acuson), Contrast-Enhanced US (CEUS) wasperformed using Coherent Contrast Imaging, a contrast specific method, after abolus injection of SonoVue® (Bracco, Italy). A low mechanical index < 0.2 wasused, allowing real time evaluation of the liver in arterial, portal and late phases.Results: CEUS was able to correctly characterize 127/135 (94%) FLL's. HCC'srevealed tumoral enhancement in the arterial phase, except in 3 well-differentiat-ed HCC's. Most HCC's appeared hypoechoic in late phase, but 24% of HCC'sremained isoechoic. All metastases and cholangiocarcinomas showed absenceof enhancement in the late phase. Thirty percent of metastases enhanced in thearterial phase but had a fast wash-out. Most hemangiomas showed a character-istic peripheral nodular or rim-like enhancement with centripetal progression. AllFNH showed strong enhancement in the arterial phase remaining isoechoic oreven hyperechoic in late phase. All focal fatty changes and 90% of regeneratingnodules were isoechoic in all phases.Conclusion: CEUS using Sonovue has a very high accuracy in the characterisa-tion of FLL, compared with the "gold standard" diagnostic techniques.

C-052Detection of hypervascular hepatocellular carcinoma: Diagnostic accuracyof early, middle, late, and whole triple arterial phase images on accelerateddynamic MR imaging with sensitivity encoding techniqueK. Mori1, H. Yoshioka2, N. Takahashi1, M. Yamaguchi1, T. Ueno1, T. Yamaki1,Y. Saida1; 1Tsukuba/JP, 2Boston, MA/US

Purpose: To assess and compare the diagnostic accuracy of early, middle, late,and whole triple arterial phase images on accelerated dynamic MR imaging todetect hypervascular hepatocellular carcinoma (HCC).

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Materials and Methods: Thirty-one patients with 102 foci of HCC underwentaccelerated dynamic MR imaging. After acquisition of T2-weighted turbo-spin-echo images with fat suppression and unenhanced T1-weighted fast-field-echoimages, gadodiamide (Gd) -enhanced triple-arterial, portal, and delayed phaseimages were obtained. Acquisition of triple-arterial phase images was startedfrom the time of peak enhancement of aorta defined by a test injection and com-pleted within a single breath hold. A bolus of 14 mL Gd was injected at a rate of2.5 mL/sec. Acquisition time for each arterial phase was 8.4 sec. Four imagesets including early, middle, late, or whole triple arterial phase were interpretedseparately by 3 observers to detect hypervascular HCC. Alternative-free-responsereceiver operating characteristic (AFROC) analysis was performed. Sensitivitywas also calculated on a lesion-by-lesion basis.Results: Mean value of the area under the AFROC curve (A1) was 0.49, 0.66,0.52, and 0.67 and mean sensitivity was 46.3, 64, 47.6 and 66% for the image setwith early, middle, late and whole triple arterial phase, respectively. The meanvalues of A1 and sensitivity were significantly higher for middle and whole triplearterial phase than for early arterial phase (P < 0.05) and tended to be higherthan for late arterial phase.Conclusion: Middle arterial phase imaging produces high diagnostic accuracyto detect hypervascular HCC that is equivalent to whole triple arterial phase im-aging.

C-053Ability of subsequent phases of multiphase spiral CT (sCT) in detection ofliver metastases and their segmental localizationE.W. Szurowska, J. Pienkowska, M. Studniarek, E.C. Izycka-Swieszewska,R. Rzepko, T. Gorycki, M. Czarnowska; Gdansk/PL

New standards of radiological examinations must be developed in view of con-stant progress in methods of treatment for liver metastases.Purpose: To evaluate the ability of subsequent phases of multiphase spiral CT(sCT) in detection of liver metastases and their segmental localization.Materials and Methods: SCT was performed in 100 patients with hepatic me-tastases. SCT included unenhanced scans (NC), hepatic arterial-dominant (HAP),portal venous-dominant (PVP) and equilibrium phase (EP). In each phase number,size of detectable lesions and adequacy of lesion topographic report in liver seg-ments were evaluated. Patients with primary cancer of gastrointestinal tract con-stituted almost 70% of the group.Results: Total of 354 liver metastases were detected on sCT. PVP revealed 346(97.7%), HAP- 298 (84.2%) and EP- 241 (68.1%) secondary lesions. NC scansvisualized 195 metastases (55.1%) when evaluated in the "abdominal window".The exact localization of metastases in liver segments was established in PVP in88% of cases, in HAP - 76%, in EP - 70% and in NC phase in 71% of cases. Thediameter of lesions ranged from 4 to 127 mm (median 21 mm). Lesions of morethan 30 mm in diameter were clearly detectable in each phase of CT examina-tion.Conclusions: PVP in sCT is of the highest sensitivity in detecting liver metastas-es and contributes to the most adequate segmental localization. In standard di-agnosis of liver metastases biphasic examination including HAP and PVP shouldbe performed.

C-054Detection of hypervascular hepatocellular carcinoma with multi-detectorrow CT with automatic bolus tracking: Different injection rate and time delayN. Nishida, A. Yamamoto, T. Kitayama, T. Ninoi, M. Hamuro, Y. Sakai,K. Nakamura, Y. Inoue, R. Yamada; Osaka/JP

Purpose: To evaluate the effect of different injection rates of contrast material onthe detectability and enhancement of hypervascular hepatocellular carcinoma(HCC) on an arterial phase image with multi-detector row computed tomographywith automatic bolus tracking system.Materials and Methods: A triple-phase protocol that included arterial, portal ve-nous and delayed phases was performed in 65 patients with 137 foci of hyper-vascular HCC. All patients were assigned randomly into two groups. In group A,95 mL of contrast material was injected at a rate of 5 mL/sec and the arterialphase image were obtained with 15 sec delay after automatic scan start trig-gered by enhancement of aorta. In group B, 3 mL/sec of injection rate and 20 secof delay were adopted. Detection of the tumor was evaluated visually by the agree-ment of two radiologists. The tumor, liver and tumor-to-liver enhancement (TLC)were measured.Results: The sensitivity for the detection overall, and over 1 cm in diameter were92% and 96% in group A, 89% and 94% in group B, respectively. Tumor enhance-ment in group A is significantly (P < .01) higher than that in group B. There was

no significant difference in liver enhancement between the two groups. The TLCwas significantly (P < .01) higher in group A.Conclusion: There is no significant difference in detectability of hypervascularHCC on an arterial phase image between an injection rate of 5 mL/sec and 3 mL/sec. But higher injection rate is effective for a significantly higher TLC.

C-055Contrast-enhanced versus baseline ultrasonography in the characterizationof benign focal hepatic lesionsT.V. Bartolotta, M. Midiri, M. Galia, G. Runza, A. Carcione, R. Lagalla;Palermo/IT

Purpose: To compare contrast-enhanced ultrasonography (CEUS) to conven-tional US in the characterization of hepatic benign lesions.Material and Methods: Thirty-three patients (23 woman, 10 men; age range: 19-72 years, mean: 45.2 years) with 55 benign hepatic lesions (size range: 0.7-12 cm;mean: 3.1 cm) (33 hemangiomas, 15 FNHs, 3 adenomas, 1 solitary necrotic nod-ule [SNN], 1 intrahepatic extramedullary hematopoiesis [IEH], 1 focal fatty areaand 1 skip-area) underwent baseline (grey-scale and color-Doppler) US and pulse-inversion harmonic imaging at low M.I. (0.05-0.08) after SonoVue administration.All examinations were videotaped and then reviewed comparing baseline withCEUS findings by two experienced radiologists blinded to the final diagnosis. Allthe lesions were confirmed by surgery, core-biopsy and typical helical CT and/orMRI findings.Results: Pre-contrast US successfully characterized 20/55 (36.4%) lesions (10/33 hemangiomas and 10/15 FNHs). CEUS enabled the correct diagnosis of 49/55 (89.1%) lesions (31/33 hemangiomas, 14/15 FNHs, 2/3 adenomas, 1 focalfatty area and 1 skip-area). Five lesions remained indeterminate even at CEUS(2 hemangiomas measuring less than 1 cm which did not show a clear-cut pe-ripheral globular enhancement, one FNH deeply located in the VIII segment, onehuge adenoma with inhomogeneous contrast-enhancement in the arterial phase,one unenhancing hypoechoic SNN). One lesion, which showed a strong homo-geneous enhancement in the arterial phase, was erroneously diagnosed as FNHinstead of IEH.Conclusion: CEUS showed an higher sensitivity than baseline US in benignfocal liver lesion characterization. Nevertheless deeply located or tiny lesionscould still represent a diagnostic dilemma at CEUS.

C-056Association of adenoma and focal nodular hyperplasia: US, CT and MRimaging findings with histopathologic correlation in 7 patientsS. Faraoun, M.-F. Bellin, D. Castaing, R. Adam, D. Azoulay, D. Samuel,C. Guettier; Villejuif/FR

Purpose: To review the ultrasononic (US), CT, and MR imaging findings in 7patients with the simultaneous occurrence of adenoma and focal nodular hyper-plasia (FNH) and to compare imaging features with histopathologic results fromresected specimens.Methods and Materials: US, helical multiphasic CT, and MR images in 7 con-secutive patients with histologically proven simultaneous adenoma and FNH werereviewed. Two abdominal radiologists evaluated lesions for number, size, homo-geneity, appearance and degrees of enhancement at CT and MR, calcifications,presence of a hemorrhagic component, pseudocapsule, central scar, and asso-ciated lesions. Imaging and pathologic results were compared.Results: Three types of simultaneous occurrence of adenoma and FNH wereidentified: one single adenoma associated with one single FNH (n = 4), one sin-gle adenoma associated with multiple FNHs (n = 1), and multiple adenomas as-sociated with multiple FNHs (n = 2). Adenoma and FNH were engulfed in 2 casesand one FNH was of a telangiectatic type. Pathologic analysis demonstrated nomalignant transformation or cellular atypia in any of the adenomas. 26 noduleswere visible on preoperative imaging studies (10 adenomas and 16 FNHs). Alladenomas appeared hypodense on unenhanced CT scans and demonstratedheterogeneous enhancement with a hyperattenuating component on arterial phaseimages. Perinodular areas of heterogeneous enhancement were noted in 2 cas-es that corresponded to peritumoral peliosis at pathology. All FNHs demonstrat-ed strong homogeneous enhancement on CT and MR images and were iso orslightly hyperintense on T2-weighted MR images.Conclusion: Radiologists must be aware that FNHs may be associated with ad-enomas, which has major therapeutic consequences.

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C-057Dynamic and delayed imaging with gadobenate dimeglumine (Gd-BOPTA)of focal nodular hyperplasia and hepatic adenomaK. Vanderdood1, D. Jans1, B. Op de Beeck2, F. De Ridder1; 1Brussels/BE,2Antwerp/BE

Purpose: To demonstrate the use of Gd-BOPTA in dynamic and delayed MRI indifferentiating focal nodular hyperplasia (FNH) from hepatic adenoma in the ab-sence of discriminating factors such as an enhancing central scar in FNH andhemorrhage in adenoma.Methods and Materials: 16 patients with known FNH or adenoma underwentMRI on a 1.5 T system using transverse T2-weighted HASTE, T1-weighted GREwith fat suppression (FS), before and immediately after intravenous administra-tion of 0.1 mmol/kg Gd-BOPTA (2 cc/sec) and a rapid saline flush. The sequencewas repeated 30 sec, 90 sec and 1 hour post contrast (delayed scan). Two inde-pendent readers evaluated lesion morphology, dynamic enhancement patternand lesion-to-liver contrast on delayed scans.Results: 25 lesions (18 FNH and 7 adenomas) were detected, all presenting ahypervascular nature in the arterial phase and a rapid contrast washout in thevenous phase. 5 out of 12 FNH presented with a central scar, demonstrating lateenhancement (after 90 sec). In 4 (57%) out of 7 adenomas hemorrhage was found,accounting for the hyperintensity on T1-weighted images before contrast and ondelayed scans. 15 (83.3%) FNH were hyperintense on delayed images, 2 (11%)FNH remained isointense, 1 (5.5%) FNH and 3 (43%) adenomas were hypoin-tense to the liver parenchyma on delayed scans.Conclusion: The dynamic enhancement pattern of hypervascular FNH and ade-noma with Gd-BOPTA is similar to Gd-DPTA. In contrast to most FNH, adenomasare hypointense on delayed scans with Gd-BOPTA (except hemorrhagic lesions).The lack of bile ductules in adenomas unables Gd-BOPTA concentration in theselesions.

C-058MRI in the diagnosis of chronic viral hepatitis (CVH)V.A. Ratnikov; St. Petersburg/RU

Purpose: To determine the additional opportunity of MRI in the qualitative andquantitative evaluation of the liver and biliary tract in patients suffering from CVH.Method and Materials: MRI (Magnetom Symphony, 1.5 T) was performed in 95patients with CVH C and 19 with CVH B. Ages ranged from 18 to 49 years. Thediagnoses were confirmed by serological and morphological researches.Results: An increase in linear size of the liver was revealed in all patients. Thesignal intensity (SI) from liver parenchyma in the group of CVH B patients did notdiffer practically from the control group and was 350-420units (U) on T1-WI. Inthe CVH C patients SI was reduced up to 260-300 U. During treatment the ten-dency of normalization of linear sizes and SI was marked. Dilatation of the hepat-ic ducts was revealed in 80% patients, common bile duct strictures in two, andcholedocholithiasis in three patients with CVH C. SI from the bile (neck of thegallbladder) on axial T1-WI with fatsat was reduced compared to the control group.This testifies to infringement of the concentration function of the gallbladder inpatients with CVH. The non-uniform signal from bile correlated with laboratorysigns of chronic cholecystitis in 18 patients with CVH C (19%) and 8 with CVH B(42%).Conclusion: This study demonstrates that CVH is accompanied by significantchanges of the liver and biliary tract. MRI and MRCP with application of quantita-tive criteria are expedient during treatment of the patients with CVH and follow-up.

C-059Focal hepatic lesions: Spectrum of findings on ferucarbotran-enhanceddynamic imaging and differential diagnosisE. Kim, D. Choi, H.K. Lim, S.H. Kim, W.J. Lee, J.H. Lim; Seoul/KR

The differential diagnosis of focal hepatic lesions in cross-sectional imaging de-pends on their morphological appearances and enhancement patterns. Howev-er, the definite value of imaging modalities for the differential diagnosis remainslimited because of frequent overlapping findings among hepatic focal lesions.Ferucarbotran (Resovist), superparamagnetic iron oxide (SPIO) particles, is oneof the recently introduced liver-specific MR contrast agent that can be intrave-nously administered as a bolus. Ferucarbotran-enhanced dynamic MR imagingcan be used to evaluate tumor vascularity as well as Kupffer cell activity of focalhepatic lesions, which is helpful for detection and characterization of focal hepat-ic lesions. In this exhibit, we present a spectrum of findings on ferucarbotran-enhanced dynamic MR imaging in a variety of benign and malignant hepatic

tumors, which are still under investigation. We also discuss the characteristicpatterns of focal hepatic lesions to help the differential diagnosis.Learning Objectives:1. To learn a spectrum of ferucarbotran-enhanced MR imaging findings in a vari-ety of benign and malignant hepatic tumors.2. To understand how to differentiate focal hepatic lesions with ferucarbotran-enhanced dynamic MR imaging.

C-060Can the measurement of the duration time of liver parenchymalenhancement with ultrasound contrast agent become a new index for livercirrhosis? A preliminary studyM. Okada1, T. Albrecht2, K.J. Wolf2, C.W. Hoffmann2, S. Kuribayashi1,Y. Kaneko3, O. Mori4, H. Kaneko1; 1Tokyo/JP, 2Berlin/DE, 3Osaka/JP, 4KashiwaChiba/JP

Purpose: To assess if the hepatic parenchymal enhancement during continuousinfusion of the ultrasound contrast agent can become an index of liver cirrhosiscompared to normal liver.Methods and Materials: We studied 28 patients (14; normal liver parenchyma,14; liver cirrhosis). They received an infusion (1.5 mL/min) of the same dose ofLevovist (4 g, 300 mg/mL) using a pump injector, and scans were performed withan HDI 5000 (Philips) in pulse inversion at MI 0.7 to 1.3. Unenhanced baselinescans of liver were followed by contrast-enhanced sweeps, scan times of thatafter injection were 1 sweep/min, starting at 2 min. Imaging data were analysedoff-line using ATL HDI Lab. Regions of interest were drawn in liver parenchymaand signal intensities were measured. Duration of liver parenchymal enhance-ment > 3 dB and area under the time-intensity curves for liver parenchymal en-hancement were analysed for each patient and compared.Results: There were no significant differences using Wilcoxon signed-ranks testin the average duration of enhancement exceeding 3 dB between liver cirrhosis(8.8 ± 4.7 min) and normal liver (9.9 ± 3.0 min). Average area under the curvesof liver cirrhosis (71.4 ± 48.0 dBmin) was similar to that of normal liver(74.8 ± 37.1 dBmin), and there were no significant differences between liver cir-rhosis (10.2 ± 5.4 dB) and normal liver (11.5 ± 4.2 dB) in the peak enhancementof the liver parenchyma.Conclusion: Liver cirrhosis gave neither prolongation nor shortening of the dura-tion of liver parenchymal enhancement compared to normal liver. Peak enhance-ment of the liver parenchyma did not become an index in our preliminary result.

C-061Liver cirrhosis: MR imaging patterns in regard to the etiologyO. Papakonstantinou, V. Hadjimanoli, M. Daskalaki, M. Kouledaki,N. Gourtsoyiannis; Iraklion/GR

Purpose: The purpose of our study is to identify MR imaging patterns in livercirrhosis of different etiology.Methods and Materials: Abdominal MRI studies of 55 consecutive cirrhotic pa-tients (21 postviral, 10 alchoholic, 6 primary sclerosing cholangitis cirrhosis(PSCC), 4 primary biliary cirrhosis (PBC), 4 hemochromatosis, 5 cryptogenic, 3Budd-Chiari and 2 Wilson disease) were retrospectively reviewed. Examinationswere performed within a five-year period, on a 1.5 magnet using pre- and post-gadolinium GRE T1-weighted and TSE T2-weighted sequences with and withoutspectral fat-suppression. Parameters evaluated included size of each liver segmentand spleen, caudate-right lobe ratio (CRL, using the right portal vein as lateralboundary), regenerative nodules, patterns of fibrosis, ascites and collaterals.Results: CRL ratio was higher in patients with alcoholic cirrhosis (p < 0.04) andPSCC; massive hypertrophy of the caudate lobe was seen in PSCC (3/6) andBudd-Chiari (2/3). Splenomegaly was common in all types of cirrhosis (46/55);noteworthy, normal splenic size was seen in 4 patients with end-stage cirrhosisand excessive ascites (2 alcoholic and 2 postviral). Regenerative nodules up to1.5 cm were seen only in postviral (7/21) and Wilson (1/2) cirrhosis whereaslobular liver appearance was found in PSCC (3/6). Fibrotic bands were morefrequent in postviral cirrhosis (7/21), peripheral wedge-shaped fibrosis in alco-holic (4/10) and PSCC (4/6), perivascular cuffing in PBC (2/4) and PSCC (1/6),whereas reticular pattern was almost equally seen in all types of cirrhosis.Conclusion: MR imaging patterns of liver cirrhosis may associate with and, oc-casionally, provide indications of the underlying pathologic process.

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C-062Characterization of hepatic cavernous hemangioma nonspecific atultrasonography: Comparison of unenhanced, gadolinium-enhanced MRimaging and multiphase spiral CTE. Szurowska, J. Pienkowska, M. Studniarek, E.C. Izycka-Swieszewska,T. Gorycki, R. Rzepko, M. Czarnowska; Gdansk/PL

Objective: To compare the ability of unenhanced, gadolinium-enhanced MRI andmultiphase sCT in the hepatic cavernous hemangioma (HH) characteristics.Materials and Methods: SCT and MR imaging was performed in 183 patientswith nonspecific hepatic masses on US. 506 lesions were detected and con-firmed pathologically or by clinical and imaging follow-up. 77 HH were detectedin 38 patients. Multiphase sCT included non-contrast scans, hepatic arterial-dom-inant, portal venous–dominant and equilibrium phase. MR sequences performedwere: SE, TSE-T1 and double echo T2-weighted images, STIR and dynamic study(TFE) after gadolinium administration. Size of lesions, their density, intensity, typeof enhancement on dynamic CT and MR scans (homogeneous, heterogeneous,nodular peripheral, ring and progressive fill-in) were prospectively analyzed bythree radiologists.Results: Moderately and heavily T2-weighted sequences correctly depicted76 HH. HH ≤ 2 cm more frequently (28/47) showed homogenous enhancementin three phases, larger lesions (22/30)- nodular peripheral in HAP and progres-sive fill-in in PVP and EP. Sensitivity, specificity, PPV, NPV and accuracy of unen-hanced versus gadolinium-enhanced MR and sCT imaging in the characterizationof HH were: 0.99 vs 0.84 vs 0.82; 1 vs 0.94 vs 0.93; 0.99 vs 0.70 vs 0.66; 1 vs0.97 vs 0.97 and 0.99 vs 0.93 vs 0.91 (significant difference between unenhancedMRI and other techniques).Conclusion: Unenhanced MR imaging is the most sensitive method in the char-acterization of HH nonspecific in ultrasonography and it should be performed asstandard in the diagnosis of HH. Routine use of dynamic MR and CT study fordifferential diagnosis of HH is unnecessary.

C-063Primary mesenchymal tumors of the liver: Radiologic and pathologiccorrelationK.A. Kim, K.W. Kim; Seoul/KR

Purpose: Primary malignant liver tumors can arise from different components ofthe liver, such as hepatocytes, bile duct epithelium, neuroendocrine cells, andmesenchymal cells. In these tumors, primary mesnchymal tumors of the liver arerelatively rare and have variable faces in radiologic concern. But these findingshave not been described in the literature, especially in adults. The aim of ourscientific exhibits is to correlate radiologic and pathologic findings of variablemesenchymal tumors of the liver.Materials and Methods: Patients with malignant liver tumor rather than of epi-thelial origin were included our review. CT, MRI or sonographic findings of pa-tients with histologically proven mesenchymal liver tumors were reviewed with aview to radiologic-pathologic correlations.Results: Variable types of tumors such as angiosarcoma, epitheloid hemangioen-dothelioma, angiomyolipoma, malignant fibrous histiocytoma, mesenchymal har-martoma, sarcomatoid hepatocellular carcinoma and alvelolar soft part sarcomawere reviewed radiologically and pathologically.Conclusion: Rare and variable primary mesenchymal tumors represent variableand interesting characteristics on CT, MR and ultrasonography. Sometimes, radi-ologic findings can aid to differentiate a primary mesenchymal liver mass fromother cell origins.

Abdominal Viscera (Solid Organs)

Pancreas

C-064Radiological diagnosis and staging of acute pancreatitis (AP): Aneducational tool using interactive and dynamic display of cross-sectionalimagesY. Hetmaniak, D. Hoa, G. Vasquez, A. Buaziza, B. Gallix, J.-M. Bruel;Montpellier/FR

Learning Objectives: Identify the Ultrasound (US) and CT findings associatedwith different causes of AP. Discuss the role of various imaging modalities in thediagnosis of AP. Recognize the main complications encountered. Learn how tostage AP by determining a "CT severity index" according to the Balthazar classi-fication.Background: AP is a frequent cause of acute abdominal pain. CT and US arethe primary modalities for the diagnosis and CT is pivotal for the staging andmanagement of AP. The purpose of this computer educational tool is to presentan interactive and comprehensive review of the imaging findings of AP, includingcomplications, and how to evaluate the "CT severity index" so that radiologistscan be precise in their examination report.Procedure Materials: Materials consist of 50 patients with acute pain who un-derwent US, CT, or MR imaging of the abdomen. The user will learn how to diag-nose and classify acute pancreatitis using an interactive computer tool, in HTMLformat, that allows the dynamic cine-display of the original image data set.Conclusion: This new interactive web based teaching tool with cine loop capac-ity simulates real life radiologist's daily work and allows an original and practicallearning method.

C-065Branch duct-type intraductal papillary mucinous tumor of the pancreas:Diagnostic value of multiplanar reformatted images in multislice CTA. Takada, S. Itoh, H. Satake, M. Ikeda, T. Ishigaki; Nagoya/JP

Purpose: To determine whether multiplanar reformatted (MPR) images are su-perior to axial images for depicting a communicating duct between the cysticlesion and the main pancreatic duct in branch duct-type intraductal papillarymucinous tumor (IPMT) of the pancreas.Materials and Methods: Twenty lesions in 19 patients with branch duct-typeIPMT underwent multiphase contrast-enhanced CT of the pancreas using a mul-tislice CT scanner. The presence of a communicating duct was confirmed surgi-cally in 5 lesions and based on the findings of endoscopic retrogradepancreatography in 15 lesions. Oblique and curved MPR images were generatedwith 0.5 mm thickness at 0.5 mm intervals to cover the pancreatic parenchymafrom pancreatic-phase axial images, which were reconstructed with 0.5 mm or1 mm thickness at 0.5 mm intervals using a 260 mm field of view. The diagnosticcapabilities of such images in detecting the presence of a tubular structure con-necting the cystic lesion and the main pancreatic duct were evaluated. The re-sults obtained for MPR images were compared with those for 0.5 mm or 1 mmaxial images.Results: The communicating duct was depicted in 13 lesions using axial imagesand in 18 lesions using MPR images. There were no lesions in which the ductwas depicted only in axial images. The degree of confidence in detecting thepresence of the duct was therefore higher for MPR images than for axial images.Conclusion: MPR images are superior to axial images in the depiction of thecommunicating duct in branch duct-type IPMT.

C-066Acute pancreatitis: Value of MRI and MRCPJ. Elias Jr, M.N. Simão, V.F. Muglia, A.C. Santos, J.S. Santos, C.S. Trad;Ribeirao Preto/BR

Introduction: Clinical and laboratory scores and computed tomography (CT) areapplied to stratify the severity of Acute Pancreatitis (AP). The use of CT in AP hasbeen criticized mainly due to the use of intravenous iodine contrast.Purpose: To determine the usefulness of MRI with dynamic IV paramagneticcontrast and MRCP in the severity stratification of AP.Methods and Materials: A prospective analysis evaluated 43 patients with APsubmitted to MRI. The predictive severity of the attack was determined using theAPACHE II score system. Outcome measurement was analyzed by hospital stayduration, fasting days and mortality rate. Thirty four patients underwent compar-ison with contrast-enhanced CT (CECT). We used the Spearman coefficient for

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correlation and the Fisher exact test for association. The significance adoptedwas 5%.Results: Thirteen men (30.2%) and 30 women (69.7%) were studied. There waspositive correlation (p < 0.0001) and significant association (p < 0.01) betweenMRI and CECT staging. There was no correlation between MRI staging andAPACHE II score, hospital stay duration and death.Conclusions: MRI with dynamic IV contrast and MRCP are comparable to CECTfor AP staging, becoming an important innocuous option, mainly in cases withhigh probability of biliary etiology.

C-067Vascular complications in isolated pancreas or combined kidney-pancreastransplantation: Multirow CT angiographyC. Cappelli, E. Neri, P. Vagli, L. Salvatori, P. Torri, M. Campinoti, C. Bartolozzi;Pisa/IT

Purpose: To investigate the role of multirow CT angiography (CTA) in the evalu-ation of vascular complications in patients submitted to isolated pancreas or com-bined kidney-pancreas transplantation.Materials and Methods: Thirty-five patients submitted to isolated pancreas(n = 15) or combined kidney-pancreas (n = 20) transplantation, with systemic-bladder (n = 7) or enteric-portal (n = 28) pancreatic drainage were evaluated withCTA. The study included unenhanced, arterial and portal phases in isolated pan-creas follow-up; in combined kidney-pancreas transplantation the urographicphase was included. The acquisition was performed with 1.25 mm thickness,0.6 mm reconstruction interval and pitch 6.Results: CTA identified the vascular complications in 14 patients: thrombosis ofa single branch of the pancreatic arterial graft (2); complete thrombosis of thepancreatic arterial graft (2); pancreatic infarction (1); stenosis of the arterial graftof the transplanted pancreas (2); stenosis of the arterial graft of the transplantedkidney (2); ectasia of the common iliac artery and pancreatic arterial graft afterthromboendarterectomy procedure (2); inflammation of the arterial graft (1); throm-bosis of the pancreatic venous graft (2).Conclusions: Our study shows that vascular complications are frequent in pan-creas and kidney transplantation and that multirow CTA is effective in detectingtheir occurrence in the follow-up.

C-068Capacities of the delayed whole-body 18F-FDG-PET imaging fordifferentiated diagnosis of pancreas volume masses (PVM)M.S. Tlostanova, L.A. Tyutin, N.A. Kostenikov, D.V. Ryjkova, E.V. Rozengaouz,A.V. Pavlovsky; St. Petersburg/RU

Purpose: To study the capacities of delayed whole-body 18F-FDG PET imaging(without an additional tracer administration) in differentiated diagnosis of PVM.Materials and Methods: PET with 18F-FDG was carried out in 86 patients withPVM (74 cases with pancreatic carcinoma and 12 with pseudotumor pancreati-tis). PET was performed twice; at 90 and 120 minutes after the 18F-FDG admin-istration. The results were analyzed with SUV calculation. PET data were verifiedby percutaneous or surgical biopsy in all the cases.Results: On delayed images SUV was significantly decreased (over 15%) in theinflammatory foci in all patients with pseudotumor pancreatitis. SUV was increased(over 10%) in 60 patients with pancreatic carcinoma. SUV value on delayed im-ages was not changed in 14 patients with pancreatic carcinoma. Early PET imag-ing sensitivity in pancreatic carcinoma detection was 89.2%, specificity - 85.1%,diagnostic accuracy - 87.7%. The sensitivity of delayed PET imaging in diagnosisof pancreatic carcinoma was 97.5%, specificity - 90.0%, diagnostic accuracy -96.0%.Conclusion: Delayed 18F-FDG-PET imaging is a feasible modality which hashigh efficiency of differentiated the diagnosis of pseudotumor pancreatitis andpancreatic tumors.

C-069Contrast enhanced ultrasonography (CEUS) of pancreatic massesM. D'Onofrio, S. Vasori, U. Rozzanigo, S. Caffarri, N. Faccioli, C. Procacci;Verona/IT

Purpose: To evaluate the role of CEUS in the study of solid and cystic masses ofthe pancreas.Materials and Methods: 100 masses of the pancreas, found on conventionalUS, were studied with CEUS, by using Sonovue (Bracco) on a Sequoia 512 (Acu-son). A dynamic observation from the early contrastographic phase (during arte-rial enhancement), to the late contrastographic phase (after venous enhancement)

was possible. All the lesions were cytologically/histologically proved. The resultswere compared with those obtained at Spiral CT and/or MRI. Seven distinct en-hancement patterns were observed: 1) Rapid intense enhancement in the earlycontrastographic phases with microbubble entrapment in the late phase [14 neu-roendocrine tumors, 4 metastases from hypervascular tumors, 3 poorly differen-tiated carcinomas]; 2) moderate enhancement in the early contrastographic phase,resulting hypoechoic in the late phase [6 poorly differentiated carcinomas, 1 ac-inar cell carcinoma, 18 neuroendocrine tumors]; 3) capsular enhancement in theearliest phases [1 solid and papillary epithelial neoplasm; 2 neuroendocrine tu-mor]; 4) no enhancement [32 ductal adenocarcinomas and 2 neuroendocrinetumor]; 5) progressive enhancement [1 solid and papillary epithelial neoplasm];6) "parenchymographic" enhancement [12 inflammatory masses]; 7) parietal nod-ules and septas enhancement [4 cystic tumors].Results: CEUS correctly characterized 74/84 (88%) solid pancreatic tumors. Inparticular all (32/32) the ductal adenocarcinomas were correctly diagnosed. Smallnodules and septas of pancreatic cystic tumors, not visible at conventional US,were detected at CEUS.Conclusions: CEUS can demostrate macrocirculation and microcirculation ofsolid pancreatic masses and can improve the characterization of cystic pancre-atic lesions.

C-070Is dual-phase spiral CT adequate for the confirmation of resectability andpreoperative staging of pancreatic carcinoma?S. Mylona, L. Thanos, A. Pagonas, V. Kalioras, S. Lyra, N. Batakis; Athens/GR

Purpose: To present the value of dual-phase spiral CT for the confirmation ofresectability and pre-operative staging of pancreatic carcinoma.Materials and Methods: In a period of 4 years 184 patients with pancreatic car-cinoma underwent dual-phase spiral CT for preoperative staging. CT scans afterIV administration of contrast material with an electronic injector were obtained inthe arterial (scan delay = 20 sec) and in the portal venous phase (scan delay =50 sec) under a protocol with a total volume of 150 mL, flow rate 5 mL/sec. Wehave correlated the CT findings with surgical-pathologo-anatomic findings.Results: Dual-phase spiral CT was positive for pancreatic carcinoma in 178 pa-tients (96.7%). In 6 patients it was false-positive (3.3%). In 44 (78.4%) out of 55patients it showed hepatic metastases, in 33 (64.7%) out of 51 patients it showedlymph node enlargement, in 49 (88%) out of 60 patients vascular invasion, and in8 (66.6%) out of 12 patients peritoneal metastases. The accuracy of the methodwas up to 90%.Conclusion: Dual-phase spiral CT is a safe, noninvasive, and accurate methodto investigate pancreatic carcinoma and should be considered as the standardpreoperative method for assessing lesion resectability.

C-071Assessment of resectability of pancreatic head cancer with CT imagingG.G. Karmazanovsky, V.A. Kubyshkin, A.V. Kotchatkov; Moscow/RU

Purpose: To investigate the value of preoperative CT in assessment of resecta-bility of pancreatic head cancer.Methods and Materials: Eighty-nine patients (52 males and 37 females; meanage 60) with pancreatic head adenocarcinoma were investigated with spiral CTwith bolus intravenous contrast enhancement. All of the patients were operatedon. Whipple procedures were performed on 56 patients and palliative operationswere performed on 33 patients.Results: Tumors of 24 patients were considered unresectable. 11 patients(Group 1) had tumors that were encircling superior mesenteric or portal veins(8 pts), superior mesenteric (2 pts) or hepatic arteries (1 pts) completely. No fatlayer was identifiable between the tumors and the vessels. 13 patients (Group 2)had CT appearances of tumors that partially (less than 2/3 of the circumferenceand in less than 20 mm) circumscribed the vessels.Tumors of all group 1 patients were not resectable with a negative margin. Amonggroup 2, four patients (30.8%) had unresectable tumors; six patients (46.1%) hadtumors that were difficult to dissect from the vessels; 3 patients (23.1%) had noevidence of vascular involvement and in fact went through curative surgery.Conclusion: The CT findings predicted correctly surgical findings in 21 of 24unresectable tumors (87.5%). When the tumor partially circumscribed the ves-sels CT was not to be relied upon in predicting whether or not the tumor was fixedagainst the vessels.

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C-072Tumor recurrence after pancreatoduodenectomy: CT diagnosisG.G. Karmazanovsky, V.A. Kubyshkin, A.V. Kotchatkov; Moscow/RU

Purpose: To analyze postoperative tumor recurrence after Whipple proceduresof periampullary cancer with computed tomography (CT).Methods and Materials: 70 patients were examined with spiral CT with bolusintravenous contrast enhancement after pancreatoduodenectomy. 27 patients hadCT appearances of tumors recurrence. Of these patients, 17 had pancreatic headadenocarcinoma, 3 had pancreatic head endocrine tumors, 2 had duodenal can-cer, 2 had ampulla of Vater cancers, and 3 had distal bile duct cancers. CT find-ings used for diagnosis of tumor recurrence included a mass formation or softtissue infiltration in the surgical bed that showed progressive expansion on fol-low-up CT, lymph node metastasis, and hepatic metastasis.Results: 20 patients (74%) had a local recurrence, 18 patients (67%) had lymphnode metastasis, and 12 patients (44%) had hepatic metastasis. All patients withlymph node metastasis had CT appearances of locoregional tumor recurrences.4 patients had local recurrence with hepatic metastasis. All these types of peri-ampullary cancer recurred within 18 - 24 months after surgery. Recurrence withinthe 6 months after surgery was more common in adenocarcinoma of the pancre-as (12 from 17 patients (70.5%)). Spiral CT had a sensitivity of 90%, specificity of95%, and accuracy of 93% in detection of periampullary tumor recurrence.Conclusion: Periampullary cancer tends to recur usually as a local recurrence.Postoperative follow-up CT for the patients should be routinely performed within3 - 6 - 12 - 18 - 24 months after surgery.

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Abdominal Viscera (Solid Organs)

Spleen

C-074Contrast-specific ultrasound (CS-US) imaging of the spleen: A pictorialessay of traumatic and nontraumatic disordersA. Nunziata1, O. Catalano2, M. Mattace Raso2, I. Matarazzo2, A. Siani2;1Naples/IT, 2Pozzuoli/IT

Learning Objective: To illustrate the appearance of several splenic lesions asshown during real-time, contrast-specific, harmonic imaging.Background: Contrast-enhanced, low-mechanical index US is a new techniqueallowing continuous, real-time assessment of splenic abnormalities. In our insti-tution we use the technology named contrast tuned imaging (Esaote, Italy) andwe employ a second-generation, sulfur-exafluoride based, microbubble contrastagent (SonoVue-Bracco, Italy). The contrast agent, at a volume of 2.4 or 4.8 mL,in injected through a peripheral vein and a 20 G needle, using a three-way stop-cock and a 5-mL normal saline flushing.Imaging Findings: A wide spectrum of splenic disorders is depicted: injury, spon-taneous hematoma, abscess, capillary and cavernous hemangioma, lymphoma-tous infiltration, metastasis, splenomegaly, and accessory spleen. Several potentialpitfalls are also shown.Conclusion: Contrast-specific US is being used with increasing frequency in theevaluation of the spleen. This is a superficial organ, with an almost homogeneousechotexture and with a dense and persistent contrast-enhancement; these char-acteristics make the spleen an optimal organ to be studied with contrast-specificUS. Radiologists should be aware of the typical and atypical appearance of splenicdisorders as shown at contrast-specific US imaging.

C-075The spleen: Normal variants and pathologies (imaging review)S. Vessal, A. Anbarasu, S.B. Rai, W. Shatwell, R. Ramachandra;Birmingham/UK

Learning Objectives: To familiarise with the normal anatomy of the spleen. Tofurther demonstrate common variations and splenic pathologies encountered inclinical practice.Background: The spleen is the largest single mass of lymphoid tissue seen inthe body. We familiarise with its normal image appearance using CT, USS andMRI. The pattern of contrast enhancement of the spleen during the arterial andvenous phases in CT can mimic disease by forming pseudomasses. Normal var-iants such as splenunculus, splenic clefts/lobulations, liver wrap-around, wan-dering spleen as well as congenital heterotaxic syndromes will be discussed. Aspectrum of splenic pathologies are demonstrated and the list of differential diag-noses that should be considered when seeing splenomegaly, cystic lesions, sol-id lesions and splenic calcification. Examples of splenic trauma - laceration,subcapsular and intraparencymal haematoma will be discussed and complica-tions such as splenosis demonstrated.Image Findings: Images of the spleen on plain radiography, CT, MRI, USS andradionuclide imaging from our institution are demonstrated along with imagingprotocols.Conclusion: There are several normal variants of the spleen which should bereadily recognised. Congenital abnormalities of the spleen such as polyspleniaare rare, this should not be misdiagnosed as splenosis. It is useful to assess thepresence and extent of splenomegaly. Further classification of parenchymal le-sions into cystic or solid can be made. Solid lesions can be further subclassifiedinto those with calcification. This poster demonstrates some splenic pathologies,a clear list of differential diagnosis is essential in interpreting any splenic lesion.

C-076Non-traumatic acute splenic lesions: Role of CTF. Garibaldi, Y. Hetmaniak, B. Gallix, J.-M. Bruel; Montpellier/FR

Learning Objectives: 1-To illustrate a pictorial review of various acute splenicpathologies of non traumatic origin. 2- To learn characteristic imaging features ofspontaneous spleen rupture or splenic infarction. 3-Understand the pivotal role ofabdominal CT when acute splenic pathology is suspected.Background: Splenic pathology is rarely suspected in patients with acute pain ofthe left upper abdominal quadrant. CT imaging is a well established tool for splenicinjury of traumatic origin but CT features of non traumatic acute splenic patholo-gy are less known. The purpose of this exhibit is to review the main causes of nontraumatic acute splenic lesions and to describe their specific CT patterns.

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Procedures: Material consisted of 30 patients with acute non traumatic splenicpathology who underwent multiphase contrast enhanced CT examination of theabdomen. The medical report of these patients were reviewed. Cases were cate-gorized according to the presence of the main CT patterns we found: Spontane-ous rupture, ischemic lesion, abscess or pseudo cyst or complicated tumoralinvolvement.Conclusion: Helical CT, in association with patients history and biology resultsis accurate to characterize the severity and the causes of acute non traumaticsplenic injury.

Abdominal Viscera (Solid Organs)

Miscellaneous

C-077The new ultrasound WHO-classification for diagnosis, staging and follow-upof patients with cystic echinococcosis (CE)W.P. Hosch, G.W. Kauffmann, T. Junghanss; Heidelberg/DE

Learning Objects: The new WHO-classification provides, for the first time, astandardized sonomorphological staging of echinococcal cysts. We demonstratethe clinical value of this classification with examples from our cohort of patients.Specific signs supporting the diagnosis of CE, and criteria for assessing cystviability are presented. This allows staging of cysts relevant for treatment deci-sions (surgery, percutaneous drainage (PAIR), albendazole or "watch&wait") andtreatment monitoring.Background: Ultrasonography plays a central role for diagnosis and follow-up ofabdominal CE due to problems regarding sensitivity and specificity of clinicalsymptoms and serological tests. This technique allows the staging of cysts withrespect to the involution process (spontaneous and treatment induced). The treat-ment options of CE have broadened in recent years with percutaneous drainage(PAIR), medical treatment and "watch&wait" as preferable strategies over sur-gery for specific cyst stages. In 2001 a standardized classification has been pub-lished by WHO allowing inter-observer comparison of treatment decisions andfollow-up.Procedure Details: 55 patients with a follow-up of up to 4 years have been seenin our referral centre for CE since 1999. Apart from 3 patients with pulmonarylesions and 1 patient with a spinal manifestation, all other patients had abdomi-nal cysts (63 hepatic, 1 spleen, 1 kidney, 1 peritoneal). We evaluated the value ofthe WHO-classification for diagnosis, therapeutic decision making and follow-up.Conclusion: On the basis of the WHO-classification ultrasonography is not onlyan excellent tool for the primary diagnosis of CE but also very valuable for clinicaldecision making and monitoring treatment response.

C-078The spectrum of manifestations of metastatic malignant melanomaC.S. Ng, V. Kundra, M.J. Jacobson, J. Szklaruk, D.G. Bedi; Houston, TX/US

Learning Objectives:1. To gain an appreciation of, and be alert in clinical practice to, the wide range ofsites, both common and uncommon, of metastases from malignant melanoma,including the lymphatic, central nervous, and musculoskeletal systems, thorax,abdomen and pelvis.2. To become familiar with the radiologic appearances of metastatic melanomaon CT, MR, and ultrasound.Background: Malignant melanoma is a tumor that is increasing in incidencethroughout the world, with a widely varying prognosis and distinctly capriciousbehavior. If, and when, the tumor metastasizes it can spread in an expected man-ner; however, frequently both the timing and sites of dissemination can be entire-ly unpredictable.Imaging Findings: This exhibit will present the wide range of manifestations ofmetastatic melanoma throughout the body, including the lymphatic, central nerv-ous, and musculoskeletal systems, chest, abdomen and pelvis, and soft tissues,as identified by the major cross-sectional modalities of CT, MR, and ultrasound.The hypervascular and hemorrhagic tendency of the tumor, and its typical MRsignal characteristics, will be illustrated. The exhibit will demonstrate the typicalsites of metastases, namely lymphatics, brain, lungs, and liver; but will also illus-trate the wide spectrum of more unusual sites of dissemination, including menin-ges, pleura, pancreas, gallbladder, gastrointestinal tract, genitourinary tract,peritoneal cavity, skeletal muscle and bone. The illustrative examples will be cor-related with the TNM staging system.Conclusions: Metastatic malignant melanoma has an extremely wide spectrumof manifestations. Practicing radiologists should be alert to these manifestations.

C-079CT and MR findings in patients with AIDS related neoplasmsG. Tognini1, F. Ferrozzi1, A. Patti1, V. Schembri1, G. Zuccoli2, M. Zompatori1;1Parma/IT, 2Reggio Emilia/IT

Learning Objectives: To familiarize radiologists with the imaging features of AIDS-related neoplasms.Background: Although high grade non-Hodgkin's lymphomas (NHL) and an un-usually aggressive form of Kaposi's sarcoma (KS) remain the most common

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malignancies in the AIDS affected population other neoplasms such as cervicalcancer, Hodgkin's disease and others have been observed with an increasedincidence, probably because of the longer survival of AIDS patients. The aim ofour exhibit is to describe CT and MR features of AIDS related neoplasms.Procedure Details: We reviewed CTand MR findings of 484 AIDS patients ex-amined between 1986-2003, amongst which 178 demonstrated pathologicallyconfirmed neoplasms. CT's were performed by using spiral (Plus, Plus 4, Sie-mens, Erlangen, Germany), and multislice CT equipment (LightSpeed 16 GEMedical Systems, Milwaukee, USA); MR examinations were performed by usinga 1.5 unit (Vision; Siemens Medical Systems, Erlangen, Germany). We demon-strated 65 NHLs, 9 Hodgkin's disease, 61 KS, 6 cervical cancers, 8 leukaemias,3 testicular, 2 larynx, 3 lung, 2 breast, 2 esophagus, 2 stomach, 3 liver, 4 kidney,and 4 adrenal carcinomas, 1 intrahepatic multinodular cholangiocarcinoma and3 stromal tumors of the gastrointestinal tract. 45/65 NHL showed extranodal in-volvement to the liver (19/65), brain (13/65), lung (16/65), pleura (2 primary effu-sion lymphomas with lymphomatous cells in the pleural effusion and no identifiabletumor mass) and gastrointestinal tract (12/65). KS involved the gastrointestinaltract (12), lung (16), liver (6), larynx (1), muscle (1), adrenal gland (1), spleen (2),pancreas (1).Conclusion: CT and MR proved useful in the evaluation of the variegate patho-logic findings of AIDS related neoplasms.

C-080Abdominal imaging of post transplant lymphoproliferative disorders (PTLD)K. Burney, I. Lyburn, R. Hopkins; Cheltenham/UK

Learning Objectives: This exhibit will review the pathogenesis, staging and ab-dominal imaging findings of post-transplant lymphoproliferative disorders (PTLD)seen in cardiac, lung, renal and liver transplant organ recipients.Background: Post-transplant lymphoproliferative disorders (PTLD) are a com-plication of immunosuppression in solid organ transplant recipients. We reviewedthe imaging of patients with a histologically proven diagnosis of PTLD treated atour sub-regional oncology unit over the past 5 years.Conclusion: PTLD is estimated to occur in between 2-5% of patients. Clinicalmanifestations are variable ranging from focal disease with graft dysfunction tosystemic illness. PTLD may be unsuspected or more extensive than expectedand imaging plays an important role in diagnosis, staging and follow-up. CT (andto a lesser extent US) is the imaging modality of choice.

C-081Does clinical examination of polytrauma guide properly CT evaluation?A. Kalai, Y.K. Maratos, T. Loeb, O. Clément, G. Frija; Paris/FR

Learning Objectives: To know the new definition of polytrauma patient based onthe risk factor. To know that a whole body scanner is indicated in polytraumapatient. To know the CT protocol in polytrauma.Background: The evaluation of the polytrauma patient is still most of time basedon regional CT oriented with the clinical finding. Based on our experience in 100patients this exhibit purposes a systematic evaluation with whole body scanner.Major findings and pitfalls are illustrated.Procedure Details: Whole body scanner includes: Axial head CT, cervical spinehelical CT with sagittal and coronal recontructions, helical CT with contrast IVwith an arterial phase on the thorax and portal phase an the abdomen and pelvis,sagittal reconstruction on the dorsolombar spine. The severity of the lesions afterthe clinical evaluation were compared to the ISS (Index Severity Score) after thewhole-body scan. 30% of the patients had at least one missed lesion when com-pared to clinical assessment .The average ISS of these patients was higher andthere was a surmortality.Conclusion: Whole-body scanning is highly recommended for polytrauma vic-tims in order to enable prompt and early treatment of lesions which might havebeen missed at the initial clinical evaluation.

C-082Radiological exploration of the embalmed cadaver of Eva PeronC. Gotta, A. Buzzi; Buenos Aires/AR

Learning Objectives: To exhibit for the first time a medical document of EvaPerón's embalmed cadaver.Background: Eva Perón was Juan Domingo Peron's wife (he was President inArgentina between 1946 and 1955, and between 1973 and 1974). For her politi-cal and social action she is known worldwide. She died of a cervix cancer in1952. When she died, she weighed less than 30 kg, so many people doubt thather embalmed cadaver (small and consumed) belonged to her. The cadaver was

embalmed by Dr Pedro Ara, Professor of Anatomy at the School of Medicine ofthe University of Cordoba. He was born in Zaragoza, Spain, and he was estab-lished in Argentina in the decade of 1930. Professor Ara carried out excellentwork with Eva Peron's cadaver. Contrary to the classical technique, Eva Peron'sembalmed body conserves its viscera.Imaging Findings: When the régime was overthrown in 1955 Eva Peron's ca-daver was deposited in the General Confederation of Work ("Confederacion Gen-eral del Trabajo", CGT). The new authorities doubted of the authenticity of thecadaver. Radiological exams were made by Dr Guido Gotta (father of one of theauthors), who confirmed that the body corresponded to a human being, and thatthere was evidence of neoplasia (abdominal nodules, bone metastasis).Conclusions: Besides its medical use, thanks to its capacity to examine theinterior of bodies, since their discovery X-rays were used for other purposes. Inthis case, they were used to determine the authenticity of Eva Peron's embalmedcadaver.

C-083Imaging of complications of drug abuseS. Van de Perre, F.M.H.M. Vanhoenacker, A. Bernaerts, A.M.A. De Schepper,P. Parizel; Antwerp/BE

Learning Objectives: To give an overview of the radiological manifestations ofacute and chronic complications of drug abuse.Background: The material is culled from our databank of the emergency depart-ment of our institution. The age of the patients in our series ranged between 17-and 30-years-old.Imaging Findings: Complications of drug abuse in the drug addict will be classi-fied according to their pathogenic mechanism or by their way of administration.Pathologically, complications are usually due to their vasoconstrictive and throm-bogenic effect on different organs, including the brain (stroke), heart (myocardialischemia), the gastro-intestinal system (ischemic colitis), the nose (nasal septumperforation due to cocaine snorting). A direct toxic effect of drug metabolites isanother pathogenic mechanism resulting in tissue necrosis, as typically seen inliver cell necrosis due to ecstacy. The route of administration (intravenously, oral-ly, inhalation or smoking) may also reflect the radiological presentation. Localabscess formation, septic thrombophlebitis, septic pulmonary emboli or blood-born infections result from intravenous access, whereas inhalation and smokingmay result in pneumothorax, pneumomediastinum and epidural pneumatosis.Indirect complications, such as an increased risk for traffic accidents can be at-tributed to the additive effect of a cocktail of drugs and/or alcohol. Complicationsrelated to smuggling are due to accidental rupture of packed drugs in the gas-trointestinal lumen.Conclusion: The radiologist should be aware of the possible causal relationshipwith drug abuse, especially when those complications are encountered in a youngpopulation.

C-084Abdominal neurogenic tumors: Comparison of radiologic and pathologicfindingsJ.-Y. Oh, K.-J. Nam, J.-C. Choi, J.-H. Cho, S.-K. Yoon, K.-N. Lee, S.-S. Choi;Pusan/KR

Learning Objectives: To demonstrate the variable radiological findings of ab-dominal neurogenic tumors and correlate with pathologic findings.Background: There is a broad spectrum of neurogenic tumors that involve theabdomen. In this exhibit, we will describe the variable radiologic findings of ab-dominal neurogenic tumors. This study included 46 patients with abdominal neu-rogenic tumors which were confirmed histologically by surgical resection (n = 29)or US guided biopsy (n = 17). Two radiologists reviewed radiologic findings retro-spectively and correlated with pathologic results.Imaging Findings: We categorized them into 3 groups by cell of origin; nervesheath origin (schwannoma in 7, neurofibroma in 4, plexiform neurofibromatosisin 1, malignant peripheral nerve sheath tumor in 3), paraganglionic cell origin(paraganglioma in 7, pheochromocytoma in 8), and ganglion cell origin (gangli-oneuroma in 5, ganglioneurofibroma in 2, ganglioneuroblastoma in 1, neuroblas-toma in 8).Conclusion: Although abdominal neurogenic tumors show a broad spectrum,some neurogenic tumors revealed characteristic radiologic findings and correlat-ed well with pathologic findings. Familiarity with various neurogenic tumors in theabdomen is helpful in the approach of the diagnosis.

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C-085Modern imaging of the portal systemP. Otal, P. Tall, L. El Hajj, A. Gozlan, V. Chabbert, G. Canevet, F. Joffre,H. Rousseau; Toulouse/FR

Learning Objectives: To illustrate normal and pathologic patterns of the portalsystem, with a special interest in multislice CT.Background: The excellent spatial resolution of multislice CT allows a bettercomprehension of abdominal structures, in particular vessels. Portal system con-stitutes a complex network with numerous connections between its different com-partments and also the systemic veins.Imaging Findings: The aim of this pictorial poster is to depict with this new imag-ing technique the different components of the portal system and to analyze, froma physiopathological point of view, the development of collateral pathways in bothpathological entities; portal hypertension and segmental portal hypertension.Multislice CT images will be correlated with MRI, Doppler and angiographies.Conclusion: Multislice CT offers a precise evaluation of normal and pathologicportal system.

C-086Imaging of alcoholismA. Buzzi, A. Doisenbant, S. Rachetta, M. Canedo, C. Garcia Pellegrino,P. Nazr, V. Alarcon, M. Mancini, A. Mancini; Buenos Aires/AR

Learning Objectives: To describe the spectrum of imaging findings in alcoholicpatients from head to toe, and from radiography to MRI.Background: Alcohol consumption has become an increasing concern as a publichealth issue. Alcohol is one of the major causes of global disease, chronic inva-lidity, accidents, violent crime, domestic violence and also marital disharmony. Indeveloping nations, alcohol ranks as the fourth cause of disability among men.Alcohol consumption is particularly problematic in Latin America and the Carib-bean (LAC). While the proportion of all deaths worldwide that can be attributed toalcohol use is 1.5%, that figure is 4.5% for the LAC nations.Imaging Findings: Adverse effects of alcohol consumption range from acutemaladies and injuries (Wernicke's encephalopathy, gastric bleeding, pancreati-tis, head injury), to a host of long-term chronic conditions that include brain dam-age, high blood pressure, stroke, cancers, (from the oropharynx to the colon),hepatic disease, peripheral neuritis, cerebellar impairment, infections, muscleand bone diseases, etc. Also, alcohol is involved in some congenital diseases.Conclusion: Alcoholism is an important public health issue. Diagnostic imagingdisplays most of its manifestations. The individual who consumes alcohol is notthe only one affected by it; the drinker's family and community also bear its costs.The public health literature on alcohol use remains largely entrenched in themedical "disease" model. It still lacks information on the social impact producedby alcohol use through violence and sexual risk behaviors.

C-087Radiological atlas of abdominal tuberculosis: The great mimickerF. Matute Teresa, P. De Diego Rey, R. Mendez Fernandez, B. CabezaMartinez, F. Ayala Lancry; Madrid/ES

Purpose: To illustrate the broad spectrum of imaging findings (CT, US, urogra-phy and barium contrast studies) of patients with proven abdominal tuberculosis.Material and Method: We review between January 1998 and July 2003, the typ-ical and atypical imaging findings of 52 patients that had a final diagnosis ofgenitourinary (13), adrenal (3), bowel (14), peritoneal (5), and hepatosplenic (16)tuberculosis.Results: Most patients had been at increased risk because of drug abuse, alco-holism, AIDS and steroid therapy. Radiological findings included low density lymphnodes, splenomegaly, hepatomegaly, intrasplenic and intrahepatic masses, asci-ties, diffusely thickened and enhanced peritoneum, mottled low density massesin the omentum, pleural effusion, thickening of the bowel, adrenal enlargement,atrophy and calcification, fallopian tube fibrosis, uterine atrophy and adhesions,ureteral and bladder fibrosis, and different patterns of renal hydronephrosis andcalcification.Conclusion: Patients with AIDS had more severe form of involvement than thosewho did not have AIDS. Sonography was the only imaging modality to demos-trate septations within the tuberculous ascites, but showed the fewest morpho-logic details in renal tuberculosis. CT is the imaging modality that best determinedthe extent of intrabdominal tuberculosis. Recognition of these manifestationsshould help optimize the correct diagnosis and management of tuberculosis inorder to obtain a favorable outcome, biopsy is mandatory in almost all cases.

C-088Predictive factors for the presence of esophageal varices in patients withhepatic cirrhosisS. Isarria, T. Ripollés, M.J. Martínez, C. Soto, A. del Val, M.D. Monedero,M.R. Pastor; Valencia/ES

Purpose: To develop a predictive model for the presence of esophageal varices(EV) in patients with hepatic cirrhosis (HC). This model would limit the endoscop-ic screening to the group of patients with high risk of bleeding from EV.Methods and Materials: 42 consecutive patients with HC were included in thisprospective study (20 men, 22 women; mean age 59.7). Physical and laboratoryexaminations, upper gastrointestinal endoscopy and Doppler ultrasonographywere recorded. Patients were divided in two groups: 1) No EV or small EV, 2)medium or large EV. The distribution of clinical, biochemical, and Doppler ultra-sonographic variables were compared in each group. The U statistic of Mann-Whitney was performed for the quantitative variables, whereas the Chi-square orthe Fisher's exact tests were used for the qualitative ones. Variables were alsoincluded in a multivariate stepwise logistic regression model. A ROC-analysiswas performed.Results: In the stepwise logistic regression, presence of medium or large EVwas independently predicted by splenomegaly, decreased platelet count, HCVinfection and a decrease of the maximum portal flow velocity (MPV). The discrim-inating ability of the prediction rule was high, with an area under the ROC curveof 0.92 (95% CI: 0.80-0.98).Conclusion: Patients with HC should be screened by upper gastrointestinal en-doscopy only if splenomegaly, low platelet count, infection by HCV and decreasedMPV are present, since these parameters confidently predict the existence ofmedium or large EV.

C-089Premier experience of multiphasic contrast material-enhanced dynamicstudy on 3.0 Tesla magnetic resonance (MR) imagingT.-J. Hsieh, G.-C. Liu; Kaohsiung/TW

Purpose: To evaluate the accuracy and sensitivity of a dynamic contrast materi-al-enhanced three-dimensional (3D) volumetric breath-hold hepatic magnetic res-onance (MR) imaging examination on a 3.0 Tesla machine.Methods and Materials: 3.0 Tesla MR imaging with serial multiphasic contrastmaterial-enhanced dynamic study was performed in 69 patients with hepatocellu-lar carcinoma (HCC). All patients had pathologic comfirmation by fine needlebiopsy and followed angiographies were performed in 1.5months. Each test re-sult was interpreted independently by two radiologists. Separate reading ses-sions were performed for images from the multi-phases. Sensitivity and positivepredictive values were calculated for each reading session.Results: One hundred twenty-nine early-enhancing lesions were detected in the69 patients on the 3.0 Tesla MR images. The followed angiographies showed 152hypervascular tumor stains. All the lesions showed in the MR images were iden-tified in the angiographies. The breath-hold dynamic examination on 3.0 Telsashowed a overall sensitivity of 84.8%.Conclusion: Multiphasic contrast material-enhanced dynamic study on 3.0 Tes-la magnetic resonance (MR) imaging 3.0 Tesla MR imaging is insensitive for thediagnosis of HCCs.

C-090Role of digital subtraction angiography, computed tomography andmagnetic resonance in detection of insulinoma: Head-to-head comparisonJ. Saponjski, M. Ostojic, V. Vukcevic, B. Beleslin, Z. Markovic, D. Saranovic,D. Masulovic; Belgrade/YU

The insulinomas are rare functional pancreatic neuroendocrine tumours. The mostcommon clinical presentations include hypoglycaemia (< 2.8 mmol/l), confusion,and loss of consciousness. Diagnosis is difficult, and performed by computedtomography, magnetic resonance or selective angiography of the pancreatic ar-teries by digital subtraction angiography (DSA).The aim of the study was to analyse head-to-head the diagnostic value of pan-creatic DSA, computed tomography and magnetic resonance in 29 patients (25female, 4 male; 37 ± 6 years) with insulinoma. The diagnosis was established bypathohistology after the surgical treatment in all patients.The tumours were localised in the pancreatic body in 20/29 patients (69%), in thepancreatic tail in 8/29 patients (27%) and in 1/29 patients (4%) in the head of thepancreas. They were 15-45 mm in diameter, well vascularized and with a clearouter border. DSA detected insulinoma in 25/29 patients (sensitivity 86%). Noneof the patients had multiple tumours. Computed tomography detected insulinoma

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in 7/29 patients (sensitivity 24%, p < 0.05 vs. DSA) in the area of pancreaticbody, whereas magnetic resonance detected tumours in 10/29 patients (sensitiv-ity 34%, p < 0.05 vs. DSA). In 4 patients in whom DSA failed to detect insulino-ma, the diagnosis was reached by computed tomography. The possible causes ofDSA failure to detect insulinomas included poor vascularization of the tumourand/or presence of excess gas in the bowel.Digital subtraction angiography is a method of choice for the diagnosis of insuli-nomas, with better sensitivity than computed tomography and magnetic reso-nance imaging.

C-091MSCT detection of active arterial contrast extravasation after bluntabdominal trauma in polytraumatized patientsU. Stessel, M. Tillich, H. Schöllnast, A. Ruppert-Kohlmayr, G. Fritz,H. Deutschmann, W. Kau; Graz/AT

Purpose: The purpose of this presentation was to evaluate the use of a stand-ardized contrast-enhanced MSCT to show sites of active haemorrhage as a guidefor surgical or angiographic treatment in patients sustaining blunt abdominal orpelvic trauma.Material and Methods: Retrospectively, 375 patients (01/2000 – 08/2003) withinitial diagnosis "polytrauma" underwent a standardized MSCT examination. Allscans were performed on a four-detector-row-scanner using collimation of 5.0 mm,pitch 1.5, RI 2, with a scan range from diaphragm to the minor trochanter. In allpatients 120 mL contrast-agent was injected with a flow-rate of 3.5 mL/s. Thescans were started with a delay of 70 s.Results: In 14/ 375 (4%) patients an active extravasation of contrast agent asreference of an active haemorrhage was detected. The locations of active haem-orrhage as determined by extravasation of contrast material shown on MSCTscans included the abdomen (spleen, liver, kidney) - 9/14 (64%), pelvis - 2/14(14%), retroperitoneum - 1/14 (8%), and thoracic wall - 2/14 (14%). The origin ofhaemorrhage was confirmed in all cases to correspond to the anatomic region inwhich extravasated contrast agent was shown by MSCT. The CT attenuation ofactive haemorrhage was greater than 100 HU in all cases, while clotted bloodshowed CT attenuation values between 70-90 HU.Conclusion: Active extravasation of contrast material (representing active haem-orrhage) after blunt abdominal trauma may be accurately detected in polytrau-matized, haemodynamically stable patients using MSCT. The MSCT findings maybe used as a guide for angiographic or surgical treatment.

C-092A comparative study in the diagnosis of SHCC with Mn-DPDP enhancedMRI, plain MRI and Gd-DTPA dynamic enhanced MRIF. Yan, K. Zhou; Shanghai/CN

Purpose: The differences in the diagnosis of SHCC between Mn-DPDP enhancedMRI, plain MRI and Gd-DTPA dynamic enhanced MRI were compared, to im-prove further the detection and diagnostic accuracy of SHCC.Methods: 26 SHCC cases confirmed by surgical pathology underwent MR ex-amination, including SE T1WI, FSE T2WI and Gd-DTPA dynamic enhanced MRI.Mn-DPDP enhanced MRI was performed at 30 min after the end of intravenousinfusion of Mn-DPDP with SE T1WI and FMPSPGR T1WI. 24 h delayed scanningwith the same sequences was obtained the next day. The detection, capsule andenhancement patterns of SHCC lesions were observed on Mn-DPDP enhancedMRI, plain MRI and Gd-DTPA dynamic enhanced MRI respectively and statistically.Results: 32 lesions were found in 26 cases. In the detection of SHCC lesions,plain MRI was 68.75%; Gd-DTPA dynamic enhanced MRI was 87.5%; Mn-DPDPenhanced MRI was 93.75%. No significant difference was found between Mn-DPDP enhanced MRI and Gd-DTPA dynamic enhanced MRI, and there was sig-nificant difference between Mn-DPDP enhanced MRI and plain MRI. Capsuleswere found in 24 lesions by pathological examination. The demonstration of thecapsules for SHCC lesions with Mn-DPDP enhanced MRI (87.5%) was higherthan that of plain MRI (20.83%) and Gd-DTPA enhanced MRI (62.5%) statistically.Conclusion: For the detection of SHCC lesions, Mn-DPDP enhanced MRI isbetter than plain MRI and Gd-DTPA enhanced MRI, and it is significantly betterthan plain MRI and Gd-DTPA enhanced MRI in the demonstration of capsules. Itprovides a new method in the diagnosis of SHCC.

C-093MR variants of the anatomic structure of the gallbladder, the biliary andpancreatic ductsG.E. Trufanov, V.V. Riazanov, V.A. Ratnikov, M.V. Litkin; St. Petersburg/RU

Purpose: To estimate variants in the anatomic structure of the gallbladder, thebiliary and pancreatic ducts and to develop a technique of research.Material and Methods: 780 patients underwent complex MRI using a 1.5 T unit.T2W HASTE, T1W TurboFLASH, including FS, and MRCP (single-slice TurboSEand multi-slice HASTE in different orientations) were acquired. 65 patients alsoexamined with ERCP.Results: In 18% of patients the merger of the hepatic lobar bile ducts was extra-hepatic. 21% revealed an additional right hepatic duct, more than half runninginto the common bile duct (CBD) low. The low fusion of the cystic duct and CBDwas revealed in 19% of the patients, and its left arrangement in 23%. Anomaliesin the form of the gallbladder are revealed in 35% and additional pancreatic ductin 10% of patients. In 13% patients the main pancreatic duct and CBD had acommon ampoule, in more than 64% of cases they enter the duodenum parallel,in 13% cases separately. It is expedient to study the mutual relationships of ducts,parenchyma and vessels with application of T2-w HASTE. General submissionabout bile and pancreatic ducts and gallbladder allows receiving single-slice Tur-boSE. For better analysis of details of anatomic structure it is necessary to studyof source images multi-slice HASTE in different orientations. The results of re-search especially are useful for planning of operative treatment.Conclusions: Complex MRI, especially reception of T2-w images and realisa-tion of MRCP, is an excellent tool for revealing variants in anatomic structure ofthe gallbladder and ductal system.

C-094The clinical utility of diffusion imaging out of the central nervous systemY. Murakami1, K. Imoto1, N. Aito1, T. Sakamoto1, M. Yamasaki2, A. Furukawa2,R. Ito2, K. Murata2; 1Kohka/JP, 2Shiga/JP

Objective: The clinical utility of diffusion imaging out of the central nervous sys-tem is not yet clear. The purpose of this prospective study is to determine the roleand the clinical usefulness of diffusion-weighted MR imaging combined with con-ventional MR imaging for the detection of visceral disease without of the centralnervous system.Material and Methods: One hundred and thirty-four cases who were referred toour hospital for the examination of visceral disease without the central nervoussystem (including 114 cases with neoplasms and 20 cases with inflammatorydisease, upper abdomen; 48, pelvis; 51, other organ; 35) were investigated. MRimaging (1.5 T) was performed using a diffusion-weighted single-shot spin-echoechoplanar sequence, T2-weighted fast spin-echo sequence, and T1-weightedspin-echo sequence. An experienced reviewer evaluated the diffusion-weightedMR images for the presence of a high-signal-intensity lesion and compared withother MR sequences. Imaging findings were correlated with findings from histo-logical specimen in 20 patients and with findings from clinical follow-up examina-tion in other patients.Results: Diffusion-weighted MR imaging depicted 62 high signal intensity le-sions, including 56 cases with malignancy and five cases with inflammation, anda case of Castleman's disease. In three patients with lymphomas, high signalintensity lesions reflected the activity of the disease process. There was no highsignal intensity lesion in cases with eight adnexal diseases.Conclusion: Diffusion-weighted MR imaging out of the central nervous systemmay possibly be useful for the extent or the activity of malignant or inflammatorydisease.

C-095Evaluation of computed tomography for assessment in lipodystrophysyndromeJ.A.G.S. Gallego, F.M.A.I. Ardoy, S.P.U. Padilla, F.G.R. Gutierrez; Elche/ES

Purpose: Lipodystrophy syndrome (peripheral fat loss and/or visceral fat accu-mulation) is a main problem in HIV-patients treated with antiretroviral therapy.The diagnosis is based on physical examination and/or standardized question-aires so there is a need for quantitative diagnostic tools. The aim of this study isto evaluate computed tomography (CT) to measure fat distribution in HIV pa-tients.Methods and Materials: 61 HIV-patients (44 men) were included. Lipodystrophywas diagnosed clinically on 31. Subcutaneous limb adipose tissue area and theirpercentage were measured by a single slice at mid thigh and mid arm by CT. Thesubcutaneous (SAT), visceral (VAT), and total (TAT) abdominal adipose tissue as

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well as the VAT/TAT, SAT/TAT and VAT/SAT ratios were calculated by a singleslice at umbilical level.Results: VAT/TAT and VAT/SAT ratios were significantly greater in lipodystrophicthan in non-lipodystrophic patients: 0.62 vs 0.41, p < 0.01 and 2.48 vs 0.38,p < 0.01 respectively in men. 0.38 vs 0.25 p < 0.05 and 1.14 vs 0.32 p < 0.05 infemale patients. SAT/TAT and mid thigh fat tissue percentage were significantlylower in lipodystrophic patients: 0.36 vs 0.57 p < 0.01 and 0.1 vs 0.2 p < 0.01respectively in men. 0.6 vs 0.75 p < 0.05 and 0.26 vs 0.46 p < 0.05 in femalepatients. No significant differences were found at mid arm. A VAT/SAT ratio > 0.98for men and > 0.35 for women had a sensitivity of 83% and 85% respectively anda specificity of 70%, to diagnose lipodystrophy syndrome.Conclusion: Computed Tomography may be a useful technique to quantify lipo-dystrophy in HIV-infected patients.

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C-097Ultrasonographic assessment of body fat distribution in type II diabetesmellitus of insulin resistant type and its relation to anthropometricmeasurementsN. Tuncbilek1, S. Güldiken1, O.O. Okten1, E. Arikan1, H.M. Karakas2;1Edirne/TR, 2Malatya/TR

Purpose: Previous studies have shown that in subjects with type II diabetesmellitus of insulin resistant type there is a relation between cardiovascular dis-eases and obesity, insulin resistance and body fat distribution. In these patientsbody fat distribution assessed with DEXA and antrophometric measurementswere correlated with ultrasonographic fat assessments.Materials and Methods: 28 subjects (14 male and 14 female with mean age of55.5 ± 8.4) in whom type II diabetes mellitus of insulin resistant type was diag-nosed with HOMA (homeostasis model assessment) were enrolled in the study.Their weights, heights, abdominal diameters, and gluteal diameters were record-ed. Body mass index (BMI, kg/m²) and the ratio of abdominal diameter to glutealdiameter (A/G) were calculated. Subcutaneous (FatSC), preperitoneal (FatPP),and visceral (FatV) fat thicknesses were ultrasonographically assessed.Results: There was a significant correlation between BMI and FatSC or FatV(p < 0.01); and between total fat ratio and FatSC and FatV (p < 0.05 and p < 0.01,respectively). There was no relation between A/G and FatSC, FatPP and FatV.Conclusion: Ultrasonographically assessed subcutaneous and visceral fat thick-nesses in type II diabetes mellitus patients of insulin resistant type may be usedas prognostic factors of cardiovascular diseases.

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C-099MRI of the upper abdomen using a new free-breathing navigator triggeredT2-weighted TSE-sequence (PACE-TSE)C. Klessen, P. Asbach, R. Kirsch, B. Hamm, M. Taupitz; Berlin/DE

Purpose: To evaluate image quality of a new free-breathing navigator triggeredT2-TSE sequence (PACE = Prospective Acquisition Correction) for magnetic res-onance imaging of the upper abdomen in comparison to a established standardbreath-hold T2-weighted sequence.Materials and Methods: Prospective evaluation of 30 consecutive patients withvarious pathologies referred to our clinic for MRI of the upper abdomen. All pa-tients were examined at 1.5 T (Siemens Magnetom Quantum) using the followingsequences: PACE-TSE (work-in-progress sequence,320 x 224 matrix, FOV320 mm, axial slice orientation, TR 2340 ms, TE 80 ms, Turbo Factor 21, 42 slic-es, 4 mm slice thickness, n = 2 excitations), breath-hold HASTE sequence(256 x 154 matrix, axial slice orientation, TR ∞, TE 63 ms, 23 slices, 7 mm slicethickness, n = 1 excitation). Three independent abdominal MRI experienced radi-ologists reviewed all images and evaluated motion artifacts, liver-spleen con-trast, depiction of intrahepatic vessels, depiction of the pancreas and the adrenalglands and overall image quality on a 4-point scale. In addition, to directly evalu-ate the influence of the respiratory trigger technique, in 10 patients the T2-TSEsequence was repeated with the respiratory trigger function switched off.Results: Mean examination time of the PACE-TSE was 7.2 minutes. The depic-tion of anatomical details and contrast was significantly better (p < .05) using thePACE-TSE sequence compared to the standard HASTE sequence.Conclusions: The PACE-T2-TSE sequence has the potential to significantly im-

prove recognition of anatomical details and contrast compared to standard breath-hold HASTE imaging.

C-100Reactive lymph node hyperplasia: A diagnostic problem in the staging ofHodgkin's disease (HD)L. Ilic-Todoric, B. Lukac; Belgrade/YU

Purpose: Therapeutic approach to HD requires determination of the disease extentto supra/infradiaphragmatic lymph nodes (LN). A problem appears when LN areof borderline size or only slightly enlarged. Should such a finding on CT be con-sidered as reactive hyperplasia or a pathological finding? The purpose of thisreport is to solve this dilemma.Methods and Materials: Infradiaphragmatic spiral CT scan was performed in250 patients with histologically confirmed supradiaphragmatic HD. Bipedal lym-phography represented the gold standard for final staging. Taking reactive hyper-plasia into consideration, we estimated and statistically analysed CT's ability todifferentiate benign and malignant conditions, and its value for staging.Results: Lymphography showed infradiaphragmatic disease in 48% of patients,21% of whom had enlarged LN, while in 79% LN were of normal size or smaller.Of the total number of patients, reactive hyperplasia and lymphographically nor-mal findings were found in 21% and 31% of patients, respectively. CT detectedenlargement in 41% of patients, and in 20% of these this finding concurred withthe lymphographic one. CT could neither detect affected normal/reduced LN, nordifferentiate reactive from malignant hyperplasia. Postlymphographic restagingof the disease showed that 37% of patients would be understaged and 21% over-staged on the basis of CT finding only.Conclusion: Reactive hyperplasia represents a risk of up/downstaging if stagingrelies on CT only. Errors can be partially assigned to the inadequate interpreta-tion of the CT findings, which cannot be taken for granted when LN are of border-line sizes. In such cases additional diagnostic procedures are necessary.

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C-101Staging of oesophageal and gastric tumours using endoscopic ultrasoundD.R. Warakaulle, M. Frenz, J. Phillips-Hughes; Oxford/UK

Learning Objectives:1. Demonstrate the normal 5 layered anatomy of the oesophagus and stomach,as seen on endoscopic ultrasound (EUS).2. Demonstrate progressive stages of local spread of oesophageal and gastrictumours (T-stage).3. Demonstrate the imaging appearances of local lymphadenopathy in the re-gions commonly involved by these tumours (N-stage).Background: EUS allows accurate local staging of gastric and oesophageal tu-mours, and has the advantage over other imaging modalities of allowing exami-nation of the gut wall in fine detail. This is crucial for the selection of patients forcurative surgery. High resolution images can be obtained due to the high fre-quencies used. However, this limits the imaging depth to approximately 5-6 cmbeyond the probe. This penetration is adequate to allow imaging of local nodes,and the detection of metastatic spread to the left lobe of the liver, ascites local tothe tumour and pericardial effusions. Therefore, using the TNM staging system,EUS allows accurate T1-T4 staging, lymph node staging to NI, and can detectbut not exclude distant spread (M1).Procedure Details: Fibre-optic endoscopy was performed under intravenoussedation.Images were obtained using a 5-10 MHz electronic array with a 270degree scanning angle. A 12 MHz Minprobe with a mechanically driven radialtransducer providing a 360 degree scanning angle was used to traverse tightstrictures.Conclusion: EUS can be used in the pre-operative assessment of patients withknown oesophageal and gastric malignancy after the exclusion of distant spreadwhich renders the patient inoperable.

C-102Detection of T-stage in cardiac cancer: Comparing MR to multislice CTZ. Pan, H. Zhang, H. Ling, B. Ding, K. Chen; Shanghai/CN

Purpose: To compare the diagnostic accuracy of MR (Magnetic resonance) im-ages with MSCT (multislice CT) for preoperative T-staging in patients sufferingfrom cardiac cancer.Materials and Methods: MR and MSCT were performed in 25 cases of cardiaccancer diagnosed by biopsy prior to operation. MR and MSCT scans were per-formed on two different days. MR sequences included FSET1W, FSET2W, FSET1W with fat suppression and dynamic enhanced FSPGR with fat suppression;MSCT was applied with dynamic triphasic contrast enhancement. All these find-ings were prospectively analyzed by two doctors separately and correlated withthe surgery pathological findings. Statistic work was performed with SPSS.Results: According to histopathologic staging, the accuracy for T1-staging de-tected with MR and MSCT were 70% and 55% respectively, 75% and 62% for T2-staging, 87% and 69% for T3-staging, 89% and 60% for T4-staging. Comparedwith MSCT, dynamic enhanced and delayed MR with fat suppression was supe-rior for revealing the involvement of esophagus and aorta, early stage of inva-siveness and providing more evidence in T2 from T3 or T3 from T4 staging(P < 0.05). Among these MR plain scan sequences, T1W with fat suppressionwas outstanding in depicting the gross features of the tumor, presence of ulcera-tion, and adjacent lymph node swelling. Diagnostic accuracy determined by ROCanalysis was marginally higher with MR scan than with MSCT scan in T-stagingof cardiac cancer.Conclusion: MR is superior in T-staging of cardiac cancer and can be used tooptimize the therapeutic strategy, thus avoiding unnecessary operation.

C-103Multidetector CT and virtual endoscopy of the esophagusS. Mazzeo, D. Caramella, E. Neri, P. Giusti, C. Cappelli, R. Bertini, A. Belcari,C. Bartolozzi; Pisa/IT

Purpose: To assess the diagnostic capabilities of multidetector CT in variousesophageal pathological conditions.Methods and Materials: Thirty-three patients underwent a multidetector CT studyafter esophageal distension by means of effervescent powder administered afterinduction of hypotonia. All acquired images were post-processed with 2D and 3Dsoftware tools. The CT data was compared with the results of conventional radi-

ology (33), endoscopy (28), US-endoscopy (14) or surgery (14). Follow-up rangedbetween 4 and 15 months.Results: Esophageal distension in the upper and middle third was classified as"good" in 32/33 cases (97%); in the lower third, esophageal distension was "good"in 21/33 cases (64%). Final diagnoses were: leiomyoma (6), squamocellular car-cinoma (6), adenocarcinoma (4), esophageal infiltration by thyroid cancer (2),benign polyposis (2), chronic esophagitis (5), post-sclerotherapy stenosis (1), noabnormalities (7). When good distension was achieved, the thickness of unaf-fected esophageal wall was < 3 mm (range between 1.5 and 2.4 mm, mean1.9 mm). Pathological wall thickening was observed in 25/33 cases (76%) withvalues ranging between 3.6 and 36 mm (mean 9.6 mm). Spiral CT demonstrated21 true positive cases and 7 true negative cases. There were 4 false negativecases and 1 false positive case. Sensitivity was 84%, specificity 87%, diagnosticaccuracy 85%, positive predictive value 95%, negative predictive value 64%.Conclusions: Evaluation of the esophagus with multidetector CT proved to be apromising and easy to use technique, allowing panoramic exploration, virtualendoluminal visualization, accurate longitudinal and axial evaluation, and simul-taneous evaluation of T and N parameters.

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C-104Barium tagged dark-lumen MR colonography: Findings in patients withinflammatory bowel diseaseF.B. Ergen, D. Akata, C. Basaran, S. Arslan, F. Batman, M.N. Ozmen,O. Akhan; Ankara/TR

Learning Objectives: To demonstrate MR colonography (MRC) findings in pa-tients with inflammatory bowel disease (IBD). To describe the technique of bari-um tagged dark-lumen MRC. To outline the advantages, disadvantages and limitsof the method.Background: Conventional colonoscopy (CC) is the most widely used methodfor the assessment of the extension and the activity of IBD. However, CC is aninvasive technique and requires long-lasting bowel preparation. Furthermore, notinfrequently the examination of the entire colon and terminal ileum wouldn't bepossible due to severe pain or fecal residue. These disadvantages are eliminatedwith barium tagged dark-lumen MRC which makes this examination more tolera-ble and acceptable by patients.Imaging Findings: Ten patients who present with symptoms of IBD underwentCC first and subsequently MRC. For fecal tagging, barium sulphate-containingcontrast agent is given with meals, beginning 48 hours before the examination.For MRC the colon was filled with 2000 mL of diluted barium. After intravenousadministration of 0.1 mmol/kg Gd-DTPA, coronal T1-weighted three-dimensionalgradient-echo sequence is performed. Additional fat-saturated axial two dimen-sional gradient-echo and coronal true-FISP sequences are obtained. Colon seg-ments are interpreted seperately (rectum, descending, transverse, ascendingcolon, caecum) when assesing the extent of the disease. Bowel wall thickeningand congestion of marginal vascularity are considered as signs of the disease.Out of sixty segments, 50 of them had colonoscopic correlation. Of these in 42(84%) the extent of disease correlated with CC. Non-correlation of findings ofMRC and CC was detected in 8 (16%) patients.Conclusion: Barium tagged dark lumen MRC can be used for the assesment ofthe extent of IBD.

C-105Evaluation of CT gastric virtual endoscope (VE) findings: Comparison withreal gastric fiberscope (GF) lesionsK. Inamoto, K. Kouzai, K. Hamada; Osaka/JP

Learning Objectives: To check VE findings compared with 66 GF lesions in 63cases. To learn about images of VE and to consider possibilities to use VE clini-cally.Background: GF is an invasive examination for patients. If VE can be used forchecking pathologies of gastric diseases it will be beneficial to detect malignantchanges of the stomach in their early stage.Procedure Details: MD-CT images were obtained on the same day as GF withSomaton Sensation 16, Siemens, Erlangen, Germany. Thin slice CT images with1 mm thickness were reconstructed to VE images by surface rendering and vol-ume rendering with Advantage Workstation 4.0_0.3 with Volume Analysis Vox-tool 3.0.26e, GE, Milwaukee, WI.USA. Results indicated that VE imagessucceeded in showing subtle alteration of mucosal folds. Gastric cancer, polyp,ulcer, erosion and gastritis were clearly visualized. By comparison studies be-tween VE and GF, a sensitivity 92.7%, specificity 90.9%, positive predictive value98.1%, negative predictive value 71.4% and accuracy 92.4% were calculated.Conclusion: 3D MD-CT examination of the stomach is noninvasive except forradiation exposure. It will be expected as a new technique of the stomach exam-inations.

C-106Gastrointestinal stromal tumor: Current concepts and imagingcharacteristicsJ.H. Lee, K. Kim, C. Park, W. Jeong, J. Lee, E. Kang, I. Cha, H. Seol; Seoul/KR

Learning Objects: To provide an in-depth review of gastrointestinal stromal tu-mors (GIST's) with their epidemiology, histopathology, clinical manifestations andthe most up-to-date therapy. To describe radiologic features of GIST's. To discussdifferential diagnosis of GIST's throughout the abdomen.Background: Gastrointestinal stromal tumors (GIST's) are unique neoplasmsthat occur throughout the gastrointestinal tract, mesentery, omentum, and retro-peritoneum. They are the most common mesenchymal neoplasm of the gastroin-

testinal tract and are defined by their expression of KIT (CD117), a tyrosine ki-nase growth factor receptor. The expression of KIT is important to distinguishGIST's from other mesenchymal neoplasms such as leiomyomas, leiomyosarco-mas, schwannomas, and neurofibromas and to determine the appropriatenessof KIT-inhibitor therapy. Imaging features of GIST's vary depending on tumor sizeand organ of origin. Since most GIST's arise within the muscle layer of the gas-trointestinal tract, they most commonly have an exophytic growth pattern andmanifest as dominant masses outside the organ of origin.Procedure Details: The purpose of this exhibit is to provide an in-depth review ofGIST's with their epidemiology, histopathology, clinical menifestation and differ-ential diagnosis. This exhibit will also reflect our experience in the radiologic eval-uation of patients with GIST's, with emphasis on the typical findings present onsmall bowel series, ultrasonography and CT (including 3D images using multide-tector CT). Examples of unusual GIST's and pathologic correlation as well as themost up-to-date therapy will be included.Conclusion: After interacting with this exhibit the radiologist will have an en-hanced understanding of GIST's including histopathology and radiologic features.

C-107Imaging of jejunal and ileal primary tumors with pathologic correlationB. Rodríguez-Vigil, M. Lamas, T. Berrocal, J. Fernández, V. Tarín, A. Alvarez;Madrid/ES

Learning Objectives: To illustrate the spectrum of usual and unusual primaryneoplasms involving the jejunum and ileum. To evaluate the efficacy of bariumstudies, US, CT and MR imaging in the management of these tumors. To under-stand the radiologic findings on the basis of pathologic correlation.Background: Preoperative diagnosis of jejunal and ileal neoplasms can be achallenge for both clinicians and radiologists. Symptoms are nonspecific andendoscopy is commonly unsatisfactory. Since early diagnosis is crucial for prompttherapy, imaging plays an essential role. Tumors develop in all histologic compo-nents of the small intestine including epithelial cells, lymphoid tissues, lymphat-ics, vessels, nerves, and muscle.Imaging Findings: We retrospectively reviewed the imaging findings of jejunaland ileal neoplasms from our digestive pathology database. Findings were corre-lated with pathology in all cases. Specific neoplasms addressed include benign(adenoma, leiomyoma, lipoma, familial polyposis, hemangioma, lymphangiomaand fibroma); and malignant neoplasms (adenocarcinoma, carcinoid tumor, lym-phoma, leiomyosarcoma, direct extension to the small bowel from extraintestinaltumors, and metastasic lesions). Enteroclysis is the primary and most effectiveradiologic modality in the evaluation of these neoplasms. CT should be the com-plementary radiologic modality and used for staging. MRI may help in specificcases. Pitfalls, diagnostic difficulties and differential diagnoses are emphasised.Conclusions: Evaluation of patients with small bowel neoplasms frequently re-quires multiple imaging modalities for diagnosis and treatment planning. Becauseof the characteristic imaging appearances of many of these tumors, this exhibitwill help the radiologist in training to better understand and recognise jejunal andileal neoplasms.

C-108Imaging findings of sigmoid diverticulitis: A pictorial essay of anatomy,pathology, differential diagnosis and radiologic treatment optionsM.C. Freund, J. Bodner, E.M. Gassner, M. Rieger, A. Gschwendtner,W.R. Jaschke; Innsbruck/AT

Learning Objectives: To understand the anatomy and pathology of sigmoid di-verticula and of the mesosigmoid. To be familiar with the typical findings of differ-ent imaging modalities in sigmoid diverticulitis and its complications and differentialdiagnosis. To be familiar with percutaneous and endovascular radiologic treat-ment options including abcess drainage and embolization for diverticular bleed-ing.Background: Sigmoid diverticulosis and diverticulitis represents a commonlyencountered disease in western countries. An exact diagnosis is a prerequisitefor further therapy.Imaging Findings: Different imaging modalities are proposed for detection ofself-limiting or complicated sigmoid diverticulitis e.g. abdominal radiography, con-trast enema, ultrasound and even catheter angiography. During the last years CThas evolved to be a primary diagnostic imaging modality in patients with left low-er abdominal pain. This pictorial essay will demonstrate the relevant anatomy ofthe sigmoid, mesosigmoid, and vascular supply as well as the typical pathologyof the diverticula and its inflammatory complications including diverticulitis, pe-ridiverticulitis, perforation, contained abcess in the mesosigmoid or rarely freeintraperitoneal perforation with peritonitis, as well as fistula formation, obstruc-

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tive ileus and lower intestinal hemorrhage due to diverticular bleeding. Variousdiseases can clinically mimic sigmoid diverticulitis. Typical examples of the differ-ential diagnosis will be demonstrated including sigmoid cancer, inflammatory boweldisease, ischemic colitis, epiploic appendagitis, pelvic inflammatory disease, ure-teral stone and inguinal hernia. Additionally radiologic treatment options will bedemonstrated including image-guided percutaneous abscess drainage and en-dovascular particulate embolization for diverticular bleeding.Conclusions: This pictorial essay will display the imaging findings of sigmoiddiverticulitis including anatomy, pathology, differential diagnosis and radiologictreatment options.

C-109The imaging findings of small intestinal lymphomaH. Kim, D. Yang, J. Kang, H. Kim; Incheon/KR

Learning Objectives: To illustrate the imaging findings of small bowel lymphomaincluding T-cell and B-cell types.Background: Small intestinal lymphomas may be divided into B cell tumors andT cell tumors and are mostly non-Hodgkin's B-cell lymphoma. The B cell tumorscontain immunoproliferative small intestinal disease (IPSID) and a variety of non-IPSID subtypes, including marginal zone B cell lymphoma of MALT, diffuse largeB cell lymphoma, mantle cell lymphoma, follicular lymphoma, and Burkitt's lym-phoma. T cell lymphomas of the small intestine are usually enteropathy-associat-ed intestinal T cell lymphomas; other forms of T cell lymphoma have been rarelyreported.Imaging Findings: The typical imaging findings of lymphoma are segmentalhomogeneous attenuation of markedly thickened bowel wall characteristicallyassociated with marked luminal dilatation. The typical radiographic features in-clude multiple nodular defects, an infiltrating form, a polypoid form, an endoexo-teric form with excavation and fistula formation, and a predominantly mesentericinvasive form with extraluminal masses. Obstructive symptoms are usually en-countered with the mesenteric nodal form. T-cell lymphoma shows a tendency ofbowel perforation. Unusually, the findings of lymphoma mimics that of adenocar-cinoma, malignant GIST, and inflammatory disease.Conclusion: The spectrum of the imaging findings of small bowel lymphoma isvariable. The CT scan shows usual and unusual findings of lymphoma-T cell andB-cell.

C-110The small bowel faeces sign: A sentinel CT sign in occlusionI. Boulay, V. Marini, M.-C. Julles, E. Petit, N. Calvo-Verjat, M. Zins; Paris/FR

Learning Objectives: To depict the CT imaging spectrum of the faeces sign,which is a consequence of small bowel occlusion, and to illustrate its causes.Background: Abdominal CT scan has been shown to be the most valuable tech-nique, in confirming the diagnosis of small bowel occlusion and to depict the site,level and cause of occlusion. Very few studies have focused on the contents ofthe bowel. Particulate faeces-like material mixed with gas bubbles within the lu-men of a dilated small bowel loop is always a pathological condition. It is theresult of a delayed intestinal transit. To access prevalence, characteristics of thisCT sign, and differential diagnosis, we have reviewed 87 CT scans of small bow-el occlusion over a period of two years.Imaging Findings: Our analysis suggests that the small bowel faeces sign isprobably more frequent than the previous reported studies, in demonstrating 11cases of small bowel faeces sign mainly observed in the ileal loops, and pointingto the site of occlusion. Faeces sign appeared as tubular gas bubbles mixed withparticulate matter with no capsule in dilated segments of small bowel loop, due toadhesions, closed loop, and tumours (adenocarcinoma, carcinoid). Differentialdiagnosis of two phytobezoars is also illustrated and discussed.Conclusion: Small bowel faeces sign may not be confused with colonic seg-ments leading to a failure to recognize the exact level of obstruction. Moreover, itrepresents a sentinel sign in determining the site of occlusion and consequentlythe cause of the obstruction.

C-111Imaging appearances and predictors of disease response in metastaticgastrointestinal stromal tumours (GIST) treated with ImatinibS. Cox, B. Lanka, M.B. Taylor; Manchester/UK

Learning Objectives: To evaluate changes in radiological appearances in pa-tients with metastatic GIST treated with Imatinib. To highlight any specific imag-ing features that can be used to predict disease relapse.Background: Imatinib (Glivec, STI-571) is a KIT tyrosine-kinase inhibitor drug,

recently developed and found to be effective in the treatment of metastatic GIST.We reviewed the pre- and post-treatment imaging findings on CT in ten patients.The duration of treatment varied from two to forty one months. The pre-treatment,eight and sixteen weeks scans were reviewed, along with the scans at the time ofany relapse. The sites of metastases, size of lesions and cystic change wereassessed.Imaging Findings: Metastases were present in the liver and peritoneum in sev-en patients each; mesentery and retroperitoneum in four and two patients re-spectively; splenic, renal and subcutaneous in one patient each. One patient hadprogressive disease at eight weeks. Nine patients responded to treatment. Themaximum reduction in size of the metastasis was at eight weeks. Most metastas-es underwent cystic change with treatment, particularly in the liver and peritone-um. Two patients are known to have relapsed at fourteen and fifteen months. Inboth cases, cystic metastases developed more solid components prior to dis-ease progression as indicated by an increase in the tumour volume.Conclusion: Ninety percent of the patients responded to treatment. Cystic changein the liver and peritoneal metastases correlates with disease response to Imat-inib. An increase in solid components may be a useful predictor of disease re-lapse.

C-112CT appearances of neoplasms of the small bowel as a cause of obstructionS. Sadiq, D. Markham; Swansea/UK

Learning Objectives: This poster presents a pictorial review of the CT appear-ances of primary and secondary tumours of the small bowel in patients present-ing with obstruction, including neoplasms that are the lead point of anintussusception.Background: Patients presenting with small bowel obstruction in two districtgeneral hospitals over the last twelve months and who were subsequently inves-tigated by CT were selected. The imaging features of those with a neoplasticaetiology were reviewed.Image Findings: The imaging reflects recent studies examining the incidence ofprimary small bowel tumours. Adenocarcinoma, non-Hodgkins lymphoma, carci-noid and leiomyosarcoma comprise the majority. Secondary tumour deposits alsolead to small bowel obstruction. We demonstrate those that metastasize intra-peritoneally (such as ovarian carcinoma), haematogenously (such as melano-ma), or by local tumour extension (such as liposarcoma and bladder carcinoma).Conclusion: It is well established that CT is a valuable diagnostic procedure inpatients with acute small bowel obstruction. It is not only useful in distinguishingobstruction from ileus, but frequently establishes the cause of obstruction. Smallbowel neoplasms are rare but have a high mortality since tumour-related symp-toms occur late and are non-specific. Endoscopy is not feasible in most cases, asenteroscopy is limited to specialist centres. Small bowel contrast studies do notreach the high level of accuracy obtained in the evaluation of the upper and lowergastrointestinal tract. CT not only allows tumour detection, but demonstrates pos-sible complications and offers the possibility of pre-operative staging in the acuteor elective situation.

C-113CT in adult intussusception: Radiologic-pathologic correlationC. Triantopoulou, P. Maniatis, I. Siafas, N. Giannakou, C. Avgerinos,C. Dervenis, J. Papailiou; Athens/GR

Learning Objectives: Review the CT characteristics of bowel intussusception inadults through a wide variety of cases. Emphasize the ability of CT imaging innarrowing the diagnostic possibilities and defining the cause of intussusception.Stress the need for familiarization with the different aspects of this rare entity.Background: Intussusception is a relatively common cause of intestinal obstruc-tion in children but is a rare clinical entity in adults. However, there is a lead pointin 80% of adult cases.12 cases of adult intussusception were retrospectively reviewed. All CT exami-nations were conducted on a spiral unit with administration of both oral and intra-venous contrast agent, using slice thickness of 5-7 mm anda pitch of 1. Site,level, cause and degree of obstruction as well as signs of threatened bowel via-bility were evaluated and correlated with surgical findings and pathology exami-nation.Imaging Findings: 8 cases of ileocolic intussusception and 4 of ileoileal wererevealed. In 9 patients findings included: 3 cases of polypoid lesions, 2 malignantneoplasms, 1 lipoma, 2 inflammatory diseases and in 1 adhesions due to pre-ceding surgery. In the other three cases no underlying pathology was proven sothey were characterized as idiopathic conditions. All neoplastic lesions were cor-rectly depicted before surgery while in the case of lipoma a specific diagnosiswas made.

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Conclusions: CT is a powerful tool in adult intussusception, providing valuableinformation regarding the involved enteric segments, the underlying pathologyand possible local complications, thus assisting in preoperative planning.

C-114Diagnosis of perforation of stomach or duodenum on multislice computedtomographyJ.-I. Nishimura, T. Ohkoshi, Y. Yamamoto, T. Inoue; Yokohama/JP

Learning Objectives: A review to determine the variety and relative conspicuityof findings in patients with perforation of the stomach or duodenum.Background: Multislice computed tomography (CT) gives us detailed informa-tion as thin-slice sagittal, coronal, and 3-dimensional images rapidly. A small vol-ume of free air can be detected, and the perforation holes were predicted in somecases. During a 2-year period 21 patients with perforation of the stomach or du-odenum underwent preoperative CT scans. There were 16 men and 5 womenaveraging 54.2 ± 15.6 (29 to 84) years old. All patients underwent to surgicaltreatment, and all sites of perforation were confirmed.Imaging Findings: Levels of perforation were the antrum of stomach (n = 1),body of stomach (n = 5), duodenal bulb (n = 14), and descending limb of duode-num (n = 1). CT images showed local extraluminal gas near the perforation sitesin 17 patients (81%), local ascites near the perforation sites in 15 patients (71%),edematous wall of perforation sites in 19 patient (90%), dirty increased density inthe fat tissue in 19 patients (90%), and a perforation hole in 8 patients (38%).Diffuse extraluminal gas and ascites were showed in 7, and 8 patients respec-tively. In 18 of 21 patients (86%), we could predict the level of perforation.Conclusion: Multislice CT is a valuable method in the diagnosis of perforation instomach or duodenum. The diagnosis can be established rapidly with high sensi-tivity.

C-115Defecographic imaging of anorectal sphincter dyssynergia syndromes: Ourexperience in 680 subjectsA. Nunziata1, A. Salzano2, P. de Feo1, A. de Rosa1, F. De Rosa1, M. Covello3;1Naples/IT, 2Frattamaggiore/IT, 3Napoli/IT

Learning Objective: Anorectal sphincter dysfunction can be responsible for evac-uation difficulties and constipation; in addition, pelvic floor disorders can be as-sociated. By using defecography associated with videoproctography, the evac-uation time and the sphincters' opening time can be assessed, obtaining furtherinformation about the physiopathology of rectal empting and anal sphincter func-tion. The aim of this study is to have functional radiological parameters of analactivity to detect anorectal sphincter dyssynergia syndrome.Background: On a consecutive series of 680 patients suffering from constipa-tion we assessed by defecography combined with videoproctography 33 casesof sphincter dyssynergia syndrome (16 males and 17 females with mean age of45 years, range of 17-34 years). All patients underwent clinical examination andendoscopy; 26 patients were investigated by anorectal manometry.Imaging Findings: In all patients defecography with videoproctography provideda sphinter opening delay > 40 s (normal values: 1-40 s) and increased evacua-tion time > 68 s (normal values: 3-68 s). Manometry revealed anal hypertonia in13 cases.Conclusion: Defecography associated with videoproctography is an accurate,simple and non- invasive method to approach anosphincteral pathology, permt-ting study of this particular type of terminal constipation, which is difficult to dem-onstrate using other techniques.

C-116Gastrointestinal stromal tumors (GIST) undergoing imatinib mesylate:MR patternsA. Messina, P. Casali, D. Vergnaghi, F. Bianchi, B. Finamore, R. Musumeci;Milan/IT

Learning Ojectives: To evaluate MRI patterns of advanced GIST treated withImatinib Mesylate. To illustrate MRI patterns of GIST. To evaluate MRI patterns oftumor response to Imatinib Mesylate.Background: GIST are rare mesenchymal tumors of the abdomen, for which aneffective, molecular-targeted therapy with Imatinib Mesylate has been recentlydeveloped.Imaging Findings: 35 pts with advanced GIST (24/35 with liver lesions and 33/35 with peritoneal involvement) undergoing therapy with Imatinib Mesylate. Allpts had a baseline MR, and then at 2, 4, 6, 12 months during treatment. Ptsresponsive to therapy (31/35) showed: A) tumor decrease in size (with an in-

crease in tumor volume at 2 months from treatment start in some cases (17%)due to necrosis or bleeding): B) Hypointensity of the lesions on T1w images (le-sion was hyperintense in rare case due to bleeding) and hyperintensity of thelesions on T2w images (correlating with the amount of degenerative tissue ornecrosis): C) Hypovascularization of the lesions on contrast-enhanced T1w im-ages in comparison to pre-treatment assessment, due to the presence of degen-erative tissue or necrosis: E) Evidence of peritoneal fluid in all pts at the firstmonths, reabsorbed in the following months.Conclusions: MRI is useful to identify tumor response to Imatinib Mesylate inadvanced GIST as from the early months of therapy with the following indicatorsof treatment activity: A) Size of lesions; B) signal intensity; C) vascularization; D)amount of degenerative tissue or necrosis; E) presence of peritoneal fluid.

C-117Crohn's disease: Spectrum of findings on helical contrast enhanced CTenterographyA.J. Madureira, R. Cunha, P. Varzim, F. Magro, I. Ramos; Porto/PT

Learning Objectives: To illustrate the spectrum of imaging findings of small-bowel Crohn's disease at contrast enhanced spiral CT after oral hyperhydrata-tion with isotonic solution (CT enterography).Background: Spiral CT has become one of the most valuable methods in theassessment of parietal inflammatory changes and extraluminal involvement insmall-bowel Crohn's disease. The accuracy of this technique depends on thepresence of well distended bowel loops.Procedure Details: After oral hyperhydration with 2000 mL of isotonic polyethyl-ene glycol electrolyte-balanced solution, contrast enhanced CT of the abdomenand pelvis was performed with a collimation of 7 mm and 5 mm, respectively. Thefollowing CT findings were evaluated: wall thickening, parietal contrast enhance-ment, extraparietal anomalies (lymph nodes, vessels and mesenteric fat), andpresence of inflammatory complications (abscesses, fistulas). The spectrum offindings of small-bowel Crohn's disease is thoroughly illustrated and discussedbased on our experience with over 50 patients.Conclusion: This method provides important information about the extent andactivity of small-bowel Crohn's disease and its extraluminal involvement and is apotential alternative to small-bowel CT enteroclysis.

C-118Bowel intussusception in adults: An imaging reviewH.D. Roach, J.M. Hanson, R. Bagree, C. Evans, A. Yong; Cardiff/UK

Learning Objectives:To outline the mechanism and causes of intussusceptionin the adult population. To provide a review of the imaging findings in intussus-ception using several imaging modalities.Background: Bowel intussusception is more commonly associated with the pae-diatric population, but can occur in adults, affecting virtually any part of the gas-trointestinal tract. In adults there is more often an underlying structural lesion,which acts as a lead point.Imaging Findings: Bowel intussusception has a classical appearance on bari-um studies and cross-sectional imaging and occasionally a lead point can beidentified. Due to the underlying structural causes, surgery is more often requiredin adults than children, resulting in the availability of histopathologic specimensfor correlation. However within the small bowel even in adults it has been shownthat the majority of cases are self-limiting. In this exhibit, we review the imagingfindings of intussusceptions affecting various sites in the gastrointestinal tractusing different modalities.Conclusion: Bowel intussusception is less common in the adult population, butis often associated with underlying structural lesions. The imaging findings arereviewed here.

C-119Can double contrast barium enema exams incidentally detect terminalileum tumoral lesions?C. Gotta, S. Merola, E. Sanabria, M. Landi, S. Ballester, C.A. Dominguez;Buenos Aires/AR

Learning Objectives: To describe a number of radiological signs, found in bari-um enema double contrast exams in 28 patients, that are specific or suspiciousof terminal ileum tumoral lesions.Background: Since 1972 there have been few reports about radiological signs indouble contrast barium enema exams that can help in the diagnosis of terminalileum pathology. Some of them use glucagon to improve the reflux of contrastmaterial through the ileo-cecal valve in order to allow the visualization of the

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terminal ileum. Reviewing the available literature, there are no reports which de-scribe specific radiological signs on this matter.Procedure Details: A total of 28 cases of tumoral terminal ileum pathology werefound. All lesions were seen for the first time at the double contrast barium ene-ma, and lately examined and characterized by the follow through or small bowelenema. In most of them abdominal computed tomography was performed.20 cases had histological confirmation based on surgical specimens. Of the re-maining 8 cases, 4 were lipomas with typical densitometric values diagnosed bycomputed tomography, thus these patients did not undergo surgery. The other 4lesions described as polipoid did not have histological confirmation as the pa-tients refused surgical resection.Conclusion: Double contrast barium enema can detect the presence of terminalileum tumoral pathology even when not yet clinically suspected. There are a fewradiological signs which allow the radiologist to recognize and diagnose it.

C-120Magnetic resonance enteroclysis (MRE) compared to X-ray double contrastsmall bowel enema (DCSBE) in diagnosis and follow-up of Crohn's diseaseM.G. Brizi, G. Masselli, L. Minordi, A. Parrella, A. Vecchioli, P. Marano;Rome/IT

Learning Objectives: To assess feasibility of MRE in patients with suspected orconfirmed Crohn's disease. To summarize MR signs of disease, particularly ofdisease activity. To integrate luminal, wall and extra-intestinal involvement, ob-tained both from MRE and conventional MRI for complete staging of disease. Tocompare MRE diagnostic accuracy with DCSBE, up to now considered the clin-ical imaging gold standard.Background: Magnetic resonance is a powerful diagnostic tool for abdominalimaging, particularly for extra-visceral tissue depiction. Newer pulse sequences,such as single shot fast spin echo (SSFSE) and steady state free precession(SSFP) with a water solution infusion via naso-jejunal tube can accurately depictthe bowel lumen in a fashion similar to conventional double contrast enema. Fur-thermore 3D and 2D fast T1 weighted sequences with iv contrast administrationallows the evaluation of wall involvement.Imaging Findings: Findings are summarized into lumen abnormalities, wall in-volvement and extra-luminal alterations. Corresponding DCSBE are shown andcompared. Signs of disease activity at MRE plus conventional MRI are stressed.Contribution of different pulse sequences is evaluated.Conclusions: MRE plus conventional MRI is feasible in the diagnosis, stagingand follow-up of Crohn's disease. Subtle mucosal lesions are still poorly depict-ed, compared to DCSBE. Extra-luminal involvement is superbly showed, particu-larly by new SSFP sequences. Disease activity signs seem to be the added valueof magnetic resonance in Crohn's disease assessment.

C-121Diagnosis and staging of colorectal carcinomas using multislice CTcolonography (MSCTC): Pictorial essay with pathologic correlationR. Iannaccone, A. Laghi, C. Catalano, A. Lamazza, F. Mangiapane, S. Trenna,D. Marin, A. Schillaci, R. Passariello; Rome/IT

Learning Objectives: To assess the role of MSCTC in the detection and stagingof colorectal carcinoma.Background: 150 patients affected by colorectal carcinoma underwent colonos-copy and MSCTC on the same day. 100 patients free of colonic lesions wereincluded as a control group. CT parameters were: collimation, 4 x 1 mm; effectivemAs, 80-165; and kVp, 120. MSCT colonography was performed before (proneposition) and after (supine position) intravenous administration of contrast mate-rial with a 60-sec delay-time. MSCTC images were interpreted by two radiolo-gists on a workstation. The results of MSCT colonography were correlated withcolonoscopy and with the results of the histopathologic examination performedon the resected surgical specimen. Intra-operative ultrasonography was used asthe reference standard for the presence of liver metastases. Sensitivity and spe-cificity for tumor detection and staging accuracy (according to the TNM classifi-cation) of MSCTC were calculated.Imaging Findings: Surgery revealed 164 carcinomas (150 primary and 14 syn-chronous lesions) in 150 patients. Colonoscopy failed to visualize the entire co-lon in 21 patients due to obstructive neoplasms and missed all 14 synchronouscarcinomas. MSCTC provided a complete evaluation of the colon in all cases,correctly identified all primary and synchronous carcinomas (164/164; sensitivi-ty, 100%), and yielded three false-positive diagnoses (specificity, 98.8%). MSCTCalso detected 21 polyps (18 true-positives and three false-positives). Overall,MSCTC correcly staged 136 of 150 primary tumors (overall TNM staging accura-cy, 90.6%).

Conclusion: MSCTC can be proposed as a comprehensive diagnostic test forthe pre-operative evaluation of patients with known, or strongly suspected, color-ectal carcinoma.

C-122Gastrointestinal stromal tumors: Radiologic-pathologic correlationJ.-H. Yoon, S.-S. Cha, S.-J. Lee, S.-S. Han, M.-S. Kang; Busan/KR

Learning Objectives: 1. To demonstrate the radiologic findings of gastrointesti-nal stromal tumor (GIST) confirmed to be immunohistochemically KIT-positive. 2.To present the characteristic features of malignant GIST and correlated thesewith histopathologic findings.Background: In our pathologic database from 1998 to 2002, we found 31 pa-tients with GIST and retrospectively reviewed their radiologic findings. Thirty oneCT, four US, and four barium studies were included.Imaging Findings: Involved organs were as follows; 13 in the small bowel (42%),10 in the stomach (32%), five in the rectum (16%), two in the mesentry (7%) andone in the colon (3%). On histochemical analysis, eight were classified as benign(26%), six as borderline (19%), and 17 as malignant (55%). Mean tumor size was7.1 cm (1.2 cm-22 cm): Benign (mean;4.3 cm, range;1.2 cm-10 cm): Borderline(mean;6 cm, range;5 cm-9.3 cm): Malignant (mean;8.9 cm, range;4 cm-22 cm).Multiplicity was demonstrated in one benign and one malignant tumour. Six cas-es showed microscopic metastasis to the surrounding lymph nodes without evi-dence on radiologic imaging.CT features were relatively smooth margination and homogeneous enhancementof smaller tumors. Poor margination with surrounding infiltration, central necrosisor ulceration was seen in larger tumors. No evidence of intestinal obstruction,peritoneal seeding or ascites was demonstated. Barium examination showed awell demarcated, smooth marginated tumor with normal overlying mucosa. Someulceration was seen in larger masses (Bull's-eye sign). US features were well-demarcated homogeneous hypoechogenicity of small masses, hyperechoic fociof ulcerated masses.Conclusion: The characteristic radiologic findings of immunohistochemically KIT-positive malignant GIST were large tumor size, poor margination, central necro-sis or ulceration. The clinical significance of each feature and differential pointsfrom benign GIST or other conditions will be discussed.

C-123CT findings of duodenal diseases with pathologic correlation: A pictorialreviewJ.-S. Cho, K.-S. Shin, B.-S. Shin, H.-Y. Jeong, S.-M. Noh, K.-S. Song;Daejon/KR

Learning Objectives: To illustrate CT findings of common and uncommon duo-denal diseases with pathologic correlation. To demonstrate a comprehensive CTanatomy of the duodenum and adjacent organs. To describe the pitfalls on CTinterpretation of duodenal diseases.Background: The duodenum may be involved by secondary process as well asprimary pathology because it is close to adjacent organs including the stomach,pancreas, liver, gallbladder, hepatic flexure of the colon, aorta, IVC, right kidneyand adrenal. Duodenal pathology can be overlooked on CT interpretation butunderstanding of CT anatomy of the duodenum and adjacent organs may behelpful in the diagnosis of various duodenal pathology.Procedure Details: Helical CT during the portal phase with water as an oralcontrast agent was performed for better detail of duodenal lesions. We reviewedCT findings with pathologic correlation in 41 patients with various duodenal dis-eases. Duodenal diseases were classified as follows; congenital (duplication,malrotation, diverticulum, and annular pancreas), trauma (intramural hematoma,iatrogenic perforation by endoscopy), inflammatory (perforated peptic ulcer, sec-ondary process by pancreatitis or cholecystitis), primary neoplasms (lipoma,adenoma, adenocarcinoma, lymphoma, and gastrointestinal stromal tumors),secondary invasion of adjacent neoplasms (pancreas, stomach, colon, and gall-bladder), bezoar, and postsurgical afferent-loop syndrome.Conclusion: Helical CT during the portal phase with water as an oral contrastagent provided a comprehensive view of the duodenum and adjacent organs.Understanding of CT anatomy and the pitfalls on CT interpretation was helpful inthe diagnosis of various duodenal diseases.

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C-124Missing the diagnosis of gastrointestinal (GI) tract perforation: Sites andcauses that may lead to a false negative CT scanV. Maniatis, A. Roussakis, H. Chrisikopoulos, R. Efthimiadou, D. Savidou,J. Pappas, J. Andreou; Maroussi, Athens/GR

Purpose: To present and analyse the CT findings in cases of GI tract perforationnot correctly diagnosed with CT.Methods and Materials: Among 147 patients with proven GI tract perforationthat had been studied with CT, we retrospectively reviewed the false negative CTscans. 16 patients were included, 11 men and 5 women (20-80 years old). Thesites and the causes of perforation were studied. CT findings that were not indic-ative for GI tract perforation will be presented and commented on. Possible ex-planations for the false-negative CT results will be proposed.Results: Sites of perforation included: duodenum in 1 case, small bowel in 5,appendix in 2 cases, and colon in 8 cases. There were no false-negative CTscans of esophageal and stomach perforations. Causes of perforation misdiag-nosed by CT included: cancer in 5 cases, diverticulitis in 3, trauma in 3, appendi-citis in 2, foreign body ingestion in 1, Crohn's disease in 1 and unknown in 1case. There were no false-negative CT scans in cases of perforation due to pep-tic ulcer, postoperative leakage, iatrogenic reasons or ischemia. Common CTfindings were: fat infiltration (15 cases), bowel wall thickening (15 cases) andascites (9 cases).Conclusion: Although CT is the best imaging method to diagnose GI tract perfo-ration, false-negative scans are possible. Radiologists must be aware of possiblesites and causes that may lead to missing the diagnosis of GI tract perforation.Correlation of the non-specific CT findings and patient's history and clinical con-dition may improve the diagnostic abilities of CT.

C-125Clinical application of three-dimensional imaging with multidetector row CTfor laparoscopic colorectal surgeryM. Matsuki, H. Kani, I. Narabayashi; Takatsuki/JP

Purpose: Laparoscopic colorectal surgery (LCS) is a minimally invasive tech-nique. However, LCS requires much time in treating the appropriate arterial baseand excising lymph nodes without causing injury to veins. Therefore, prior to thissurgery, it is very important to obtain anatomical information, which can varybetween patients, with regard to colorectal cancer.Method and Materials: Fifty-eight patients with a confirmed diagnosis of coloncancer (caecal (n = 4), ascending colon (n = 6), transverse colon (n = 7), descend-ing colon (n = 2), sigmoid colon (n = 22) and rectal (n = 17)) were evaluated us-ing 4 row multidetector CT (MDCT) before LCS. Contrast-enhanced CT scanswere acquired at arterial and venous phases. Three-dimensional (3D) images ofthe vessels, colorectum, cancer and swollen lymph nodes were reconstructed bythe volume-rendering technique and then fused (integrated 3D imaging). Weevaluated the usefulness of integrated 3D imaging in laparoscopic colorectalsurgery in comparison with the surgical findings.Results: In all of the fifty-eight patients, the integrated 3D images demonstratedclearly the distribution of arteries feeding the colorectal cancer, as well as theanatomical location of colorectal cancer and arterial and venous systems. Thesefindings enabled us to accurately ligate appropriate arterial bases and to exciselymph nodes safely and fast without damaging to the veins. Moreover, we couldarrange and rotate the integrated 3D images to correspond to the operative view,which is very useful in the intraoperative navigation of LCS.Conclusion: Integrated 3D imaging with MDCT is useful in the preoperative sim-ulation and intraoperative navigation of LCS.

C-126MR volumetric evaluation for resectable rectal cancer with preoperativeconcurrent chemoradiotherapy: Correlation with histologic parametersY. Kim, J. Lee, H.-J. Jang, J.-H. Lee, D. Kim, H. Chang, K.-H. Jung,S.-Y. Jeong, J.-G. Park; Goyang, Gyeonggi/KR

Purpose: To investigate utility of MR volumetry for resectable rectal cancer be-fore and after preoperative concurrent chemoradiotherapy.Methods: 104 patients with respectable locally advanced rectal cancer under-went preoperative concurrent chemoradiotherapy. Among them, 78 patients (55men and 23 women; median age 55 years; range, 27-75 years) who had MRIbefore, and 1 month after concurrent chemoradiotherapy were enrolled into thisstudy. Radiation of 45 Gy/25 fractions was delivered to the pelvis, followed by a5.4 Gy/3 fractions boost to the primary tumor. Chemotherapy was administeredconcurrently with radiotherapy and consisted of 2 cycles of 5-FU (500 mg/m2/

day) and leucovorin (20 mg/m2/day) for five days during the first and fifth weeksof radiotherapy. Surgery was performed 4-6 weeks after the completion of chem-oradiation. MR volumetric examinations for tumor volume before and after chem-oradiotherapy were perfomed in workstation software using T2-weighted axialimages.Results: According to Dworak grade, grade 1 was present in 26.9% (21/78),grade 2 in 44.9% (35/78), grade 3 and 4 in 14.1% (11/78), respectively. Primarytumor downstaging occurred in 57.7% (45/78). The mean tumor volume was21.1 cm3 (1.4-80.3 cm3) in MR volumetry before chemoradiotherapy and 6.5 cm3

(0-34.8 cm3) in after chemoradiotherapy. When the tumor volume reduction ratewas correlated with the Dworak grade, mean tumor volume reduction rate was58.8% (15.90-100%) in grade 1, 66.1% (0-94.8%) in grade 2 and 73.9% (34.5-100%) in grade 3 and 4. The tumor volume reduction rates demonstrated statis-tically significant differences among Dworak grades.Conclusion: In MR volumetric evaluation for rectal cancer before and after pre-operative chemoradiotherapy, tumor volume reduction rate is well correlated withhistologic reduction grade.

C-127Functional MRI defecography in posterior pelvic floor disorders incomparison with evacuation proctographyF. Maccioni, M. Colaiacomo, A. Bruni, F. Ricci, M. De Vargas Macciucca,M. Marini, F.I. Habib; Rome/IT

Purpose: To evaluate the role of dynamic MRI in the diagnosis of posterior pelvicfloor disorders, in comparison with conventional proctography.Methods and Materials: Fifty patients with posterior pelvic floor disorders un-derwent defeco-MRI performed in the supine position using a standard 1.5 T unit,and conventional defecography. To establish normal reference values, 16 normalvolounteers underwent defeco-MRI. The rectum was insufflated with air. We usedT2-weighted HASTE sequences at rest, squeeze and strain, in the axial andsagittal planes. We also performed a dynamic study using a T2-weighted HASTEmodified sequence, acquiring a single mid-sagittal slice, repeated every secondfor 20 seconds, starting with the patient at rest then in squeezing and finally instraining. MR findings were compared with evacuation proctography, consideredas gold standard. Rectocele and pelvic floor descensus were graded either withthe standard reference values, and with modified values obtained from normalvolunteers.Results: MRI vs evacuation proctography identified 13/15 rectoceles, 25/28anorectal junction descents, 7/9 rectal prolapses, and 4/6 diskinetic pubo-recta-lis syndromes. MRI detected additional findings in 30% of patients (4 enteroce-les, 10 uterine descents, 11 cystoceles, 4 perianal pathologies- abscesses, analfistulas). MRI, using specific reference values provided 90% sensitivity, 93% ac-curacy, 84% NPV for the anorectal junction descent, while using conventionalvalues provided 63% sensitivity, 75% accuracy and 57% NPV.Conclusions: Defeco-MRI requires a short examination time, is well acceptedand gives reliable information for the diagnosis of posterior pelvic disorders. Spe-cific reference values should be used to correct the bias of the supine position.

C-128Correlation between MR findings and pathology in evaluation of theaffected bowel wall in Crohn's diseaseF. Maccioni, M. Colaiacomo, A. Bruni, A. Cocco, S. Parlanti, F. Siliquini,M. Marini, A. Marcheggiano; Rome/IT

Purpose: To correlate MR findings with the corresponding pathologic specimensobtained at the level of the pathologic wall in patients with Crohn's disease (CD).Method and Materials: 27 patients with known CD underwent MRI after oraladministration of a superparamagnetic contrast, using T2-weighted plain and fat-suppressed HASTE sequences, and Gd-enhanced T1-weighted FLASH sequenc-es on axial planes. Degree and pattern of wall signal, wall thickness andabnormalities of perivisceral fat were evaluated. Disease activity was evaluatedusing standard clinical scores. Endoscopic or surgical pathologic specimens wereobtained in all patients (GS). MR findings were inter-correlated and correlatedwith pathologic findings (GS) either prospectively or retrospectively, with a side-by-side analysis of results.Results: High wall Gd-enhancement and high T2 wall signal were observed inpatients with active disease and diffuse transmural inflammatory cells infiltratesat GS (n. 14). In patients with active disease a layered pattern of Gd-enhance-ment was observed, associated with either submucosal oedema or fibrosis at GS(n.8); in this group of patients, however, T2-weighted images showed high or lowwall signal in presence of oedema or fibrosis, respectively. In patients with nonactive disease poor Gd-enhancement and low T2 wall signal were observed and

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diffuse wall fibrosis was found at GS (n.5). In 8/27 patients active inflammationand fibrosis coexisted within the same loop, either at MR and GS.Conclusions: MRI offers reliable information on the wall affected by CD, allowingcharacterization of different pathologic conditions (submucosal oedema vs fibro-sis, diffuse fibrosis or inflammation).

C-129Spectrum of findings of celiac disease on MRI of the small bowelP. Paolantonio, A. Laghi, E. Tomei, I. Baeli, F. Iafrate, R. Ferrari, R. Passariello;Rome/IT

Purpose: The aim of our study was to describe morphological abnormalities ofthe small bowel in a population of patients with known celiac disease using MRImaging with polyethilenglycol solution as an oral contrast agent (PEG-MRI).Materials and Methods: Twenty nine patients, 19 adults and 10 children withknown celiac disease underwent MR study of the small bowel. After an overnightfast, immediately before MR examination a fixed amount of 10 mL/kg of bodyweight of PEG solution was orally administered. MR study protocol includedHASTE (TR/TE/acq.t.: inf/90 ms/18 s) and True-FISP (TR = 4.8 ms; TE = 2.3 ms;Flip Angle 50°). sequence obtained sequentially on axial and coronal planes.Results: Images analysis showed alterations of mucosal pattern of ileal loopswith an incresed number of folds (5 or more folds per inch) ("ileal jejunalization")in 18 patients; reversal jejuno-ileal fold pattern in 6 patients; intestinal intussus-ception was observed in two patients and hyposplenism in one patient. MR wasalso able to identify mesenteric lynfadenopaty. No alteration of small bowel loopswas observed in five patients.Conclusions: PEG-MRI is a feasible and reproducible imaging technique in bothadult and paediatric populations; it may suggest a diagnosis of celiac disease aswell as it is able to identify potential intestinal complications together with extra-intestinal findings.

C-130Preoperative evaluation of early gastric cancer for laparoscopicgastrectomy by 3D-CT angiography using 16-row multislice CT angiographyS. Kumano1, H. Miki1, T. Mochizuki2; 1Onsen-gun/JP, 2Ehime/JP

Purpose: The purpose of this study was to determine the efficacy of 3D-CT an-giography (3D-CTA) using 16-row multislice CT (MSCT) in the pre-operative sim-ulation of laparoscopic gastrectomy for early gastric cancer.Method and Materials: Twenty patients with early gastric cancer underwent CTexamination using 16-row MSCT (0.625-mm x 16). 2 mL/kg of 300 mgI/mL con-trast material was intravenously injected at a rate of 4 mL/sec. Timing for thearterial phase scan was determined by using a test bolus injection. Portal phasescan was performed 70 s after the start of bolus injection. For 3D-CTA, CT imag-es of 0.625 mm thickness were reconstructed at 0.625 mm intervals. With a com-puter workstation, 3D-CTA was produced using volume rendering and maximumintensity projection techniques.Results: 3D-CTA demonstrated the left gastric artery (LGA), right gastric artery(RGA) and left gastric vein (LGV) in all cases. 3D-CTA also demonstrated theLGA arising from the celiac trunk in 19 cases and from common hepatic artery(CHA) in one case; the left hepatic artery (LHA) from the LGA in two cases; anaccessory LGA from LHA in one case; and the RGA from the proper hepaticartery in 13 cases, from the CHA in five cases, and from the LHA in one case.Regarding the venous system, 3D-CTA demonstrated LGV flowing into portalvein in 10 cases, splenic vein in 9 cases, and the junction of portal and splenicveins in one case.Conclusion: 16-row MSCT 3D-CTA clearly demonstrated the vascular anatomyin all cases that is necessary for laparoscopic gastrectomy, and was thought tobe useful for the preoperative simulation of laparoscopic gastrectomy.

C-131Douglas pouch hernias: Evaluation with entero-colpo-defecographyM. Estienne1, M. Moretti1, M. Valle1, P. Meinero2, O. Brunetti1; 1Lavagna/IT,2Santa Margherita Ligure/IT

Purpose: To assess the usefulness of entero-colpo-defecography (ECD) in theevaluation of Douglas pouch hernias and to improve the technique by a simpleand non-invasive method.Methods and Materials: 73 female patients (mean age: 63 years) with clinicalsymptoms of obstructed defecation underwent ECD. Our standard technique in-cludes: 500 mL of diluted barium suspension given orally at least 1½ hours be-fore examination; a small gauze opacified with iodamide placed into the vagina;rectal filling with 200 mL of thick barium paste. Static and spot lateral radiographs

of the pelvis are obtained at rest, during squeeze and push, and during and afterevacuation. If widening of the rectovaginal space (RVS) is observed during thedynamic phase, in the absence of an enterocele, a barium sigmoid enema isperformed and further lateral films are obtained at maximum straining.Results: Widening of RVS was observed during ECD dynamic phase in 16 of the73 patients (22%). Thirteen of these patients had small bowel loops prolapsinginto RVS (enterocele). For the three remaining patients, in which the widening ofRVS could not be explained by enterocele, we performed a sigma barium enemademonstrating the presence of a sigmoidocele. We did not find a peritoneocelewithout bowel contents.Conclusions: Douglas pouch herniations may account for symptoms of obstructeddefecation. Defecography alone is not able to evaluate the hernia contents andperitoneography is an invasive technique. Visualization of Douglas pouch herni-as is improved by the use of our ECD technique allowing a correct identificationof enteroceles and sigmoidoceles.

C-132MRI with phased-array coil of the anal canal: Normal anatomy andpathologic findings in anal canal carcinomaF. Iafrate, A. Laghi, I. Sansoni, R. Ferrari, D. Marin, M. Celestre, P. Foti,R. Passariello; Rome/IT

Purpose: To assess the normal anatomy of the anal sphincter complex by theacquisition of high resolution T2 weighted sequences using a phased –array coiland to describe different patterns of diffusion of anal canal carcinoma.Materials and Methods: Twenty-seven patients, 15 males and 12 females, (meanage 41.5 y.o.) underwent MRI evaluation of the pelvic region, using a supercon-ductive 1.5 T magnet (maximum gradient strength, 25 mT/m; minimum rise time600 microseconds), equipped with phased-array coil. High-resolution T2-w TSEsequences (TR, 4055 ms; TE, 132 ms; matrix 390 x 512; in-plane resolution,0.67 x 0.57 mm) were acquired in multiple planes.Results: Optimal image quality of the anal sphincter complex was obtained in allcases providing an overall view of the anal region. Different muscular layers wereobserved between the upper and lower aspects of the anal canal. Good visuali-zation of intersphincteric space, levator ani muscle and ischioanal space wasobtained in all cases. A panoramic overview of the entire muscular complex, in-cluding puborectal, levator ani, external and internal sphincter muscles is depict-ed. Intersphincteric space as well as ischio-rectal fossa are clearly evaluated.Twenty patients were studied in order to stage anal canal carcinoma and to de-scribe different patterns of diffusion.Conclusion: High-resolution MR images with phased-array coil provides optimaldepiction of the anal canal and the anal sphincter complex, is comfortable for thepatient and easily repeated. MRI, thanks to optimal image quality was useful forstaging of anal canal carcinoma and for describing different patterns of diffusionaccording to morphology.

C-133Virtual colonoscopy 2D or 3D or (always) both?G.F. Rust, M.F. Reiser; Munich/DE

Problem: The standard procedure for assessing virtual colonography is the as-sessment of the 2D-images. For trouble shooting one uses 3D intra-luminal im-ages. The partial volume effect of the 2D-images leads to a decrease in contrast,against which the 3D-images are nearly free of partial volume effect. So the tech-nique with the lower accuracy (2D-images) decides if the technique with the higheraccuracy will be disposed. Particularly for polyps less than 10 mm in size thisapproach could be a problem.Material and Methods: The 3D-assessment includes intra-luminal fly-throughsas well as extra luminal fly-overs looking behind the folds (Rendoscopy, Inc.). 40patients were examined (Sensation 16). Three groups: 1) 2 readers for 2D-as-sessment only on a MagicView (Siemens), 2) 2 readers for 3D assessment onlyand 3) 2 readers for 2D/3D assessment (both Rendoscopy). The 3D assessmentis performed only in the antegrade direction because the fly-over the folds has noblind areas. All patients get conventional colonoscopy after virtual colonoscopyfor evaluation purposes.Results: Polyps over 10 mm of size were not overlooked in any of the groups.The limited 2D assessment leads to the well known decreased values of spe-cificity and sensitivity in the literature. Both 3D groups did not show any signifi-cant difference in the assessment, while the sensitivity and specificity of polypssmaller than 10 mm is increased significantly.Conclusion: 3D assessment (fly-throughs and fly-overs) increase polyp detec-tion rates significantly for polyps less than 10 mm in size.

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C-134Improvement in the diagnosis of colonic polyps with sixteen-MDCTE. Chavarri, C. Trinidad, C. Martinez, G. Fernandez, S. Vazquez,M. Rodriguez-Castilla; Vigo/ES

Purpose: To evaluate the accuracy of 16 row multidetector CT-colonography(MDCTC) in detection of colorectal polyps compared to colonoscopy.Method and Materials: Between December 2002 to August 2003, 150 patientswere prospectively studied by MDCTC and compared with colonoscopy. All pa-tients were referred to CT immediately after colonoscopy. CT was performed with16 x 0.75 mm, 120 KV and 50 mAs in both supine and prone positions after co-lonic air insufflation. This method was well tolerated for all patients. Independent-ly, two experienced radiologists interpreted axial, sagittal and coronal imagesand 3D endoluminal reconstructions (virtual colonoscopy). In cases of disagree-ment, the diagnosis was established by consensus. Sensitivity, specificity, pre-dictive values and kappa test were analysed. Both methods were compared withChi-Squared test.Results: In our series, the prevalence of colorectal polyps was 49%. When pol-yps were 5 mm in size or greater MDCTC had a 96% sensitivity, 97% specificity,92% PVP and 99% PVN. The agreement between colonoscopy and MDCT wasobserved in 91%. No statistical differences were found between these methods.Conclusion: CT colonography is emerging as a potential alternative to conven-tional colonoscopy in the screening of colorectal cancer. 16 Row MDCTC repre-sents a reliable imaging method to detection of colorectal polyps with a highaccuracy, particularly when the polyp size is 5 mm or greater. This suggests animprovement over single slice CT.

C-135Helical CT signs in the diagnosis and evaluation of intestinal ischemia andnecrosis in patients with acute abdomenA. Kalogera-Fountzila, C. Kouskouras, A. Lefkopoulos, N. Fotiadis,D. Karanikolas, I. Tsifountoudis, A.S. Dimitriadis; Thessaloniki/GR

Purpose: To prospectively evaluate the characteristic spiral CT features of intes-tinal ischemia and necrosis in patients with acute abdomen.Materials and Methods: Twenty patients, aged 15-92 (median 67), were exam-ined in a three year period, using helical CT without oral contrast administrationand after intravenous injection of contrast medium. The clinical manifestationsconsisted of acute abdomen and/ or sepsis in all patients. The diagnosis of bowelischemia was confirmed with surgery, where colonic and/ or small bowel resec-tion was performed in 18 patients within 24 hours. One patient with the presenceof portal gas was found to be normal at surgery and one patient died beforesurgery and had a confirmatory autopsy.Results: The causes of critical intestinal ischemia were diverse, including supe-rior mesenteric artery thromboembolism in 3 (15%) patients, inflammation in 5(20%), intussusception in 1 (5%), volvulus in 2 (10%), adhesions in 4 (20%), HIVinfection in 1 (5%) and unknown etiology in 5 (25%). Spiral CT identified necrosisof colon and small bowel in 9 (45%) patients, necrosis of small bowel only in 4(21%), and of colon in 5 (26%). Suggestive findings included intramural air in 13(65%) patients, thickening of the bowel wall in 14 (70%), thinning in 4 (20%),double or concentric ring sign in 8 (40%) and bowel dilatation in 13 (65%). Pres-ence of increased density of mesenteric fat was noted in 7 (35%), mesentericvein dilatation in 10 (50%), free intraperitoneal air in 3 (15%) and peritoneal fluidor blood in 13 (65%).Conclusion: Spiral CT can accurately demonstrate signs of bowel ischemia andis often helpful in determining the primary cause of ischemia or necrosis.

C-136A comparison of single and multi row CT colonography in the detection ofcolorectal polypsP. Vagli, E. Neri, S. Picchietti, G. Naldini, M. Rossi, C. Bartolozzi; Pisa/IT

Purpose: To compare the diagnostic accuracy of single and multi row CT colonog-raphy (CTC) for detection of colorectal polyps.Materials and Methods: Between 1996 and 2003, seventy-two consecutive pa-tients with a moderate to high risk of developing colorectal cancer underwentCTC followed by complete CC within 24 hours. CTC was obtained by means ofsingle row CT (n = 20) and multi-row CT (n = 52). Sensitivity and specificity ofsingle and multi-row CTC for detection of colorectal polyps was determined bymeans of lesion location in four colonic segments (cecum-ascending c-a, trans-verse t, descending d, sigmoid-rectum s-r).Results: All colonic segments were completely visualised in each patient bothby single and multi row CTC study. CTC identified 63 polyps (< 6 mm) in 44 pa-

tients (c-a N = 17, t N = 17, d N = 19, s-r N = 10), and 33 polyps (6-20 mm) in 24patients (c-a N = 5, t N = 3, d N = 12, s-r N = 13). CTC generated 28 false posi-tives (FP) for polyps smaller than 6 mm and 10 FP for polyps 6-20 mm. Falsenegatives (FN) were 4 for polyps < 6 mm, and 2 for polyps 6-20 mm. Sensitivityof single and multirow CTC for detecting polyps were 80% and 89% respectivelyfor polyps < 6 mm, and 83% and 94% for larger polyps 6-20 mm (p < 0.01). Over-all sensitivity and specificity of CTC for small polyps (< 6 mm) was 88% and 87%respectively. Overall sensitivity and specificity increases for larger polyps (6-20 mm) at 94% and 96% respectively.Conclusion: Multi-row CTC demonstrated a higher diagnostic accuracy than sin-gle-row CT in detection of colorectal polyps.

C-137Virtual colonoscopy: Detection of elevated lesionsC. Capuñay1, P.M. Carrascosa1, R. Castiglioni1, M. Ulla1, S. Chandra2,J. Carrascosa1; 1Buenos Aires/AR, 2Cleveland, OH/US

Purpose: To determine the diagnostic accuracy of virtual colonoscopy (VC) forthe detection of elevated lesions in comparison with conventional Colonoscopy(CC).Materials and Methods: Between March 1998 and August 2003, 500 patientswere evaluated with VC and CC. All patients had personal or family history ofcarcinoma or adenoma, or had coloproctologic symptoms. VCs were performedin two different scanners (helical CT scanner, PQ5000; Picker and 4-row CT scan-ner, Mx8000; Philips Medical Systems) with slices of 4 and 2.5 mm thickness,every 2 and 1.3 mm reconstruction interval respectively. All patients followed astandard colonic cleansing regime. VCs were performed in supine and proneacquisitions, to redistribute colonic gas. Findings of the two methods were com-pared and divided into normal studies and studies with pathological findings. Thesecond group was subdivided in three groups according to the diameter of thelesions: 2a) Lesions < 5 mm; 2b) Lesions between 5-9 mm and 2c) Lesions above9 mm.Results: There were 233 normal patients. In the group of pathologic findings VCdetected a total of 413 elevated lesions whereas CC 376 lesions. The generalSensitivity (S) was 94%, Specificity (Sp) 80%, positive predictive value 86% andNegative predictive value 92%. In group 2a) the S and Sp was 87% and 86%, 2b)95% and 91% and 2c) 100% and 100%.Conclusion: VC is a good method for the detection of elevated lesions with highS and Sp. It is fast, has no complications, and allows evaluation of the completecolon in all cases.

C-138Completion colonography: Value of immediate multislice CT examinationafter incomplete colonoscopyN. Bontozoglou, V. Sotiropoulos, I. Biliara, N. Mathou, D. Karagiannis;Athens/GR

Purpose: To evaluate the clinical utility of multislice CT (MSCT) colonographyperformed immediately after incomplete colonoscopy in the detection of colorec-tal cancer.Methods and Materials: Twenty three consecutive patients with incomplete colon-oscopy underwent CT colonography on the same day, without additional prepa-ration. The CT examinations were performed with IV contrast, in supine and proneposition using a 4 channel multislice scanner (Siemens Somatom Plus 4 VolumeZoom). The imaging parameters were collimation 2.5 mm, feed/ rotation 12.5 mm,mAs 165 for the supine and 70 for the prone position, slice thickness 3 mm andreconstruction interval 1.5 mm. MSCT colonography interpretations were donewith multiplanar 2D and virtual endoscopic 3D reconstructions. All positive re-sults for colon cancer were compared with histopathologic examination.Results: MSCT colonography evaluated the entire colon in all 23 patients withincomplete colonoscopy. There were 9 colon cancers revealed by surgery in 9patients. All cancers were diagnosed by MSCT, while 4 colon cancers were missedby incomplete colonoscopy. Additionally in 2 patients MSCT helped to furthercharacterize the colonoscopic abnormality and in all patients with colon cancerprovided useful information about the extent of the disease. There were no falsepositive results in MSCT colongraphies.Conclusion: Immediate CT colonography after incomplete colonoscopy is a fea-sible, useful tool for the evaluation of the entire colon and for the accurate detec-tion of colorectal cancer.

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C-139Perineal complications of Crohn's disease: Value of MRIF.J. González, C. Juanco, R. Landeras, T. Piedra, P. Merino, M. Lopez,M. Silván; Santander/ES

Purpose: To assess the value of MRI performed with phased-array coil in thedemonstration of the pelvic and perianal complications of Crohn's disease.Methods: Twenty patients with active Crohn's disease were studied (10 male;mean age 43years). MRI examinations were performed using a 1.5 Tesla systemperformed with phased-array coil, T1 and T2 weighted fast spin echo high resolu-tion sequences sequences in two or three orthogonal planes were performed,with and without fat suppression, with some cases also being studied before andafter gadolinium enhancement. The following parameters were considered: pres-ence of a fistula and relation with the sphincters, and presence of abscesses orcomplications. Parks' classification was used to describe perianal abscesses andfistulas.Results: The MRI results were correlated with surgical and clinical findings. In 18patients cutaneous, deep perineal or enterovesical fistulas or abscesses werediagnosed at MRI which showed close correlation with findings at surgery orexamination under anaesthetic. In two patients no fistulas or abscesses wereseen at MRI nor was there any evidence of complications on clinical examinationand flexible sigmoidoscopy. Concordance with surgery was 90%. There was onefalse negative examination in a patient who had a colovesical fistula.Conclusion: MRI can accurately show the pelvic and perineal complications ofCrohn's disease with good correlation with clinical and surgical findings.

C-140Multidetector-CT (MDCT) enterography with Polyethylene Glycol (PEG)solution versus multidetector-CT enteroclysis in small bowel Crohn'sdiseaseL.M. Minordi, M.G. Brizi, G. Masselli, M. Politi, C. Giangregorio, A. VecchioliScaldazza, P. Marano; Rome/IT

Purpose: The aim of this work is to evaluate MDCT enterography with PEG asan alternative to MDCT enteroclysis in patients affected by small bowel Crohn'sdisease.Materials and Methods: A total of 15 patients, known or suspected to haveCrohn's disease, underwent abdominal unenhanced and contrast-enhanced four-row MDCT completed by 2D Multiplanar Reconstructions (MPR). Distention ofsmall bowel (classified in a four-point scale) was obtained with oral administra-tion of 2000 mL of PEG balanced solution (n = 7) and with an enema of methyl-cellulose by naso-jejunal tube (n = 8). Results were compared with conventionalradiology. Potential of small bowel distention, terminal ileum involvement, extra-luminal findings and complications were evaluated by two experienced radiolo-gists.Results: All patients showed one or more thickened loops (range 5-10 mm), 9patients a target sign, 10 perienteric stranding, 7 comb sign, 5 fibro-fatty prolifer-ation, 5 prestenotic dilatation and 1 patient a fistula. Small bowel distention byMDCT enterography with PEG was considered excellent in 6% of cases, good in40%, moderate in 34% and poor in 20%, though distal ileum tract distention wasgood in 79% of cases. Small bowel distention by MDCT enteroclysis was consid-ered excellent in 53% of cases, good in 20%, moderate in 12% and poor in 15%;distal ileum tract distention was good in 82% of cases.Conclusions: PEG MDCT enterography shows terminal ileum involvement, ex-traluminal findings and complications of Crohn's disease as well as MDCT ente-roclysis, though MDCT enteroclysis gives better bowel dilatation, especially inthe jejunum.

C-141CT-enteroclysis: Single-detector-CT (SDCT) versus multidetector-CT(MDCT) in small bowel Crohn's diseaseL.M. Minordi, M.G. Brizi, A. Parrella, C. Giangregorio, M. Politi, G. Restaino,A. Vecchioli Scaldazza, P. Marano; Rome/IT

Purpose: To evaluate the diagnostic role of SDCT vs MDCT in patients affectedby small bowel Crohn's disease.Materials and Methods: 30 patients, known or suspected to have Crohn's dis-ease, underwent abdominal SDCT (n = 18) and four-row MDCT (n = 12) com-pleted with multiplanar reconstruction (MPR). Distention of small bowel wasobtained with an enema of methylcellulose by naso-jejunal tube. In each studywe looked for small bowel distention, site and number of pathological loops, de-gree of mural thickening and enhancement, comb sign, perienteric stranding,fistulas, fibrofatty proliferation, lymph node enlargement and abscesses, com-

paring the two CT techniques, considering patient discomfort and respiratoryartifacts. Results were compared with double-contrast small bowel enema andevaluated by two experienced radiologists.Results: The integrated diagnosis showed 10 negative patients, 15 with signssuggestive for Crohn's disease, 1 with reflux ileitis, 1 with ischemic ileitis and 3with non-specific ileitis. CT detected 48 positive loops (sensitivity 92%, specifici-ty 77%, diagnostic accuracy 88%); conventional radiology showed 42 positiveloops (sensitivity 93%, specificity 100%, diagnostic accuracy 94%). CT-enteroclysisfalse positives were due to poor bowel distention and false negatives to proximalbowel localization of disease; conventional study false negative cases were dueto unseparable loops. Mild respiratory artifacts were present in 66% (12 of 18patients) of SDCT examinations vs 16% (2 of 12 patients) of MDCT examina-tions.Conclusions: MDCT-enteroclysis in comparison with SDCT-enteroclysis reduc-es scanning time, respiratory artifacts and patient discomfort, allows a betterspatial resolution, more evident on MPR, and improves pathological pattern rep-resentation.

C-142Detection and staging of gastric lesions combining axial CT and virtualendoscopy imagesS. Visconti, V. Panebianco, M. Celestre, T. Celano, D. Tancredi, F. Iafrate,R. Passariello; Rome/IT

Purposes: The aim of our study was to develop a virtual endoscopy examinationprotocol for the stomach after CO2 distention, and to identify AGC lesions ac-cording to Borrmann's classification based on tumor morphology.Methods and Materials: Virtual endoscopy of the stomach was performed in 33patients with gastric lesions. The stomach was distended with 6 g of top efferves-cent granules used for double contrast upper GI studies (Duogas, Bracco), afterintramuscular injection of 20 mg of scopolamine butylbromide. All patients under-went a Spiral CT Volume Zoom examination (120/80/1 mm/1 mm/8 mm/0.l5 secKV/mAs/slice-coll./slice-width/feed-rot/rot.time). In 7 cases spiral CT was repeat-ed in a prone position because of a limited gastric distension by air. Real timeendoscopy images were reconstructed using a volume rendering technique witha dedicated workstation and specific software (Vitrea 2.2-Vital Images), and eval-uated combined with axial images by two radiologists. One week later a fiberop-tic gastroscopy was performed in all patients.Results: Image quality was graded as optimal in 30 cases. In 3 cases the stom-ach was not distended. Virtual endoscopy correctly showed gastric lesions (ul-cerative lesions n = 16, vegetating lesions n = 12, benign lesions n = 5). We founda good correlation with surgical specimens in 14 cases.Conclusions: The actual role of virtual gastroscopy combining axial CT and VEimages is to evaluate the locoregional and distant extension (perigastric tumorinvolvement, distant metastasis) of tumors. It's potential roles are replacing bari-um studies and examining patients with surgical gastric exclusion.

C-143Traumatic bowel perforation after blunt abdominal trauma: Analysis of theCT findings according to the perforation site and the elapsed time since thetraumaH. Kim, H. Shin, S. Park, S. Park, H. Kim, W. Bae, I. Kim; Cheonan/KR

Purpose: To evaluate the efficacy of CT in predicting the perforation site and thedifferential findings according to the elapsed time from the trauma in patientswith bowel perforation after blunt abdominal trauma.Methods and Materials: Abdominal CT's of 57 patients with bowel perforationafter blunt abdominal trauma confirmed by surgery were retrospectively analyzedwithout knowledge of the surgical results. The interval from the trauma to CT was2 to 72 hours (mean, 7 hours). The CT findings of traumatic bowel perforationincluding extraluminal air collection, segmental bowel wall thickening, localizedinter-mesenteric fluid, bowel wall discontinuity, and mesenteric hematoma wereanalyzed. The predicted perforation sites were classified as: duodenum, jejunum,jejuno-ileal junction, ileum, and colon. Based on the mean elapsed time (7 hours),the patients were divided into the early lapse group (n = 37) and the late lapsegroup (n = 20), and the differential CT findings were analyzed.Results: Diagnostic accuracy of predicting the perforation site was: duodenum(100%), jejunum (81%), jejuno-ileal junction (100%), ileum (93%), and colon (20%).Extraluminal air collection was more frequently seen in the late lapse group (80%)than in the early lapse group (43%) (p < 0.05), whereas other CT findings showedno statistically significant difference in the incidence.Conclusion: Duodenal, jejunal and ileal perforation could easily be predicted byabdominal CT. But predicting colonic perforation was difficult. Bowel perforation

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did not usually show extraluminal air early after trauma. Careful evaluation of theCT after blunt abdominal trauma is important for immediate and appropriate pa-tient management.

C-144Contrast-enhanced magnetic resonance imaging of the terminal ileum inchildren with Crohn's diseaseP. Paolantonio, A. Laghi, O. Borrelli, C. Miglio, M. Celestre, D. Marin,S. Cucchiara, R. Passariello; Rome/IT

Introduction: To evaluate the diagnostic value of gadolinium enhanced MRI withpolyethylene glycol solution as oral contrast agent (CE-PEG-MRI) in revealinginflammation of the distal ileum in children with Crohn's disease (CD) and indifferentiating them from other inflammatory bowel diseases.Subjects and Methods: Seventy-five consecutive paediatric patients referredfor suspected CD underwent ileo-colonoscopy with biopsy and CE-PEG-MRI.The distal ileal mucosa was assessed by endoscopic and histological scores.The CD activity was measured by means of paediatric Crohn's disease activityindex (PCDAI).Results: Active CD was diagnosed in 26 cases, active ulcerative colitis (UC) in18, spondyloarthropathy and indeterminate ileo-colitis in 11. In all CD patientsCE-PEG-MRI showed a high concordance with endoscopy and histology. Of the18 UC patients the CE-PEGMRI was negative in 15 and showed mild parietalcontrast enhancement of the terminal ileum in 3 of the 7 patients with backwashileitis. Among the group of SpA patients, CE-PEG-MRI was negative in 4 andrevealed mild parietal contrast enhancement in 7. No increase in wall thicknessin any of the UC and SpA patients was demonstrated. Sensitivity and specificityof CE-PEG-MRI were 84% and 100%, respectively. The test optimally correlatedwith endoscopic and histological scores (r: 0.94; r: 0.95, respectively) as well aswith the PCDAI in the CD patient group (r: 0.91).Conclusions: High correlation of CE-PEG-MRI with ileal endoscopy, histologyand PCDAI makes this test of great interest as a tool for monitoring the clinicalcourse and the effect of therapy in CD patients.

C-145Small bowel sonography in celiac disease after oral administration ofsonographic contrast mediumP. Mirk, R. Foschi, I. De Vitis, L. Guidi, A. Vecchioli-Scaldazza, P. Marano;Rome/IT

Purpose: To assess the usefulness of sonography in celiac disease after smallbowel loop filling by sonographic contrast medium.Materials and Methods: 33 consecutive patients with clinical suspicion or diag-nosis of celiac disease were prospectively examined by US before and after (30'-40') drinking of 500-750 mL of an isosmotic water solution of polyethilene glycol.14 patients had celiac disease (positive histology or AGA or EMA antibodies); 19patients had previous celiac disease but were clinically negative, or had otherbenign disorders, and were considered as normal.Results: After contrast administration intestinal loops were better or slightly bet-ter shown in 12/33 and 16/33 patients (36.3% and 48.4%), or unchanged in 5/33(15.5%). Among celiac patients, observed intestinal abnormalities were: segmentaldyskinesia; transient intussusception; reduced number of jejunal folds; increasednumber of ileal folds; hypotonic dilated fluid-filled loops; increased intestinal mo-tility. Extra-intestinal abnormalities in celiac patients were: spleen size reduction;mesenteric lymphadenopathy; liver steatosis; free peritoneal fluid. 4 celiac pa-tients had no detactable abnormalities (false negatives); there were no false pos-itives. Overall accuracy was 87.8% (sensitivity: 71.4%; specificity: 100%; PPV100%; NPV 82.6%)Conclusions: Small bowel filling by sonographic contrast medium improves USevaluation of wall thickness, mucosal fold pattern, and intestinal motility. Tran-sient intussusception was the single most diagnostic sign, whereas other fea-tures were less specific and of limited value unless found in combination.

C-146Preoperative MRI and transrectal US in the staging, and post-irradiationtherapy restaging, of rectal cancerI. Miucin-Vukadinovic; Sremska Kamenica/YU

Purpose: The goal of the study was to determinate and compare the value ofMRI and transrectal US (TRUS) in the staging, and post-irradiation therapy re-staging, of rectal cancer. This study was designed to evaluate the down-stagingeffect of preoperative radiation.Method and Materials: 34 patients (range, 38-86) with biopsy-proven rectal can-

cer underwent imaging using a 1.5 T scanner and transrectal US (7.5 or 10 MHztransducer) before, and after radiation therapy (50 Gy, a daily fracton of 2 Gy, 5days a week).Tumors were staged according to the TNM staging system. Twoobservers independently scored the tumor stage. The standard of reference washistopathology (after surgical resection).Results: All patients underwent radiotherapy before surgery for rectal carcino-ma. Before radiotherapy MR examination detected 20.6% T2 (B1), 41.2% T3 (B2),8.8% T2N1 (C1) and 29.4% T3/4N1 (C2) tumors. Down-staging of one or more Tstages occurred in 44.1% with tumor regression in 23.5%. The MRI tumor stageagreed with the histological stage in 86% of patients. TRUS correctly staged 81%of lesions. T category was correctly restaged after preoperative radiation in only61.8%.Conclusion: Preoperative radiotherapy is becoming the standard of care for re-sectable, locally advanced adenocarcinoma of the rectum. MRI and TRUS ena-ble selection of appropriate patients for preoperative radiotherapy. PreoperativeTRUS can establish the depth of penetration of a tumor and showed less sensi-tivity for lymph node staging. MRI showed better diagnostic accuracy (with ten-dency for overstaging) then TRUS for interpretation of complete pelvic status inthe pre- and post-irradiation period.

C-147Echographic efficacy evaluation of gastric ulcer treatmentS. Pimanau, N. Mikhailava; Vitebsk/BY

Purpose: The objective of this study was to investigate the possibilities of nonin-vasive abdominal echography in efficacy evaluation of chronic peptic ulcer phar-macotherapy.Method and Materials: 87 patients with gastric ulcers in the exacerbation phasewere examined before the course of pharmacotherapy and after it. Ultrasoundinvestigation was carried out after administration of 400-500 mL deaerated liq-uid. On echography a chronic gastric ulcer was visualized in 84 cases. In theacute exacerbation phase the peptic ulcer was deep, filled with echogenic con-tents, the ulcer edge being sharp and overhanging. Periulcerous infiltration washypoechogenic, 50-90 mm long, 6-12 mm thick, and its area made up about 400-900 mm2. The peripheral edge of periulcerous infiltration seemed sharp. In thecourse of effective treatment both ulcer dimensions and periulcerous infiltrationarea reduced on echograms. Periulcerous infiltration reduction speed made upabout 10 mm2/day. The reparative process was also accompanied by ulcer flat-tening. In cicatrization the ulcer was not visualized on echograms, a hypoecho-genic stripe 3-4 mm thick generally remaining. In the absence of reparation, theechographic picture of the ulcer and periulcerous infiltration didn't change essen-tially. Parallel endoscopic study of the stomach revealed either coincidence withechographic findings of qualitative characteristics of the reparative process pos-itive dynamics or its absence. In 6 cases the results of ultrasound and endoscop-ic investigations didn't coincide; echograms showed slight infiltration with a centralsmall echogenic area at the site of ulcer regarded as ulcer reparation, while en-doscopy revealed a red scar.Conclusion: Thus, abdominal ultrasound investigation of the stomach enablesreliable evaluation of gastric ulcer dynamics in the course of conservative treat-ment.

C-148Comparison of multi-slice CT-colonography in ultra-low-dose techniquewith high resolution video-colonoscopy in the detection of colorectalpolypsM. Cohnen, C. Vogt, K. Andersen, A. Saleh, A. Beck, S. vom Dahl, V. Aurich,D. Häussinger, U. Moedder; Düsseldorf/DE

Purpose: To prospectively compare MSCT-colonography using an ultra-low-dosetechnique (ULD-MSCTC) with high-resolution video-colonoscopy (HR-VC) as thestandard technique for detection of colorectal cancer and polyps.Patients and Methods: 115 patients underwent MSCT-colonography (ULD-MSCTC) after standardized oral bowel cleansing immediately before video-colon-oscopy (HR-VC). Patients were scanned with an ultra-low-dose MSCT-colonography protocol (10 mAs, CTDIw eff: 1.14 mGy). After noise reduction us-ing an mathematical algorithm by dedicated software, ULD-MSCT-colonographicimages were analyzed by a team of two readers in a blinded fashion and theresults were compared with the results of HR-VC.Results: 150 lesions were detected by HR-VC in 115 patients. Sensitivities fordetection of polyps < 5 mm, 5-10 mm, and > 10 mm in size were 76% (73 of 96polyps), 91% (30 of 33 polyps) and 100% (9 of 9 polyps) respectively. All colorec-tal tumors (4 of 4, 100%) were prospectively diagnosed. The sensitivity to detectflat lesions was 50% (4 of 8 flat lesions). The overall specificity was calculated at87%. The calculated effective dose ranged between 0.75 and 1.25 mSv.

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Conclusions: ULD-MSCTC has an excellent sensitivity and specificity for thedetection of colorectal lesions > 5 mm despite a significant reduction in radiationexposure.

C-149Defecographic findings of young asymptomatic volunteersS.-W. Yoon1, K. Kim2, H. Park2, J.-S. Yu2, M.-S. Park2, H. Kim1; 1Gyunggi-do/KR,2Seoul/KR

Purpose: Defecography is a technique of examining the rectum and anal canalby using fluoroscopy during defecation. This study was done to determine therange of normal findings of defecography in young asymptomatic volunteers.Methods and Materials: Twenty-nine asymptomatic young volunteers (Age: 22-29 year-old, average 23.8 year-old) underwent defecography. Anorectal angle,perineal descent, length and width of anal canal, rectocele, rectal intussuscep-tion and incontinence were evaluated.Results: The range of anorectal angle was 82o-149o in resting state, compared to63o-116o in squeezing state, and 95o-116o in straining state, respectively. Thepelvic floor in straining state descended an average of 1.62 cm from the inferiormargin of the ischial tuberosity, its broad range of position from –5.2 cm to 0.8 cmimplying a wide variation of anorectal angle and perineal descent. Mild degreerectocele with less than 2 cm of depth was found in 12 out of 29 cases. Rectalintussusception was noted in six and rectal incontinence was seen in one. For-mation of rectocele and intussusception during defecation was common in asymp-tomatic young volunteers.Conclusion: The wide range of defecographic measurements warrants the ne-cessity of other complementary studies on anorectal function to improve the di-agnostic accuracy. Therefore, the interpretation of defecographic findings shouldbe made with caution and should not be used as the sole criteria for selection ofa treatment modality.

C-150Right-side colonic diverticulitis: Sonographic and CT findings (differentialdiagnosis)E. Blanc, M.J. Martínez, T. Ripollés, M. Agramunt, C. Soto, R. Pastor;Valencia/ES

Purpose: To describe the sonographic and CT features in right-side colonic di-verticulitis and to differentiate this entity from other right-side acute abdominalconditions.Methods and Materials: 16 patients with a final diagnosis of diverticulitis of theascending colon or cecum were retrospectively reviewed. Sonography was per-formed in all patients and CT in 13. The following findings were evaluated: thepresence of an inflamed right colonic diverticulum, pericolonic infiltration, focalcolonic wall thickening and the identification of a normal appendix. The diagnosiswas confirmed by surgery, clinical course, or barium enema.Results: Sonography and CT showed pericolonic inflammation and focal colonicwall thickening in all cases. The inflamed diverticulum was seen with sonographyand CT in 15 (94%) and 13 (100%) patients respectively. The normal appendixwas identified with sonography in 7 (44%) and with CT in 5 (38%) cases. Theinitial diagnosis was: right-side colonic diverticulitis (n = 11), acute appendicitis(n = 2), perforated colonic carcinoma (n = 2) and an inflammatory mass (n = 1).Conclusions: Right-sided colonic diverticulitis is a condition that can clinicallymimic other causes of right abdominal pain like acute appendicitis, perforatedcolonic carcinoma, salpingitis, ileocecal inflammatory pathology, epiploic appen-dicitis and omental infartion. In this series the most common sonographic and CTfindings included the presence of a right colonic diverticulum with thickening ofthe adjacent pericolonic wall and pericolonic infiltration. Both ultrasound and CTcan be extremely useful in the early diagnosis of this entity avoiding unnecessarysurgery procedures, in a primarily benign and self-limiting condition that can betreated conservatively.

C-151An accurate scanning technique for detecting recurrent rectal cancer:Enhancement of early-phase dynamic helical CTJ. Tanaka, S. Tsukuda, A. Heshiki; Iruma-gun/JP

Purpose: To evaluate the usefulness of dynamic enhancement of helical CT inthe detection of local recurrence of resected rectal cancer.Methods and Materials: In 142 patients with a history of curatively resected T2or T3 rectal cancer, follow-up plain CT indicated that they had a loco-regionalrecurrent tumor; consequently, they underwent follow-up pelvic helical CT pro-viding accurate early-phase contrast enhancement in the lower pelvic region.

The patients were divided into four groups according to grade of contrast en-hancement of the suspected mass-like lesion before and after contrast enhance-ment, and correlation between groups and results obtained by biopsy and/orsurgery was assessed. If no correlation was found, patients were followed up fora period lasting from 400 days to two years. As of June 2002, results had beenobtained for 80 patients; and correlation between these results and grouping bycontrast enhancement ratio was analyzed.Results: All patients in the highest-grade group (n = 10) had local recurrence.When only the highest-grade group was considered positive, there were no falsepositives and only one false negative.Conclusion: Our results suggest that early-phase contrast enhancement is use-ful for accurately detecting recurrent rectal cancer. This can be easily achievedusing SmartPrep function, and should be used to distinguish recurrent tumorsfrom post-surgical scar tissue, because these two tissue types do not exhibitsimilar enhancement patterns.

C-152Staging of gastric carcinoma by MR imaging in vitroC. Sato1, S. Naganawa1, H. Kumada2, T. Miura2, T. Ishigaki1; 1Nagoya/JP,2Toyohashi/JP

Purpose: To evaluate the accuracy of cancerous invasion to gastric wall withmagnetic resonance imaging in vitro.Methods and Materials: Twelve specimens of gastric carcinoma were examinedwith a 1.5 T MR using a small loop surface coil. They were fixed in formalin within2 days prior to imaging. The field of view was 30 mm, a matrix size was 256 x 256,and the section thickness was 2 mm. The T1- and T2-weighted images were ob-tained. Two radiologists evaluated the MR images independently, and consensuswas obtained if there were any discrepancies between the two. Findings on MRimages were compared with histopathologic findings.Results: MR images depicted the normal gastric wall as consisting of the 4 lay-ers clearly. Cancerous invasion was detected in 4 of 12 specimens with mucosalinvasion, 3 with submucosal invasion, 2 with the invasion to muscularis propria, 2with subserosal invasion, and the rest that extended into the serosa. The MRimaging-determined grade correlated with the histopathologic findings for 11 of12 tumors. The overall accuracy was 91.6%.Conclusion: MR imaging has an accurate diagnostic capabilities for the evalua-tion of the cancerous invasion to the gastric wall in vitro. The results of the presentstudy may encourage the further development of an endoscopic surface coil.

C-153Role of MR imaging in the assessment of patients with Crohn's diseaseF. Maccioni, M. Colaiacomo, A. Bruni, M. D'Avanzo, S. Parlanti, M. Marini,M. Zippi; Rome/IT

Purpose: To investigate the value of MRI in the overall assessment of Crohn'sdisease (disease activity, disease extension, complications).Method and Materials: 119 consecutive patients with Crohn's disease under-went MRI in the context of a clinical evaluation including biochemistry, endosco-py, histology and radiology. All patients underwent MRI after oral administrationof a superparamagnetic contrast agent, using standard sequences (HASTE T2-weighted, with and without fat-suppression and Gd-enhanced T1-weightedFLASH). Two independent radiologists evaluated MR images on printed films.Disease length, presence of strictures, fistulae, abscesses, phlegmons and anyother abdominal complication were evaluated at the level of each segment. GoldStandard (GS) for morphological assessment were: Barium studies, CT or US,and surgery when performed. At the level of the affected segments bowel wallthickness, T1 wall Gd-enhancement, T2 wall signal, T2 fibro-fatty proliferationsignal were evaluated and graded (0-3) to assess disease activity. GS for dis-ease activity were endoscopy, biological activity and CDAI.Results: MRI detected 90% of overall disease length, 75% of fistulae, 92% ofstrictures; adhesions were overestimated. In 11% of patients MRI showed com-plications requiring surgery (1 hydronephrosis, 4 abscesses, 5 phlegmons, 1pancreatic duct stone, 1 enterovesical fistula, 2 ovarian involvements). The fol-lowing MRI findings were statistically correlated with the clinical and biologicalsigns of active disease: bowel wall thickness (r = 0.59), wall Gd-enhancement(r = 0.84), T2 wall signal (r = 0.80), T2 fibro-fatty proliferation signal (r = 0.76).Conclusions: MRI, giving reliable information on different aspects of the disease(activity, extent, complications), can influence the planning of medical and surgi-cal therapy.

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C-154Radiologic findings of pseudomyxoma peritonei with pathologiccorrelation: Usual and unusual manifestations, and pitfallsM. Takeuchi1, K. Matsuzaki1, S. Yoshida1, H. Nishitani1, H. Shimazu2,H. Uehara1; 1Tokushima/JP, 2Oe-gun/JP

Learning Objectives: To recognize usual and unusual radiologic findings of pseu-domyxoma peritonei with pathologic correlation.Background: Pseudomyxoma peritonei is a rare neoplastic condition in whichgelatinous intraperitoneal fluid collections associated with mucinous disseminat-ed implants are observed. Although a ruptured appendiceal mucocele is the mostcommon cause, pathologies arising from other origins may cause this conditionwith various imaging manifestations.Imaging Findings: The usual imaging findings were of mucinous, fluid-like ma-terial spread over the peritoneal cavity with organ scalloping observed in theliver, splenic and mesenteric margins, with central displacement of small intesti-nal loops. Within the material, cyst-like round structures may be observed andclarified by the septal enhancement on contrast-enhanced images. Punctate,annular, or curvilinear calcifications may be disseminated. Dropping appendicealmucocele or a rare urachal tumor located in the female pelvis may simulate anovarian tumor and be misdiagnosed as gynaecological disease. Demonstrationof the continuity to the cecum or urachus was the diagnostic clue. Localized dis-ease in the female pelvis may simulate ovarian carcinomatous peritonitis, andscalloping of the uterine margin may suggest this condition. Because synchro-nous mucinous tumors of the ovary and the appendix may occur, careful obser-vation to detect the slight irregularity of the omentum adjacent to the cecum isnecessary to avoid overlooking an occult primary appendiceal lesion.Conclusion: To recognize various imaging findings is important to make the cor-rect preoperative diagnosis. In particular occult appendiceal lesions must not beoverlooked. Multiplanar observation on CT and MRI was important to recognizethe complex organic-pathologic relationships to identify the primary neoplasm.

C-155Retroperitoneal cystic masses: CT findingsD. Yang, H. Kim, J. Kang, T. Seo, H. Kim, S. Kim, J. Kim; Incheon/KR

Learning Objectives: To illustrate the CT findings of the different types of retro-peritoneal cystic masses.Background: Retroperitoneal cystic masses, which arise within the retroperito-neal space but outside the major organs of that compartment, are uncommon.However, the widespread use of computed tomography (CT) for evaluating ab-dominal and retroperitoneal diseases has increased the detection rate of retro-peritoneal cystic lesions. In this exhibit, we conduct a literature review and presentthe CT findings of our own patients to illustrate the CT appearance of differenttypes of retroperitoneal cystic masses.Imaging Findings: A variety of CT features were identified in various retroperito-neal cystic masses. The disease entities include cystic lymphangioma, retroperi-toneal mucinous cystadenoma, müllerian cyst, cystic change of paraganglioma,epidermoid cyst, cystic teratoma, tailgut cyst, mucocele of appendix, perianalmucinous adenocarcinoma, cystic change of leiomyosarcoma after chemothera-py, pancreatic and nonpancreatic pseudocyst, lymphocele, urinoma, and hemato-ma.Conclusion: Knowledge of CT findings of various retroperitoneal cystic massesmay be helpful for differential diagnosis.

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C-156A pictorial review of out of hours CT abdomen and pelvis performed foracute abdominal pain: A personal experience of what a trainee radiologist isup againstC. Tam, D. Nicholson; Manchester/UK

Background and Objective: CT is an extremely valuable tool for achieving pre-operative diagnosis and avoids unnecessary laparotomy for acute abdominal pain.However, even for an experienced radiologist, it can be a real test. As a traineenear completion of training, I have learned from my mistakes and many othersand have compiled a series of cases (all with clinical correlation) to share in thehope that others might benefit.Imaging Findings: A brief clinical history and laboratory investigations are fol-lowed with relevant images and eventual clinical outcome given at the end of thepictorial review so that readers can test themselves objectively. Outcomes of someof these cases were of extreme consequences including several deaths. A largenumber of these cases were also shown as a lecture format in this years Associ-ation of UK Radiological Trainees' annual meeting in Oxford, UK. Cases includesubtle perforation of a duodenal ulcer, Crohn's small bowel stricture with me-senteric abscesses, subtle anterior resection anastomatic leakage, closed looplarge bowel obstruction with a necrotic caecum, mesenteric ischaemia with sub-tle superior mesenteric vein thrombosis, various appearances of perforated co-lonic tumours and its mimics, fulminating ulcerative colitis, confusion caused bycaecal tumour and appendicitis, subtle obturator hernia causing bowel obstruc-tion and a case of fat necrosis of the right iliac fossa mimicking appendicitis.Conclusion: CT abdomen and pelvis in acute abdomen can be extremely diffi-cult and help from senior colleges should be sought early if in doubt to avoid direconsequences.

C-157Cystic dystrophy of the duodenal and gastric wall in heterotopic pancreas:CT and MR findingsM. Pages, A. Garcia Diez, C. De Juan, M. Pellicer, M. Sanchez, J.R. Ayuso,T.M. Caralt, C. Ayuso; Barcelona/ES

Learning Objective: Our purpose is to describe the CT and MR findings of cyst-ic dystrophy of the duodenal and gastric wall in heterotopic pancreas (CDHP)which allows an accurate diagnosis of this pathology usually associated withchronic pancreatitis.Background: Cystic dystrophy in heterotopic pancreas is characterized by thedevelopment of cysts in heterotopic pancreatic tissue localized in the duodenalor gastric wall. Cyst formation is related to cystic dilatation of an anomalous ductbordered by pancreatic excretory epithelium, or to pseudocysts caused by pan-creatitis of the heterotopic pancreas. We reviewed CT and MR findings in fivepatients with cystic dystrophy in heterotopic pancreas (CDHP). They underwentspiral CT (n = 5) and MR/ cholangio-MR (n = 2). Diagnosis was confirmed byendoscopic US in all cases. Three cases were pathologically proven after sur-gery.Imaging Findings: The CT and MRI findings of CDHP consists of cysts, (nor-mally multiple), located in the inner wall of the second part of the duodenum andless frequently in the stomach. The duodenal or gastric walls affected are thick-ened and inflammatory changes are observed around the cysts. Signs of chronicpancreatitis are frequently seen. MR/ cholangio-MR shows high intensity lesionscorresponding to the cysts.Conclusion: CDHP presents some CT and MR features which permit an accu-rate and reliable diagnosis. When a cystic lesion is found in the duodenal or gas-tric wall CDHP should be included in the differential diagnosis with other cysticmasses such tumors or abcesses.

C-158Imaging of pancreatic transplantation using portal-enteric drainagetechniqueL. Herraiz, E. Sanz, A. Cima, S. Dieguez, A. Bermejo, J. Benito, S. Borruel,A. Sánchez; Madrid/ES

Learning Objetives: To become familiar with the radiologic appearance of un-complicated and complicated pancreatic allograft transplant in the portal-entericdrainage technique.Background: The more physiologic portal-enteric drainage technique of pancre-

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atic allograft is widely applied instead of the traditional systemic-bladder drain-age one. Despite the higher technical complications, and thanks to its favorableinfluence on serum glucose and lipid profiles, this technique is the preferred treat-ment for patients with severe type I diabetes mellitus and end-stage renal disease(simultaneous pancreatic-kidney transplantation). Therefore an understanding ofthe anatomic configuration and the spectrum of postsurgical complications isneeded.Imaging Findings: We retrospectively reviewed computed tomographic scans(CT), ultrasounds (US) and doppler studies of 14 patients who had undergonepancreatic transplantation using portal-enteric drainage in our hospital betweenJanuary 2002 and July 2003. We review the usefulness, limitations and potentialpitfalls of CT and US. Acute postoperative complications, including acute rejec-tion, transplant pancreatitis, peripancreatic collections and abscess, pseudocysts,vascular complications (thrombosis, pseudoaneurysm) and exocrine leaks, aredepicted. Furthermore, CT- guided percutaneous biopsy and drainage is a safeand an alternative method for obtaining tissue from the transplanted pancreaswith graft dysfuntion, and collections.Conclusion: Knowledge of normal anatomic configuration and the radiologicappearance of normal pancreatic transplant will allow proper interpretation andearly treatment of the spectrum of portsurgical complications in this kind of pan-creatic allograft.

C-159Atypical complications of gastric bypass surgeryV.J. Pizzitola, M.-G. Knuttinen, M.T. Mitchell, A.E. Gasparaitis; Chicago, IL/US

Learning Objectives: To demonstrate atypically occurring complications of themore commonly performed gastric bypass surgeries with respect to both ana-tomical features and motility abnormalities.Background: The more common current gastric bypass procedures include theRoux-en-Y procedure and bilio-pancreatic diversion with duodenal switch proce-dure. The more typical complications of these surgeries include anastomotic leaksand stenoses, both of which have been reported in the current literature. Moreatypical complications, however, have not been comprehensively demonstrated.Imaging Findings: Gastric bypass/gastric stapling is a common surgical proce-dure at our institution. We have encountered several atypical complications, doc-umented with flouroscopic studies using water soluble contrast. We offer fiveunusual complications which include the following: Internal herniation throughthe small bowel mesentery, internal herniation through the transverse mesoco-lon, external herniation through the abdominal wall incision, enterocutaneousfistulas, Roux-en-Y configuration with anti-peristaltic inversion of the gastroen-teric Roux limb, and incorrect anastomosis of the Roux limb with the excludedstomach (resulting in a Roux-en-O configuration).Conclusion: Our findings expand those of the current literature to include themore infrequent complications of gastric bypass surgery. In the fluoroscopic eval-uation of post-operative gastric bypass patients, a thorough understanding ofexpected post-operative bowel configuration is essential. In addition to assess-ing anatomical abnormalities, it is equally important to assess for abnormalitiesof motility.

C-160Body packing: Radiology in the social problem of drug smugglingG. Pärtan1, K. Lomoschitz1, P. Pamberger1, W. Bauer2, W. Hruby1; 1Vienna/AT,2Schwechat/AT

Learning Objectives: To illustrate the imaging findings of drug smuggling byhiding drug packs within the body. To outline the social and legal framework ofbody packing and it's diagnosis. To outline the advantages and limitations of theseveral imaging methods applicable for the diagnosis of body packing.Background: Body packing is one of the common ways to smuggle drugs intothe target countries, mostly by airline travel.Procedure Details: Suspects are brought to our institutions on a voluntary ba-sis, most of them preferring radiological work-up to going into custody until thedrugs are (or are not) excreted by natural ways. It has to be emphasised, thatbody packing of narcotic drugs is a potentially life threatening infliction, since asignificant number of body packers die because of leakage of the packs withinthe intestinal tract. The examination of choice is an AP abdominal radiograph. Inequivocal cases or if avoidance of the minimal X-ray exposure is of special im-portance (e.g. potentially pregnant persons), ultrasound should be performed.CT is an excellent additional investigation if findings should still be equivocal.This may be the case with some packing methods which render the ingesteddrugs very difficult to detect.Conclusion: Radiological investigation of suspected body packing is an invalua-

ble tool which however confronts radiologists with a situation delicate for legaland social reasons. Familiarity with the radiographically more subtle variations ofbody packing is important.

C-161Imaging findings of familial mediterranean feverN.J. Khoury, G.E. Ishak, M.C. Haddad; Beirut/LB

Learning Objectives: To illustrate the spectrum of imaging findings of the wholebody in patients with familial Mediterranean fever (FMF).Background: The imaging characteristics of FMF have been described in fewreports in the radiological literature dealing only with abdominal manifestations.In this study, we performed a retrospective review of the medical records andimaging studies of 37 patients with proven FMF, diagnosed between 1992-2002.Imaging Findings: The commonest clinical manifestation were recurrent perito-neal attacks with abdominal pain (75.6%) and fever (40.5%). Abdominal imagingfindings included ileus (n = 12), focal peritonitis (n = 3), ascitis (n = 2), splenom-egaly (n = 5), and hepatomegaly (n = 2). One patient developed fatal peritonealmesothelioma, and 13.5% of patients developed amyloidosis with sonographicfindings of renal parenchymal disease or cardiomyopathy. Arthritis was second infrequency occurring in 36.1% of patients. Radiographs were normal (n = 4) orshowed joint effusion and soft tissue swelling (n = 4) due to synovitis. Two pa-tients developed seronegative destructive arthropathy. Pleuritis was encounteredin 13.9%. Polyarteritis nodosa (PAN) was present in 2 patients, multiple sclerosisin one, and autoimmune hemolytic anemia in one patient.Conclusion: FMF predominantly involves abdominal viscera but can affect otherorgans. The majority of patients have nonspecific imaging findings and the radio-logic diagnosis is rarely considered. Amyloidosis, mesothelioma, and destructivearthropathy are potential serious complications of FMF. Polyarteritis nodosa,multiple sclerosis, and autoimmune hemolytic anemia are rare associations orcoincidence with FMF.

C-162Mucosal associated lymphoid tissue lymphomas: Imaging evaluation withpathologic correlationD. Voultsinou, T. Gerukis, N. Staurogianni, K. Anastasiadou,A. Anagnostopoulos, P. Palladas; Thessaloniki/GR

Learning Objectives: To identify the radiological features of extra nodal nonHodgkin MALT lymphoma. To illustrate the spectrum of appearance of the dis-ease in its various locations in the human body. To list the various imaging strat-egies. To discuss the differential diagnosis.Background: Mucosal associated lymphoid tissue (MALT) lymphoma arises inextranodal mucosal lymphoid tissue and has only been recognized recently. Itaffects several extranodal structures such as the stomach, the lung, the eye andthe salivary glands. It is generally low grade and has an indolent course, as itremains long confined to the initial site. In this exhibit we describe and illustratethe most common radiological patterns of MALT lymphoma.Imaging Findings: We retrospectively reviewed clinical and radiographic recordsin 17 cases with confirmed low-grade gastric MALT lymphoma. The study groupconsisted of 10 men and 7 women (mean age 62 years). The predisposing fac-tors of MALT lymphoma, number and location of lesions, and course of the dis-ease were evaluated. We determined the most probable diagnosis on the basisof the radiologic findings and correlated them to pathologic and immunohisto-chemical findings of endoscopy, biopsy and bone marrow examination.10 out of17 patients presented with MALT lymphoma of the stomach, 2 in the parotid gland,2 in the lung, 2 in the large intestine (sigmoid colon, rectum), 1 in ileocecal valveand 1 in the orbit Rectal MALT lymphoma coexisted in one patient, and parotidgland and lung lymphoma in 2 patients. All patients were treated with chemother-apy. The disease resolved in 15 patients.Conclusion: The correlation of imaging, endoscopic and pathologic findings sig-nificantly contributes to diagnosis and follow-up of MALT lymphomas, early diag-nosis of which results in complete regression.

C-163Spectrum of radiological findings in abdominal tuberculosisJ. Branera, A. Malet, A. Malet Munte, A. Massuet, D. Gil; Sabadell/ES

Learning Objectives: To present radiological findings in images obtained by dif-ferent techniques of abdominal, genitourinary (GU), and gastrointestinal (GI)manifestations of tuberculosis.Background and Imaging Findings: Abdominal tuberculosis is a rare cause ofintra-abdominal infection, and is defined as infection of the peritoneum, hollow or

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solid abdominal organs, and abdominal lymphatics with Mycobacterium tubercu-losis organisms. This is a retrospective analysis of radiological studies (plain filmstudies of the abdomen, urography, CT, US and barium studies) of 25 patientsclinically diagnosed with intraabdominal TB. Functional, dynamic, and morpho-logical signs have been evaluated. We present the radiological manifestationssignificative of abdominal TB, together with commentaries about its radiologicalappearance, emphasizing the differential diagnosis in each case. We include dif-ferent sites of GI and GU disease. In 11 of the 15 cases, the suspicion of GU TB(73.3%, 9) was based on urography as positive results on laboratory tests hadnot yet been obtained.Conclusion: Imaging techniques play a key role in the diagnosis of new, atypicalpresentations of TB. They enable us to know the extent and location of the le-sions even before laboratory results become available, thus permitting the startof empirical treatment in the interin, prior to histological confirmation. The inci-dence of extra pulmonary and atypical TB is on the rise. For this reason, TBshould be considered in the differential diagnosis of GI and GU in appropriateclinical situations.

C-164Pelvic floor pathology: A radiological approachM. Pons Renedo, L. Garcia del Barrio, P. Domínguez Echávarri, D. CanoRafart, M. Elorz Carlon, A. Benito Boillos; Pamplona/ES

Learning Objectives: To show the important role of the radiologist in the diag-nostic work up of patients with pelvic floor disorders. To review the radiologicaltechniques used in this type of patient. To illustrate the various findings detecta-ble at these techniques in pelvic floor pathologies.Background: Pelvic floor disorders are actually common complaints in medicalpractice and their symptoms include incontinence, prolapse, constipation andpelvic pain. Anatomical knowledge is essential to understand the radiologicalfindings and to correlate with clinical evidence. There are three pelvic compart-ments which may be affected: Anterior, which includes bladder; medium, whichincludes vagina; and posterior, which includes rectum. The main radiological tech-niques we may use are cystography, defecography, colonic transit and functionalmagnetic resonance (MR).Imaging Findings: We show the main findings detected with cystography(cystocele); defecography (rectocele, rectal prolapse, anismus, pelvic floor de-scent); colonic transit (evacuational disorders or generalised disorder); and func-tional MR (complex pelvic floor pathologies, which include several compartments)Conclusion: Radiologists play a pivotal role in the diagnostic approach to pelvicfloor pathologies. Therefore, we elaborate a systematic review of techniques andfindings in this type of patients.

C-165The role of the abdominal doppler ultrasonography and CT angiography inthe diagnosis of ligamentum arcuatum syndromeI. Kiss, T. Wittmann, F. Izbéki, L. Kardos, Z. Morvay, A. Palkó, L. Csernay;Szeged/HU

Delayed gastric emptying can be caused by functional and organic diseases.Among the organic causes, ligamentum arcuatum medianum syndrome (LAMS)is a rare phenomenon.Aims: To evaluate the diagnostic value of different procedures in LAMS.Patients and Methods: 5 women (mean age 34 years) with a previously estab-lished diagnosis of delayed gastric emptying were studied. Other organic andfunctional causes of delayed gastric emptying were ruled out by 2D ultrasound,endoscopy and gastric manometry. After an initial symptom analysis the pres-ence of delayed gastric emptying was confirmed with a barium study. As therewas suspicion of LAMS, abdominal doppler ultrasonography (DUS) and CT ang-iography (CTA) were performed.Result: Of the typical clinical symptoms an early feeling of fullness and post-prandial vomiting were present in all cases. The barium emptying study showed amarkedly delayed emptying time (4 h) and an external compression on the hori-zontal part of the duodenum in all patients. Sagittal distance between the superi-or mesenteric artery and the aorta was shorter by DUS (5 mm vs. the 15-20 mmnormal value). Similar values were obtained by CTA at 5.8 mm compared to the15-20 mm normal value.Conclusion: LAMS is a rare organic disorder in the background of delayed gas-tric emptying. If the suspicion of the diagnosis emerges on the basis of clinicalsymtoms and standard barium emptying studies, abdominal doppler ultrasoundand CTA are both valuable methods for confirmation.

C-166Pelvic floor evaluation in women with anorectal or urogenital symptoms:MR-colpocystodefecography gives clear-cut answersE. Schepens, B. Op de Beeck, B. Dumon, M. Van Outryve, P. Pelckmans,J.-J. Wyndaele, W. Tjalma, P.M. Parizel; Edegem/BE

Learning Objectives: Recognising the changes in relationship between the pel-vic organs leading to pelvic floor abnormalities on dynamic MR-Colpocystode-fecography. Understanding the associated changes seen on the axial images.Through this knowledge being able to sharpen the indications for MR-colpocysto-defecography.Background: Pelvic floor abnormalities are very hard to evaluate clinically. Sur-gery to resolve these problems has a failure rate of one in three. This is mainlybecause of the lack in understanding the multi-compartmental involvement. FromJanuary 2001 to August 2003 we have seen 150 patients for MR-colpocystode-fecography. Although the patient is in the decubitus position, this does not changethe interaction between the pelvic organs.Image Findings: Patients are prepared by filling the vagina and rectum with ul-trasound gel. Multiplanar TSE T2-weighted images are acquired throughout thepelvis. Midsagittal repeated True-FISP gives a dynamic image of the act of defe-cation and sometimes micturition. On the axial images we recognise paravaginalherniation of the bladder, position abnormalities of the uterus, and ligament andmuscular atrophy as a cause of pelvic organ descent. The dynamic images showenteroceles, peritoneoceles, anterior rectoceles, uterine and vaginal prolapses,cystoceles, rectal intussusceptions and prolapses. Inability to relax the anal sphinc-ter or puborectalis muscle is generally confirmed on manometric studies and canbe diagnosed as puborectal dyskinesia.Conclusion: MR-colpocystodefecography is a reliable imaging method to evalu-ate pelvic floor descent and anismus. Given the cost of the examination it shouldbe reserved for female patients with prominent descent on clinical examination,post hysterectomy, or after failed pelvic floor surgery.

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C-168Virtual dissection: A new method to easily detect easily colonic polyps withmultidetector CTM. Cadi, O. Lucidarme, R. Chollet, S. Le Calvez, P. Grenier; Paris/FR

Learning Objectives: To describe a new approach to CT colonography for de-tecting colo-rectal polyps with multidetector row CT (MDCT). To display the re-sults and to present the benefits provided by this technique.Background: Virtual dissection‚ (GEMS) is an original application to display theentire inner surface of the colon without the need for navigation. The methodconsists of displaying the straightened and flattened colon using surface render-ing. We performed 30 virtual colonoscopies with a GE LightSpeed 16 MDCT. Theacquisition parameter and each step of the imaging procedure will be described.Procedure Details: All patients underwent CT colonography in both supine andprone positions, the following parameters were used: 120 kVp; 80–150 mAs; 2.5-mm collimation; 1.25-mm reconstruction intervals and rotation time, 0.5–0.75 sec.The colon was assimilated to a cylinder manually defined. Time to display thestraightened and flattened colon using surface rendering was about 5 minutes.Normal aspect, polyps and artifacts were displayed. Polyp detection was fasterand easier with this method compared to axial images and the usual virtual en-doscopy mode with forward and reverse viewing fly-through volume renderedmovies.Conclusion: This method makes it possible to stretch the colon virtually and tocut it along its axis similar to a real dissection on the pathologist's table. Theentire colon can then be inspected from above without the need for navigation.This technique for virtual dissection needs only a minimum of time of operatorinteraction.

C-169Incidence and morphology of cisterna chyli on heavily T2-weighted imagesA. Erden, S. Fitoz, B. Yagmurlu, I. Erden; Ankara/TR

Purpose: To determine the presence, size, configuration and location of the cis-terna chyli on MR cholangiopancreatography (MRCP) images obtained by usingsingle-shot fast spin-echo (SSFSE) sequence.Materials and Method: Image data of 125 consecutive patients (66 female and59 male; mean age 50.2 ± 1.3) who were referred for MRCP with a clinical suspi-

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cion of biliary or pancreatic disorders were re-evaluated for the demonstration ofthe cisterna chyli. Thin-collimation source images (TR: 30000-30000 msec, TE:850-970 msec, ETL: 25, bandwidth: 31.2 kHZ, FOV: 36-46 cm, matrix: 256 x 224- 256, NEX: 0.5, slice thickness: 3 mm) were postprocessed with a MIP (maxi-mum intensity projection) algorithm at the prespinal level and analyzed by threeradiologists. The presence, size, configuration and location of the cisterna chyliin relationship to the spine were noted. The discrepancies between the resultswere eliminated by consensus.Results: In 120 of 125 patients (96%), the cisterna chyli was identified as a dis-tinct structure. Mean ± SD diameters of the duct in longitudinal, anteroposteriorand transverse planes were 33.45 ± 1.74 mm, 5.23 ± 0.13 mm and5.23 ± 0.15 mm, respectively. Its appearence was polymorphic and the most com-mon configuration was noted as "tubular" (42.5%). It was located at the level ofL1-2 (33.3%) in 40 cases and at the midline in 84 of cases (67.2%).Conclusion: The cisterna chyli seems to be potentially present on most of theheavily T2-weighted images. The details regarding its morphology can easily bedemonstrated after reconstruction with MIP algorithm.

C-1703D-MRCP using TSE with restored pulse: Comparison between breath-holding and free breathing method with PACES. Hirohashi, P. Lerttumnongtum, S. Kitano, K. Ueda, N. Marugami, T. Taoka,K. Kichikawa; Nara/JP

Purpose: The purpose of this study is to clarify the clinical utility of 3D-MRCPusing the free-breathing turbo spin echo (TSE) with PACE by comparing with 3D-MRCP using breath-holding TSE.Materials and Methods: 29 patients (13 males and 16 females, average age 63)with suspected biliary or pancreatic abnormality. We performed both 3D-MRCPwith breath-holding and with free-breathing using a PACE technique on a 1.5 Tunit. The imaging parameters of 3D-MRCP with breath-holding is TSE with re-stored pulse (TR = 988-994 msec, TE = 454-457 msec, slab thickness = 48-60 mm, no. of partitions = 16-20, effective slice thickness = 3 mm). The imagingparameters of 3D-MRCP with free-breathing is TSE with restored pulse(TR = 1630 msec, TE = 635-650 msec, slab thickness = 60 mm, no. of partitions =60, effective slice thickness = 1 mm). We compared both 3D-MRCP images re-constructed by the workstation. The average total acquisition time of the breath-holding method is 28.5 seconds, and that of free-breathing method with PACE is6.3 minutes.Results: In all cases, 3D-MRCP image using the free-breathing method withPACE is superior to that using the breath-holding method. The difference is moredominant in patients who have difficulty in breath-holding. In the depiction of finestructures such as the cystic duct or branch ducts of the pancreas, 3D-MRCPusing free breathing with PACE is superior to that using the breath-holding method.Conclusion: 3D-MRCP using free breathing with PACE provides clear 3D-MRCPimages in all patients even if the patients experience difficulty breath-holding.The finer structure can be depicted by this method because isotropic voxel eval-uation can be conducted.

C-171MDCT evaluation with volumetric measurement of liver metastases pre- andpost-chemotherapy compared with bidimensional measurementM. Danti, C. Catalano, F. Fraioli, F. Venditti, V. Votta, P. Nardis, R. Passariello;Rome/IT

Purpose: To assess the accuracy of volumetric measurement of liver metastas-es with multidetector-row CT (MDCT) compared with bidimensional measure-ment to evaluate treatment response (pre- and post-chemotherapy).Materials and Methods: Thirty-five patients with liver metastases from colorec-tal cancer, underwent MDCT with the following parameters (Sl. Coll. 1 mm; sl. Th.1.25 mm) before treatment and 6 months later. Seventy-three metastases weredetected. Bidimensional and volumetric measurements were performed on adedicated workstation (Vitrea 3.2, Vital Images Inc) by three blinded radiologistsusing electronic callipers on axial images for bidimensional measurement and aspecific alghorithm for volumetric measurement. Based on MDCT images beforeand after chemotherapy, all lesions were divided into groups regarding therapeu-tic response.Results: In 67 metastases there was a perfect correlation between bidimesionaland volumetric measurement. In 4 lesions volumetric evaluation showed a de-crease in disease > 30% whilst bidimensional measurement categorized the le-sions as stable; in 2 metastases volumetric measurement showed an increase indisease while bidimensional evaluated disease as stable.Conclusion: Volumetric measurement is an appropriate technique to evaluate

treatment response in patients with liver metastases undergoing chemotherapy;moreover the spread of new dedicated workstations seems to have overcomelimits of inapplicability as clinical routine.

C-172Suspected bile duct leaks after laparoscopic cholecystectomy: Role ofmangafodipir-enhanced MR cholangiographyM. Aduna1, J. Larena1, D. Martin1, B. Martínez de Guereñu2, J. Alústiza3;1Bilbao/ES, 2Vitoria/ES, 3Donosti/ES

Purpose: The aim of our study was to assess the role of mangafodipir-enhancedMR cholangiography in the detection and location of bile duct leaks post laparo-scopic cholecystectomy.Methods and Materials: 29 patients with clinical suspicion of bile duct leak afterlaparoscopic cholecystectomy were included. All studies were performed on a1.5 T (Magnetom Symphony) or a 1 T (Magnetom Expert) scanner. Our protocolincluded an axial and coronal FS GRE 3D T

1 after IV bolus injection of mangafo-

dipir trisodium. The contrast-enhanced MR cholangiograms were evaluated forthe presence and location of bile duct leaks. Correlation was obtained in all cas-es with surgery (12), ERCP (5), percutaneous drainage (4) and clinical follow-up(8).Results: In 16/29 cases bile duct leakage was proved by surgery, ERCP or drain-age means. Contrast-enhanced MRCP depicted the leakage in 15/16 and ruledout leaks in all 13 cases (sensitivity: 93.75%; specificity: 100%; PPV: 100%; NPV:92.85%). The leak site was depicted in 8 patients and arose from: main bile duct(4), cystic duct remnant (1), right variant segmental branch (1) and Luschka duct(2). CE-MRCP succesfully revealed the origin of the leak in 7 patients.Conclusion: Contrast enhanced MR cholangiography with IV mangafodipir triso-dium can accurately diagnose the presence and location of bile duct leaks inpatients who have undergone laparoscopic cholecystectomy.

C-173Internal hernia of the anterior part of the abdomen: Imaging in the multi-detector-row CT eraN. Hongo, H. Mori, S. Matsumoto, Y. Okino, A. Adachi, A. Kaku; Oita/JP

Purpose: Internal hernia of the anterior part of the abdomen (IHAPA) is difficultto diagnose preoperatively because of its rarity and lack of imaging landmarks.The purpose of this study is to clarify the CT features of IHAPA by CT, especiallywith multi-detector row CT (MDCT).Methods and Materials: The CT scans in 8 patients with surgically confirmedIHAPA through a transverse mesoclolon (n = 4) or an omentum (n = 4) were ret-rospectively reviewed; furthermore, the transverse mesocolic type was classifiedinto intramesenteric type (n = 2) and transmesenteric type (n = 2). Special atten-tion was paid to the herniated sac-like appearance, hernial orifice, running courseof the omental fat and transverse colon.Results: The closed loop of the small bowel was observed in all cases. A sac-likeappearance, enclosed by transverse colon was identified in both cases with in-tramesenteric type, but was not observed in other types of IHAPA. Fatty continu-ation between the hernial orifice and omentum was identified in two out of fourcases with omental type of IHAPA. Furthermore, the transverse colon passedabove to the hernial orifice in all cases with omental type, while this finding wasnot observed in any of the transverse mesocolic type.Conclusion: The relationship between the hernial orifice and transverse colon,and sac-like appearance enclosed by transverse colon are the diagnostic key ofIHAPA on CT. Particularly, MDCT would become feasible to diagnose the IHAPApreoperatively, even though it lacks of vascular landmarks.

C-174Contrast enhanced MRI using oral PEG solution in the follow-up of patientswith known Crohn's diseaseM. Scettro, A. Grasso, F. Monetti, G. Rescinito, G. Rollandi, C. Neumaier;Genoa/IT

Purpose: Aim of our study was to analyze, in the context of an extensive evalu-ation, Crohn's disease activity index (CDAI), and conventional enteroclysis, thevalue of MRI to identify disease extension and complications in patients withknown disease.Material and Methods: Abdominal MRI of 29 patients in a period of 12 monthswith a diagnosis of Crohn's disease were analyzed by two experienced gastroin-testinal radiologists, in consensus, looking for any intestinal and extra-intestinalabnormality. MRI studies were performed on a 1.5 T (Intera NT, Philips) with aphased array coil. MRI was performed using a polyethylene glycol (PEG) solution

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as oral contrast agent to distend the small bowel (CE-PEG-MRI), using standardsequences (SS-TSE T2 and TFE T1 with fat saturation after Gd-DTPA and Busco-pan 10 mg i.v.).Results: MR imaging had an overall sensitivity of 98% and a specificity of 93%for active disease. Bowel wall enhancement (ratio of signal intensity of abnormalto normal bowel > 1.3:1), bowel wall thickening greater than 3/4 mm and increasedmesenteric vascularity were useful in identifying active disease.Conclusion: The experience shows that the method is complementary to con-ventional enteroclysis in the detection of superficial and transmural abnormalitiesin patients with Crohn's disease. In addition, CE-PEG-MRI can provide excellentinformation concerning mesenteric involvement, disease activity, and complica-tions of Crohn's disease. Finally MRI may become a gold standard in the identifi-cation of recurrant disease.

C-175withdrawn by authors

C-176Reduction of ionising radiation exposure to patients due to new imagingtechnology for medical diagnostics of the gastrointestinal tract: Aretrospective study covering 20 years in a Norwegian referral hospitalA. Nyquist1, G. Saxebøl2, H. Olerud2, B. Bjørnarå1, T. Gudmundsen1;1Drammen/NO, 2Oslo/NO

Purpose: To examine possible changes in ionising radiation doses to patients(collective effective dose) undergoing diagnostic imaging procedures of the gas-trointestinal tract over the last 20 years in view of shift in modalities from X-raybased examination to endoscopy, ultrasonography (US) and magnetic resonanceimaging (MRI).Methods and Materials: Retrospective study of patient files for the period from1983 to 2002. The main groups were oesophagus, stomach, small bowel, largebowel, and biliary tract: Barium studies, endoscopies, US, CT, and MRI. For eachtype of X-ray based examinations, including the necessity for fluoroscopy duringendoscopies, the mean effective radiation dose was obtained from the Norwe-gian Radiation Protection Authority (NRPA) as published in 1997.Results: The number of X-ray based examinations (using a contrast medium) ofthe oesophagus, stomach, and large bowel, decreased by 34%, 94% and 80%,respectively. X-ray based examination of the small bowel and plain radiographyof the abdomen remained unchanged. Endoscopies of oesophagus / stomachand the large bowel increased by nearly 350%. X-ray based examination of thebiliary tract almost disappeared with US, ERCP and MRCP taking over. The an-nual collective effective dose for the all GI tract examinations was reduced by61%, from 18.4 manSv in 1983 to 7.1 manSv in 2002.Conclusion: The shift in modalities used for diagnostic imaging of the gastroin-testinal tract from X-ray examination to US, endoscopies and MRI resulted in asignificant reduction in exposure to ionising radiation of patient, and need to beconsidered when discussing further development and structure of diagnostic im-aging in general.

C-177Perfusional enhanced ultrasound in the diagnostic evaluation of SiccasyndromeG. Argalia, D. Salera, G. Giuseppetti; Ancona/IT

Purpose: Sicca syndrome is a relatively common disorder especially among old-er women. It may be caused by an autoimmune disorder like Sjogren's syndrome(SS) or by several other illnesses. Our purpose is to evaluate the diagnostic pos-sibilities of contrast enhanced ultrasound in the characterization of sicca syn-drome.Methods and Materials: We studied 60 consecutive patients with sicca syn-drome, 40 affected by SS (23 with primary Sjogren's syndrome, 17 with second-ary Sjogren's syndrome due to connetivitis) and 20 patients with a sicca syndromenot related to SS. All patients were selected according to the European Commu-nity Study Group diagnostic criteria for Sjogren's syndrome (the gold-standard ofthe study) and underwent contrast enhanced ultrasound examination with time-intensity curve analysis obtained before and during saliva stimulus, salivary glandsscintigraphy and labial gland biopsy.Results: 40 SS patients had an echo contrast enhancement before and duringsaliva stimulus significantly lower (p < 0.001) than the non SS ones. The 23 pa-tients with primary SS showed a significantly lower enhancement during salivastimulus than the secondary SS patients (p < 0.005); no statistically differentenhancement was seen in basic conditions (p = 0.069).In the study group (60 subjects with sicca syndrome) the enhanced ultrasound

showed a sensitivity of 87.5%, a specificity of 85% and an accuracy of 86.7% onthe diagnosis of SS. Our experience confirmed the good diagnostic accuracy ofsalivary glands scintigraphy and labial biopsy.Conclusion: The preliminary results show this method is useful in the functionalstudy of parotid glands in the characterization of sicca syndrome.

C-178Fusion imaging of 3D angiographies of arteries and veins around thestomach by multiphase fusion technique under a single-breath hold using16 row multidetector row CT: Its usefulness for preoperative simulation andintraoperative navigation of laparoscopy-assisted gastrectomyM. Matsuki, H. Kani, I. Narabayashi; Takatsuki/JP

Purpose: Gastric arteries and veins can vary between patients; therefore, it re-quires much time to ligate arteries, and veins can be damaged during regionallymph node excision under laparoscopy-assisted gastrectomy (LAG). We evalu-ate the efficacy of fusion imaging of three-dimensional angiographies of arteriesand veins around the stomach by the multiphase fusion technique under single-breath hold using 16 row multidetector row CT (MDCT) in the preoperative simu-lation and intraoperative navigation of LAG.Methods and Materials: Contrast-enhanced CT scan using 16 DAS MDCT wasperformed on 10 patients before LAG. Images at both arterial and venous phaseswere obtained under a single-breath hold. Three-dimensional CT angiographiesat the arterial and venous phases were reconstructed using the volume-render-ing technique and then fused. 1) The detectability of the left gastric artery (LGA),right gastric artery (RGA), left gastric coronary vein (LCV), right gastric vein (RGV)and Helens' gastrocolic trunk (GCT) on the multiphase fusion images was evalu-ated in comparison with the surgical findings. 2) In intraoperative navigation, theclinical usefulness of multiphase fusion imaging was evaluated.Results: 1. In nine of ten patients (90%), the multiphase fusion images coulddemonstrate clearly, simultaneously and three-dimensionally the LGA, RGA, LCVand GCT without a respiratory gap. 2. We could arrange and rotate a multiphasefusion image to correspond to the operative view, which was very useful in theintraoperative navigation of LAG.Conclusion: The multiphase fusion imaging is considered to be very useful inthe preoperative simulation and intraoperative navigation of LAG.

C-179Three-dimensional endosonographic guidance of needle positioning ininterstitial brachytherapyA.F. Christensen, M.B. Nielsen, S.A. Engelholm; Copenhagen/DK

Interstitial brachytherapy is used in the treatment of anal carcinoma, so far with-out image guidance during needle positioning.The aim of the study was to de-scribe a procedure for optimizing needle positioning guided by three-dimensional(3-D) endosonography.Twelve patients who received external radiation therapy for anal carcinoma werereferred for interstitial brachytherapy under 3-D endosonographic guidance. Theprocedure was initiated by anal endosonography performed with a 10 MHz rotat-ing endoprobe. Cross-sectional images of the anal sphincters were stored on a3-D system during retraction of the endoprobe. Afterwards, any projection couldbe reconstructed. From this scanning the optimal positioning of the needles wasdetermined. The needles containing radioactive isotopes were inserted throughholes in an externally fixated disc. Repeated endosonography assured that opti-mal tumor coverage was obtained by adjusting the number, loading or position ofthe needles.In all patients endosonography was able to visualize the extent of the tumor andthe position of each needle so that both the distance from needle tip to uppertumor border, as well as the distance from the anal orifice to the lower tumorborder could be determined.In 8 patients endosonography showed a, at least 2 clock-positions larger circum-ferential tumor size than manual examination. This made an increase in numberof needles necessary. In 5 patients endosonography influenced the extent of load-ing of the needles. In 2 patients endosonography led to a change in positioning ofthe needles.3-D endosonography guidance of interstitial brachytherapy in anal carcinomaseems possible, which may influence the radiation coverage.

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C-180CT diagnosis of interstitial hernias of the anterior abdominal wallN. Silland, M.-C. Julles, I. Boulay, C. Sadoudi, M. Zins; Paris/FR

Purpose: 1. To describe CT findings of interstitial hernias which form a group ofvery unusual hernias which are located between the different muscle layers ofthe abdominal wall and include: a) spigelian hernias and b) interparietal inguinalhernias. 2. To determine CT criteria that allows accurate classification of intersti-tial hernias.Methods and Materials: CT scans of 13 patients with surgically proved spige-lian hernia (n = 7) or interparietal inguinal hernia (n = 6) have been retrospec-tively reviewed. CT assessment included: 1) Assessment of the hernial sac(anatomic situation, extension, content) and 2) assessment of the fascial defect(anatomic situation, relationship to the inferior epigastric vessels).Results: In all cases (n = 13), the hernial sac was located between the internaland external oblique muscles. The fascial defect was located at the spigelianaponeurosis, above the inferior epigastric vessels in the seven cases of spigelianhernia, and at the internal inguinal ring, lateral to the inferior epigastric vessels inthe six cases of interparietal inguinal hernia.Conclusion: Assessing only the hernial sac does not allow accurate classifica-tion of interstitial hernias. Diagnosis is established by precise analysis of theanatomic situation of the fascial defect.

C-181The role of magnetic resonance cholangiography in patients with biliary-enteric anastomosisY.A. Akhmetov; Almaty/KZ

Purpose: The study was aimed at investigating the role of MR-cholangiography(MRC) in the examination of patients treated with biliary-enteric anastomosis.Methods and Materials: MRC was performed in 23 patients (13 female and10male, mean age: 59.9 years) undergoing biliary-enteric anastomoses (18 hepati-co-jejunostomies and 5 choledocho-duodenostomies). MRC was performed witha non-breath-hold 3D turbo spin echo sequence (TR = 5000 msec, TE = 700 msec,ETL = 128) with an acquisition time from 4 min to 6 min. 11 patients subsequent-ly underwent percutaneous transhepatic cholangiography (PTC) in order to con-firm the MRC findings and to perform a therapeutical procedure. 4 patients withcholedochoduodenostomy were examined with ERCP. The remaining 8 patients,with no evident symptoms or signs of bile duct dilation, were examined duringtheir surgical follow-up without the performance of any invasive procedure.Results: The degree of bile duct dilation was correctly evaluated with good pan-omaric assessment of the ducts and site of anastomosis in all 23 patients. Bothdilated and non-dilated bile ducts were well depicted. MRC correctly showed ste-nosis of anastomosis in 10 of 10 patients, 5-18 mm stones in 9 of 9 patients andbile ducts irregularities in 3 of 5 patients with cholangitis.Conclusion: MRC is a safe, noninvasive technique in the study of biliary-entericanastomoses and can be used to the screening of symptomatic patients. MRCPimages may serve as a guide for planning of interventional procedures.

C-182Cystic duct imaging using both magnetic resonance cholangiography(MRC) and 3D contrast-enhanced magnetic resonance cholangiography(CEMRC) for laparoscopic cholecystectomyH. Mutlu, E. Silit, Z.M. Pekkafali, E. Ozturk, C.C. Basekim, E. Kizilkaya;Istanbul/TR

Purpose: In this study, we determined if mangafodipir trisodium (Mn-DPDP)-enhanced MRC improve visualization of the the cystic duct compared to unen-hanced MRC.Materials and Methods: Twenty-four patients (twenty-one female and three malepatients) age range 21-91 (mean 57.9) underwent MRC and CEMRC before lapar-oscopic cholecystectomy. Patients with bile duct obstruction were excluded fromstudy. All patients were imaged using both routine MRC sequences (axial, coro-nal, half-Fourier acquisition single shot turbo spin-echo images and oblique coronalheavily T2-weighted turbo spin-echo images) and CEMRC axial and coronal vol-umetric 3D spoiled gradient-echo acquisitions. The imaging findings were ana-lyzed by two separate MR experienced radiologists. Both MR imaging techniqueswere analyzed with the chi-square test.Results: The cystic duct was evaluated with both techniques. Routine MRC re-vealed cystic ducts in 9 patients (37%) and CEMRC in 16 patients (66%). Thecystic ducts were not visualized due to impaired liver function (in two patients)and duodenal superposition (in four patients).Conclusion: CEMRC is superior to routine MRC in revealing of the cystic duct

anatomy and preoperative information may increase the safety of laparoscopiccholecystectomy.

C-183Abdominal wall hernia: A pictorial review of imaging findingsE. Girela, A. Moreno, M.A. Corral, E. Parlorio, M.A. Chans; Murcia/ES

Purpose: To pictorially show our experience in diagnosing, and evaluating ab-dominal wall hernias (AWH) by means of US and CT. To review the radiologicalanatomy, highlighting those details that are a clue for diagnosis. To show imagesof the different types of hernia and conditions that may simulate it.Methods: We have selected 87 patients with proven AWH that had previouslyundergone US or CT.Results: 116 hernia were diagnosed in 87 patients: 49 indirect inguinal, 17 directinguinal, 11 femoral, 17 Spigelian, 12 eventrations, 6 umbilical, 2 lumbar, 1 epi-gastric, 1 obturator. The radiological examination was performed, in a descend-ing order of frequency, for: Clinical suspicion of AWH, mass, intestinal occlusion,trauma, non-specific discomfort, acute scrotum, other causes. We initially per-formed US with provocation manoeuvres (Valsalva, standing up). CT was per-formed in doubtful cases on US, in very obese patients and in severe trauma. CTled more frequently than US to an incidental diagnosis of hernia. Most relevantshown cases are: acute appendicitis in scrotal hernia (Amyand hernia), inguinalcystocele with lithiasis and a papilloma in the orthotopic bladder, obturator herniabetween external obturator muscle fascicles and Spigelian hernia with bowelperforation secondary to trauma. As examples of conditions that may simulatehernia we show: Enlarged lymph nodes, wall hematoma, Nuck cyst, spermaticcord sarcoma and wall lipoma.Conclusion: US and CT are valuable modalities for the study of AWH. They canoffer additional, information, relevant for the surgeon and allow the diagnosis ofother entities that might simulate a hernia.

C-184Frequency of visualization and shape of the non-symptomatic appendix atmulti-detector row helical CT only using intravenous contrast materialM. Tsuboi, K. Takase, T. Ishibashi; Sendai/JP

Purpose: To evaluate the frequency of visualization and shape of the normalappendix at multi-detector row helical CT only using intravenous contrast material.Methods and Materials: We conducted a retrospective study of abdominal CTscans obtained between September 2002 and September 2003 in 100 patientswho did not have acute appendicitis. These patients were randomly chosen forreview. We assessed frequency of visualization, maximal diameter, maximal muralthickness, position and length.Results: The prevalence of appendectomy was 12% (12/100). Sensitivity, specif-icity and accuracy of visualization of normal appendix were 86% (76/88), 100%(12/12), 88% (88/100), respectively.The mean of maximal diameter, maximal mural thickness, and length, were5.12 mm (2.6-7.7 mm), 2.25 mm (1.4-3.3 mm) and 71.7 mm (24-127 mm), respec-tively.Conclusion: Multi-detector row CT with intravenous contrast material is a highlyaccurate technique for detecting the vermiform appendix.

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Biopsy

C-185Percutaneous core-biopsy of non-palpable breast lesions: Indications forconventional upright stereotactic and ultrasound guided proceduresC. Doumitriou, A. Papatheodorou, D. Tosonidou, F. Takis, D. Tsavoulis,K. Tsikos, N. Batakis; Athens/GR

Learning Objectives: To describe the indications and diagnostic limits of eachprocedure, to present the steps taken to perform each procedure as well as thepossible complications, and potential pitfalls.Background: The early diagnosis of breast cancer is a challenge in breast imag-ing work-up. To detect malignancy in non-palpable breast lesions without unnec-essary open biopsies, percutaneous biopsy of the suspect lesion should beundertaken. Percutaneous breast biopsy can be performed under sonographicor X-ray guidance. Whatever method is used, certain principles apply.Exhibit Details: The exhibit will be divided into subsections focusing on the indi-cations and diagnostic limits of each procedure, the necessary equipment foreach method and the steps taken to perform each procedure through samplecases. We will focus on practical issues such as needle size, site of entry, numberof tissue probes that we need to take according to the lesion type. Also the avoid-ance of complications, and other useful tips will be presented. A special refer-ence will be made to the histological findings that require surgical excision andthe potential pitfalls in case of false negative samples. We will also present ashort time follow-up diagram for the histologically confirmed benign lesions.Conclusions: Whenever a non-palpable breast lesion is considered for biopsy,either X-ray or ultrasound guided procedures are performed. Each method hasits indications, advantages and disadvantages, and the examiner should be fa-miliar with those factors for proper procedure selection.

C-186The use of carbon marking after stereotactic 11-gauge vacuum-assistedbreast biopsy and during advanced breast biopsy instrumentation system(A.B.B.I.)J.A. López-Ruiz1, I. Basarrate2, I. Zabalza1, J. Mieza2, J.J. Echevarría1;1Galdakao/ES, 2Bilbao/ES

Purpose: We present the use of activated charcoal to mark the biopsy site andneedle track after stereotactic 11-G Vacuum-Assisted Breast Biopsy, and duringA.B.B.I./SiteSelect excision, in order to show the advantages of carbon markingin such breast interventional procedures.Materials and Methods: We are performed 611 stereotactic 11-G Vacuum-As-sisted Breast biopsies (Mammotome) and 16 A.B.B.I./SiteSelect procedures. Inevery case, after 11-G Vacuum-Assisted biopsy we mark the biopsy site andneedle track through the anterior reception-samples camera (1-2 mL of charcoalsuspension) before and during withdrawal of the needle. In A.B.B.I. and SiteSe-lect procedures, before the action of rotating distal circular blade, we mark aparallel-guide wire track by means of a spinal needle inserted inside the circun-ference of skin-cut surface. The needle is conected to a syringe with 0.5-1 mL ofcharcoal suspension.Results: Marking eliminated the need for postprocedural hook-wire needle pre-operative localization (if necessary) after 11-G Vacuum-Assisted Breast Biopsy.The biopsy site and needle track are identified by surgeons and pathologists. InA.B.B.I. /SiteSelect procedures, the marking allows a good correlation betweenthe orientation of sample, before (inside the breast) and after excision. So, if asurgical procedure is necessary after, the surgeon will know the precise site foraditional excision.Conclusion: The 4% charcoal suspension is safe and effective for marking thebiopsy site and needle track, after stereotactic 11-G Vacuum-Assisted BreastBiopsy, and for marking the sample of A.B.B.I. / SiteSelect procedures, beforethe excision.

C-187False negative (FN) results after needle core biopsiesL. Pina, R. Gil Marculeta, O. Cosin Sales, M. Pons Renedo, P. Domínguez,J. Noguera; Pamplona/ES

Purpose: To show our experience with false-negative (FN) results after needlecore biopsies.Materials and Methods: Prospective study. From July-1998 to March 2000, 546core biopsies were performed (313 with Tru-cut and 233 with vacuum-assisteddevices), finding 183 carcinomas. Non malignant lesions after core biopsies that

proved to be malignant in further surgery or follow-up, were considered as FN.Results: Eleven cases were considered FN (6%). A) Four cases were found after14-G core biopsies: two architectural distorsions initially diagnosed as radial scarsproved to be malignant after surgery, and one case of microcalcifications, firstdiagnosed as adenosis, underwent 6 month follow-up corresponding to a ductalcarcinoma in situ. Also a ductal carcinoma in situ was found inside a fibroadeno-ma (first diagnosed as fibroadenoma). B) Also seven cases were found after vac-uum-assisted biopsies, all of them microcalcifications that were confirmed in theradiograph of the specimen: five cases were initially diagnosed as atipical ductalhyperplasia and corresponded to four ductal carcinomas in situ, and one infiltrat-ing ductal carcinoma; the remaining two cases were first reported as ductal ecta-sia and interstitial microcalcifications, becoming two ductal carcinomas in situ(one of them was diagnosed 12 months later after core biopsy). The averagediameter of the lesion was 31.5 mm. None of the lesions were removed com-pletely.Conclusion: Results such as radial scar, atypical ductal hyperplasia, interstitialmicrocalcifications and ductal ectasia may occult a carcinoma after needle corebiopsies.

C-188The percutaneous triple sample (FNAC, core biopsy, and cylinder smears) inbreast cancer diagnosis: Results in 77 patientsI. Vizcaino, V. Torres, S. Picó, E. Blanc, C. Soto, S. Isarria; Valencia/ES

Purpose: To evaluate a combined method to sample tumoral tissue in breastcancer.Materials and Methods: A prospective study using at the same time FNAC, corebiopsy and cylinder smears was performed in 77 patients. We used a 25 G nee-dle (1-2 passes) and a thin-wall 16 G needle (2-5 cylinders, 1 mm/1 cm sized).Smears of core biopsy cylinders were systematically prepared to cytological ex-amination. The lesions were targeted using palpation, ultrasound, coordinatesplate, and a stereotactic device depending on the lesion. All patients had breastcancer. The results were evaluated regarding the sensitivity to breast cancer di-agnosis.Results: The overall sensitivity of three-way diagnosis was 99% (the false nega-tive case was a non-palpable DCIS that showed necrosis in cylinder and no tu-moral cells in both, FNAC and cylinder smears). The sensitivity of FNAC was thesame as core biopsy: 86%. The sensitivity of cylinder smears was 95%. Benigntissue in cylinders with malignant cells in cylinders smears was seen in 7 cases(2 DCIS, 1 necrotic medullar carcinoma, 1 intracystic carcinoma and 3 IDC). Fi-brous tissue was found in the cylinders of these 7 cases.Conclusion: The combination of FNAC, core biopsy and cylinder smears show ahigh sensitivity to breast cancer diagnosis. Cylinder smears must be obtainedsystematically in core biopsy in order to prevent the false negative results. Weakcohesion of tumoral cells can explain this phenomenon.

C-189Verification of clusters of breast microcalcifications without accompanyingmass in stereotactic mammotome biopsyR. Chrzan, T.J. Popiela, W. Nowak, A. Urbanik; Krakow/PL

Purpose: The aim of this study was to determine the usefulness of stereotacticmammotome biopsy (SMB) under the guidance of digital mammography in veri-fication of clusters of breast microcalcifications BI-RADS 3-5 categories withoutaccompanying mass.Materials and Methods: Material included 102 women (age range 37-78 years)with clusters of breast microcalcifications of BI-RADS category 3-5, without ac-companying mass. In every patient conventional mammography and digital mam-mography of cluster of microcalcifications were performed. In all womensubsequent SMB was ordered. This procedure was performed in 95 patients. In 7patients performing of SMB was not possible and in these patients surgical biop-sy was performed.Results: In 95 women with SMB performed, pathological examination proved thepresence of: only benign lesions in 85 women, an atypical lesion in 1 woman,malignant lesions in 9 women. In 7 women with malignant lesions, cancer wasdiagnosed in preinvasive stage. Most (98.7%) clusters of microcalcifications, clas-sified as BI-RADS 3 corresponded to benign lesions. BI-RADS 4 group lesionswere benign in 58.3%, atypical in 8.3%, malignant in 33.3%. In BI-RADS 5 group,in all cases malignant lesions were found.Conclusion: It was found, that SMB can be used as a safe and reliable methodof verification of the nature of clusters of breast microcalcifications without ac-companying mass in all cases of BI-RADS 4 and 5 categories and in selectedcases of BI-RADS 3 category. SMB enables avoiding surgery in a considerablenumber of patients with microcalcifications of BI-RADS 4 category.

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Digital mammography

C-190Is digital mammography useful for the follow-up of patients with previousconservative treatment for breast cancer?C. Balleyguier, M. Razgallah, A. Athanassiou, C. Dromain, H. Marsiglia,R. Sigal; Villejuif/FR

Purpose: Mammographic follow-up of patients after conservative treatment forbreast cancer by screen-film mammography is difficult and sometimes impossi-ble due to the post-radiation and surgical changes. Digital mammography (DM),with post-processing tools, might facilitate the reading.The purpose of this presentation is to evaluate the accuracy of DM and to de-scribe the post-therapeutic changes in these patients.Materials and Methods: DM (Senograph 2000D, GEMS®) was performed in 77patients 3 and 6 months after conservative treatment (surgery and radiotherapy)for breast cancer. Mammograms were indepedently read by two senior radiolo-gists. Both radiologists performed screen-reading, using commercially availablepost processing tools (magnification, zoom, contrast inversion, thickness com-pensation). They evaluated the overall image quality. The following features werealso analysed: breast density (according to BIRADS classification), skin thicken-ing, parenchymal changes with glandular oedema (4 grades), scar and microcal-cifications.Results: All DM were considered as of diagnostic quality by both radiologists.Importance of glandular oedema was correlated to breast density (BIRADS 4,n = 16; oedema 4, n = 14), (BIRADS 3, n = 41; oedema 3, n = 48). Analysis ofskin and dermal thickness was facilitated by the algorithm of thickness compen-sation. Visibility of scars (n = 54) and microcalcifications (BIRADS 2, n = 21; BI-RADS 3-4-5, n = 6) was improved by digital magnification and digital contrastvariations.Conclusion: Digital mammography due to the post processing tools seems tofacilitate dramatically reading of mammography in patients with previous con-servative treatment for breast cancer, and helps to delineate post-therapeuticchanges.

C-191The experimental study of average glandular dose and digital contrast withCR mammography systemE. Ishida, T. Sanada, K. Ishihara; Ube/JP

Purpose: We researched the average glandular dose and digital contrast usingthe EPIO with Mo target /Mo filter (Mo/Mo) and Mo target /Rh filter (Mo/Rh) andFuji CR system.Materials and Methods: The contrast images were taken of the BR12 phantomwith a 1 cm thick acrylic phantom (2×2 cm2) which was on the top of it. The topslab which is 1 cm in thickness was moved 2 cm forward against lower slabs.Total thickness of the BR12 phantom was varied 2 cm, 4 cm, 6 cm and8 cm.Incident beam qualities were altered with target filter combination and ap-plied tube voltage. Tube voltages were varied between 26 kV and 32 kV with Mo/Mo and between 28 kV and 34 kV with Mo/Rh. Exposures (mAs) were deter-mined with an incorporated auto exposure control unit. The average glandulardose for various beam qualities were calculated using the exposure-to-averageglandular dose conversion factors.Results: In 2 cm phantom, Mo/Mo has better contrast than Mo/Rh and dose wasnot affected by varying filter and X-ray tube voltage.In 4 cm phantom, contrast of Mo/Mo with over 30 kV and one of Mo/Rh with28 kV and 30 kV were about the same contrast but dose was decreased about12~20% with Mo/Rh. We found it better using Mo/Rh than using Mo/Mo with over30 kV.In 6 cm, 8 cm phantom, Mo/Mo needed a large dose and resulted in alower contrast by increasing X-ray tube voltage than Mo/Rh.

C-192Image quality of commercially available digital mammography systemscompared by contrast-detail analysisT.D. Geertse, R.E. van Engen, L.J. Oostveen, R. Visser, M.A.O. Thijssen;Nijmegen/NL

Purpose: To compare image quality of commercially available digital mammog-raphy systems (including Fuji FCR 5000 MA, GE Senographe 2000D, Lorad Se-lenia.).Materials and Methods: Image quality has been quantified using contrast-detail

analysis (CDMAM 3.4 phantom): threshold contrast versus object diameter. Im-ages (8 per case) have been produced at different exposure settings, differentsimulated breast thicknesses, identical glandular dose: 1.1, 1.8 and 2.2 mGy forrespectively 3, 5 and 7 cm PMMA (representative for clinical practice). A compu-ter program has evaluated the images. The calculated curves are compared.Results: For 3 cm PMMA, the curves of all systems seem to be fairly compara-ble. For 5 cm PMMA, the threshold contrast seems to be slightly higher (lowerquality) for the Fuji FCR 5000MA at smaller discs and slightly lower (higher qual-ity) for the Lorad Selenia for larger discs. For 7 cm PMMA contrast-detail visibilityappeared to be largely dependent on spectrum used. Using Mo/Mo or Mo/Rhtarget-filter, contrast-detail visibility of the GE Senographe 2000D and the LoradSelenia are fairly comparable. However, contrast-detail visibility is better usingMo/Rh. The GE Senographe 2000D also incorporates Rh/Rh, which improvescontrast-detail visibility further. Results for other digital systems will be presentedat ECR 2004.Conclusions: It appears that the achievable image quality of a system not onlydepends on detector characteristics but also on available combinations of target,filter and tube voltage. Therefore image quality comparisons show different re-sults using optimized spectra for each digital system, compared to using the samespectrum for all systems.

C-193Determination of imaging performance of a digital mammographyM. Takamura, E. Tsuboi, M. Ogawa, R. Suzuki, A. Chihara, A. Horii, M. Shima,Y. Machida, Y. Kodera; Nagoya/JP

Purpose: The method of calculating DQE of a general digital imaging system isproposed by IEC and it is coming to the stage of final draft. However, in digitalmammography, nothing is decided yet.This study examines the evaluation meth-od for image quality of a digital mammography with clinical equipment throughphysical evaluation of the mammographic comuputed radiology (CR) systemsunder clinical conditions.Materials and Methods: We used two CR systems. One consisted of a singleplate image reader (FCR 5000MA, Fuji), which includes dual-side reading and50-micron pixels. Other consisted of a single plate image reader (FCR 5000H,Fuji), which includes single-side reading and 100-micron pixels. Digital charac-teristic curves, pre-sampling MTFs and digital Wiener spectra were measured asindices of image quality. Pre-sampling MTFs were measured from slit and edgeimages at 28 kV. Digital Wiener spectra were measured at 28 kV with breast equiv-alent filter.Results: Pre-sampling MTFs with both readings were almost the same. DigitalWiener spectra with dual side reading were superior to those with single sidereading. NEQ of CR system with dual side reading was superior to that withsingle side reading because of the good efficiency of light condensing.Conclusion: New mammographic CR systems with dual side readings shouldbe a further powerful tool for detecting low-contrast lesions in the breast. Wienerspectra need to determine exposure conditions, in order to perform comparisonbetween institutions, since it is strongly influenced by beam quality and dose.

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Magnetic resonance

C-194Isotropic high-resolution (1-mm3) MR dynamic imaging and single-voxelproton spectroscopy of the breast: An effective way to present morphology,dynamics, and metabolism of breast lesionsA. Fausto, A. Iozzelli, F. Sardanelli; Milan/IT

Learning Objectives: To show a short way to present breast MR dynamic imag-ing obtained using 1-mm3 isotropic 3D acquisition and single-voxel proton spec-troscopy.Background: During a standard breast MR exam, including a precontrast short-tau inversion recovery (STIR) or fast spin-echo T2-weighted fat-sat and a dynam-ic Gd-enhanced 3D sequence, at least 700 native and subtracted images areproduced. Moreover, maximum intensity projections (MIPs) of a subtracted phaseand dynamic curves must be shown. If performed, proton spectra could be givenwith localizing images, too.Procedure Details: Seventy breast MR exams were performed at our Depart-ment as follows: 40-slice axial STIR; 128 T1-weighted 3D gradient-echo coronal1-mm partitions (384 x 192-mm field-of-view; 384 x 192 matrix; 1-mm3 voxel) with0.1 mmol/kg Gd-chelate and 120-s time resolution (4 postcontrast phases), giv-ing 680 native and 512 subtracted for a total of 1192 images; single-voxel spin-echo (TE 135 ms) proton spectroscopy. We present firstly an axial MIP of the firstsubtracted sequence similar to cranio-caudal X-ray mammography (XM) views,two lateral MIPs similar to lateral 90 degrees XM views, and a coronal MIP. Then,only selected images are presented: STIR, precontrast T1-weighted, and post-contrast subtracted images (morphology); percent enhancement-to-time curvesfor regions of interest (dynamics); proton spectra with/without choline peak at3.14-3.34 ppm and lipids peaks (metabolism). Representative cases will be shownin correlation XM, ultrasound, and pathologic proof.Conclusion: Breast MR high-resolution imaging and proton spectroscopy canbe effectively summarized in no more than 24 images (2 x 16-in-one films), 2% ofthe acquired/subtracted 1192 images.

C-195MR guided interventional procedures in breast pathology managementI. Herraiz, L. Concepción, J. Ballesteros, A. Fernández-Moscoso, J. Gallego,M. García-Franco; Alicante/ES; presented by S. Lopez-Celanda; Alicante/ES

Learning Objectives: To descibe MRI-guided core biopsy of MRI-suspected le-sion, hook wire placement or clip marking for excisional biopsy of non-palpable,MRI-only visualized lesions.Procedure Details: All procedures were performed on a 1.5 T Philips GyroscanIntera Unit. Standard CE breast MRI imaging protocol included a dynamic volu-metric T1-weighted acquisition prior and after Gd-DTPA injection employing abilateral surface coil. Localization was achieved either by employing a stereotaticdevice or by triangulation methodology with external markers with a flexible uni-lateral surface coil. Imaging acquisition was tailored to each case. Titanium clips(INRAD®) or nitinol (SOMATEX®). 15 G Titanium coaxial needles (SOMATEX®)and 16 G automatic biopsy gun were employed (TSK ACECUT®,). Our seriesincludes 44 patients with 56 MRI suspected lesions. Reevaluation of them withconventional methods (mammography and sonography) allowed location of halfof them resulting finally in a total of 36 MRI-guided interventional procedures.This includes 20 MRI-guided core biopsies in lesions measuring 5-12 mm, 9 MRI-guided presurgical hook wire localization and 7 clip placements to assist locationof a MRI visible single lesion. Pathologic evaluation resulted in 10 cases of infil-trative ductal carcinoma and 18 benign lesions. The only biopsy false negativeresult was in the smallest lesion (5 mm).Conclusions: All MRI-suspected lesions must be reevaluated by conventionalmethods.In MRI-only visible lesions we favor clip marking or hook wire location if size issmaller than 7 mm. In lesions highly suspicious for malignancy additional clipmarking during core biopsy procedure is recommended.

C-196When is dynamic breast MR imaging really a problem-solving technique inclinical practice?F. Sardanelli, A. Fausto, A. Iozzelli, B. Babaei, P. Panizza, A. Del Maschio;Milan/IT

Learning Objectives: To review old and new indications to dynamic breast MRimaging.Background: Dynamic breast MR is a high-cost technique with a sensitivity of95% for invasive and 75-80% for in-situ cancers and a specificity limited to 70-80%. On the basis of more than 500 exams, both problem-solving MR for on-indication cases and misleading MR for non-indication cases will be shown.Indications to dynamic breast MR:1. Presurgical local staging/treatment planning: 1.1. detection of multifocal/multi-centric cancers in mixed and dense breasts; 1.2. evaluation of anatomical rela-tions in special cases.2. Operated breast: 2.1. differential diagnosis between surgical scar and recur-rence; 2.2. suspected residual tumor, also immediately after surgery; 2.3. suspi-cious nodule in patients with implants.3. Evaluation of the effect of neoadjuvant therapy (total, viable, and necrotic tu-mor volume).4. Occult breast cancer with known metastases.5. Screening of women at high genetic-familial risk of breast cancer: 5.1. carriersof BRCA1 or BRCA2 deleterious mutation or their first degree relatives with un-known genetic status; 5.2. women without genetic testing with strong familial his-tory of frequent breast/ovarian cancer.6. Special cases with undefined diagnosis at X-ray mammography (XM) and ul-trasound: 6.1. patients on anticoagulation therapy; 6.2. multiple areas to be bi-opsed - e.g., multiple hypoechoic nodules at ultrasound or multiple clusters ofXM-detected microcalcifications; 6.3. diffuse XM/ultrasound changes without lo-calized target for biopsy.7. Difficult biopsy localization - e.g., suspicious XM finding very close to the tho-racic wall, not ultrasound-detectable.Conclusion: Breast MR should be performed only on indication.

C-197Invasive ductal carcinoma of the breast: MRI using microscopy coil andpathologic correlationY. Kanemaki, Y. Kurihara, A. Suzuki, Y. Nakajima; Kanagawa/JP

Learning Objectives: The purpose of this study is to describe the magnetic res-onance characteristic imaging using microscopy coil of invasiveductal carcinomaand pathologic correlation.Background: We reviewed the MR findings of seven patients with biopsy proveninvasive ductal carcinoma. Surgery was performed in all patients. The surgicalhistopathological diagnoses include; Invasive ductal carcinoma.Imaging Findings: All MR imaging was performed with a 1.5 T Gyroscan NTIntera/Master. The patient was placed in a prone position with the breast hangingin a Microscopycoil. Axial T2 weighted Turbo-spin Echo images were obtainedusing a TR/TE of 1500/120. Axial T1 weighted 3D FFE images obtained using aTR/TE of 43/8.7, a flip angle of 50 degree. Whole scans were performed with fatsaturation techniqe; and correction algorithms of the heterogeneous sensitivityof the surface coil. The slice thickness was 1.6 mm with 0.8 mm of overcontigu-ous slice. Field of view (FOV) was 70 mm with a Matrix of 256×512. After gadodi-amide hydrate (0.1 mmol/kg) was injected intravenously, axial and coronal imageswere obtained with the same paramaters. Whole process took approximately20 min on average.Results: The mean diameter of visualized lesions was 27 mm. After gadodiamidehydrate all the lesions enhanced. On the MR images, "Bridging Enhancementand Strand-like Enhancement" appearance areas were visualized in the all masses.Conclusion: Our preliminary results suggest that invasive ductal carcinomas havea characteristic apperarence on magnetic resonance imaging technique usingmicroscopy coil.

C-198Value of maximum enhancement speed parametric 3D MR images in theassessment of breast carcinoma extension and distributionJ. Camps-Herrero, V. Ricart-Selma, C. Martinez-Rubio, M. Lloret-Martí,I. Martínez-Gómez, B. Ballester-Sapiña, J. Cordero-Garcia; Alzira/ES

Learning Objectives: To illustrate the value of systematic breast magnetic reso-nance imaging (MRI) parametric 3D images in the assessment of carcinoma ex-tension.

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Background: Accuracy of pre-treatment diagnosis of breast carcinoma exten-sion is essential in order to plan the most effective therapeutic approach. Exten-sion of carcinomas can be difficult to interpret on 2D images, especially if theirdistribution is segmental or irregular. Also, additional multifocal or multicentricfoci can be problematic to localize in respect to the main tumour and the anatomyof the remaining breast. It is furthermore important for breast surgeons to appre-hend the extent of the disease in radiological images in order to plan the surgicalapproach.Procedure Details: T1-weighted FLASH 3D pre- and post-contrast images wereobtained in patients diagnosed with breast cancer on core biopsy. Analysis ofimages was done with a dedicated software for breast MRI (Asymedâ). Paramet-ric images for maximum enhancement speed, maximum enhancement, multipla-nar and 3D reconstructions, speed of enhancement curves and enhancementcurves are analysed in each patient. 3D images were viewed as video clips witha 360 degree rotation around both breasts. Maximum tumor diameter was meas-ured in all images and distribution was reported following surgical anatomy. Allshown cases have been histopathologically proven in respect to size and exten-sion.Conclusion: Besides analysis of morphology and speed of enhancement curves,maximum enhancement speed parametric 3D images stand as a useful approachto tumor extension, giving additional information and an overall view of distribu-tion of the disease in respect to breast anatomy.

C-199Radiological findings of breast cancer recurrence: Role of magneticresonance mammographyP. Belli, M. Costantini, A. Canadè, A. Magistrelli, G. Pastore; Rome/IT

Learning Objectives: To illustrate the role of magnetic resonance mammogra-phy (MRM) in diagnosis of breast cancer recurrence. To describe clinical, mam-mographic, ultrasonographic and MRM findings of breast cancer recurrence andto report the respective values of sensitivity and specificity in a series of 40 pa-tients.Background: The rate of breast cancer recurrence is 1-2% per year. Follow-upof patients after conservative surgery includes a periodic clinical examinationand a mammography every 6 months during the first 2 years and every yearthereafter. Post-treatment changes may mimic or obscure recurrent cancer. Di-agnostic problems are encountered with conventional imaging and fine-needleaspiration cytology. Increased vascularity and vascular permeability occurs inrecent scars and inflammation; however majority of scars 6 months after surgerydo not enhance significantly at MRM while all malignancies do.Imaging Findings: In our series all cases of proved recurrence showed over70% maximum signal intensity enhancement at minute 1 and plateau or wash-out dynamic curve at MRM. Only two cases of scar showed more than 70% max-imum signal intensity enhancement at minute 1 and the curve in all benign caseswas gradual. The quantitative data should be always correlated with the morphol-ogy of enhancement curve. Irregular shape or margins and inhomogeneous en-hancement proved to be important criteria for recurrence assessment.Conclusion: MRM appears a valuable tool to differentiate post-treatment chang-es from recurrent carcinoma and to guide the pathological confirmation. Its highnegative predictive value may have an impact on follow-up of treated breasts.

C-200Management of bone metastases from breast under systemicchemotherapy: MRI vs. ICTPK. Nakatani, Y. Murata, A. Nishioka, T. Ohnishi, Y. Ogawa, S. Yoshida;Nankoku/JP

Purpose: Metastatic bone tumor from advanced breast cancer is common. Bonescan, used clinically to detect bone metastasis, is not suitable for patients duringsystemic chemotherapy because of the flare phenomenon. Use of pyridinolinecross-linked carboxyterminal telopeptide of type I collagen (ICTP) has recentlybeen discussed for detecting bone metastases. We evaluated the utility of ICTPin managing bone metastasis under chemotherapy, in comparison with MRI.Materials and Methods: Nineteen patients with advanced breast cancer under-going systemic chemotherapy participated in our study. ICTP and MRI were as-sessed before and after systemic chemotherapy (mean duration, 9.2 months;range, 3-16 months).Results: On initial MRI, bone metastases were diagnosed in 10 patients (n = 7:≥ 3 lesions (group A, mean ICTP level = 7.49 ng/ml), n = 3: < 3 lesions (group B,mean ICTP = 2.90 ng/ml)). The remaining 9 patients did not display any bonemetastases (group C, mean ICTP = 3.88 ng/ml). Change in ICTP level displayedcorrelations with MRI findings before and after treatment in group A, but not in

group B. In group C, ICTP level remained < 5 ng/ml, including in the case of 1patient in whom bone metastasis appeared on MRI after chemotherapy.Conclusion: Change in ICTP level was associated with MRI findings in patientsdisplaying multiple bone metastases, but not in patients with few or no bone me-tastases. ICTP can be substituted for MRI when managing multiple bone metas-tases in patients with advanced breast cancer undergoing chemotherapy, althoughnot in cases with few or no bone lesions.

C-201Peripheral rim enhancement of intraductal papilloma of the breast ondynamic MR imaging: A diagnostic pitfallT. Nakazono, H. Kumazoe, T. Satou, T. Hamamoto, Y. Nakafusa, S. Kudo;Saga/JP

Purpose: Intraductal papilloma is a benign epithelial tumor of the breast and it isimportant to differentiate it from breast cancer. Few reports about dynamic MRimaging of intraductal papilloma are available and we evaluated dynamic MRfindings of intraductal papilloma and its diagnostic pitfalls.Materials and Methods: The subjects are eleven intraductal papillomas of ninewomen (36-82 years old). We reviewed the clinical history, MR findings, and path-ological results. T1-weighted images (T1WI), T2-weghted images, postcontrastdynamic images, and delayed postcontrast 3D T1WI with fat suppression wereobtained. We evaluated intensity of the tumors, presence of ductal dilatation, cystformation, and intraductal hemorrhage, dynamic enhancing pattern (rapid or grad-ual), and presence of peripheral rim enhancement. We correlated MR findingswith pathological results.Results: Tumor size ranged 5-20 mm. Ten tumors were detected on both dynam-ic study and delayed postcontrast T1WI, and one was not detected on either ofthem. Eight tumors had ductal dilatation, two had cyst formation, and eight hadintraductal hemorrhage. Nine tumors had gradual enhancement and one had rapidenhancement pattern on the dynamic study. Three relatively large tumors (10-20 mm) had peripheral rim enhancement and were misdiagnosed as breast can-cer. From pathological findings, peripheral rim enhancement was thought to bechronic inflammation and fibrosis of duct wall surrounding the tumors.Conclusion: Three of ten intraductal papillomas showed peripheral rim enhance-ment presumably reflecting chronic inflammation and fibrosis of the duct sur-rounding the tumors. This finding could be a preoperative diagnostic pitfall ofintraductal papilloma on MR imaging.

C-202Dynamic MRI in determining histopathological prognostic factors ofinvasive breast cancersN. Tuncbilek1, H.M. Karakas2, O. Okten1; 1Edirne/TR, 2Malatya/TR

Purpose: To quantitatively evaluate the relation between enhancement parame-ters in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) andhistopathological prognostic factors.Materials and Methods: 55 patients with surgicopathological diagnosis of breastcarcinoma were evaluated with 1.0 T MR scanner as a part of their preoperativediagnostic work-ups. Dynamic studies were performed in axial plane using 3Dfast low angle shot (FLASH) sequence. Time intensity curves (TICs) were ob-tained from the regions showing maximal enhancement in subtraction images.The correlations between enhancement parameters and histopathological find-ings were analyzed using stepwise multiple regression analysis, Student's-T testand Spearman moments correlation coefficients.Results: Significant correlations were determined between the presence of lymphnode metastasis and tumor size (r = 0.397, p < 0.01), contour characteristics(r = 0.369, p < 0.05), and edge characteristics (r = 0.495, p < 0.01). A highly sig-nificant correlation was found between histological grades and qualitative en-hancement patterns (r = 0.403, p < 0.01). Statistically significant differences werefound between the groups with and without lymph node metastasis regardingenhancement in the 1st minute (p < 0.01) and TIC slope (p < 0.05). A significantdifference was found between the histological grades I and III regarding all quan-titative enhancement parameters, whereas no difference was found between thegrades I-II, and II-III.Conclusion: DCE-MRI helps to predict prognostic factors of breast cancer byrevealing qualitative and quantitative enhancement features of the primary tu-mor. Additional morphological factors further improve our ability to predict lym-phatic metastasis.

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C-203Breast lymphoma: MRI findings with correlation to mammographic andechographic findingsA. Quiles, L. Tortajada, M. Sentis, M. Villajos, A. Darnell, X. Andreu;Sabadell/ES

Purpose: To describe the clinical presentation, radiological findings, and evolu-tion of breast lymphoma in our series, concentrating on the subgroup of patientsundergoing MRI.Materials and Methods: We retrospectively reviewed 13 cases of breast lym-phoma (3 primary, 9 secondary, 1 indeterminate) diagnosed at our center be-tween 1990 and 2002. Clinical and therapeutic parameters were evaluated aswell as radiological appearance on mammography (n = 11), echography (n = 7),and MRI (n = 8).Results: The most frequent clinical presentation was a palpable nodule (n = 11).On mammography, five had well-defined borders, four unclear borders, one dif-fuse affection, and one only skin thickening. Four had cutaneous involvementand four associated adenopathy. On echography the majority behaved like solidlesions. The behavior of the lesions in T2- and T1-weighted sequences was vari-able, with a predominance of hyperintense lesions at T2 (n = 6). The borders ofthe majority (n = 5) of lesions were poorly defined on MRI. In the dynamic study,all cases showed contrast uptake, whether single or multiple, with signal-timeintensity curves similar to those of infiltrating carcinoma of the breast. MRI foundtumor foci not detected by the other techniques in three cases, showing previ-ously undetected bilaterality in two.Conclusion: The radiological findings for breast lymphoma are nonspecific. Itcan present as a focal (in the majority of cases) or diffuse lesion. MRI demon-strates the extension of tumor affection with greater precision than conventionalradiologic techniques and is useful in the evaluation and follow-up of patientswith lymphoma.

C-204Evaluation of low signals in breast lesions on fat-suppressed T2 weightedimages correlated with histopathologyI. Isomoto1, T. Koshiishi2, T. Okimoto1, H. Ihara1, T. Hayashi1, M. Uetani1,K. Hayashi1; 1Nagasaki/JP, 2Omura/JP

Purpose: The purpose of this study is to correlate low signals (LS) in breastlesions on fat-suppressed T2WI with histopathology and to evaluate the useful-ness of the distribution patterns of LS in the differentiation of benign and malig-nant breast lesions.Materials and Methods: Between July 1998 and September 2002, MR imagingwith pathological correlation was available in 157 breast lesions of 153 patients.All patients were female. The patients' ages ranged from 16 to 82 years (mean:52 years). MR imaging was obtained using 1.5 T unit. Both breasts were scannedwith transverse fat-suppressed T2WI using a fast spin echo sequence. The distri-bution patterns of LS classified 4 types and were correlated with pathologicalfindings.Results: LS on FS-T2WI were identified in 50 of 157 breast lesions. The centraltype of LS was seen in 34 malignant lesions, but in none of benign lesions. Theinhomogenous type of LS was only seen in 7 malignant lesions. The linear type ofLS was only seen in 9 benign lesions. The nodular type of LS was only seen in 3phyllodes tumors that also showed linear type of LS. LS in malignant lesionshistologically corresponded to fibrosis or hyalinization. The linear type of LS cor-responded to fibrous septations in the lesions.The nodular type of LS also corre-sponded to massive fibrosis.Conclusion: Evaluation of patterns of LS is important to differentiate betweenbenign and malignant lesions.

C-205Utility of initial MRI on predicting extent of residual disease afterneoadjuvant chemotherapy: Analysis of 49 breast cancer patientsY. Murata, K. Kubota, K. Nakatani, M. Tadokoro, Y. Ogawa, S. Yoshida;Nankoku/JP

Purpose: The aim of this study was to evaluate the utility of initial MRI on predict-ing the extent of residual breast cancer following neoadjuvant chemotherapy.Materials and Methods: The present study investigated 49 patients with breastcancer (mean age, 51 years; range 27-67 years) who had undergone dynamicMRI with gadolinium enhancement both before and after neoadjuvant chemo-therapy. MRI features before and after chemotherapy were compared with patho-logical diagnosis following surgery in each case.Results: MRI features of breast cancer before neoadjuvant chemotherapy were

classified as either localized solitary nodular (SN; n = 28) or multiple nodular /unlocalized dendritic (MN/UD; n = 21). MRI typing was independent of neoadju-vant chemotherapy in 44 patients (SN, n = 27; MN/UD, n = 17). Extent of residualtumour correlated with post-chemotherapeutic MRI features in cases displayingSN before chemotherapy, except for 2 cases having extensive DCIS componentsand 3 cases of pathologically complete response (pCR). Of the 21 patients dis-playing MN/UD on initial MRI, 14 had positive margins necessitating wider resec-tion. No cases of MN/UD before chemotherapy were diagnosed as pCR.Conclusion: MRI features of breast cancer, when classified as SN or MN/UD,are predictive of the morphology of residual tumours following neoadjuvant chem-otherapy. SN-type tumor on initial MRI has a possibility for pCR after neoadjuvantchemotherapy.

C-206Screening model with MRI in women with breast prosthesesM. Calabrese, L.E. Bacigalupo, D. La Forgia, M. Dulbecco, F. Migliori; Genoa/IT

Purpose: To show our experience using a magnetic resonance imaging (MRI)protocol for the screening of women with breast prostheses in the evaluation ofboth breast parenchyma and implant integrity.Materials and Methods: 80 women with breast implants (age 22-65) underwentbreast MRI, performed in a 1.5 T MRI unit with dedicated breast coil. The firstsequences for the prostheses examination were: T2-w. fast spin-echo, fast inver-sion recovery (IR), silicone-selective and water-selective IR, T1-w. gradient-echo(GE) with spectral fat saturation. Then, for the evaluation of the parenchyma, weused the following modality: T1-w. GE sequence one time before and 5 timesafter the i.v. administration of gadolinium chelate (0.1 mmol/kg dose, automaticinjector) and 90 s of temporal resolution. The whole examination time was 40minutes. All suspected implant ruptures and suspicious intramammary lesionswere verified surgically. The remaining cases are in follow-up.Results: We found 61 women with single lumen implants (57 silicone, 4 salinesolution) and 19 double lumen implants. MRI detected 15 intracapsular ruptures(10 monolateral, 5 bilateral) and 4 cases of residual silicone from a previousprosthesis removal. Also 4 cases of primitive invasive ductal carcinoma (1 nega-tive to the other imaging techniques) and 1 case of recurrent carcinoma (suspectat clinical and US evaluation) were found and all verified by histopathology.Conclusion: An integrated approach for the evaluation of implant integrity andbreast parenchyma in a single one-time protocol is proving to be time saving andreliable, and well accepted by the patients.

C-207MR-imaging segmentation based on wavelet 2D-transform: Application inautochtoneous rat mammary tumorsS. Benderbous, A. Lopez, S. Colas, A. Ouahabi, P. Bougnoux; Tours/FR

Purpose: Developing new tools for describing heterogeneous tumors should pro-vide new functional insights into tumor biology. It may also help for diagnosis andfollow-up in patients during cancer treatment. Heterogeneous tumors can be chem-ically induced in female rats. In such a model, autochtonous tumors develop frommammary gland and grow into heterogeneous solid tumors. We propose to ana-lyze mammary tumor in rats from magnetic resonance images using a new wave-let-based method for segmentation.Materials and Methods: At the age of mammary gland maturation, 10 sprague-dawley rats received a single subcutaneous injection of 15 mg/kg of N-methyl-nitrosourea. Time to tumor appearance, growth and location of the tumors withinthe mammary gland chains were monitored by weekly palpation. The rats wereimaged when tumor size reached 1 to 2 cm using a bruker imager at 2.35 T. T1,T2 and proton density weighting images (100 µm2 resolution) were acquired be-fore and after caudal intravanous injection of Gd-DOTA (0.2 mmolGd/kg) or60 µmol Fe/kg of iron oxide nanoparticules.Results and Conclusions: Mammary tumors appeared nodular and fuzzy form(see figures). Wavelet-based segmentation permitted rapid, reliable, consistentand highly reproducible measurement of tumor texture from MR images with min-imal operator interaction. Wavelet-based segmentation helps in increasing con-trast between tumor and non-tumor tissues by suppressing background noise.Further developments are needed to obtain information correlated with vasculardensity, capillary permeability and necrosis. This new method should be useful tostudy tumor growth and specifically the heterogeneous components of the tumor.

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C-208Dynamic contrast enhanced magnetic resonance mammography in thedetermination of multicentricity in breast cancersN. Tuncbilek1, H.M. Karakas2, O.O. Okten1, H.H. Sezer1; 1Edirne/TR,2Malatya/TR

Purpose: Dynamic contrast enhanced magnetic resonance mammography (DCE-MRI) is increasingly used in breast cancers. The efficacy of the technique, on theother hand, is still under investigation. In this study, the sensitivity and the specif-icity of mammography, sonography and DCE-MRI in the determination multicen-tricity of breast cancers were investigated.Materials and Methods: 63 female (ages between 30 and 78, mean 50.6 yrs)with mamographically and ultrasonographically determined mass lesions wereinvestigated with dynamic 3D fast low angle shot (FLASH) sequence. Sensitivityand specificity of the conventional imaging were compared to the ones for DCE-MRI.Results: Mammographically 40 cases (63.5%) had unifocal lesions whereas theremaining cases (23 cases - 36.5%) were suspicious for multicentricity as lesionperipheries were not discernible because of the dense glandular pattern. Ultra-sonographically 43 cases (68.3%) were unifocal whereas the remaining cases(20 cases - 31.7%) were considered indeterminate for multicentricity. With DCE-MRI, on the other hand, 15 cases (23.8%) were shown to have multicentricity.Histopathologically multicentricity has been shown in 16 of the cases. Sensitivityof the mammography in determining the multicentricity was 50% whereas its spe-cificity was 32%. These values were found to be 38 and 21% for ultrasonography,and 93 and 100% for DCE-MRI, respectively.Conclusion: In patients with an indeterminate multicentricity, DCE-MRI may beused as a effective method in preoperative treatment planning.

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Ultrasound

C-209Breast ultrasound: An evaluation of the use of frequency-modulated(CHIRP) signal pulsesS.S.S. Tan, B.P. Tan, G.K.L. Wansaicheong, B.K. Chong; Singapore/SG

Purpose: High-frequency breast ultrasound is sometimes limited by the variableattenuation of breast tissue components. Ultrasound signal pulse generation mayutilise amplitude, phase or frequency modulation. Traditional pulses have beenamplitude or amplitude-phase modulated. Frequency-modulated pulses (chirps/coded pulses) are now offered by manufacturers. This theoretically provides bet-ter signal-to-noise ratios and improved image quality. We aimed to study the ben-efits of frequency-modulated (CHIRP) signals in breast ultrasound.Materials and Methods: We performed a prospective study of 50 consecutivebreast examinations with and without the CHIRP Coded Excitation software op-tion on an Acuson Sequoia (Siemens AG, Germany) with a high-frequency lineartransducer (15L8-w). Standard longitudinal and transverse images were obtained.Post-processing factors and use of Tissue-Equalisation software were standard-ised. Paired images were reviewed by 3 independent readers experienced inbreast ultrasound. A 5-point scale was used to rate: similarity of subcutaneousand retromammary fat appearance (A), retromammary fat image quality (B), shad-owing from Cooper's ligaments (C), and visualisation up to/including the chestwall (D). Results were analyzed with Student's t-test.Results: The overall image quality score was 4.0 with CHIRP and 3.1 without.The score for (A) was increased by 19%, for (B) by 28%, (C) was reduced by 30%and (D) increased by 45% with CHIRP. All these improvements were statisticallysignificant (p < 0.001).Conclusion: CHIRP provides improved penetration and contrast resolution inhigh-frequency breast ultrasound, with a 30% (CI: 24 - 38%) improvement inoverall image quality.

C-210Differential diagnosis of solid breast tumors based on the difference of thevalues of the vascular parameters using color and pulse DopplerultrasoundA. Vakali, A.L. Kelekis, I. Oikonomou, K. Kouskouras, N. Michailidis,A.S. Dimitriadis; Thessaloniki/GR

Purpose: To evaluate the relationship between malignant or benign, with thedifferences in the maximum and minimum values of each vascular parameterdetected in the mass.Materials and Methods: A hundrend and fourty patients, 134 women and 6 men,aged 17-80 were evaluated. Based on the histologic results, 54 patients had be-nign solid tumors and 58 patients malignant. We measured the number of ves-sels, the major systolic velocity (PS), the end diastolic velocity (ED), the resistanceindex (RI) and the glosing index (PI) appearing in all the slices we took. We notedthe maximum and minimum values of all the above parameters that appeared inthe same mass in different slices and calculated the differences.Results: For the benign tumors the mean values for the differences between themaximum and the minimum number of vessels was (DIFFVES) 3.26 (P < 0.00),the DIFFPS was 3.23 cm²/sec (P < 0.00), the DIFFED was 2.38 cm²/sec(P < 0.01), the DIFFRI was 0.12 (P < 0,03) and DIFFPI was 0.45 (P < 0.15). Forthe malignant tumors the mean values for the differences between the maximumand minimum were DIFFVES 8.13, DIFFPS 8.54 cm²/sec, DIFFED 3.3 cm²/sec,DIFFRI 0.2, DIFFPI 1.48. We used the Mann-Whitney and Kolmogorov-Smirnovstatistic test in the SPSS statistic program.Conclusion: Important role in the differentiation of benign from malignant tumoris the variety of the quantative values in the same mass. The reason is that greatdifferences between the number of vessels, the PS and ED in a mass, favormalignancy.

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C-211In vitro US evaluation of sentinel node for detecting metastasis in breastcancer: Comparison with histopathologic resultsJ. Shin, H.-Y. Choi, B.-I. Moon, S. Sung; Seoul/KR

Purpose: To assess the accuracy and the effect of in vitro US study of sentinelnodes (LNs) for differentiating benign from metastasis during the operation ofbreast cancer.Materials and Methods: Fresh 183 sentinel LN specimens were examined byUS for the presence of metastasis or not, in 30 patients with breast cancer. Sono-graphic criteria of malignant lymph nodes was defined as uneven cortical thick-ness of more than 3 mm in depth or the absence of hilum or showing roundhypoechoic node. Histopathologic results were correlated with those obtainedwith the US study. Statistical analysis was performed with the Fisher's exact test.Results: On US examination, 150 (150/183, 81.9%) of the 183 sentinel LNs werebenign. Among 150 benign LNs, only four (4/150, 2.6%) were proven to containmetastasis at histopathologic study, all showed the evidence of focal microme-tastasis in the cortex. 33 sentinel LNs showed sognographic malignant criteria.Twenty (20/33, 60.6%) of the 33 sentinel LNs were confirmed to show metastaticevidence on histopathologic study. According to pathologic results, the misdiag-nosed 13 lymph nodes on US revealed uneven cortical thickening in 9 nodes anda hilar loss in 4 nodes. The sensitivity, specificity, positive predictive value, nega-tive predictive value and accuracy were 83.3%, 91.8%, 60.6%, 97.3% and 90.7%respectively, which showed the presence of statistical significance (p < 0.05).Conclusion: The in vitro US evaluation of the sentinel node specimens duringoperation for breast cancer may be helpful in the decision of the extent of lymphnode dissection.

C-212Reliability of US-diagnosis of metastatically affected regional lymph nodesin the presence of female breast cancerE. Shevchenko, A. Zubarev; Moscow/RU

Purpose: Analysis of false-positive and false-negative results of US in diagnosisof metastatic lymph nodes (l.n.) in breast cancer.Materials and Methods: 346 patients with breast cancer (stages T1N0-T3N2)were examined on HDI 5000 ATL Philips with morphological verification. 105patients (30.35%) had metastatic deposition in regional l.n.Results: Precision of US-diagnosis of unchanged l.n. was equal to 0.86, specif-icity - 60.7%, sensitivity - 84.8%. False-negative results were found in 15 cases(4.3%). In B-mode the oval shape remained unchanged in all 15 cases, corticallayer and core were differentiated. Thickness of cortex: 0.15-0.3 cm, node size:0.3 x 0.5 cm-1.2 x 0.9 cm. In 10 cases blood flow was located in portal region, 5cases - 1 longitudinal vessel in center of the l.n. Sizes of the l.n. with micrometas-tases were up to 1.2 cm. We had false-positive results in 27 patients (7.8%).Round shape was found in 11 cases, oval - in 12, in 4 patients 2 l.n. joined togeth-er in 1 irregularly shaped node. In 10 cases there was uneven thickening of cor-tex in one pole of node with size fluctuation. Differentiation of cortex and corewas absent in 17 cases and echogenity was diffusely lowered. Subcapsular ves-sels were located in 14 cases, aberrant vessels - in 1, distortion of central vessel- in 6, local absence of perfusion - in 1. False-positive cases corresponded tosinus-histiocytosis, hyperplasia of lymphoid tissue.Conclusion: Only use of the full complex of US-symptoms of metastatically af-fected l.n. lets us improve the precision of diagnosis.

C-213Inter- and intraobserver agreement in breast ultrasonography: Significanceof internal echoes at image interpretationJ. Tsutsumi, K. Shimamoto, M. Ikeda, A. Sawaki, H. Satake; Nagoya/JP

Purpose: To evaluate the significance of internal echoes among diagnostic UScriteria for breast lesions.Materials and Methods: 100 breast masses (50 benign, 50 malignant) wereinterpreted by 6 radiologists and 20 radiological technologists using a four-pointrating scale, and the kappa statistics were employed for analying interobserveragreement. To assess reproducibility in judgments, double reading was done in50 cases, and a total of 150 cases were interpreted for each observer. US criteriaincluded shape, border, boundary echoes, internal echoes (homogeneity andecho level), posterior echoes, lateral shadow, gland surface, depth-width ratio(D/W) and total impression in differentiating benign from malignant lesions. Toevaluate the significance of internal echoes at US image interpretation, US imag-es were modified to make the internal echoes invisible by painting with blackcolor using the Adobe Photoshop.

Results: ROC analysis showed a significant difference in diagnostic perform-ance between the original US images and modified US images (p < 0.05). Thekappa value of posterior echoes was highest whereas that of boundary echoesshowed the lowest value in both the original and modified US images. Inter-ob-server agreement in shape, border, and category in the original images was sig-nificantly higher than that in the modified images (p < 0.05). Reproducibility inboundary echoes and gland surface was fair, and that in posterior echoes andthe D/W was good.Conclusion: The internal echoes are important for image perception of breastlesions. Lack of internal echoes should degrade the diagnostic performance ofbreast US.

C-214Preoperative wire localisation of breast lesions by tissue harmonic imaging(THI) sonographyD.-A. Clevert1, E. Jung2, N. Rupp2; 1Munich/DE, 2Passau/DE

Purpose: To obtain a fast and reliable preoperative wire localisation of occultlesions in dense breast tissue by tissue harmonic imaging (THI) sonography,when localisation in mammography is not reliable enough.Materials and Methods: In addition to biplane mammography for breast screen-ing or for follow-up examination after breast saving therapy in 350 patients withmastopathic or fibrotic breast tissue ultrasound was performed by two independ-ent radiologists. With the aid of a multifrequency probe (5-10 MHz) lesions weredocumented by conventional B-Mode and by THI in similar projections. In 25lesions not precisely identified in mammography sonographically guided punc-ture with wire localisation was performed.Results: In 22 of 350 patients 25 circumscribed suspect lesions with a diameterof 8 mm on the average were identified, which were regarded as suspect in ultra-sound but not in mammography. 19 of 25 lesions have been found by B-Modeand THI, additional 6 only by THI. In B-mode the course of the needle and thewire was reliably seen in 16 of 25 cases, in THI in all 25 cases. After operativeremoval of tissue histopathology revealed in 19 cases a ductal or lobular carcino-ma, in three cases metastasis and in the remaining three cases benign compli-cated cysts with fibrotic tissue.Conclusion: THI is superior to a B-mode ultrasound in differentiating suspiciouslesions in dense glandular breast tissue. If tumor signs in mammography are notreliable enough or if a precise localisation is not possible, sonographically guidedpuncture by THI can give reliable results.

C-215Axillary US and US-guided fine needle aspiration biopsy in the assessmentof lymph node metastases in breast cancer patientsM. Podkrajsek, M. Hocevar, M. Music, M. Kadivec, M. Bracko; Ljubljana/SI

Purpose: Sentinel lymph-node biopsy (SLNB) is an alternative to routine axillarylymph-node dissection (ALND) in clinically node-negative breast cancer patients.However, in 40% of patients in whom SLNB was performed, nodal metastaseswere revealed in the sentinel nodes. The aim of this study was to evaluate theability of axillary ultrasound (US) and US-guided fine-needle aspiration biopsy(FNAB) to detect the axillary lymph-node (LN) metastases in clinically node-neg-ative patients.Materials and Methods: From January 2001 to July 2003, axillary US was per-formed in 145 patients with cytologically proven breast cancer in whom SLNBhad been planned. In the patients with US-suspicious axillary LN, US-guidedFNAB was performed.Results: In 39/145 patients, US-guided FNAB was performed. In 26/39 patients,FNAB was positive. Definitive histology report revealed LN metastases in 55/145patients. US-guided FNAB was concordant with the histology in 25/55 patients(45% sensitivity). In the group of 29 patients with a false negative US result, therewere twelve micrometastases, the mean diameter of metastases was 4.9 mm. Inone patient, US-guided FNAB was false positive (95% PPS).Conclusions: US-guided FNAB is a valuable method in detecting axillary LNmetastases in clinically node-negative breast cancer patients. Almost half of ax-illary lymph-node-positive patients can be spared the SLN biopsy procedure andthe second operation. However, false positive results are possible.

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C-216US-diagnosis of intraductal papillomas of female breastE. Shevchenko, A. Zubarev; Moscow/RU

Purpose: To assess the role of sonography in the diagnosis of intraductal papil-lomas.Materials and Methods: During 3 years of research, in 19 of 517 female patientsbeing operated, intraductal papillomas (3.7%) were verificated. All lesions wereimpalpable. Ductography was conducted using "Omnipaque" contrast agent (Ni-comed) in combination with "Mammodiagnost UC" Philips. All patients were ex-amined using HDI 5000 ATL Philips scanner with linear transducer in B-modeusing Sono CT and in Power Doppler at the frequency of 5-12 MHz. Age range29-70 y.o. (mean age 52.5 ± 23.1 y.o.). Mean size of intraductal papillomas was0.42 ± 0.98 cm (0.07-1.5 cm).Results: In B-mode, intraductal papillomas looked like mural hypoechogenic le-sions with heterogenic structure, had round and even more often irregular shape,were distinct-contoured with anechogenic inner components of dilated lactifer-ous duct. Cystadenopapillomas were seen distinctly inside the cyst cavity in formof mural lesions with characteristics analogous to those of intraductal papillo-mas. In Power Doppler only in 3 papillomas low-velocity blood flow was located(V max = 5.8-1.8 cm/sec, V min = 3.0-6.3 cm/sec, RI = 0.42-0.66). A single feed-ing vessel presented it. During sonography in 4 of 19 women papillomas were notdistinguished, although the exact X-ray location was known (21.1%).Conclusion: High resolution sonography may be used in diagnosis of intraductalpapillomas as a main add-on to ductography and clinical research.

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Miscellaneous

C-217Neuro endocrine breast carcinoma: Five clinical cases and review ofcurrent literatureB.P. Boyer, P. Granger, A.L. Guérin, P. Henrot, E. Netter, P. Troufléau, J. Stinès;Vandoeuvre-les-Nancy/FR

Learning Objectives: To illustrate clinical presentation and imaging findings inneuro endocrine breast carcinoma. To discuss the prognosis and therapeutic in-terest of this diagnosis.Background and Procedure Detail: Breast is a very unusual site for primaryneuro endocrine carcinoma.Some imaging features may allow to approach this diagnosis, that can be sup-ported by guided fine needle aspiration. The estimation of this lesion is controver-sial in terms of malignancy potential and prognosis.We study clinical, radiological and pathological patterns of five histologically provencases. Data of the current litterature are discussed and related to this personalseries.Conclusion: Radiological approach of neuro endocrine carcinoma diagnosis isfeasible, and may be of clinical interest.

C-218Can a mammogram dictate to you the diagnosis? A review of characteristicmammographic findingsA.N. Chalazonitis1, J. Tzovara2, T. Vrakatselis1; 1Athens/GR, 2Ioannina/GR

Learning Objectives: Participants will obtain an approach to various mammo-graphic patterns and improve their diagnostic skills in breast imaging.Background: Mammography is considered by far the single most important im-aging modality for breast diseases. Except from radiologists with vast experi-ence, many other physicians without specific knowledge are unable to discriminatenormal from abnormal findings in the mammograms.Imaging Findings: The main aim of this exhibit is to provide a pictorial review ofcharacteristic radiological findings in 15 different mammograms. Various exam-ples due to different causes are illustrated and mammographic findings, as wellas differential and final diagnosis are also discussed. All cases have been select-ed by reviewing our Hospital teaching files.Conclusion: Our exhibit will allow participants to challenge their skills in thedetection of both normal and abnormal mammographic signs.

C-219Breast imaging and histopathologic correlation of fibroadenomas inpatients with transplanted kidney: Different features from usualfibroadenomaE. Son1, E.-K. Kim2, K. Oh2; 1Sungnam/KR, 2Seoul/KR

Learning Objectives: To analyze the imaging and histopathologic features offibroadenomas in kidney transplanted patients and to compare findings of fibroad-enomas in kidney transplanted patients with those in a control group.Background: From 1990 to 1999, 1,438 patients underwent renal transplanta-tion at our institute. All patients received immunosuppressive therapy with cy-closporin A and steroid after renal allograft. We examined ten female patientswho were diagnosed with fibroadenomas during chemotherapy, and comparedthe data obtained with that of fibroadenomas in the normal population.Procedure Details: Twenty-two fibroadenomas developed in ten patients. Eightof the 10 patients had multiple fibroadenomas and 7 had bilateral fibroadenomas.The mean diameter of the fibroadenomas was 4.17 ± 2.5 cm. By mammographythe lesions were spherical in shape and had a well circumscribed margin with ahigh density mass. None of the lesions showed calcification or spiculation. Sono-graphic findings of the masses showed relatively high echogenecity with higherL/T ratios than benign masses, however, features of homogeneous internal echoand well circumscribed margin were consistent with benign.Conclusion: The fibroadenomas that developed in patients with renal transplan-tation showed a tendency to be multiple, bilateral and larger than those in thecontrol group. These fibroadenomas also exhibited a more rapid growth, a morespherical shape and an unusually high internal echo and higher L/T ratio thanusual fibroadenomas.

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C-220Mammographic and ultrasonographic features following autogenousmyocutaneous flap reconstruction mammoplastyS. Kim1, H. Kim1, J. Park2, K. Sung1; 1Seoul/KR, 2Madison, WI/US

Learning Objective: To present mammographic and ultrasonographic (US) find-ings in various types of reconstruction using autogenous myocutaneous flap af-ter mastectomy or breast conserving operation.Background: Breast reconstruction is an integral part of a woman's breast can-cer management and yields positive psychological benefits for the patient. Autol-ogous tissue reconstruction has gained in popularity in part owing to adversepublicity regarding prosthetic implant safety. It can alter breast anatomy and ar-chitecture drastically. In this exhibit, we describe mammographic and US findingsin the various types of reconstruction using autogenous myocutaneous flap aftermastectomy or breast conserving operation.Procedure Details: Mammography and ultrasonography obtained in patients whohad undergone reconstruction mammoplasty using the autogenous myocutane-ous flap procedure were reviewed to facilitate recognition of both normal andabnormal postoperative appearances of the various types of reconstruction us-ing autogenous myocutaneous flap after mastectomy or breast conserving oper-ation. Normal mammographic and US findings include predominance of fattyappearance, surgical clips, and surgical scars. Abnormal mammographic andUS findings include fat necrosis, calcifications, and locally recurrent carcinoma.US findings of fat necrosis were cystic, complex and solid appearing masseswith circumscribed or ill-defined margins in peripheral portions of flap. US findingof locally recurrent carcinoma was ill-defined heterogeneous hypoechoic lesionsin reconstructed breast, similar to those of primary breast cancer.Conclusions: Breast reconstruction using autogenous myocutaneous flap hasincreased in popularity with various methods. Mammography and sonographyfacilitated excellent visualization of normal and abnormal findings of various re-constructed breasts using autogenous myocutaneous flap.

C-221Extramammary pathology mimicking breast diseaseE. Rabanal, R. Rosell, J. Salvia, R. Garcia; Sabadell/ES

Learning Objectives: To present the imaging findings in cases suspected initial-ly of breast disease which turned out to have extramammary pathology.Background: We reviewed our records for the last ten years. During that time,76,443 mammary studies were performed. All cases with extramammary pathol-ogy were selected. They were classified into two broad categories: those whichhad abnormal physical findings (palpable mass or skin thickening) and thosewith abnormal findings in the mammogram (calcifications, nodules and thickenedlymphatics).Imaging Findings: Cases were classified as follows: Microcalcifications second-ary to filariasis. We will see more of these cases due to increased immigration.It's important to know this entity to make the correct diagnosis and avoid unnec-essary examination or biopsy. Uniform skin thickening and/or oedema, second-ary to systemic disease (sclerodermia), congestive heart failure or lymphoedema.Palpable skin nodules (infected sebaceous cysts), simulating mammary abscess-es. Chest wall disease: Empyema necessitatis draining into the breast. Extramam-mary (chest wall) lipomas and Dercum's disease. Neurofibromas in vonRecklinghausen's disease. The imaging findings of these processes will be re-viewed and their salient features described in order to suggest the correct diag-nosis.Conclusion: It is important to know the features of extramammary disease inorder to make the correct diagnosis, avoiding further examinations and unneces-sary invasive procedures.

C-222The reality of microcalcifications in breast tissues shown by synchrotronradiation imagingJ. Okamoto, Y. Kanemaki, K. Imamura, N. Ehara, Y. Inada, I. Maeda,K. Miyamoto, Y. Nakajima, M. Fukuda; Kawasaki/JP

Purpose: The aim of this study was to approach the reality of microcalcificationsof benign and malignant diseases using synchrotron radiation imaging, and tomake a comparison with conventional X-ray images.Materials and Methods: Surgical and biopsied specimens fixed in wax blockswere imaged using synchrotron radiation (SR), and conventional mammographyunit (CONV) as well. Studied were 98 patients (40 benign, 58 malignant). SRimaging was performed at SPring-8 in Japan in refraction-enhancement mode.CONV images were evaluated visually using a magnifying glass. SR images were

inspected on a monitor without magnification. Morphology of microcalcificationwas categorized to 3 groups: small round, amorphous (Am), and pleomorphic(Pl).Results: 1,319 calcifications were observed in 98 CONV images and 9,225 cal-cifications in SR images. 7,906 of 9,225 (86%) were invisible in CONV images.SR imaging revealed that great numbers of specks were recognized collectivelyas a single calcification in CONV images, and 949 of 1,319 calcifications in CONVimages were found to consist of multiple specks. The incidence was especiallyhigher in Am and Pl types (602/755 and 187/204, respectively). Comparing ma-lignant with benign diseases, there was a striking contrast in Am-type calcifica-tions; majority of Am-type calcifications in malignant diseases were found ascollectives of fine specks (84/432), to the contrary 69/170 in benign (p < 0.0001).Conclusion: Synchrotron radiation imaging showed that majority of amorphousand pleomorphic type calcifications, especially of amorphous type of malignantdiseases, in conventional images were essentially collectives of multiple specks.

C-223Psychological perceptions of women due to mammographic follow-upB. Barreau1, R. Gilles1, S. Tastet1, I. Brault2, J.-M. Gillet3, M. Fawzi3, I. Audigey4,T. Pousse5, J. Stinès6; 1Bordeaux/FR, 2Lyon/FR, 3Biarritz/FR, 4Cognac/FR,5La Rochefoucauld/FR, 6Vandoeuvre-les-Nancy/FR

Purpose: To investigate women's experience who undergo mammographic fol-low-up for lesions ACR3.Materials and Methods: Multicentric prospective study carried out on womenwith ACR3 classified mammographic lesion from March to December 2002. Thesurvey was performed at the first follow-up mammography and included ques-tionnaire concerning examination, perceptions and stress related to this follow-up period. The responses were analysed using chi-square test.Results: 129 women answered the questionnaire. All women were satisfied withthe mammography and the medical staff except that the mammography was painfulin 56 cases. For 24 women, the period between mammographic follow-up wastoo long. In 33 women, the quality of life was altered. Communications of theexperience to a relative was frequent (100/129 cases) but satisfactory in only 25cases. For 113 women, medical information was considered relevant. The medi-an of the scale of stress was 5 (0-10). There is two pickaxes, one at 2, the secondat 5. "Low-stressed" women could have an avoidance coping. "High-stressed"women could use a helplessness-hopelessness coping strategy.Conclusion: Women reported relevant medical information and comprehensionof the short follow-up -mammography. They were reassured by the medical care,but the evaluation of the scale of stress was high, probably due to the diagnosis.

C-224Mammographic density changes in postmenopausal hormone therapy:Effects of various agents using a new scoring systemS. Orguc, C. Göktan, G.Y. Ovali; Manisa/TR

Purpose: To evaluate the changes of mammographic breast density due to post-menopausal hormone replacement with various agents using a new scale and tocompare the new scoring system with the classical methods.Materials and Methods: 222 women who received hormone replacement thera-py in Celal Bayar University hospital between 1999-2003 were examined withbaseline and follow-up mammograms. The effects of various hormone regimens,selected according to the gynecological status, were evaluated by two radiolo-gists. Wolfe classification and a new scoring system were used to assess thechange of mammographic density. The new scale divides each breast into tenwedge shaped slices on the CC positioned mammograms. Change of density isscored according to the number of slices, which have an increase of density incomparison with the baseline mammograms. The results were statistically evalu-ated to compare the effects of various hormone regimens using a control groupof 75 patients who did not receive any hormonal therapy. Statistical analysis wasalso carried out to determine the effect of using different scales.Results: Tibolone effected breast density is less than preparations containingoestrogen. Degree of mammographic change differs depending on the scale used.The new scale is more sensitive in depicting changes of breast density.Conclusion: Preparations containing oestrogen effect the mammographic den-sity more than tibolone regimens. The new scaling system is highly efficient andobjective in determining the changes of breast density.

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C-225Mammographic stability of malignant lesionsP. Domínguez Echávarri, M. Pons Renedo, O. Cosín Sales, R. Gil Marculeta,J. Noguera Tajadura, L. Pina; Pamplona/ES

Purpose: To show our experience with mammographically-detected suspiciouslesions that proved to be malignant and which mammographic findings were foundin previous studies without significant changes.Materials and Methods: Retrospective study. We reviewed our archives search-ing for mammographic stability of malignant lesions. Clinical, mammographic andpathologic features are reported.Results: Six cases were found. All cases were non-palpable. Three cases weremicrocalcifications and the remaining were architectural distortions. The lesionsshowed mammographic stability for an average time of 47.66 months, rangingfrom 12 to 72 months. Pathology reports were consistent with three low-gradeductal carcinomas in situ and three infiltrating ductal carcinomas inside radialscars. No axillary involvement was found in any case.Conclusions: The stability of suspicious lesions does not ensure benignity. Low-grade carcinomas in situ and carcinomas arising into radial scars may show asnon-changing suspicious microcalcifications or architectural distortions. A promptbiopsy must be recommended in these lesions, even if long-term stability is found.

C-226Experience of clinical application positron emission tomography and F-18fluorodeoxyglucose for breast cancer detectionN.A. Kostenikov, L.A. Tyutin, D.V. Ryjkova, A.S. Arzumanov, A.A. Stanzhevsky,M.S. Tlostanova; St. Petersburg/RU

Purpose: To evaluate sensitivity and specificity of positron emission tomography(PET) and 18-F-fluorodeoxyglucose (18F-FDG) in breast cancer diagnosis andto assess tumor dissemination.Materials and Methods: 62 patients were examined: 10 without mammary dis-ease, 10 with fibrous cystic mastopathy, and 42 with breast cancer, which washystologically proven. PET-scans (Ecat Exact 47) in "Whole body" mode wereperformed 90 min after intra-venous injection of 370-420 MBq 18F-FDG. The T/NT ratio for radiopharmaceuticals was evaluated.Results: In all patients with malignant tumors the T/NT ratio for PET-18FDG washigher than 2.0 (M ± m = 7.2 ± 0.99). It was shown that PET has a high diagnos-tic accuracy in breast cancer detection with sensitivity 97% and specificity 100%.PET scanning in the "Whole body" mode was allowed to assess dissemination oftumor process with high accuracy. PET 18F-FDG sensitivity was around 87.8%to100% in diagnosis of regional and distant metastases. It was related to metas-tases localisation.Conclusion: PET with 18F-FDG has high diagnostic accuracy in diagnosis ofbreast carcinoma and staging of tumor extent.

C-227Results and experiences of mammographic screening programS.O. Farkas, Z. Dömötöri, G. Szentmártoni, J. Szilvási, P. Magyar, K. Karlinger,E.K. Makó; Budapest/HU

Purpose: The aim of this presentation is to show the results and efficiency of theNational screening program of the period of 01. 1988-07. 2003.Materials and Methods: Women aged between 45-65 were invited in three roundsin the mentioned period of time. Bilateral mammography with double projectionwas performed, and read in a double blind manner, according to the strict, pre-scribed methods. If needed, additional mammographic X-ray, US, FNAB and corebiopsy was performed.Results: The acceptance rate was low, around 35.7% (13532 women werescreened during five years). We called back around 6% of the screened patientsfor additional X-ray examination (1.5%) or for US (4.5%). We performed FNAB in3% of all cases (405 women). 301 cases were proven benign. The overall rate ofhystopathologicly verified invasive cancers per 1000 women were 8 (104 pa-tients). We could detect an increasing rate of small cancers and better lymphnode state by the time, because around 88% of the examined women were al-ready screened by us before, during the 5-year-period. Number of interval carci-nomas was nine (0.07%).Conclusions: Comparing to European standards our screening program wasthe same, but the acceptance rate was lover. The high non-acceptance rates canbe explained mainly by the cross-screening possibilities of Budapest, Hungaryand because the high risk population is not informed well enough. However, dueto the mental hygenic program running in Hungary, we could detect an increasednumber of inquisitive women.

C-228Tubular carcinoma of the breast: Clinical, mammographic andultrasonographic findingsF. Zandrino1, M. Calabrese2, L.E. Bacigalupo2, F. Musante1; 1Alessandria/IT,2Genova/IT

Purpose: Tubular carcinoma is a well differentiated invasive adenocarcinoma,with a prevalence ranging from 1 to 10% of all carcinomas of the breast. Thepurpose of this presentation is to analyse its clinical, mammographic, and ultra-sonographic features, with histopathological correlation.Materials and Methods: In a retrospective review of 472 consecutive histologi-cally proven carcinomas of the breast, 14 pure (tubular component of at least75%) tubular carcinomas were found (2.97%) in 12 women (age 54 ± 10 yrs).Results: Three lesions were palpable. On mammography, five were not detecta-ble; the remaining presented as nodules with spiculated (3 lesions) or irregular(2) margins, spiculated nodules with microcalcifications (2), distorsion (1), orasymmetric density (1). On US, 1 lesion was not detectable; the remaining pre-sented as hypoechoic lesions with irregular (12) or well defined (1) borders. For12 tumours, diagnosis of carcinoma was made with cytology; in 2 cases corebiopsy: in the first a complex sclerosing lesion with atypical cells was suggested,in the second differential diagnosis between tubular carcinoma and sclerosingadenosis was proposed. Lesion size was 10.1 ± 5.1 mm. Only in 1 patient weremetastatic axillary nodes found.Conclusion: In our series, tubular carcinoma presented mainly as a non-palpa-ble, small-sized lesion, with non-specific mammographic patterns and a hypoe-choic ultrasonographic appearance. Lymph node metastases are rare, aspreviously reported in the literature.

C-229Dose distribution in tangential irradiation for breastH. Ohtani, S. Usui, Y. Jincho; Tokyo/JP

Purpose: Skin injury, lung disease and conservation radiation therapy for breastis reported. In a previous investigation, local management and survival rates werereported on the face of treatment effect's records, but the real irradiation doesn'tbecome clear. This report is to measure the dose distribution of the effect on thecritical organ by tangential irradiation of the left breast.Materials and Methods: Measurement was performed with a semiconductordetector. Irradiation was performed with X-ray beams at 124 degrees. Irradiationfield sizes were established 10×20 cm2 to investigate influence by field sizes.Irradiation was done on the wedge of 30 degrees.Results: Dose equivalent was accurately measured with semiconductor detec-tors. From the results, breasts, thyroid gland, heart, both lung fields, kidney, ova-ry, and uterine doses become clear.Conclusion: The dose distribution at tangential irradiation of left breast wasmeasured. Consequently, the breast in which a radiation injury tends to be en-countered, lung field, and the dose of important internal organs could be ob-tained. The necessity to confirm the dose distribution in the body for tangentialirradiation in breast preservation treatment, refers to a radiation injury, and thisstudy estimates these doses.

C-230The importance of radiological imaging of mammary implants aftersimulation of recreational diving conditionsI.O.J. Verslegers, S. Van Poucke, B. Stockman, W. Tjalma, M. Van Goethem,A.M.A. De Schepper, P.M. Parizel; Antwerp/BE

Purpose: To assess the influence of 24 days of repetitive hyperbaric simulationson the form and structure of single-lumen silicone gel-filled implants.Materials and Methods: 6 new implants from 2 different manufacturers and 2removed implants were submitted for 68 simulated dives in a hyperbaric cham-ber, with an average of 3 dives a day and with a maximal depth of 18 m. A stand-ard X-ray and MRI were performed before, after 11 and 24 days of repetitivediving, and 43 days after the experiment. MRI was performed using a 1.5-T su-perconductive magnet (Symphony-, SiemensAG, Erlangen, Germany) with a bodyand spine coil, and a gradient echo T1-W sequence (3D FLASH), slice thickness2 mm. The prostheses were checked for bubble formation, volume changes, in-tegrity and morphological appearance.Results: There were no significant changes in form, nor in shell integrity. After 11days of repetitive diving, there were some tiny bubbles in the implants, confirmedby X-ray and MRI. After 24 days, there were significant bubbles in 4 of the im-plants (increase in implant volume up to 10%); in the other 4 there was a slightincrease in number and volume of bubbles. There was no significant change inthe bubbles 43 days after the last dive.

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Conclusion: The significant bubble formation in some single-lumen silicone gel-filled implants after 24 days of repetitive diving, raises concern about the influ-ence of repetitive stress on the lifespan of implants in correlation with the numberand depth of dives.

C-231Resection of non-palpable breast cancer using 3D imaging created bymultislice helical CT: A new interventional technique to design resectionlines in breast preserving surgeryK. Oda, T. Kubota, H. Satake, A. Sawaki, T. Ishigaki, Y. Nimura; Nagoya/JP

Purpose: We report a new method for an adequate segmental resection of non-palpable breast cancer employing an interventional technique using three-dimen-sional images of contrast-enhanced CT.Materials and Methods: Eight patients with non-palpable breast cancer (DCIS6, invasive carcinoma 2) were included in this study. Diagnosis of carcinoma wasmade by cytology, but the extent of the lesion could not be clearly shown by US.One hour before the operation, contrast-enhanced helical CT was performed usinga Toshiba Aquilion (Toshiba Corp. Tokyo) with the patient in the supine position,following the insertion of VATS (Video Assisted Thoracoscopic Surgery) markers(Hakko, Japan) under US guidance. CT scan was performed 75 seconds afterthe injection of contrast medium. The detector row configuration was 4 x 1-mm.Maximum intensity projection (MIP) was performed on three-dimensional recon-struction (3D-CT). Using three-dimensional images of CT, anatomical relation-ship of VATS markers, nipple and carcinoma demonstrated as a well-enhancedfocal-clumped lesion or segmental lesion was evaluated and lines of resectionwith 2 to 3 cm surgical margin were designed. Curative resection was confirmedin X-ray films of resected specimens based on the relationship between the le-sion and the VATS markers in preoperative three-dimensional CT images.Results: In all 8 cases, adequate segmental resection with cancer free surgicalmargins was accomplished and the cosmetic results of the surgery were satis-factory.Conclusion: Three-dimensional images of contrast-enhanced CT with this inter-ventional technique is a useful method to design resection lines for non-palpablemammary carcinomas.

C-232European breast screening performance: Does case volume matter?H.J. Scott1, A.G. Gale1, D. Wooding1, D. Walter2; 1Derby/UK, 2Augsburg/DE

Purpose: U.K. Breast Screening Radiologists typically read over 5,000 screen-ing cases per annum, whereas in Europe this figure is much lower as in manycountries national breast screening programs are in their infancy. The PERFORMSscheme in the U.K. permits Radiologists annual self-assessment of their film-reader skills. As part of the EU funded European Breast Cancer Network a numberof German Radiologists have now read the current PERFORMS assessment set.We investigated whether real-life case volume affects reading performance bythe comparison of matched groups of Radiologists from these two countries.Materials and Methods: We analysed the data from current sets of difficult re-cent screening cases. For each case individuals identified which key mammo-graphic features were present, whether the case was abnormal and should berecalled or not. For this analysis the participants were matched on age, gender,film-reading protocols and years of experience. Assessment of case volume waselicited by questionnaire data. The Radiologists were compared on several keyperformance measures; cancers detected, correct recall and correct return toscreen, signal detection performance statistics and real-life screening practice.Results: It was found that whilst the performance of the German Radiologists onthe current test sets was excellent (correct cancer detection rate > 85%) on aver-age they performed less well than their UK counterparts.Conclusion: We argue that this is closely related to the volume of cases read perannum by individuals within each country, and theoretically their performancewill be equivalent as their case volume increases.

C-233The cytogenetic method of dosimetric control for screening mammographyV. Demin, E. Djomina; Kiev/UA

Purpose: It is advisable to study a degree of risk due to the unfavourable conse-quences of irradiation of the breast with screening mammography in Ukraineafter the Chernobyls disaster.Materials and Methods: The correlation of cytological (cytogenetic) and physi-cal findings were accomplished. The test-tubes with donor human blood wereplaced on upper and lower surfaces of breast of tissue-equivalent Aldersons phan-

tom. The test-culture of lymphocytes of human peripheral blood were used forbiological dosimetry. Physical dosimetry are realised with the thermoluminescentsystem ALNOR.Results: The chromosome aberrations are becoming 13 + 2.5% on the uppersurface of breast (normal control level is 3%) on mammography in two projec-tions (upper-lower and lateral), The fragments of chromosome type are 7%, radi-ation markers – dicentric chromosome are 1.5%; equivalent dose is 6.08%.Conclusion: There is a risk of radiation induced genetic lesions in breast tissueafter mammography. Instability genome is a basic radiation carcinogenesis. Thisis very real for women in Ukraine after the Chernobyls disaster.

C-234Efficiency of the multidetector row CT in the diagnosis of breast cancer andevaluation of intraductal spreadingH. Kani, M. Matsuki, I. Narabayashi; Takatsuki/JP

Purpose: The purpose is to analyse the efficiencies of multidetector row CT(MDCT) in the diagnosis of breast cancer and evaluation of intraductal spread-ing.Materials and Methods: Pathologically diagnosed 82 breast lesions from 75patients were examined by MDCT. The lesions included the following: 68 invasivecarcinomas, 2 noninvasive ductal carcinomas, 2 fibroadenomas, 3 papillomasand 7 other benign lesions. Non-contrast CT and contrast-enhanced CT scans at60, 120 and 240 sec after the start of enhancement were performed using 4 rowMDCT. The imaging was performed under the following conditions: 0.5-sec gan-try rotation speed, 5.5 helical pitch, 1 mm slice thickness and reconstruction in-tervals of 1 mm. The items examined were as follows: 1) In time-enhancementpatterns during four phases, the early enhancement and plateau patterns weredefined as a malignant tumor and gradual enhancement pattern was defined asa benign lesion. Its ability in the diagnosis of malignant tumor was evaluated inthe comparison with histopathologic findings. 2) The abnormal enhancement con-tinuing to the tumor at 120 sec after the start of enhancement was estimated asintraductal spreading of breast cancer. The detectability of intraductal spreadingwas evaluated by the comparison with histopathologic findings.Results: 1. The sensitivity, specificity and accuracy of the diagnosis of malignanttumor were 95.4%, 63.6% and 89.6%, respectively. 2. The sensitivity, specificityand accuracy of the detactability of intraductal spreading of breast cancer were87.0%, 81% and 83%, respectively.Conclusion: MDCT is very useful for the diagnosis and preoperative estimationof breast cancer.

C-235An exploratory study about mammographic practice (ACR 3 from BI-RADS)three months after a medical continuing education on breast cancerB. Barreau1, S. Tastet2, M. Deghaye1, V. Picot2, I. Brault1, P. Marelle1,L. Ceugnart1, D. Aucant1, S. Haber1; 1Paris/FR, 2Bordeaux/FR

Objectives: Evaluation of practices, three months after a medical continuingeducation, when abnormalities ACR 3 (probably benign) are detected on mam-mography.Materials and Methods: A questionnaire (33 items) about these practices wassent to 755 radiologists three months after medical continuing education (May-December 2002). The answers were analysed with chi-square test.Results: 225 radiologists completed the questionnaire; 102 radiologists prac-ticed breast screening; 211 used the BI-RADS classification; 204 radiologistsfollowed-up the abnormality with a short interval, 36 made a biopsy and 11 over-classed the image; 148 radiologists asked for advice from other radiologists, 49from an expert, 45 submitted to a multidisciplinary committe and 15 asked for asecond reading. A short interval-follow-up disturbed 115 radiologists about aneventual unfavourable evolution of the abnormality and 57 radiologists about le-gal problems; 36 had difficulty in explaining to patients the short interval-follow-up. The median of the scale (0 to 10) of the radiologists perceived stress is 3.Conclusion: These French radiologists have consistent practices with the BI-RADS classification and the ANAES recommendations. They may have difficul-ties in explaining the procedure to patients. The radiologist's ethic is based on the"primum non nocere".

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C-236Histopathological perspective on the first German mammography screeningproject: A two year reviewG. Gohla1, U. Sauer1, P. Hanisch1, W. Boecker2, H. Junkermann1, U. Bonk1;1Bremen/DE, 2Münster/DE

Purpose: The aim of this investigation was to critically review the role of thehistopathologist in a mammography screening project.Materials and Methods: The first model mammography screening project inGermany has been running in Bremen for the last two years. All women between50 and 70 years of age have been offered mammography and any suspect find-ings were investigated by core biopsy. These cases were reviewed in the Pathol-ogy Dept. of the University Münster and discussed at a weekly multidisciplinarymeeting. Lesions were classified using the 5 point B classification scale as rec-ommended by the European Union.Results: In the first two years of the screening project, a total of 22000 womenhad mammography. Suspicious areas were detected and core biopsies wereobtained from 401of these women. 46 % were classified B5 (malignant) 46% ofthese cases were classified B1,2 (regular breast tissue, benign) and 8% of thesecases were classified B3 and B4 (atypia probably benign, suspicious of malig-nancy). In 90% of all cases there was agreement amongst the reviewing his-topathologists, but in 10% there was no interobserver consensus. Thesedisagreements centered on flat epithelial atypia, atypically hyperplasia and pap-illary lesions.Conclusions: The consensus amongst experienced breast histopathologists issatisfactory in clearcut cases, but it should be improved in less well classifiedlesions. These lesions are more likely to be seen in a screening situation and incore biopsies. In this area it is certainly advisable to cooperate closely with theclinician and radiologist.

C-237Usefulness of multi-slice CT for nonpalpable breast lesions withmicrocalcifications: Correlation with mammographic findingsH. Satake, A. Sawaki, K. Shimamoto, S. Ishigaki, K. Oda, T. Imai, T. Ishigaki;Nagoya/JP

Purpose: To evaluate the usefulness of multi-slice CT for nonpalpable breastlesions with microcalcifications, compared with mammographic findings.Materials and Methods: 40 cases with nonpalpable microcalcification of the breastrecommended for biopsy on MMG. They included 26 malignant lesions (ductalcarcinoma in situ, n = 18; ductal carcinoma in situ with microinvasion, n = 8) and14 benign lesions (mastopathy, n = 6; intraductal papilloma, n = 2; other, n = 6).On multi-slice CT images, the presence of focal or segmental enhancement inthe region consistent with microcalfications was regarded as positive diagnosisfor malignancy. All mammographic and CT findings were assessed with a con-sensus between two radiologists.Results: 4 cases of benign lesions pathologically were assessed as "suspiciousmalignant" on MMG, while, in three of them, focal or segmental enhancementappeared on multi-slice CT. Although seven cases of breast cancer were as-sessed as "probably benign" on MMG, six cases acquired focal or segmentalenhancement on CT. For cancer diagnosis, the sensitivity of MMG and multi-sliceCT were 69.2% and 96.0%, specificity was 71.4% and 57.1%, and negative pre-dict value were 58.8% and 88.9%, respectively. Breast conservation surgery withsimulation using 3D CT images was performed successfully in 17 cases of breastcancer.Conclusions: The sensitivity and the negative predict value of multi-slice CT fornonpalpable breast microcalcifications were superior to those of MMG. Whenbiopsy is recommended according to MMG, additional examination of multi-sliceCT enables the indication for biopsy to be more optimized and is useful for plan-ning the treatment.

Cardiac

C-238The value of magnetic resonance imaging in the assessment of adultpatients with corrected transposition of the great arteriesS. Shine, E. Kavanagh, C. Cantwell, K. Walsh, A.E. Wood, J.G. Murray;Dublin/IE

Learning Objectives: To illustrate the role of magnetic resonance imaging (MRI)in the assessment of adult patients with corrected transposition of the great ar-teries (TGA).Background: TGA is a complex congenital heart anomaly, traditionally correctedby "venous switch" in the neonate. Adult survivors require ongoing imaging toassess long-term sequelae including shunt complications, right ventricular fail-ure and valvular dysfunction. MRI offers a comprehensive, minimally invasiveand non-ionising investigation for these patients. Over 2 years, 21 consecutivepatients (15 male, 6 female; aged 16-41 years) with TGA (19 surgically correctedd-loop, 2 congenitally corrected l-loop) were imaged on a 1.5 Tesla/SymphonyMR scanner using T1, True FISP and gadolinium-enhanced arteriography se-quences.Imaging Findings: In 19 shunts imaged (10 Mustard, 1 Senning, 2 Blalock-Taus-sig, 2 Rastelli, 3 Fontan, 1 Waterstom), complications included an occluded Bla-lock-Taussig shunt, a stenosed Mustard pulmonary venous conduit and 3 stenosedMustard systemic venous conduits. Patency was confirmed in all remaining con-duits. Ventricular disease, ejection fraction and valvular dysfunction were assessed.Displacement and compression of the inferior pulmonary vein as a result of onemarkedly dilated Fontan atrium was noted. Dilatation of the SVC/IVC and pulmo-nary veins was observed in several patients. Unilateral lung hypovascularity as-sociated with an atretic ipsilateral pulmonary artery was found in 2 cases. Ananeurysmal ascending aorta (4.3 cm) was detected following a Waterstom shunt.Extracardiac findings included azygos-continuation of the IVC, hepatic venouscongestion, hepatomegaly and ascites.Conclusion: Magnetic resonance imaging offers comprehensive, minimally in-vasive assessment of adult patients with transposition of the great arteries.

C-239MRI pictorial essay on cardiac myxoma in uncommon locationsK. Vanderdood1, B. Op de Beeck2, F. De Ridder1; 1Brussels/BE, 2Antwerp/BE

Learning Objectives: We fully illustrate the morphology, contrast enhancementand mobility of myxomas in rare locations such as the right ventricle and unusualattachment to the tricuspid valve.Background: Although benign myxoma is the most common primary cardiactumor (25%), it remains a rare finding with an incidence of 0.5 per million popula-tion per year in the western world. Myxomas are found in the left (75%) or right(20%) atrium and seldom in the ventricles. These pedunculated tumors typicallyarise from the atrial septum near the fossa ovalis and much less frequently fromthe mitral valve. Intracardiac obstruction and systemic emboli are the major com-plications.Imaging Findings: Myxomas in an uncommon cardiac location should be differ-entiated from other primary (malignant) and secondary (thrombus; metastasis)cardiac tumors. MRI allows visualization of the narrow pedicle, its attachmentand the changing tumor shape and mobility during the cardiac cycle, unlike mostmalignant processes. In contrast to most thrombi, myxomas have low signal in-tensity on cine gradient-echo images and show contrast enhancement. The wa-ter-rich myxomatous stroma, fibrous stroma, calcifications and hemorrhageaccount for the heterogeneous T2-weighted SE images. Increased interstitial spacein the myxoid region and inflammatory zones enhance after intravenous Gd-DPTAon T1-weighted SE images. Lobular tumor surface and higher volume increasethe pre- and postoperative risk for systemic emboli. Furthermore, the exact loca-tion on MRI is most helpful in planning the surgical access.Conclusion: Myxomas in uncommon locations can be differentiated from othercardiac tumors by evaluating tumor morphology, mobility and enhancement.

C-240How to study with CMR a patient submitted to Ross procedure: A step bystep follow-up protocolR. Ribes1, A. Luna2, J. Vida1, P. Caro3; 1Cordoba/ES, 2Jaen/ES, 3Cadiz/ES

Learning Objectives: To describe an adequate protocol to study patients sub-mitted to Ross procedure with MR. To identify and quantify postsurgical compli-cations in this group of patients with MRI.

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Background: Ross procedure is widely accepted as one of the best methods foraortic valve replacement, especially in children and young adults. Ultrasound isusually used in their follow-up, but tit offers a limited evaluation of the right out-flow tract, being important to discard homograft stenosis. MRI overcomes thelimitations of ultrasound and may replace the number of digital subtraction angi-ograms traditionally performed in the follow-up of these patients.Procedure Details: We describe step by step our MR protocol, to study patientssubmitted tothe Ross operation. Examples of the MR features of common pres-entations and complications are shown from our series of 53 patients. Our proto-col consists of the following steps: • Black-blood coronal and transverse turbospin echo T2-weighted images. • CineMR gradient-echo sequences allow func-tional qualitative assessment of themotion of valves and chambers, the detectionof either valvular regurgitation orstenosis, and areas of altered myocardial con-tractility or relaxation. We perform GRE-CineMR sequences in left two chamber,right two chamber, fourchamber, short axis (at several levels from the apex to thebase), left ventricular outflow tract, right ventricular outflow tract, and aorticrootviews. • Phase contrast images are performed to obtain quantitative dataabout magnitude anddirection of blood flow through the right and left ventricularoutflow tracts.Conclusions: CMR allows an accurate evaluation of patients submitted to Rossprocedure and identification of the postsurgical complications.

C-241Focal outpouching lesions of the left ventricle: Comprehensive evaluationwith cardiac magnetic resonance imagingJ. Seo, K.-H. Do, Y. Choe, J.-W. Song, J. Lee, T.-H. Lim; Seoul/KR

Learning Objectives: To review causes showing focal outpouching lesions ofthe left ventricle. To present the MR techniques used to evaluate those diseases.To illustrate typical MR appearances of various causes.Background: The causes of focal outpouching of the left ventricle are as follows:1) true aneurysm; a chronic complication of myocardial infarction, which containsthe endocardium, epicardium, and thinned fibrous tissue replacing the myocar-dium, 2) pseudoaneurysm; a consequence of rupture of the ventricular free walldue to acute infarction and confined by the pericardium, 3) diverticulum; a con-genital outpouching of ventricular wall including all of three layers, and 4) hiber-nating myocardium due to chronic ischemia with paradoxical outpouching atsystole. MR imaging is useful in differentiating these causes by using variableimaging sequences to evaluate the myocardial contractility, perfusion and viabil-ity. In this exhibit, we will show the usefulness of MR imaging to differentiatethese pathologies using various MR imaging sequences.Imaging Methods and Findings: Cardiac MR imaging methods include; 1) cineimaging for wall motion analysis, 2) first pass myocardial perfusion imaging, and3) delayed enhancement imaging. Images were obtained along the short axisand horizontal long axis of the heart. By analyzing the shape, contractility, mo-tion, perfusion, and contrast enhancement, it is possible to differentiate the caus-es of the outpouching lesion of the left ventricle.Conclusion: Cardiac MR imaging is useful in differentiating various causes offocal outpouching of the left ventricle.

C-242Features of cardiac disease demonstrated on CT pulmonary angiographyS.J. McKie1, J.H. Reid2, D.J. Hardwick2, J. Murchison1; 1Edinburgh/UK,2Melrose/UK

Learning Objectives: On a CT pulmonary angiogram (CTPA) the heart andmediastinal structures are frequently overlooked. This pictorial review will dem-onstrate the features of cardiac disease that may be evident on a CTPA.Background: Only one third of patients being investigated for PE are proven tohave had an embolic event. CT pulmonary angiography (CTPA) allows assess-ment of not only the pulmonary arteries for embolism, but also of the bronchi,lung parenchyma, mediastinum and heart. Co-existent underlying or incidentalcardiac disease is often present. A potentially life-threatening alternative diagno-sis in a patient with chest symptoms can be reliably identified.Imaging Findings: Multiple cardiac abnormalities are described on routine CTPA.Pathologies of the myocardium including HOCM, pericardial disease, valvulardisease, coronary artery disease, and intracardiac abnormalities are demonstratedpictorially.Conclusion: CTPA is an increasingly frequently used investigation for the detec-tion of pulmonary embolism. Most patients investigated have pathology other thanPE as a cause of their symptoms. Frequently information about the heart is yield-ed that provides important clues to determine the cause for the presenting symp-toms and signs or reveals co-existing pathology.

With this investigation being used more frequently in daily practise in many pa-tients with unexplained breathlessness or chest pain it is important to have aclear understanding of the features of cardiac disease as seen on a CTPA.

C-243Secondary dextrocardia: Imaging findings and differential diagnosisO. Persiva, J. Cáceres, J. Andreu, M. Martinez, S. Roche; Barcelona/ES

Learning Objectives: To present the causes of dextrocardia in adults. To de-scribe the signs that suggest the correct diagnosis.Background: We define dextrocardia when 50% or more of the cardiac silhou-ette lays in the right hemithorax. In secondary dextrocardia, imaging techniquesshow normal anatomical relationships of the cardiac chambers, with the apex onthe left side. Primary dextrocardia (situs inversus and situs ambiguous) is exclud-ed from this study.Imaging Findings: The following causes of secondary dextrocardia were found:1. Loss of volume of the right lung, (congenital or acquired). We describe theimaging findings which suggest the correct diagnosis in the chest radiograph.2. Elevation of the left hemidiaphragm (paralysis or hernia). Differentiation be-tween diaphragmatic paralysis and hernia is easily accomplished with bariumstudies.3. Cardiac dextroposition. Incomplete rotation of the cardiac axis projects thecardiac silhouette to the right of the midline. A 20 degrees left posterior obliqueprojection shows a normal cardiac outline, confirming the dignosis.4. Alterations of the thoracic cage (scoliosis and pectus). They are easily identi-fied in the chest radiograph and there is no need of further work-up.5. Herniation of the heart into the right hemithorax after chest surgery. It is aclinical emergency.6. False dextrocardia, due to anterior mediastinal masses overlapping the rightheart border. CT is necessary to confirm the suspected diagnosis.Conclusion: Secondary dextrocardia is not uncommon in adults and can be easilydiagnosed if one is aware of its imaging manifestations.

C-244MRI in monitoring of aortic and mitral valve surgery resultsE. Mershina, V. Sinitsyn, S. Dzemeshkevitch, T. Poustovitova; Moscow/RU

Purpose: To define the role of MRI in examination of patients after valve surgeryfor assessment of heart chambers remodeling and mechanic valve functioning.Materials and Methods: 42 patients (males 25, females 17; mean age - 47.6 yrs,range 32-67) with mitral and aortic prostheses were examined, 20 of them hadMRI before surgery. 17 pts had only aortic valve prosthesis, 17 - only mitral, 8 -both. MRI has been done twice - 10-20 days and 12-24 months after surgery. MRIwas performed with a 1.0 T MR imager using ECG-gated T1-SE (or T1-TSE),bright-blood GRE-CINE-technique and phase-contrast MRI.Results: 9 pts (of 20) had a positive dynamic study of heart chambers dimen-sions and volumes in early postoperative stage. In the area of prostheses signalof low intensity was defined in all the patients (artifacts). Narrow flow of low signalintensity along the prostheses leaflets corresponded to normal function of pros-thesis (46 of 50 valves). 4 pts had signs of mechanical valve dysfunction (3 -mitral paravalvular leaks, 1 - aortic prosthetic valve stenosis). MRI data were inagreement with the results of echocardiography. MRI was able to diagnose suchpostoperative complications as atelectasis (4), mediastinal haematoma (2), pleu-ritis (2).Conclusion: MRI could give an objective information about heart morphology(chamber dimensions, hypertrophy degree) and mechanic valve functioning (nor-mal and abnormal flow) in patients after surgery. It can be safely performed inpatients with artificial heart valves.

C-245Negative calcium scoring: Can it rule out severe stenosis?P.M. Carrascosa1, C. Capuñay1, P. Garcia Merletti1, P. Johnson2, S. Chandra2,R. Pissinis1, J. Carrascosa1; 1Buenos Aires/AR, 2Cleveland, OH/US

Objective: To determine the presence of stenosis greater than 50% (in at leastone coronary vessel) proved by digital angiography (DA) in patients with a nega-tive calcium score and correlate findings with CT angiography.Methods: 30 patients were evaluated. CTs were performed with a 4-row CT scan-ner. The calcium score was calculated according to the Agatston method. A cal-cified plaque was defined as a lesion of at least two adjacent pixels with signalintensity above 130 HU. The second enhanced acquisition was performed follow-ing the administration of 130 mL of non-ionic contrast with 4 x 1 mm collimationand 0.5 mm slice increment. DAs were performed on a digital angiographer. Meas-

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urements were done by means of QCA. Stenosis was considered positive if itwas greater or equal than 50%.Results: there were 14 patients with high grade calcium score. Eleven had pos-itive DA for at least 1 coronary artery and in 3 cases the DA did not show severestenosis. There were 14 patients with negative calcium scores (Grade 0), 5 hadnegative DA findings, and 9 had positive DA findings. In these patients, the con-trast CT acquisition revealed that the cause of the stenosis was due to soft plaques.Conclusion: high grade calcium scores predict severe stenosis. Negative re-sults do not exclude them. In this study the 33% of the patients had negativecalcium scores but significant stenosis due to soft plaques. A contrast CT acqui-sition instead of the calcium score will be necessary to rule out all the severestenosis.

C-246Positron emission tomography and 13N-ammonia application to evaluatemyocardial blood flow in the asymptomatic patients with coronary arterycalcificationD.V. Ryzkhova, I.E. Itskovich, L.A. Tyutin, L.A. Kofal; St. Petersburg/RU

The purpose of this study was to assess myocardial blood flow (MBF) in theasymptomatic patients with coronary artery calcification (CAC).Methods: 26 symptom-free patients with CAC were included in study. All of themhadn't any symptoms of CAD (chest pain, severe arrhythmia, heart failure) andmyocardial infarction history. The patients with significant myocardial hypertro-phy weren't included. The myocardial blood flow at rest (MBF rest) and duringdipyridamole test (MBF stress) was evaluated by 13N-ammonia dynamic PET("Ecat Exact 47", Siemens). The coronary calcium score (CCS) was measuredby MSCT coronaroangiography ("Somatom Volume Zoom", Siemens) using theAgatston method.Results: Myocardial perfusion abnormalities during stress test were revealed in9 patients with CAC, there were patients with silent ischemia (1st group). We ob-served normal myocardial perfusion at rest and during stress test in the remain-ing 17 patients (2nd group). The mean values of total CCS were less than 100Units and close between the both group (89.27 ± 11.84 Units vs. 84.9 ± 9.44Units, p = NS). MBF-values at rest didn't differ between the both patients' groups(76.58 ± 8.0 mL/100 g/min vs. 74.46 ± 9.25 mL/100 g/min, p = NS). MBF stressmean values were significantly decreased in the 1st group (137.1 ± 35.6 mL/100 g/min vs. 207.8 ± 39.7 mL/100 g/min, p < 0.005).Conclusion: The CCS less than 100 Units isn't a reliable marker of flow-unlimit-ing stenoses in asymptomatic patients.Soft lipid-laden plaques is a cause ofmyocardial ischemia in symptom-free patients with CAC and low CCS. Thesepatients should undergo stress studies to detect silent ischemia.

C-247Detection and assessment of myocardial inflammation and fibrosis byEcho-densitometry and CE-MRI in patients with mild and mediummyocarditis: Validation by WBC-MIBI SPECTM. Deryugin, I. Itskovitch, V. Soukhov, S. Boytsov, A. Svistov; St.Petersburg/RU

Background: Echo-densitometry and CE-MRI are novel methods for assess-ment of inflammatory myocardial infiltration (IMI) and myocardial fibrosis (MF).The purpose of the current study was to validate these methods in patients withmild/medium myocarditis using WBC-MIBI SPECT.Methods: CE-MRI was performed in 53 patients using T1-weighted TurboFLASHinversion recovery. Inflammation was evidenced by use of threshold method (sig-nal intensity > +2.0 SD). Left ventricle Echo-densitometry performed in long-axisviews from left parasternal border at ES/ED with following percentage cyclic var-iation indexes (CVI) calculation. SPECT was performed 16-20 hrs p.i. of 750 MBq99mTc-WBC and 10 min p.i. of 99mTc-MIBI.Results: All patients were divided into 3 groups based on scintigraphic data: firstgroup – 20 patients with diffuse leukocytes uptake that considered as IMI; insecond group there were 21 patients with local leukocytes uptake and abnormalMP (IMI+MF); third group consisted of 12 patients with only MF. Control grouppatients (n = 7) had normal MP and no leukocytes uptake. CVI was 38 ± 10% incontrols; 10.6 ± 21% in 1st; -5.2 ± 22% in 2nd and -19 ± 23% in 3rd group. CE-MRIwas able to detect IMI in 88% of patients. Regression analysis revealed goodcorrelation between IMI by CE-MRI and by WBC-SPECT (r = 0.70, P < .01). Fur-thermore, good correlation was found between CVI and 99mTc-MIBI uptake(r = 0.51, P < .01) both for IMI and MF detection.Conclusion: CE-MRI enables exact detection of IMI as compared to WBC-SPECT.The results of videodensitometry studies demonstrated that different types of IMIwere associated with definite CVI percentage, while CVI became negative withMF appearance.

C-248One-year CT evaluation of pulmonary veins following percutaneouscryoablation in patients treated for atrial fibrillationB. Ghaye1, D. Szapiro1, C. Timmermans2, L.-M. Rodriguez2, H.-F. Tse3,C. Geller4, G. Ayers2, R.F. Dondelinger1; 1Liège/BE, 2Maastricht/NL,3Hong Kong/CN, 4Magdeburg/DE

Background: Pulmonary vein isolation (PVI), using radiofrequency energy, fortreatment of atrial fibrillation (AF) has been associated with complications includ-ing pulmonary vein (PV) stenosis or thrombosis. The purpose of this study was toprospectively evaluate the PV morphology following cryoablation.Method: 50 patients underwent percutaneous PVI in 3 academic centers. Con-trast-enhanced, single-slice or multi-slice spiral CT (1-2.5 mm thick slices) wasobtained before, 3 and 12 months following PVI. All examinations were read blindedto the location(s) of ablation. PVs were evaluated quantitatively and qualitatively:the diameter at ostium and at 1 cm from ostium were measured. The presenceand location of luminal irregularity or thrombosis was also assessed.Results: In ablated veins, the mean diameters at ostium were right inferior PV1.58 ± 0.34, 1.55 ± 0.29 and 1.66 ± 0.15 cm, right upper PV 1.59 ± 0.22,1.53 ± 0.24 and 1.47 ± 0.26 cm, left inferior PV 1.29 ± 0.33, 1.24 ± 0.33 and1.13 ± 0.25 cm, left upper PV 1.73 ± 0.38, 1.70 ± 0.36 and 1.67 ± 0.35 cm be-fore the procedure and, 3 and 12 months after the procedure respectively. Nosignificant difference (p > 0.05) was found between diameter in ablated versusnon ablated veins before and after the procedure. Three patients presented withluminal irregularity before the procedure. No patient showed luminal irregularityor thrombosis of PV following cryo-ablation.Conclusion: These results suggest that PVI for the treatment of AF is not asso-ciated with stenosis or thrombosis of cryoablated PVs after one year follow-up.

C-249Myocardial delayed enhancement on MRI: Its prognostic significance inpatients with congestive heart failure due to nonischemic dilatedcardiomyopathyH. Saito, H. Otani, T. Ishibashi, A. Sato, K. Takase, T. Matsuhashi, T. Yamada,S. Takahashi; Sendai/JP

Purpose: Histological hallmark of Dilated Cardiomyopathy (DCM) is a progres-sive interstitial fibrosis with a numerical decrease of contractile myocytes. myo-cardial fibrosis can impair myocardial contraction, and can be an arrhythmogenicsubstrate. Myocardial delayed enhancement (DE) on MRI can visualize myocar-dial fibrosis. The aims of this study were comparison of the local myocardialcontraction between the myocardium with DE and without, and evaluation ofmyocardial DE's prognostic significance in patients with congestive heart failuredue to nonischaemic DCM.Materials and Methods: Delayed enhanced MRI and myocardial tagged imageswere taken in 27 patients (55 ± 16 yrs, 21 male) referred for congestive heartfailure due to nonischaemic dilated cardiomyopathy, whose left ventricular (LV)end-diastolic volume index > 90 mL/m2 and LV ejection fraction < 50%. The pa-tients were followed for a mean of 12 ± 6 months.Results: Myocardial DE was present in 13 patients (48%). In these 13 patients,the average amount of myocardial DE was 6 ± 11% of LV myocardium (2-54% ofLV). Myocardial axial thickening was 13 ± 23% in the segments with myocardialDE, and 28 ± 27% without (p = 0.001). Myocardial circumferential shortening was6 ± 10% in the segments with myocardial DE, and 10 ± 7% in without (p = 0.004).Kaplan-Meier analysis demonstrated that the patients with DE > 8% of LV hadsignificantly increased mortality compared to the patients with DE < 8% of LV(p = 0.01).Conclusion: Myocardial axial thickening and circumferential shortening werereduced in segments with myocardial DE. Myocardial DE may have prognosticsignificance in patients with congestive heart failure due to nonischaemic DCM.

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C-250Electron beam CT (EBCT) in the detection of abnormal myocardial contrastenhancement in patients with recent and chronic myocardial infarctionsT. Vesselova, V. Sinitsyn, S. Ternovoy; Moscow/RU

Purpose: of the study was to determine the occurrence of low-density areas inthe myocardium of the left ventricle (LV) in patients with myocardial infarction(MI) seen during non-invasive EBCT coronary angiography.Material and Methods: 35 patients (51.5 ± 12.0 years old) with ischemic heartdisease and MI were included in the study. In 16 patients with first myocardialinfarction (MI) EBCT was performed during first 2 weeks after coronary event. In19 patients EBCT was done 12 months after an MI. EBCT angiography and ven-ticulography were done with Imatron C-150 imager.Results: Low-density areas in LV myocadium were seen on EBCT images in allpatients with MI. In 35% of patients these findings were accompanied by myocar-dial thinning and in 20% cases intracavitary thrombi were present. In 8.6% pa-tients with transmural MI low-density myocardial regions were visualized onnon-contrast images. In 22.9% patients with MI subendocardial low-density zoneswere seen. Results of EBCT were in agreement with myocardial scintigraphy.Characteristics of hypodense areas (HU values) in patients with recent and chronicMI were similar. Calcifications and significant stenoses of coronary arteries werefound in all patients with old MI, the mean (SD) Agatston score was 293.5 ± 311.5.In patients with subacute MI the mean Agatston score was 194.9 ± 328.0 (NS).Four patients from this group had coronary score = 0.Conclusion: During EBCT coronary angiography most of the low-density areascorresponded to sites of previous myocardial infarctions. Some of these areasmay correspond to hypo-perfused areas of ischemic, but viable myocardium.

C-251Progression of coronary artery disease in relation to coronary stenosismorphology: Quantitative coronary angiography analysisJ. Saponjski, M. Ostojic, B. Beleslin, V. Vukcevic, M. Nedeljkovic, S. Stojkovic,A. Dordjevic/Dikic, I. Nedeljkovic; Belgrade/YU

Objective: The aim of this study was to analyze progression and regression ofcoronary stenosis in relation to stenosis morphology.Methods: The study group consisted of 53 patients (43 male, 10 female; meanage 54 ± 11 years). Coronary stenoses were analyzed by quantitative coronaryarteriography including percent diameter stenosis (%DS) and changes in ob-struction diameter between two arteriographies. According to the Ambrose ang-iographic lesion morphology 4 groups were identified: Group I (n = 18)-simpleconcentric lesion morphology, Group IIa (n = 20) -simple eccentric lesion mor-phology, Group IIb (n = 22) -complex lesion morphology, and Group III (n = 6)with complex and multiple coronary stenoses. The follow-up period between firstand second arteriography were similar for all groups (I, 8 ± 9 months; IIa, 11 ± 10months; IIb, 7 ± 8 months; III, 6 ± 5 months; p = ns).Results: Progression of coronary artery disease was identified in 66%, 75%,80% and 100% of lesions in Ambrose groups I, IIa, IIb, and III, respectively. Onthe contrary, regression of coronary stenosis was documented in 33%, 25%, 20%and 0% of lesions in groups I, IIa, IIb, and III respectively. However, comparingthe lesions with non-significant and significant stenosis (cut-off point 50% DS),progression of coronary stenosis was higher for the lesions with DS < 50% for allgroups (except group III where all the lesions were with DS > 50%), reachingstatistical significance in group I (I, +0.52 ± 0.55 vs -0.24 ± 0.32 mm, p < 0.01;IIa, 0.61 ± 0.80 vs 0.13 ± 0.32 mm, p = ns; 0.66 ± 0.69 vs 0.33 ± 0.56 mm, p = ns).Conclusion: Coronary lesion morphology of simple type was associated withlower rate of coronary stenosis progression.

C-252Noninvasive assessment of coronary microcirculatory function inpostmenopausal women by positron emission tomography and 13N-ammoniaD.V. Ryzhkova, N.A. Kostenikov, L.A. Tyutin, V.E. Savello; St. Petersburg/RU

The aim of this study was to assess coronary microcirculatory function in post-menopausal women.Methods: We measured myocardial blood flow (MBF) with a 13N-ammonia PETscan at rest, during cold pressor testing (CPT) for an indirect measurement ofendothelium-dependent vasomotion, and during dipyridamole hyperemia (en-dothelium-independent vasomotion) in 16 postmenopausal women without coro-nary artery disease. 10 young healthy women served as controls.Results: Rest-MBF and hyperemic-MBF did not differ between the young andthe postmenopausal women (rest: 76.3 ± 12.6 vs. 82.4 ± 14,.1 and dipyridamole:

220.3 ± 38.4 vs. 216.8 ± 34.9 mL/100 g/min; NS). Coronary flow reserve was sim-ilar between the two groups (the young women: 2.96 ± 0.91, the postmenopausalwomen: 2.71 ± 0.86; NS). CPT induced a similar increase of rate-pressure prod-uct in the young and the postmenopausal women (10580 ± 730 vs. 9659 ± 1653beats/min/mmHg), CPT-MBF was significantly decreased in the postmenopausalwomen (64.2 ± 12.3 mL/100 g/min) compared with the young women(87.48 ± 14.7 mL/100 g/ min; p < 0.05).Conclusion: PET with 13N-ammonia during CPT is a noninvasive imaging tech-nique to detect MBF abnormalities, which associated with endothelial dysfunc-tion in postmenopausal women.

C-253Contrast-enhanced magnetic resonance imaging at true end-diastole toquantify reproducible transmural extent of myocardial hyper-enhancementY.-J. Kim, B. Choi, K. Choe; Seoul/KR

Purpose: To determine feasibility of contrast-enhanced MRI (ce-MRI) at true end-diastole (ED) free from limitation of time for inversion-recovery and trigger win-dow for quantifying transmural extent of infarction.Methods and Materials: MRI was performed in 18 patients with myocardial inf-arction. Cine imaging and ce-MRI with same registered slices in short axis wereperformed. To allow true ED ce-MRI, ECG synchronization should use two RR-intervals for one acquisition of a segment of k-space by setting the heart rate tohalf that of the true heart rate. Trigger delay time was adjusted to the RR-intervalfor imaging at ED and to the sum of RR-interval plus the time between R-waveand the end-systole (ES) determined in cine images for imaging at ES.Results: Wall thicknesses of the ED and the ES ce-MRI were greater than thoseof the ED and the ES cine images (7.5 ± 1.3 mm > 6.2 ± 1.4 mm, 9.4 ± 1.8 mm >8.6 ± 1.8 mm respectively). Subendocardial hyperenhancement was detected in13 patients. Among them, systolic wall thickening was observed with cine imag-ing in 8 patients and the transmural extent of hyperenhancement measured onED ce-MRI decreased by 5-30% on ES ce-MRI proportional to the degree ofsystolic thickening of the epicardially nonenhanced myocardium. Transmural hy-perenhancement in 4 patients showed no difference in thickness between end-diastole and end-systole.Conclusion: Ce-MRI at ED is constantly possible by using two RR-interval peracquisition of a segment of k-space and useful to avoid the variation in infartsizing with irreproducible cardiac phase other than end-systole in case of suben-docardial infarction.

C-254Comparison of computed tomography (CT) and magnetic resonance (MR)for screening of pulmonary veins (PVs) complications of cryotherapy forpercutaneous ablation of atrial fibrillation (AF)B. Ghaye1, D. Szapiro1, L.-M. Rodriguez2, C. Timmermans2, R.F. Dondelinger1;1Liège/BE, 2Maastricht/NL

Purpose: To prospectively compare CT and MR for evaluation of potential com-plications, including stenosis or thrombosis of PVs, of cryoablation for AF.Methods and Materials: 21 patients underwent percutaneous cryo-ablation ofAF. Cardiac spiral CT and MR were performed before the procedure, at 24 hours,and at 3 months following AF cryo-ablation. CT was performed with spiral CT (PQ5000, Phillips, Eindhoven, The Netherlands) using 2 mm thick slices reconstruct-ed every 1 mm, 1-s rotation time, 120 mA and 130 kV per rotation following IVperipheral injection of 120 mL of 30% iodinated CM. MR was performed on a1.5 T Symphony VA15 system (Siemens, Erlangen, Germany) using a multi-sliceT1-weighted dark-blood turbo-spin-echo pulse sequence and bright-blood cinetrufisp sequence. All CT and MR examinations were quantitatively and qualita-tively read blinded to the location(s) of ablation.Results: For CT, the mean diameters at LA-PV junction and at 1 cm from ostiumwere 1.6 (0.98-2.33) and 1.29 (0.78-1.74) cm before the procedure, and 1.45(0.98-2.05) and 1.17 (0.83-1.49) cm 3 months after the procedure, respectively.For MR, measurements were 1.64 (1.3-2.3) and 1.17 (0.7-1.7) cm before theprocedure, and 1.62 (1.1-2) and 1.09 (0.7-1.6) cm 3 months after the procedure,respectively. For both techniques, no significant difference was found betweendiameter, nor morphological abnormality, in ablated and not ablated veins beforeand after the procedure.Conclusion: Preliminary results suggest that CT and MR are equivalent tech-niques to demonstrate absence of complications after PV isolation using cryo-ablation of AF.

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C-255Congenital cardiac diseases associated with right aortic arch anomalyB. Yi, M. Moon, M. Song; Seoul/KR

Purpose: To present variable congenital cardiac and extracardiac defects asso-ciated with right aortic arch in fetal echocardiography.Methods and Materials: 30 fetuses with right aortic arch were retrospectivelyreviewed (1996.1-2002-6). Associated cardiac and extracardiac anomalies wereevaluated on fetal echocardiography. Postnatal diagnosis or autopsy were corre-lated with fetal echocardiography.Results: In 30 fetuses with right aortic arch, combined congenital cardiac dis-eases were as follows, TOF (8), VSD(1), and DORV with pulmonary stenosis(1).Associated extracardiac anomalies were oligohydramnios(2), arthrygryposis(1),splenic cyst(1), and shortening of long bones(1). On postnatal echocardiogra-phy, previously non-diagnosed VSD were found on two neonates and TGA with-out VSD in one neonate. Overall incidence of combined cardiac defects is about43.6%.Conclusion: Right aortic arch associates variable cardiac defects and extracar-diac anomalies in about half of fetuses. Prenatal diagnosis of right aortic archmust be followed further echocardiography and targeted fetal sonography for exactdiagnosis.

C-256Potential myocardial iron content evaluation by MR in βββββ-thalassemia majorpatients treated by deferoxamine or deferipronM. Galia, M. Midiri, T. Bartolotta, A. Maggio, R. Lagalla; Palermo/IT

Purpose: To evaluate the usefulness of MRI to assess myocardial iron content inpatients with β-thalassemia major treated by Deferoxamine B mesylate (DF) orDeferiprone (L1) chelation therapy.Method and Materials: 72 consecutive patients with β-thalassemia major (35treated by DF and 37 by L1) underwent, at enrollment and after one year treat-ment, heart MRI (1.5 T unit) with an electrocardiogram-triggered gradient-echoT2 weighted sequence. Liver MRI was obtained at the same time in all patients.Measurements of the heart to muscle signal intensity ratio (HSIRs) were com-pared between the two groups and with laboratory parameters, liver iron concen-tration (LIC) and liver to muscle signal intensity ratio (LSIRs).Results: HSIRs were significantly increased in DF (t = -2.8; p = < 0.01) and L1group (t = -3.1; p = < 0.01) after one year treatment. No statistically significantdifference in the values of HSIRs was present between the two groups at thebeginning (p = 0.25; t = 1.13) and after one year treatment (p = 0.20; t = 1.28).HSIRs were inversely correlated to LIC (r = 0.52; p = < 0.001) but not to ferritinlevels (r = 0.10; p = 0.18). A positive correlation was found between the variationof HSIRs and that of LSIRs (r = 0.52; p = < 0.001), and a mild correlation (r = 0.40;p = < 0.001) was found between the γ-glutamyltransferase levels and the HSIRsvalues.Conclusion: MRI is usefull to detect HSIRs variations during iron chelation ther-apy. Moreover it is non-invasive and easily repeatable.

C-257Application of 123-Iodine labelled 15-Iodinepentadecanoic acid for detectionof myocardial viability in patients with CHD and resting regional LVdysfunctionV. Soukhov, I. Savicheva, A. Partsernyak, A. Svistov; St.Petersburg/RU

Purpose of this study was to assess 123-Iodine labeled 15-iodinepentadecanoicacid (123I-PDA) - synthetic radiolabeled free fatty acid with the potence for detec-tion of myocardial viability.Methods: 107 patients (80 male and 27 female, mean age 49 ± 8 yrs) who hadhistory of myocardial infarction and resting regional left ventricular dysfunctionwere examined. Blood supply, regional myocardial oxidative metabolism and re-gional metabolic substrate utilization were assessed by SPECT at 3-5 and 35-40 min after i.v. injection of 400 MBq with 123I-PDA. Echocardiography with lowdoses of dobutamine was used for measuring inotropic reserve.Results: Early 123I-PDA SPECT demonstrated high specificity in diagnostics ofperfusion defects (up to 85%). The delayed images showed foci of remaininghigher activity in regions of ischemic, but viable myocardium. 387 of a total of1050 myocardial segments had abnormal resting wall motion. In 189 of them nooxidative metabolism and inotropic reserve were detected, that indicated scarredmyocardium. 314 of them were considered to be viable as they demonstratedboth oxidative metabolism and inotropic reserve.Conclusion: 123I-PDA as an agent for simultaneous perfusion and oxidative me-tabolism evaluation may be used for identifying myocardial viability. Diagnostic

value of this method in combination with low doses of dobutamine echocardiog-raphy even in the cases of severe myocardial metabolic damage is nearly equalto PET with 18FDG and should be applied for detection of viable myocardium.

C-258Comparison of MRI and nuclear medicine in detection and analysis of leftventricular infarctionR.M. MacMillan1, T. Vakhtangadze2, M.R. Rees2; 1Philadelphia, PA/US,2Bristol/UK

Aims: To compare standard SPECT perfusion imaging with last contrast enhancedMRI for the detection of infracted myocardium.Materials and Methods: 34 patients (13 female, 21 male) from two centres withproven myocardial infarction by ECG, clinical and echo criteria underwent stress/rest Tc99 sestamibi Gated SPECT scanning with a dual headed gamma cameraand late contract enhanced MRI on identical 1.5 Tesla scanners in each centreusing a protocol which imaged 15 minutes after injection of 0.1 mmol/kg IV gado-linium. Analysis of segments used a 17 segment system, with a total of 578 seg-ments analysed in both imaging methods.Results: 183 segments demonstrated scars on MRI and 132 segments demon-strated scars on isotope imaging. Comparison of isotope imaging to MRI showedthat 8 segments who had scars on isotope scanning failed to show on MRI whilst42 scars on MRI were not demonstrated on nuclear imaging. The majority ofthese scars were small or sub-endocardial. In some cases these scars had is-lands of functioning myocardium within them. Some scars seen as completelynon perfused defects on nuclear imaging were demonstrated to be partial thick-ness scars on MRI.Conclusion: There was no significant difference in the findings from each centreindicating reproducibility and transferability of technique and findings. MRI wasable to detect smaller scars than nuclear imaging and viable myocardium in prox-imity to scar tissue.

C-259Prenatal diagnostics of obstructive heart lesionsG. Spanovic1, I. Jovanovic2, V. Parezanovic2, A. Zvezdin1; 1Novi Sad/YU,2Belgrade/YU

Purpose: Aim of prenatal diagnostics of obstructive heart lesion is to make rightdecision about the way leading further pregnancy, and decision about the time,place and way of labor. Sensitivity and sensibility of fetal echocardiography arevery high - between 95 and 98%.Methods and Materials: 2 648 fetuses were examined in period of seven years.40 fetuses with the diagnosis of some obstructive lesions of the heart were inves-tigated. Control group was made of 120 fetuses with normal echocardiogramsdivided into four groups according to gestational weeks. Echocardiographic tech-niques used: M-mode, 2 D and Doppler techniques.Results: Examination were made between 20 and 39 weeks of gestation. Allcardiac structures show linear growth with progression of pregnancy. Both halfsof the fetal heart are the similar size. 32 obstructive lesions of the left heart and 8lesions of the right heart were diagnosed. There is statistically significant differ-ence in size of the left and right structures in fetuses with obstructive lesionsaccording to each other and also the same structure of the normal fetal heart.Conclusions: Obstructive lesions of the left heart were diagnosed much morefrequently (80%) than the obstructive lesions of the right heart (20%) in the ex-amination material. Left heart hypoplastic syndrome was dominated lesion-75%of obstructive lesions of the left heart and 60% of all diagnosed obstructive le-sions. Difficult obstructive lesions are progressive, have poor prognosis andpresent one of the indications for abortion.

C-260Cardiac MRI in patients with systemic sclerosisE. Ciabattoni, L. Salvolini, G. Pomponio, C. Mabiglia, A. Giovagnoni; Ancona/IT

Purpose: To assess the value of MRI as a technique to investigate cardiac changesin patients with scleroderma.Materials and Methods: Twenty six patients (3M-22F) aged 18 to 78, with scle-roderma, underwent MRI examination of the heart. Fifteen healthy subjects werestudied as controls.All exams were performed using a superconductive 1.5 T dedicate system.Morphologic and dynamic evaluation of the heart were obtained.Myocardial perfusion and delayed enhancement post iv Gd-chelate injection wereobtained in all cases.Pericardium thickness, left ventricular (LV) and right ventricular (RV) wall thick-

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ness, LV and RV telediastolic volume, LV and RV telesystolic volume, septumthickness, right and left fraction, LV peak filling rate (PFR), LV peak ejection rate(PER), LV and RV stroke volume, LV mass were measured.All patients were also investigated using traditional techniques (ECG, Color Dop-pler US, NM).Results: In SSc patients an increase in septum as well as in RV wall thicknesswas detected (p = 0.5). Perfusions defects were found in 14/26 patients. LV infe-rior wall and septum were the most frequently involved areas, without a clearrespect of coronary blood flow territorial distribution. Seven out of 14 patientswith perfusion defects showed late contrast enhancement, generally in the match-ing areas.Conclusions: This preliminary reports demonstrated that MRI can show mor-phological and perfusional alterations of the heart at early clinical stages.

Cardiac

Multidetector CT (MDCT)

C-261Tips and tricks to effectively obtain diagnostic image quality with multisliceCT coronary angiographyF. Cademartiri, N.R. Mollet, B. Koudstaal, K. Nieman, P.J. de Feyter,P.M.T. Pattynama; Rotterdam/NL

Learning Objectives: 1. To understand the essential features specific to 4- and16-slice CT-image acquisition in cardiac and coronary artery examinations. 2. Toknow the ingredients for reliable and consistently-good cardiac multislice CT-im-aging in a time-efficient manner. 3. To know what problems are likely to occurduring scanning and how these can be avoided. 4. To shorten the learning curvefor obtaining high-quality cardiac CT examinations.Background: Encouraged by beautiful cardiac multislice CT (MSCT) images pre-sented at radiology and cardiology meetings, and by the favorable preliminaryreports on high diagnostic value, more and more radiologists consider startingup their own cardiac MSCT program. The quality of the examinations initiallyobtained then, however, often does not live up to the high expectations.Procedure Details: A common cause for insufficent image quality is the poorattention to detail during image acquisition. In fact cardiac MSCT depends on theskill and dedication of the CT-technician. As an international training center forcardiac MSCT, we have noticed some common mistakes likely made by lessexperienced operators. Generally, the basic procedures issues tend to go wrong:e.g., positioning the patient, placing the ECG-electrodes, choosing appropriatefiltering, applying basic cardiac anatomy and physiology knowledge, etc. We willprovide a step-by-step "how-to" pictorial with tips and tricks for successful cardi-ac CT imaging, illustrated by many examples of "right and wrong". Issues ad-dressed include handling of patient and workflow, data acquisition, andstandardized image post-processing.Conclusion: A step by step approach to Cardiac MSCT scanning prevents scanfailure.

C-262Tomographic imaging of sinus venosus defects with multidetector CTangiography (MDCTA) and magnetic resonance imaging-angiography (MRI-MRA)J.C. Hellinger, A. Napoli, F. Chan; Stanford, CA/US

Learning Objectives: 1. Describe tomographic imaging techniques for assess-ment of sinus venosus defects (SVD). 2. Illustrate intra and extracardiac anoma-lies during MDCTA and MRI-MRA for SVD.Background: SVD with associated partial anomalous pulmonary venous return(PAPVR), accounts for 1-2% of congenital heart anomalies. Clinical presentationis nonspecific and thus, diagnosis relies on imaging. Transesophageal echocar-diography (TEE) and digital subtraction angiography (DSA) have been estab-lished as standard for this purpose. However, both are invasive and not withoutrisk. MDCTA and MRI-MRA are alternative noninvasive means to image thesepatients. MRI offers the additional benefit to assess shunt ratios with cine phasecontrast (PC) sequences. In this exhibit, we highlight our experience with MDC-TA and MRI-MRA in 9 exams having surgically proven SVD-PAPVR.Procedure Details: Five exams were performed on 8 or 16 channel MDCT. Con-trast was injected at 4 cc/sec, employing bolus trigger technique. Two of the 16-MDCT were retrospectively ECG-gated with 0.625 mm thickness. Non-gatedstudies were acquired at 1.25 mm, with a pitch of 1.35-1.375 and rotation time of0.5-0.6 seconds. Sequences employed in the four MRI-MRA exams included ECG-gated T1, balanced steady state free precession, PC, and 3D-SPGR angiogra-phy. 3D post-processing employed volume rendering and maximum intensityprojection techniques.Conclusion: Anatomic defect size and location; number of abnormal veins) anddynamic evaluation for SVD-PAPVR corroborated TEE, DSA, and/or surgical find-ings. We identified on all MDCTA, a jet of contrast crossing the defect into the leftatrium (CT shunt sign). Our preliminary experience indicates tomographic imag-ing is a reliable noninvasive alternative to TEE and DSA for assessment of SVD-PAPVR.

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C-26316-row multislice CT coronary angiography: Technique, protocol, and earlyclinical experience with 0.375 s gantry rotation time and improved temporalresolutionF. Cademartiri1, N.R. Mollet1, K. Nieman1, B. Ohnesorge2, P.J. de Feyter1,G.P. Krestin1; 1Rotterdam/NL, 2Forchheim/DE

Learning Objectives: Discuss the importance of temporal resolution in non-in-vasive coronary imaging. Describe the technical features of a new 16-row MSCTscanner with 0.375 s rotation time. Describe an optimised protocol for non-inva-sive coronary angiography with 16-row MSCT and 188 ms temporal resolutionProvide examples of the improved temporal resolution.Background: After the introduction of 16-row multislice CT scanners (Sensation16, Siemens, Germany) with 0.75 mm collimation and 0.42 s rotation time (210 mssingle segment effective temporal resolution), it has become feasible to scan theheart for the purpose of non-invasive coronary angiography within 20 s usingECG-gated protocols. Therefore, breath-hold is no longer a major problem. Thelimiting factors remain: spatial resolution and temporal resolution. Both are influ-encing the capability to visualise smaller structures (e.g. coronary artery sidebranches and stents) at higher heart rates (> 70 bpm).Procedure Details: We evaluated a new scanner technology with increased gantryrotation speed of 0.375 s providing effective temporal resolution of 188 ms withsingle-segment reconstruction and 94 ms with multi-segment reconstruction. Tech-nical improvements are described and protocol optimisation is discussed. Sever-al examples showing the performance of this new system are displayed.Conclusion: ECG-gated 16-row multislice CT coronary angiography with 0.375 sgantry rotation time provide improved image quality.

C-264Optimize 3D visualisation of multidector CT (MDCT) coronary angiogramsfor read-outD.W. Crook, T. Boehm, T. Schertler, B. Baumert, B. Marincek, S. Wildermuth;Zürich/CH

Learning Objectives: To sensitize radiologists to the application of reformattingand 3D-reconstuctions in cardiac CT which depict the coronary arteries in amanner consistent with standard catheter angiography in routine clinical prac-tice. To demonstrate a step by step approach to acquistion, optimized recon-struction techniques, and read-out algorithms in the evaluation of the coronaryvessels.Background: Recent advances in the temporal and spatial resolution of MDCThave opened the door to the use of CT in routine cardiac diagnostics, which isevolving rapidly as a noninvasive method. CT coronary angiography has com-pared favorably with conventional catheter coronary examinations, however newreconstruction and visualization methods are continuously being developed andare often lacking in meeting the demands of the routine clinical setting. It is cru-cial that radiologists become attuned to the standard approach to the coronaryangiogram used in clinical cardiology so that advantage is not lost in the compe-tition to provide services.Procedure Details: In this educational module, we present a step by step as-sessment of coronary vessels based on 3D-reconstructions of isotropic MDCTdatasets with special consideration to projections and visualization techniqueswhich correspond with the standards of clinical cardiology. Optimization of timeconsuming 3D renderings of ECG triggered datasets as well as read-out algo-rithms are demonstrated in examples for normal coronary vessels in addition torepresentative cases of coronary artery pathology.Conclusion: As advances in MDCT open up new possibilities in coronary imag-ing, streamlinig 3D approaches is essential for the interpretation of MDCT coro-nary angiograms in routine clinical practice.

C-265MDCT angiography for non invasive imaging of coronary artery bypassgrafts: A pictorial essayR. Marano, M.L. Storto, R.L. Patea, L. Aquilani, A.G. D'Agostino, L. Bonomo;Chieti/IT

Learning Objectives: 1. To describe an optimised scanning protocol for CABGassessment with MDCT. 2. To describe the most common Coronary Artery By-pass Grafts configurations. 3. To display examples of CABGs with 4-row and 16-row MDCT and DSA correlation.Background: Four-row MDCT scanner has made non-invasive cardiac imagingreliable. The newest 16-row MDCT scanner are characterized by higher rotationspeed (0.420 sec) and lower slice-thickness (0.75 mm). The effective temporal

esolution is 105-210 msec (depending on heart rate and reconstruction algo-rithm). Larger volumes can be studied with isotropic spatial resolution(0.6 x 0.6x 0.8 mm), increasing the feasibility and the accuracy of the MDCT inthe visualization of coronary artery bypass graft (CABG).Imaging Findings: CT scan protocol (4 and 16-row MDCT), grafts (venous andarterial), artefacts (surgical clips), visualization of distal anastomosis, and athero-sclerotic graft's disease (stenoses and occlusions) are illustrated.Conclusion: Multidetector technology allows the visualization of coronary arter-ies and grafts with high image quality, making non invasive assessment of CABGreliable.

C-26616-row MSCT angiography for non-invasive imaging of coronary arterybypass grafts: Improved results with 0.375 s rotation timeR. Marano1, F. Cademartiri2, N. Mollet2, K. Nieman2, T.G. Flohr3, P.J. de Feyter2,G.P. Krestin2; 1Chieti/IT, 2Rotterdam/NL, 3Forchheim/DE

Learning Objectives: Describe the technical features of a 0.375 s rotation 16-row MSCT scanner. Describe common coronary artery bypass graft configura-tion. Illustrate the scan protocol. Display examples of CABG with 16-row MSCTand DSA correlation.Background: 16-row MSCT scanners (rotation time < 500 msec) have been re-cently introduced, improving the performance of previous 4-row and 8-row MSCTscanners.Procedure Detail: A 16-row MSCT scanner (Sensation 16, Siemens, Germany),featuring an increased rotation speed (0.375 sec) has been recently introduced.The resulting effective temporal resolution is 94-188 msec (depending on heartrate and reconstruction algorithm). Larger volumes can be studied with isotropicspatial resolution and higher temporal resolution. The capability to scan largervolumes increases the feasibility and the accuracy of this technique in the visual-isation of coronary artery bypass grafts (CABG). The scan protocol to evaluateCABGs with 16-row MSCT is described. Different types of conduits (arterial and/or venous), artefacts (surgical clips) and distal anastomoses of the graft are illus-trated with DSA correlation. Furthermore, atherosclerotic graft's disease (sten-oses and occlusion) as well as native coronary artery disease is displayed withDSA.Conclusion: ECG-gated 16-row multislice CT coronary angiography with 0.375 sgantry rotation time provide improved image quality in the evaluation of CABG.

C-267Significance of combined use of MSCT and PET for detection of ischemicmyocardial lesionsL.A. Tyutin, I.E. Itskovich, E.V. Rozengaouz, D.V. Ryjkova, L.A. Kofal;St. Petersburg/RU

Objective: To compare the MSCT and PET results in studying the condition ofmyocardial blood supply and to decide advisability of using them together.Materials and Methods: 53 patients with suspected diagnosis of coronary ar-tery disease were examined by MSCT and PET. MSCT data was obtained usingSiemens Volume Zoom CT scanner. Retrospectively ECG-gating image recon-struction was conducted. PET was performed on Ecat-Exact-47 (Siemens) with13N ammonia at rest and during pharmacological test with vasodilatators (ade-nosine, dipyridamole).Results: The first group comprised 16 (30.2%) patients without stenoses in cor-onary arteries according to the results of MSCT. PET also didn't detect reductionin perfusion of myocardial ischemic genesis in these patients. The second groupincluded 10 (18.9%) patients with low-grade (< 50%) stenosis of coronary arter-ies. In these patients PET at rest and during stress didn't reveal a reduction inperfusion of myocardium. Invasive coronarography was not performed for the 1and 2 groups. The third group included 23 (43.4%) patients with different gradesof stenosis in coronary arteries, according to the MSCT. There was reduction inperfusion in the corresponding myocardial segments revealed during at rest and/or stress-PET. There was invasive coronarography done for these patients, whichconfirmed the existence of stenosis.Conclusion: Invasive coronarography is not recommended for the patients withthe absence of coronary stenosis detected by MSCT and ischemic myocardialchanges by the results of PET. Invasive coronarography proves the high level ofcoincidence within the groups of patients with positive results of MSCT and PET.

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C-268Direct visualization of myocardial bridging in left anterior descending arterywith multislice CTY.-J. Kim, B. Choi; Seoul/KR

Purpose: To determine the feasibility and usefulness of MSCT for evaluation ofmyocardial bridging.Methods and Materials: Ten volunteers (M:F = 8:2, mean age 55) without ischem-ic heart disease and 34 consecutive patients (M:F = 20:14, mean age 56) withischemic chest pain underwent CT coronary angiography (Sensation 16, Sie-mens, Germany). Reconstruction was done around -400 ms from R peak andmultiplanar reformation and volume rendering were included. Myocardial bridgewas determined by demonstration of tunneled segment dip into myocardium. In-vasive coronary angiography was performed in 12 patients.Results: Twelve tunneled segments in LAD were detected in two volunteers (20%)(n = 2) and 9 patients (26.5%) (n = 10). Nine were located in middle LAD (2 involunteers, 7 in patients) and 3 in distal LAD (in patients). with 4 to 36 mm inlength, 0 to 4.5 mm in greatest depth. The cross-sectional areas of tunneled seg-ments were 39% smaller than those of the just proximal and 10% smaller thanthose of just distal to the tunneled segments. Calcification in LAD was detected in1 volunteer and 4 patients with myocardial bridge but not in tunneled segmentitself. Significant stenosis was detected in proximal LAD of two patients and mildstenosis in one patient which were confirmed by invasive coronary angiography.Five patients showed only myocardial bridging in LAD without coronary arterialstenosis.Conclusion: MSCT directly visualizes tunneled segment within myocardium andgives useful information about myocardial bridging and neighboring coronary ar-teries.

C-269Multi-detector row CT for the assessment of atrial septal defect andpulmonary venous drainage in adultsG. Morgan-Hughes, A. Marshall, C. Roobottom; Plymouth/UK

Purpose: To evaluate retrospectively ECG-gated multi-detector row computedtomography (CT) for the full evaluation of secundum and sinus venosus atrialseptal defects (ASD), in adults, in comparison to trans-esophageal echocardiog-raphy (TOE).Materials and Methods: Twelve patients undergoing TOE for further assess-ment of presumed ASD, as a prelude to definitive treatment, also underwent ret-rospectively ECG-gated multi-detector row CT. The multi-detector CT scans werecompared to TOE for defect and pulmonary vein visualisation. Secundum ASDsizing; measurements, before possible device closure, were compared, and vir-tual angioscopy of the right atrium was evaluated for direct, three-dimensionaldefect visualisation.Results: Larger secundum ASDs (greater than 2.0 mm) were well visualisedwith multi-detector row CT, but smaller defects and sinus venosus defects werenot. For maximal secundum defect size there was a mean difference between thetechniques of 0.9 mm (limits of agreement minus 5.5 to plus 3.6 mm). Overallthere was moderate agreement for the defect and rim sizing measurements. Pul-monary venous drainage was universally fully and correctly evaluated with multi-detector CT, which compared favorably to TOE. Virtual angioscopic visualisationof secundum defects was possible in 4 patients, but the images produced wereconsidered of limited clinical value.Conclusions: Retrospectively ECG-gated multi-detector row CT offers alterna-tive imaging of ASD in adults, allowing visualisation of significant secundum de-fects, pulmonary venous drainage and defect sizing. Further investigation, toestablish the accuracy of defect and rim sizing measurements and to re-exploredirect defect visualisation with advanced post-processing tools, is required.

C-270Detection of necrotic myocardial segments using multi-slice computedtomography: Comparison with nuclear medicineP.M. Carrascosa1, C. Capuñay1, P. Garcia Merletti1, P. Johnson2, D. Smith2,R. Pissinis1, J. Carrascosa1; 1Buenos Aires/AR, 2Cleveland, OH/US

Objective: To determine the diagnostic accuracy of MSCT in the detection ofnecrotic myocardial segments in comparison to Nuclear Medicine (NM).Methods: Twenty patients were evaluated with MSCT and NM within 7 days ofeach other. Rest and stress NMs studies were performed with 30mCi Techne-tium-99m Sestamibi on a SPECT scanner (ADAC Genesis; Philips Medical Sys-tems). CTs were performed at rest on a MSCT scanner (Mx8000; Philips MedicalSystems) using spiral retrospective ECG tagging. Scanning parameters were:

1.3 mm slice width, 0.6 mm slice increment and 130 mL of non-ionic contrast(320 mgI/ml) administered with a delay scan of 18 seconds.NM and CTs datasets were reoriented perpendicular to the left ventricle longaxis. Segmental analysis was performed on 18 segments within the short axisplanes (6 basal, 6 mid-ventricular and 6 apical segments).A positive NM finding was defined as a perfusion defect within a segment at bothrest and stress. A positive CT finding was defined as a hypo-intensive regionwithin a segment. Statistical analysis was performed using a 95% confidenceinterval calculated by the exact binomial method.Results: 360 segments were evaluated on both NM and MSCT. NM detected 59necrotic segments whereas MSCT detected 50. There were 50 true-positive, 281true-negative, 20 false-positive and 9 false-negatives findings. The sensitivity was84.7%, specificity 93.4%, positive predictive value 71.4% and negative predictivevalue 96.9%.Conclusion: MSCT showed high sensitivity and specificity for the detection ofmyocardial necrotic segments compared with NM.

C-271Evaluation of myocardial bridging by multislice computed tomographyP.M. Carrascosa1, C. Capuñay1, M. Vembar2, P. Johnson2, R. Pissinis1,J. Carrascosa1; 1Buenos Aires/AR, 2Cleveland, OH/US

Objective: To determine the usefulness of multiphase reprocessing MSCT coro-nary angiography in the identification of Myocardial Bridging (MB) and the detec-tion of related ischemia.Methods: 220 patients were studied. CTs were performed in a 4-row CT scannerwith 4 x 1 mm collimation, 0.5 mm slice increment and 130 mL of non-ionic con-trast. Ten patients with MB diagnosed with MSCT were evaluated with NuclearMedicine (NM). Rest and stress studies were performed with 30mCi Technetium99m Sestamibi. Segmental analysis were performed on 18 segments within theshort axis plane (6 basal, 6 mid-ventricular and 6 apical) in both methods. Posi-tives NM findings were defined as a perfusion defect within a segment at bothrest and stress. Positives CT findings as hypo-intense region within a segment.Results: All the MBs were placed in the LAD. DA detected 11 cases, whereasMSCT only 10. The sensitivity was 90.9% and the specificity 100.0%. In 3 casesthe MB of the LAD had greater diameter in the 95% phase and they were com-pressed in the 75% phase. Six cases showed ischemia in the NM studies. Therewere 4 true-negatives, 5 true-positives and 1 false-negatives findings. The sensi-tivity was 83.3% and Specificity 100%, Positive predictive value was 100% andthe negative predictive value was 80%.Conclusion: MSCT can detect the presence of MB in coronary arteries. It isessential for this identification a multiphase reprocessing of the CT data and canalso detect the presence of myocardial perfusion defects.

C-272Comparison of electron-beam computed tomography and multislice spiralcomputed tomography for detection and quantification of coronary calciumI.S. Fedotenkov, N.V. Gagarina, V.E. Sinitsin, S.K. Ternovoy; Moscow/RU

Purpose: To compare EBCT and MDCT for detection and quantification calcifiedplaques of coronary arteries on the group of same patients.Methods: 45 patients (30 men mean age 60 years, ± 7.6 years standard devia-tion (SD) [median age, 61 years; age range 40-76 years] and 15 women meanage 61 years, ± 8.5 years SD [median age, 64 years; age range 47-74 years] withknown coronary artery disease underwent EBCT and then MDCT within 5 days.Patients were free of beta-blockers therapy.Results: A total of 3000 lesions were detected and scored. Of the 45 patients, 8had negative results (score = 0), and 37 had positive results (score 21-2636 byEBCT and 50-2539 by MDCT). Mean calcium score (CS) for EBCT -507.1. MeanCS for MDCT -541.5. Correlation coefficient for EBCT and MDCT was 0.976(p < 0.0001). According to the Bland-Altman plot mean difference between EBCTand MDCT was 34.4 ± 133.1, variability coefficient was 22%. The variability coef-ficient for the whole patient data was high. In group with CS 0-99, correlationcoefficient for EBCT and MDCT was 0.72 and coefficient of variation -66%, in thegroup with CS 100 - 399 - 0.81 and 27%, in the group with CS 400 - 1000 - 0.85and 16%, in the group with CS > 1000-0.95 and 0.4% accordingly.Conclusions: Our study demonstrates a direct comparison of EBCT and MDCTfor detection and quantification of coronary calcium with good agreement of re-sults. The degree of comparison depends on calcium score level.

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C-273Efficacy of radiation protection accessories in CT of the heartJ. Gellissen, E. Schulz, U.H. Melchert, T. Leibecke, H.B. Gehl,B.M. Stoeckelhuber; Lübeck/DE

Purpose: To predict the local, gonadal, thyroidal and eye dose with and withoutdifferent protection devices in retrospective-gated multi slice CT of the heart.Material and Methods: Radiation dose was measured with an Alderson phan-tom and a digital dose meter with and w/o an infradiaphragmatic lead drape, acervical lead protection and an eye shield. Measurements were done with theionization chamber placed over the heart, uterus, thyroid gland and eyes. HelicalCT of the heart was performed with an Aquilion MSCT (Toshiba). The dose wasdetermined with slice collimation and pitch between 1 and 2.5 using constantvoltages and current-time-products for retrospective gated CT.Results: Local dose over the heart ranged from 142 to 584 µSv. Gonadal dosewas determined with 61 to 190 µSv w/o lead protection and 23 to 39 µSv using acircular infradiaphragmatic lead drape, meaning a gonadal dose reduction of upto 80%. With use of protection devices the dose to the thyroids could be reducedby 36.5% and 39% in terms of using an eye shield.Conclusion: Radiation causing gonadal dose in cardiac CT is predominantlyextracorporal radiation and only in a lesser degree due to scatter radiation frominside the body. An effective dose reduction of 80% can be achieved by conse-quent use of a circular lead drape closely adapted to the inferior helical range.The use of organ adapted shields covering the thyroids or eyes mainly results ina decrease of the surface dose and is recommended as well for all patients re-ceiving cardiac CT.

C-274ECG-gated multi-detector row spiral CT (MDCT) in the assessment ofmyocardial infarction (MI): A retrospective studyM. Francone, I. Carbone, M. Danti, K. Lanciotti, F. Mirabelli, L. Alessandra',C. Gaudio, C. Catalano, R. Passariello; Rome/IT

Purpose: This study was performed to evaluate the ability of MDCT in detectingMI in patients referred for MDCT of the coronary arteries.Materials and Methods: 106 consecutive patients referred for MDCT of the cor-onary arteries in the period between October 2002 and August 2003 were retro-spectively evaluated for the presence of MI. Images were acquired using a 4-rowspiral CT scanner with 0.5 s gantry rotation time. In all patients detailed clinical,ECG, US and scintigrafic (when available) data were collected in order to identifythe presence of MI. When a patient with MI was found, MDCTA images wereanalyzed on both axial and multiplanar reconstruction in order to confirm thepresence of an infarcted area.Results: Our study population included 33 patients who previously underwentcoronary percutaneous transluminal angioplasty (PTA) and stent placement (atotal number of 45 stents) and 14 patients with previous by-pass surgery. Afterclinical assessment, MI was found in 17 patient (9 septal, 4 apical, 3 anterior wallof left ventricle, 1 infero-septal). MDCT was able to detect the presence of MI in14/17 cases (82.3%), showing a regional hypoattenuated area and wall thinning.In all cases, localization and extention of ischemic area were perfectly correlatedwith clinical known data. In two patients with sub-endocardial involvement, MIcould was not detectable with MDCT. In one patient the presence of motion arte-facts affected image quality and myocardial scar wasn't visualized.Conclusions: The presence of MI is usually well depicted with retrospective ECGgated MDCT.

C-275Noninvasive evaluation of patent ductus arteriosus in adults with multisliceCT angiographyS. Yotsumoto, R. Tanaka, M. Higashi, K. Kimura, H. Naito; Osaka/JP

Purpose: Precise assessment of patent ductus arteriosus (PDA) in adult is stillchallenge. It is often difficult to get good image with US when acoustic window islimited. DSA is chosen to depict PDA in detail. However, it is sometimes impossi-ble to assess PDA accurately due to overlap of PDA and aortic arch. MultisliceCT (MSCT) with ECG-gate can provide good image in cardiovascular disease.The purpose of this study is to evaluate the usefulness of ECG-gated MSCTangiography for planning a treatment of PDA.Methods and Materials: Between May 2002 and August 2003, retrospectiveECG-gate MSCT angiography was performed in 9 patients with PDA. Slice thick-ness was 1 mm in 4 row MSCT, and 0.5 mm in 16 row MSCT. Volume renderingand multiplanar reconstruction was used to assess the morphology of PDA (lengthand diameter, shape of infundibulum). We decided a treatment of each patient

(coil embolization or plugging or division) referring to MCST angiography.Results: PDA was well visualized in all cases. Coil embolization was performedin 5 cases, plugging in one, division in one. Two patients are scheduled for coilembolization and division. Diameter of PDA measured with MSCT was well cor-responding to DSA in IVR cases.Conclusion: MSCT angiography was able to obtain precise image of PDA. MSCTangiography was useful to decide a treatment of adult patients with PDA.

C-276Highly accurate coronary angiography using sub-millimetre multislice CT:Heart rate and coronary artery calcification should be the gatekeepersG. Morgan-Hughes, P. Owens, A. Marshall, C. Roobottom; Plymouth/UK

Purpose: Sub-millimetre multislice CT coronary angiography (coronary CTA),reconstructed using partial segmental reconstruction algorithms (PSRA), mayprovide sufficient image resolution for clinical usage of the technique. Howeverheart rate and coronary artery calcification (CAC) have been identified as factorsthat impede accurate vessel assessment. We aimed to evaluate coronary CTAand the importance of these parameters.Materials and Methods: Following cardiac catheterisation patients underwentcoronary imaging using a GE Lightspeed 16. First, CAC was quantified using alow tube current (80 mAs). Coronary CTA was performed with a 16 x 0.625 mmcollimation and PSRA giving a temporal resolution of 125 mseconds. All 13 majorcoronary artery segments were evaluated for the presence of > 50% stenoses.Occluded and stented segments were not evaluated.Results: 90% (298/332) segments of coronary artery were assessable with cor-onary CTA. In assessable segments the sensitivity (Se) and specificity (Sp) fordetection of > 50% were 84% (26/31) and 97% (260/267) respectively. If patientswith heart rates > 65 bpm were excluded: assessability 99% (151/152), Se 88%,Sp 98%. If patients with CAC scores > 400 were excluded: assessability 93%(171/184), Se 91%, Sp 98%. Excluding both groups: assessability 100% (106/106), Se 100%, Sp 99%.Conclusions: Sub-millimetre coronary CTA provides accurate coronary arteryvisualisation, but widespread clinical applicability may be limited by patient spe-cific parameters. Adequate heart slowing prior to coronary CTA, followed by theexclusion of patients with high CAC scores provides a technique that appearssufficiently accurate for clinical applicability.

C-277MDCT coronary angiography: Optimization of the image reconstructionphaseY. Nagatani, R. Takazakura, N. Nitta, M. Takahashi, K. Murata; Otsu/JP

Purpose: To investigate the relationship between the heart rate and the optimalimage reconstruction phase in MDCT coronary angiography.Material and Method: 37 patients underwent cardiac MDCT (8 DAS) (Aquilion8,Toshiba, Japan) to obtain coronary angiography. Scan data were subsequentlyreconstructed at 10 different kinds of phases in ECG wave. These methods canbe classified as follows according to the used wave in ECG; 1).The center of thereconstruction phase is positioned at the peak of T-wave (method T-p), the end ofT-wave (method T-e) and the midpoint of descending curve of T-wave (method T-m). 2).The end of the reconstruction phase is positioned at the peak of P-wave(method P). 3).The center of the reconstruction phase is positioned using nterval(method R30, 40, 50, 60, 70, 80). All patients were classified into 3 groups ac-cording to their heart rates (HR) (group 1; HR < 60 (n = 14), group 2; 60 < HR;< 70 (n = 10), group 3; HR < 70 (n = 13)). Two radiologists assessed image qual-ity in blind fashion and scored as follows (2:good,1:fairly, 0: bad). Bonferroni/dunntest was performed for statistical analysis.Results: In group 1, significantly better image quality was achieved in method P,RR70, RR80 than other methods. Among them, highest image quality was ob-tained by method P. The best result was obtained by method P in group 2 and T-m in group 3.Conclusion: Optimal image reconstruction phase in MDCT coronary angiogra-phy shifts from late diastolic phase to late systolic phase as heart rate increases.

C-278Assessment of aorto-coronary bypass grafts patency by 16 detector rowscomputed tomographyG. Tognini, F. Ferrozzi, V. Schembri, A. Patti, M. Zompatori; Parma/IT

Purpose: To evaluate the role of 16 detector row CT (MDCT) angiography in thefollow-up of patients with aorto-coronary bypass grafting.Method and Materials: 36 patients (22 males, 14 females) underwent MDCT

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evaluation of the grafts by 16-MDCT with 0.625 mm detector collimation (Light-Speed 16, GE, Milwaukee, USA). 21 patients were asymptomatic, 3 showed ef-fort angina and 12 positive exercise test for myocardial ischemia. The patientshad 83 bypass grafts.120 mL of contrast medium were injected with a flow rate of 4 mL/s and the delaytime was determined by using Smartprep. ECG synchronized images were re-constructed retrospectively. Postprocessing included volume rendering mode andthin MIP. Coronary angiography represented the gold standard in 15 patient with38 bypass.Results: 12/83 grafts (9 saphenous, 3 left internal mammary artery (LIMA) werenot well visualized and excluded from further evaluations. 71/83 were evaluatedfor stenosis or occlusion; 52 were patent (38 saphenous, 13 LIMA, 1 radial arterygraft), 19 occluded (16 saphenous, 3 LIMA).35/52 bypass showed no significant stenosis, 17/52 (15 saphenous, 2 LIMA)showed stenosis > 50%.7/38 (6 saphenous, 1 LIMA) bypass evaluated with coronary angiography werenot correctly visualized by MDCT. Sensitivity, specificity, negative, positive pre-dictive values and accuracy of MDCT when compared with coronary angiogra-phy in the 31 visualized grafts were 95%, 96%, 96%, 95%, 96% for the assessmentof occlusion, and 73%, 90%, 93%, 69%, 86% in the assessment of significantstenosis (> 50%).Conclusion: MDCT is useful in the follow-up of aorto-coronary bypass grafts.

C-279MSCT and echocardiography in evaluation of primary cardiac tumorsE. Czekajska-Chehab, A. Tomaszewski, M. Wójcik, A. Drop; Lublin/PL

Purpose: Comparative analysis of echocardiographic and MSCT images in pa-tients with primary cardiac tumors.Material and Methods: Primary cardiac tumor was found in 5 (2 male, 3 female;average age of 60) out of 292 MSCT studies perfomed with 8-row LightSpeed(GE). MSCT images (8 x 1.25 collimation) were compared with echocardiographictransthoracic (TTE) and transoesophageal (TEE) images (SONOS 550 Phillips).Two out of five tumors (right atrium lipoma and aortic valve fibroelastoma) werediscovered in a routine MSCT study of coronary arteries and left ventricle myxomain an elective coronarography. Atypical left ventricle myxoma with mitral stenosisand epicardial cyst were primary visualized in transoesophageal echocardiography.Results: Both methods allows to evaluate tumors size, localization and struc-ture. The biggest advantage of echocardiography was aknowledged possibility ofevaluation of lesions mobility while the biggest advantage of MSCT was possibil-ity of both 3D and 2D imaging in arbitrary planes using multiplanar reformationswith evaluation of tumor relations towards adjacent tissues and simultaneousvisualisation of coronary arteries.Conclusions: MSCT and echocardiography (TTE and TEE) are complementarymethods in diagnosis of primary cardiac tumors.

C-280Usefulness of 16-slice multidetector row computed tomography (MSCT) inassessment of dilated cardiomyopathyS. Hosoi, T. Mochizuki, T. Haraikawa, J. Funada; Ehime/JP

Purpose: The purpose of this study is to show the potential benefits of 16-sliceMSCT for the diagnosis of DCM.Methods and Marerials: We studied 30 consecutive patients, including 10 DCM,10 coronary artery disease (CAD), and 10 patients with non-cardiac disease asa normal control. DCM was diagnosed on the basis of the clinical data by cardiol-ogists. The MSCT system used in this study was a LightSpeed 16 (GE MedicalSystems) with available gantry rotation speeds of 0.4 sec. All cardiac imagesreconstructed were divided into 10 phase data sets in a R-R interval on ECG.End-diastolic (ED) and end-systolic (ES) phase could be visually extracted, andthe LV wall thickness and volume was measured. Moreover, the segmental LVwall motion was evaluated by the cardiac movie image which was reconstructedusing the 10 phase data.Results: Image quality of MDCT were considered sufficient for this analysis.Concerning about the rate of coronary artery stenosis, DCM group were signifi-cantly less than CAD group (p < 0.01). In DCM group, both LV wall thickness ofED and ES were smaller than other groups (p < 0.01). LV volume between DCMand CAD group had no significant difference. LV wall motion in DCM group had atendency to be diffusely hypokinetic.Conclusion: Using 16-slice MSCT, LV function and coronary artery stenosis wasable to be evaluated and distinguished the features of DCM and CAD. This studyrevealed a potential ability of MDCT as a useful method for the diagnosis of DCM.

C-281Multiple full volume scans: Which is the ideal phase to evaluate myocardialperfusion with MCT?P.M. Carrascosa1, C. Capuñay1, P. Garcia Merletti1, P. Johnson2, R. Pissinis1,J. Carrascosa1; 1Buenos Aires/AR, 2Cleveland, OH/US

Objective: To determine the best phase to evaluate myocardial perfusion bymultislice CT in correlation with nuclear medicine (NM).Methods: 20 patients were evaluated. Scans were performed within 7 days ofeach. NM studies were performed at rest (RNM) and stress (SNM) with 30mCiSestamibi with SPECT scanner. CTs were performed with a 4-row CT scanner(Mx8000; Philips Medical Systems) with 2.5 mm collimation.Five CT phases were performed: P1) Un-enhanced phase. Enhanced phases:P2) starts with a delay scan of 18 seconds. P3) starts 30 sec post P2. P4) starts30 sec post P3. P5) starts 60 sec post P4.NM and MSCT datasets were reoriented in a short axis plane and 18 segmentalanalysis was performed (6 basals, 6 midventriculars, 6 apicals). CTs performedwere correlated with RNM and SNM. CTs considered positive findings an hypo-dense area in any segment.Results: MSCT versus RNM and SNM:P1: Sensitivity (S) 31% and 28%, Specificity (Sp) of 97% and 98%P2: S 80% and 72%, Sp 89% and 90%.P3: S 33% and 36%, Sp 94% and 96%.P4: S 43% and 46%, Sp 95% and 96%.P5: S 38% and 33%, Sp 93% and 97%.In general evaluation MSCT versus RNM showed: S 89%; Sp 85% and versusSNM: S 79% and Sp 86%.Conclusion: The best P to evaluate MP was P2, with higher S. Other phases hadhigh Sp but low S.MSCT with P2 was able to detect hypo-perfused areas. Betterresults were obtained versus RNM.

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C-282Pulmonary complications after bone marrow transplantation:A radiologist's perspectiveS. Prabhu, K. Burney, A. Valencia, P. Goddard; Bristol/UK

Learning Objectives: We aim to present the pulmonary complications occurringin bone marrow transplant recipients which when reviewed in relation to the timeelapsed since the transplant can aid the radiologist in reaching the diagnosis.Background: A variety of pulmonary complications occur in bone marrow trans-plant (BMT) recipients and are a major cause of morbidity and death.Imaging Findings: HRCT is useful in detection of pulmonary abnormalities, butthese findings are generally non-specific. These complications, which reflect theimmunologic status of the patients, occur in three phases. This pattern can beused to interpret CT scans. The neutropenic phase (up to 3 weeks after BMT) ischaracterized by fungal infections, alveolar haemorrhage, pulmonary oedema,and drug reactions. At CT, fungal infections like angioinvasive aspergillosis ap-pear as nodules surrounded by a halo of ground-glass attenuation; alveolar haem-orrhage and drug reactions, as bilateral areas of ground-glass attenuation orconsolidation. The second phase (3 weeks to 100 days after BMT) is dominatedby cytomegalovirus pneumonia, which appears as multiple small nodules withareas of consolidation or ground-glass attenuation, and pneumocystis cariniipneumonia again mostly as ground-glass attenuation. The late phase (more than100 days after BMT) is characterized by bronchiolitis obliterans revealing bron-chial dilatation and a mosaic pattern of attenuation, bronchiolitis obliterans withorganizing pneumonia (BOOP), the CT findings usually being patchy consolida-tion or ground-glass attenuation and chronic graft-versus-host disease.Conclusion: If CT findings are considered in relation to the time elapsed afterBMT, diagnostic options can be narrowed sufficiently to enable accurate diagnosis.

C-283Small pulmonary nodules: An easy approach to the differential diagnosisJ. Rimola, X. Gallardo, E. Castañer, J.M. Mata, A.M. Quiles, P. Bermúdez;Sabadell/ES

Learning Objectives: To know the anatomy of the secondary pulmonary lobule,which is essential to the interpretation of high-resolution CT (HRCT). To learn aneasy way to approach the differential diagnosis of small pulmonary nodules.Background: A wide variety of pathologies may present with small pulmonarynodules, which are defined as rounded opacities smaller than 1 cm in diameter.Differences in appearance, distribution and attenuation of nodules provide usefulclues for correct diagnosis. Helical CT and HRCT enable correct identificationand characterization of small nodules.Imaging Findings: We illustrate different examples of multinodular lung diseas-es in an easy-to-understand way. A simple algorithm is used to help in the differ-ential diagnosis. We classify nodules according to distribution (centrilobular,perilymphatic or random) and show the most representative cases of each pat-tern. We present a wide variety of entities, including: Infections such as tubercu-losis (endobronchial spread or miliary TB), nontuberculous mycobacteria, fungus;sarcoidosis; tumors (lymphangitic carcinoma, hematogenous metastases); sili-cosis and coal worker's pneumoconiosis; hypersensitivity pneumonitis; cryptogenicorganizing pneumonia; histiocytosis; etc.Conclusion: An easy way to assess multiple nodular opacities in the lung isuseful to reach an accurate diagnosis.

C-284Differential diagnosis of unilateral hyperlucent lungM. Nishino1, K. Hayakawa2, H. Hatabu1; 1Boston, MA/US, 2Kyoto/JP

Learning Objectives: To review differential diagnosis of unilateral hyperlucentlung, understand pathological mechanisms causing the findings, and to be famil-iar with the imaging findings and clinical manifestations characteristic in eachcondition.Background: Unilateral hyperlucent lung on chest radiograph is seen with vari-ous pathological conditions. The conditions include both acute and chronic proc-esses, and thus need accurate and prompt diagnostic evaluation. The findings onchest radiograph can provide clues to differentiate various causes of this condi-tion and help to achieve proper management.Imaging Findings: We present cases of unilateral hyperlucent lung, emphasiz-ing specific imaging findings along with characteristic clinical manifestations. The

cases include proximal interruption of pulmonary artery, pulmonary hypoplasia,Swyer-James syndrome, congenital lobar emphysema, foreign body aspiration,and Bochdalek hernia. Findings on chest CT which can confirm or support thediagnosis are also reviewed and discussed.Conclusion: Familiarity with the characteristic imaging findings of unilateral hyper-lucent lung is essential for radiologists to make accurate diagnosis for appropri-ate patient management.

C-285Multislice CT of primary and multisystemic pulmonary vasculitis: A pattern-based approach to differential diagnosisK. Marten1, M. Prokop2, P. Schnyder3, E.J. Rummeny1, C. Engelke1;1Munich/DE, 2Utrecht/NL, 3Lausanne/CH

Learning Objectives: 1. Provide an overview of multislice CT (MSCT)-findingsin primary and systemic disease-related pulmonary vasculitis and analyse theirvascular basis. 2. Enhance the technical and diagnostic ability to differentiatespecific entities based on a combined clinical and radiological non-invasive dif-ferential diagnostic algorithm.Background: Pulmonary vasculitis (PV) occurs in a wide variety of systemic andprimary pulmonary vascular disorders with overlapping radiological features.Procedure Details: By use of volumetric multislice HRCT and CTA the differen-tial diagnosis of PV is comprehensively reviewed including: 1) Large vessel PV:Takaysu's and giant cell arteritis; 2) Medium size vessel PV: Polyarteritis nodosa;3) Small vessel ANCA-associated PV: Microscopic polyangiitis, Wegener's dis-ease, Churg-Strauss syndrome; 4) Immune complex-associated small vessel PV:Lupus pneumonitis, rheumatoid arthritis, acute lung allograft rejection; 5) Immunecomplex-associated PV affecting all vessel sizes: Behcet and Hughes-Stovinsyndromes; 6) Other granulomatous small vessel vasculitis: Sarcoidosis, Lang-erhans cell histiocytosis; 7) Other capillaritis: Goodpasture's syndrome, idiopath-ic pulmonary hemosiderosis. The identification of macroscopic vascularpathologies and the parenchymal abnormality spectrum is revisited and classi-fied into aneurysms, stenoocclusive disease, pulmonary hypertension, infarc-tion, diffuse alveolar hemorrhage, or chronic eosinophilic pneumonia-typeconsolidation. A CT-based imaging strategy is developed for non-invasive differ-ential diagnosis complementing the classical clinical workup.Conclusion: Multislice volumetric CT is valuable for non-invasive differential di-agnosis of PV and can indicate and guide diagnostic procedures and medical,interventional or surgical therapy. CT diagnosis should be based on differentia-tion of central and peripheral morphologic types of vascular pathologies in com-bination with the individual clinical setting.

C-286Benign tumors of tracheobronchial tree: CT and pathologic correlationJ.M. Ko, J.I. Jung, M.H. Chung, K.J. Kim, S.W. Song, K.Y. Lee, S.T. Hahn,S.H. Park; Seoul/KR

Background and Learning Objective: Most tumors of the tracheobronchial treeare malignant in nature. Benign tumors are extremely rare (approximately 1.9%of all lung tumors). Clinical and radiologic features of these tumors are oftenindistinguishable from those of malignant tumors. However recognition and earlydiagnosis of these lesions may allow for conservative treatment and excellentpatient outcome. The aim of this study is to illustrate the CT findings of variablebenign tumors of tracheobronchial tree and correlate with the pathologic findings.Imaging Findings: This study included 15 patients with benign tracheobronchialtumors which were confirmed histologically by surgical resection (n = 13) or bron-choscopic biopsy (n = 2). The tumors were classified the anatomic locations ofthe lesions into trachea (n = 4), bronchus intermedius (n = 1), lobar bronchus(n = 8), and segmental bronchus (n = 2). Pathologic diagnoses were hamartoma(n = 5), leiomyoma (n = 3), lipoma (n = 2), schwannoma (n = 2), amyloidoma(n = 1), inflammatory polyp (n = 1), and bronchial adenoma (n = 1). CT demon-strated all tumors confined in the tracheobronchial lumen. 10 of 11 bronchialtumors occluded the bronchial lumen completely, resulting in distal parenchymalcollapse. 1 case in the segmental bronchus showed mass within the dilated bron-chus. Tracheal tumors revealed eccentric, polypoid mass in all cases. Of the 5hamartomas, 2 showed calcified nodules and the others showed soft tissue den-sity nodules. Lipomas presented fat density on CT in both cases. Other benigntumors showed low attenuation, soft tissue density masses without characteristicdifference on CT.Conclusion: Familiarity with various benign tumors in tracheobronchial tree ishelpful in the approach of the diagnosis.

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C-287Pleural effusion: How much is there?M.-P. Debray, Z. Boudiaf, B. Rigolle, G. Foulon, E. Schouman Claeys, J. Laissy;Paris/FR

Learning Objectives: To enhance the limitations of chest X-ray and axial chestCT slices in estimating the volume of pleural effusions. This interactive presenta-tion will allow the reader to test himself, comparing his own subjective estimationto the real volume computed from 3D shaded surface displays (SSD). To outlinethe usefulness and ease of post-processing with spiral CT to obtain a true as-sessment of the pleural fluid volume.Background: Assessment of the volume of pleural effusions is very impreciseboth on chest X-ray and axial chest CT slices. The amount of fluid may be re-quired by clinicians for therapeutic purposes. 3D SSD of the effusion providesrapid computation of its volume. In this exhibit we will recall the physiopathologicmechanisms involving the preferential locations of pleural effusions. We will showpleural effusions of various volumes on chest CT along with the correspondingchest X-rays and the precise volume of the effusion computed from 3D recon-struction.Procedure Details: Various cases of free or collected pleural effusions on spiralchest CT (CT Twin and MX 8000 IDT), are presented, including coronal and sag-ittal reformations. CT images stand along with the corresponding chest X-ray,obtained in the upright and supine position, and with the computed volume of theeffusion using 3D reconstruction.Conclusion: Pleural volumetry is readily available using spiral CT data recontruc-tion. It should be more often used, to assess the amount of fluid to withdraw withthoracocentesis, before drainage or for monitoring in intensive care unit patients.

C-288Lung consolidations in various clinical entities: Clinico-radiologiccorrelation presented in an interactive CD-ROM in HTML formatS. Mylona, S. Tandeles, L. Thanos, S. Lyra, P. Ellinas, N. Mpatakis; Athens/GR

Learning Objectives: To present lung consolidations as found in CT and plainradiographs in various clinical entities. To give a differential diagnosis based onclinical and radiologic features.Background: Radiologists often encounter lung consolidations in plain radio-graphs and lung CT. There is a broad spectrum of clinical entities, which eitherpresent as lung consolidations or involve lung consolidations. Clinical informa-tion and radiologic features help to approach the right diagnosis.Procedure Details: 30 cases are presented in a question and answer formatusing HTML resources in an interactive CD-ROM. Reference is made to properdiagnostic work up and to other relevant clinical information. Histopathologicalconfirmation is presented where it is needed.Conclusion: Radiologists must be trained to deal with patients presenting withlung consolidations using clinical and radiological features.

C-289HRCT patterns of cardiogenic pulmonary edemaE. Chambrier, S. Zafatayeff, Y. Badachi, P.A. Grenier, C. Beigelman-Aubry;Paris/FR

Learning Objectives: To be familiar with typical and atypical HRCT appearanc-es of pulmonary edema based on 50 patients. To emphasize the role of HRCT insuggesting this diagnosis in the setting of acute dyspnea, especially if pulmonaryembolism is suspected.Background: Pulmonary edema, a frequent cause of acute dyspnea, can beclinically difficult to detect. HRCT is crucial in suggesting this diagnosis, particu-larly when pulmonary embolism is suspected. Actually, bolus intravenous injec-tion of iodinated contrast in case of pulmonary edema may worsen heart failureand lead to patient death.Imaging Findings: The HRCT signs of pulmonary edema are usually dividedinto interstitial and alveolar patterns, and both can be associated. Classic signsof interstitial edema, which accounts for 70% of cases, are peribronchial andperibronchovascular thickening, septal lines, ground glass opacity, pleural effu-sion, cardiac enlargement and pulmonary veins dilatation. Alveolar edema is char-acterized by bilateral, patchy or coalescent areas of airspace consolidation,predominantly basal and perihilar. Butterfly pattern is found in 5% of cases. Atyp-ical patterns are due to preexisting lung or heart disease, such as right upperlobe edema related to mitral regurgitation, or heterogeneous distribution of ede-ma due to preexisting lesions of emphysema or constrictive bronchiolitis. Highlyselected cases will be used to illustrate typical and atypical patterns.Conclusion: The varied HRCT appearances of cardiogenic pulmonary edema

have to be recognized in order to delay the performance of angioCT of pulmo-nary arteries if pulmonary embolism is suspected.

C-290Imaging of chronic lung diseases using morphological and functional MRIM.U. Puderbach, C. Fink, S. Ley, C. Plathow, A. Schmähl, H.-U. Kauczor;Heidelberg/DE

Learning Objectives: To describe an imaging protocol for morphological andfunctional MRI of chronic lung diseases and to illustrate typical image findings.Background: Chronic lung diseases such as fibrosis, chronic obstructive pulmo-nary disease (COPD) and cystic fibrosis, are very common and widespread. Theyrequire repeated imaging for monitoring of therapy and disease progression.Beside pulmonary function tests, CT is established as the modality of choice forthe diagnosis and follow-up. MRI, however, may offer additional morphologicaland functional information.Procedure Details: All exams are performed with a 1.5 T MR scanner. The im-aging protocol includes breathhold T1 and T2 weighted morphological MRI withand without ECG-gating. For assessment of vascular structures contrast-enhanced3D MR angiography with parallel imaging techniques is performed. Functionalmeasurements include contrast-enhanced 3D perfusion with high temporal reso-lution as well as dynamic CINE MRI to assess the lung movement. Typical imagefindings are correlated to CT findings.Conclusion: MRI visualizes pulmonary abnormalities in patients with chroniclung diseases which correspond to CT findings. Additionally MRI offers informa-tion regarding the pulmonary vasculature and perfusion. MRI is a promising radi-ation free method for follow-up and therapy monitoring in patients with chroniclung diseases.

C-291Smoking-related interstitial lung diseases: Radiologic-pathologiccorrelationA. Hidalgo, T. Franquet, A. Giménez, R. Pineda, M. Madrid; Barcelona/ES

Learning Objectives: 1. To review the radiological findings of smoking relatedinterstitial lung diseases and their pathologic correlations. 2. To provide someradiological clues for the correct diagnosis.Background: Interstitial lung disease (ILD) represent a heterogeneous group oflung disorders of known or unknown cause. Recently, it has been appreciatedthat cigarette smoking is related to the development of several ILDs includingdesquamative interstitial pneumonia (DIP), respiratory bronchiolitis-associatedinterstitial lung disease (RIBLD), pulmonary Langerhans'cell histiocitosis (PLCH)and idiopathic pulmonary fibrosis (IPF).Procedure Details: We reviewed the plain radiograph, CT, and HRCT findings offour intersitital lung disorders that have been linked to smoking. Several exam-ples of the radiological forms of SRILD and their differential diagnosis are provid-ed. We will also show how the radiologists can get the diagnosis through someclinical and radiological clues.Conclusion: The link between several interstitial lung disease and smoking hasbeen recently indicated. Radiologists have to be aware of these entities and tosuggest a diagnosis as accurate as possible by the knowledge of clinical contextand the radiological features.

C-292The spectrum of CT appearances in pulmonary amyloidosisA. Aylwin, P. Gishen, A. Nicholson, S. Copley; London/UK

Learning Objectives: To review the CT appearances of pulmonary amyloidosis.Background: Amyloidosis has three main histopathological subgroups, with typ-ical imaging characteristics: 1) Tracheobronchial disease with plaques, nodulesor circumferential thickening of the trachea or segmental airways; 2) Nodularparenchymal disease with single or multiple nodules demonstrating sharp lobu-lated margins, spiculated masses simulating tumours, and a rare form associat-ed with Sjögren's syndrome and lymphocytic interstitial pneumonitis (nodulesand lung cysts); and 3) Diffuse alveolar septal disease showing ground glassopacification, interlobular septal thickening, and traction bronchiectasis on HRCT.It is often possible to divide cases into localized amyloidosis with tracheobronchi-al deposition or nodular disease, or the systemic type with diffuse parenchymaldisease or lymphadenopathy on the imaging findings, but cases demonstratingoverlapping features are not uncommon.Procedure Details: The CT appearances of 8 cases of biopsy-proven pulmo-nary amyloidosis will be demonstrated.

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Conclusion: The spectrum of CT appearances of pulmonary amyloidosis of bothlocalised and systemic types will be demonstrated. The CT features of localizedand systemic disease may overlap.

C-293Thoracic complications after pneumonectomy: Incidence and imagingfeaturesJ. Seo, E. Chae, J.-W. Song, J. Lee, K.-H. Do, K.-S. Song; Seoul/KR

Learning Objectives: To review the early and late complications of pneumonec-tomy in a series of 273 patients in a tertiary medical center. To review the role ofimaging in the diagnosis and management of these complications.Background: This exhibit is the retrospective review of thoracic complications ina series of 273 consecutive patients who underwent pneumonectomy in a terti-ary hospital during the past 5 years.Imaging Findings: The complications are classified into early and late, accord-ing to the time elapsed after surgery. Early complications include bronchopleuralfistula, postpneumonectomy empyema, pulmonary edema, pneumonia of thecontralateral lung and combinations of these complications. Late complicationsare categorized into recurrence of primary disease, infection, complications re-lated to the treatment such as chemotherapy and radiation, and delayed surgicalcomplications such as delayed BPF, postpneumonectomy syndrome and es-ophagopleural fistula.Conclusion: Incidence and imaging features of these complications will be illus-trated.

C-294Paraquat poisoning of the lung: A study of 47 patients with paraquatintoxication for 21 yearsA. Ichinose1, K. Kimura2, M. Tsuboi1, H. Saito1, T. Ishibashi1, S. Takahashi1;1Miyagi/JP, 2Akita/JP

Learning Objectives: To analyze 47 patients who had taken paraquat intoxica-tion and to compare those with 24% paraquat intoxication to those with 5%paraquat-diquat intoxication, especially with respect to the change of their chestX-rays and CT.Background: Paraquat is a widely used herbicide that has toxic effects on thelungs, liver, and kidneys. Paraquat has been known to induce acute pulmonaryfibrosis, causing progressive respiratory failure and death. In Japan, 5% paraquat-diquat product has been used since 1986, in place of 24% paraquat product,.However, there is no report that compares the influence these products have onthe lung.Procedure Details: There were 39 patients from whom chest X-rays were taken,and 22 of those (56.4%) had abnormal findings, which were composed of 10ground-grass patterns, 4 reticulogranular patterns, 4 pulmonary edemas, 4 car-diomegalies and pulmonary congestions, 2 pneumothoraxs, and 1 mediastinalemphysema. Pulmonary edema was found only in the patients with 24% paraquatintoxication; in all cases, the plasma paraquat concentration was much higherthan others. All reticulogranular patterns were found a few days later, and thosein the patients with 5% paraquat-diquat intoxication were potentially reversible.Conclusion: 24% paraquat product has more influence on the lung than 5%paraquat-diquat product. Pulmonary fibrosis caused by 5% paraquat-diquat prod-uct is potentially reversible.

C-295Thoracic CT findings of adult T-cell leukemia/ lymphomaF. Okada, Y. Ando, Y. Kondo, S. Matsumoto, T. Maeda, H. Mori; Oita/JP

Learning Objectives: To assess the pulmonary CT findings in patients with adultT-cell leukemia/lymphoma.Background: Adult T-cell leukemia/lymphoma patients have a high frequency ofrespiratory complications related to infiltration of the lungs by leukemia cells, andthese complications are often life-threatening. The authors retrospectively reviewedCT scans of the lung in 87 patients with adult T-cell leukemia/lymphoma who hadundergone chest CT scans between January 1996 and March 2002. Parenchy-mal abnormalities, enlarged lymph nodes, pleural effusion, and pleural thicken-ing were evaluated. In 46 patients who underwent surgical biopsy or autopsy, theCT-pathological correlation was performed with the actual specimens.Imaging Findings: On the CT scans, abnormal findings were seen in 60 patients(69.0%). The CT findings consisted of ground-glass attenuation (n = 37), centri-lobular nodules (n = 25), thickening of bronchovascular bundles (n = 22), andconsolidation (n = 13). These abnormalities were predominantly seen in the pe-ripheral lung parenchyma (n = 26). Pathologically, these findings corresponded

with atypical lymphocytes infiltration along the interstitium and the alveolar spac-es. Pleural effusion and enlarged lymph nodes were found in 22 patients and 27patients, respectively.Conclusion: The CT findings in patients with adult T-cell leukemia/lymphomaconsisted mainly of ground-glass attenuation, centrilobular nodules, and thicken-ing of the bronchovascular bundles in the peripheral lung. These CT findings,though non-specific, are considered as suggestive of thoracic involvement inpatients with adult T-cell leukemia/lymphoma.

C-296High resolution CT imaging of the lung for patients with primary Sjögren'ssyndromeC. Lohrmann, M. Uhl, K. Warnatz, N. Ghanem, E. Kotter, O. Schaefer,M. Langer; Freiburg/DE

Purpose: To assess pulmonary abnormalities in patients with primary Sjögren'ssyndrome using high-resolution computed tomography (HRCT).Material and Methods: The HRCT scans of 24 patients over a ten-year-periodwith diagnosis of primary Sjögren's syndrome were retrospectively reviewed re-garding the presence, extension and distribution of 16 pathological findings.Results: 19 patients (79.2%) showed pathological findings and in 5 (21.8%) theHRCT scan was normal. A predominance of abnormalities in the lower lobes andsubpleural areas was detected. Bronchiectasis, thin-walled cysts and small pul-monary nodules in 11 patients (46.2%), ground-glass attenuation and emphyse-ma in 9 patients (37.8%), interlobar-septal thickening in 7 patients (29.4%),honeycombing in 6 patients (25.2%), bronchial wall thickening and tree-in-budpattern in 5 patients (21.0%), mosaic perfusion in 4 patients (16.8%), and archi-tectural distorsion in 3 patients (12.6%). Airspace consolidation, air trapping, largenodules (10-30 mm) and masses (> 30 mm), mediastinal lymph node enlarge-ment (> 15 mm) and free pleural fluid were seen each in 1 patient (4.2%). In 8 of11 patients (73%) with thin-walled cysts areas of ground-glass attenuation weredetected.Conclusion: HRCT seems to be contributive to the characterization of the widevariety of lung abnormalities in primary Sjögren's syndrome. Airway disease aloneor in association with the presence of varying degrees of interstitial disease rep-resent the main findings in accordance with earlier reports. Unexpectedly, almosthalf of the patients have thin-walled cysts on the HRCT scans, which etiology isunclear but could be associated with areas of ground-glass attenuation indicat-ing lymphocytic interstitial pneumonia.

C-297Investigation of the bulky hilum: How accurate are radiologists at detectinghilar pathology on the chest radiograph?S. Desigan, D. Murray; London/UK

Purpose: To determine the accuracy of radiologists in detecting hilar pathologyon chest radiographs.Materials and Methods: A retrospective study was performed, analysing thechest radiograph and computed tomography (CT) findings of 15 patients, all ofwhom had initially been referred for thoracic CT as part of the investigation for a"bulky hilum" as detected on chest radiography. 15 radiologists, comprising 7consultants and 8 specialist registrar trainees who were blinded to the initial CTfindings, were asked to assess the chest radiographs for the presence or ab-sence of a hilar mass and their recommendations for clinical follow-up in eachcase were recorded. They were then scored for accuracy as compared to thethoracic CT results.Results: The results showed marked variation between observers in the twogroups. The participants had an accuracy of 55%, sensitivity of 68% and specif-icity of 51%. Positive predictive values of registrars and consultants were 34%and 45% respectively. Negative predictive values were 67% for registrars and76% for consultants.The group as a whole detected only 3 out of 5 hilar massesconfirmed by CT.Conclusion: The wide range of responses demonstrates the very subjective na-ture of interpretation of the lung hila on chest radiographs, and the difficulty in-volved in correctly identifying or excluding hilar masses on chest X-rays. One ofthe most useful aspects of this study has been to provide feedback to individualsfor educational purposes and personal audit.

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C-298Small bronchiectases and bronchiolectases in high resolution computedtomography (HRCT) in patients with pneumoconiosisM. Paslawski, W. Krupski, K. Krzyzanowski, J. Zlomaniec; Lublin/PL

Purpose: The aim of the study is to evaluate the diagnostic value of HRCT inrevealing small bronchiectases and bronchiolectases in patients with previouslydiagnosed pneumoconiosis.Material and Methods: The study comprises a group of 38 patients, 21 men and17 women, aged between 23 and 74 years, with pneumoconiosis in which HRCTwas performed. HRCT was performed in all patients in the prone position, fromthe level of the apices to the level of the diaphragm. The collimation of the scanswas 2 mm, with 1 cm intervals between sections. The HRCT examinations wereassessed retrospectively by two radiologists, and the presence and character ofbronchiectases were noted.Results: Bronchiectases were seen in 22 patients (58%). In 15 of them the "sig-net-ring sign" and "tram track sign" were seen, with lack of normal tapering. Bronchiwere visible in peripheral lung areas, within 2 cm from the parietal pleura in 10patients. 4 patients had varicose bronchiectases with the typical "string of pearls"appearance. In 2 patients, cystic bronchiectases were seen, presenting with thepicture of "cluster of grapes".Conclusions: Bronchiectases is very often seen in patients with pneumoconio-sis, especially in advanced stages. HRCT is the modality of choice to diagnosethe presence of small bronchiectases and bronchiolectases. Typical HRCT pat-terns include "signet-ring sign", "tram track sign", lack of normal tapering, andvisible bronchi in peripheral lung areas, within 2 cm from the parietal pleura. Invaricose bronchiectases, the "string of pearls" appearance, and in cystic bron-chiectasis, the "cluster of grapes" appearance are typical.

C-299Introspective on neospect (Tc-99m depreotide) in the determination of thenature of solitary pulmonary nodulesJ.D. Birchall, R.H. Ganatra, D.J. Green, K. Griffith, A.C. Perkins, K. Pointon,J. Poveda, D.H. Rose; Nottingham/UK

Purpose: To assess the impact of Tc-99m depreotide peptide imaging in clinicalpractice.Background: SPNs occur on 1 in 500 chest radiographs with 30% being due tolung cancer. Conventional imaging is fairly effective in determining the nature ofthe SPN, although 15-20% remain indeterminate following CT scan. The SPNwill often have needle biopsy either via bronchoscopy or percutaneously whichhave a recognised complication rate of 5-10%. Depreotide is a Tc-99m labeledanalogue of somatostatin with affinity to receptors types 2, 3 and 5. Various tu-mours including lung cancer, breast cancer, lymphoma and neuroendocrine tu-mours express these receptors.Materials and Methods: We undertook a retrospective review of one years' re-ferrals for depreotide imaging comparing the results with subsequent biopsy orsurgical histology where available. Additionally we assessed if the referring clin-ical question had been answered.Results: 24 depreotide studies performed, with 18 showing increased uptakewithin the SPN. 6 patients (25%) with positive studies had had a previous inde-terminate lung biopsy thus enabling planning of further biopsy or wedge resec-tion with frozen section. Depreotide and histology agreed in all 17 patients whohad subsequent histology of the SPN (16 malignant, 1 benign). Further biopsywas avoided in 5 out of 6 patients with negative studies. Specific answers weregiven to the clinical referring question in 23 cases.Conclusion: Depreotide effectively determined the nature of the SPNs with abil-ity to avoid biopsies in the 25% of patients with benign disease and to promptfurther invasive investigation following an indeterminate biopsy.

C-300Pleural invagination in progressive massive fibrosis (PMF) in silicosis andmixed dust pneumoconiosisH. Arakawa, K. Honma, H. Shida, H. Mori, Y. Saito; Tochigi/JP

Purpose: Invagination of the pleura often accompanies progressive massive fi-brosis (PMF) in pneumoconiotic lung. To elucidate the relation between PMF andthe pleura covering them, we conducted a retrospective study comparing CT andautopsy findings in silicosis and mixed dust pneumoconiosis (MDP).Materials and Method: The study group was an autopsy series of 58 consecu-tive patients with complicated silicosis or MDP. CT images were examined todetermine the location, shape, composition and size of PMF, distance betweenthe lesion and the covering pleura, presence of pleural thickening, a band-like

structure between the lesion and pleura, and pleural effusion. Autopsy data werereviewed for the presence of pleural thickening and invagination and were com-pared with the CT findings.Results: We identified 120 PMF lesions. Pleural invagination was found in 39(32.5%) PMF and was always associated with pathologically determined pleuralthickening. CT images showed pleural thickening in 36 (92.3%) and invaginationin 17 (43.6%) lesions. 13 lesions were associated with ipsilateral pleural effusion(p < 0.01). Statistical analysis revealed pleural invagination was associated withpleural thickening (p < 0.001) and proximity of the lesion to the pleura (p < 0.01)but not with radiographic profusion of pneumoconiotic opacities, or the shape,composition, size of PMF (p > 0.05). 5 PMF were radiographically identical torounded atelectasis.Conclusions: Fibrous thickening of the pleura and invagination into the adjacentPMF are not uncommon in advanced silicosis and MDP. Some lesions resemblerounded atelectasis. CT is beneficial in assessing these pathologic features.

C-301Imaging of diffuse cystic disease of the lungJ. Echeveste, M. Fernández-Velilla, M.I. Torres, T. Berrocal, M. Pardo,N. Gomez-León; Madrid/ES

Purpose: The aim of this teaching exhibit is to illustrate a spectrum of usual andunusual cystic diseases involving the lung, and to evaluate the efficacy of plainradiographs and computed tomography (CT) imaging in the diagnosis and man-agement of these conditions, with emphasis in high resolution CT (HRCT).Methods and Materials: We retrospectively reviewed the imaging findings ofpatients with diffuse cystic lesions involving the lung from our data base of tho-racic pathology. A cystic lesion was defined as an air-containing, well-definedspace, variable in size. The pertinent embryology and pathologic basis of theradiographic findings are discussed. Pitfalls, diagnostic difficulties and differen-tial diagnoses are emphasised.Results: Specific topics addressed include diffuse cystic diseases of the infancy(bronchopulmonary dysplasia, pulmonary interstitial emphysema, types I, II, andIII congenital cystic adenomatoid malformation, chronic eosinophilic pneumonia,and pneumatoceles), and diffuse cystic diseases of the adulthood such as hon-eycomb lung (secondary pulmonary fibrosis), Langerhans cell histiocytosis, pul-monary lymphangioleiomyomatosis, tuberous sclerosis, and lymphoid interstitialpneumonia. We also include pulmonary diseases simulating cysts such as con-genital diaphragmatic hernias, diffuse bronchiectasis, and emphysema.Conclusions: HRCT is an adequate imaging modality to assess diffuse cysticdisease of the lung, allowing an excellent visualisation of the cysts as well asother secondary findings (distribution, size, location, and wall thickness). Becausemany of these disorders have characteristic imaging appearances, this exhibitwill help practising radiologist to better understand, recognise and differentiatecystic diseases involving the lung.

C-302Beware the normal chest X-ray in suspected lung cancer: A pictorial reviewof the potential pitfallsA.K. Basu, K. Jeyapalan, J. Entwisle, R. Bhatt; Leicester/UK

Purpose: To demonstrate that a standard PA chest X-ray can be falsely reassur-ing in patients where there is a high index of clinical suspicion for lung cancer.Materials and Methods: We reviewed the patients with suspected lung cancerwhose chest X-rays were radiologically normal and had further CT cross section-al imaging. Emphasis was placed on the hidden review areas on a standard PAchest X-ray, e.g. the mediastinum, the apices, behind the diaphragm and behindthe heart. We present a pictorial review of these hidden areas and illustrate thepotential lesions not seen on a "normal" chest X-ray.Results: CT can often demonstrate lesions not visible on chest X-ray.Conclusion: A normal PA chest X-ray may be falsely reassuring in patients sus-pected of having lung cancer. Therefore in patients with a high index of clinicalsuspicion a CT should be carried out despite the normal PA chest X-ray withcareful review of the hidden review areas.

C-303Should a chest radiograph be requested in all cases of febrile neutropeniaadmissions? A study in a university hospitalA.V. Acharya, A.K. Burnett; Cardiff/UK

Purpose: To evaluate the clinical utility of obtaining chest radiographs, in theabsence of chest symptomatology, in patients admitted with acute neutropenicsepsis.

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Methods: Prospective study of 35 in patients with febrile neutropenia admitted tothe Haematology ward was carried out in this university hospital over a period of4 months. Symptoms & signs, chest X-ray findings and changes in managementbecause of these findings were assessed in these patients. We also conducted aquestionnaire survey of haematologists of South Wales regarding obtaining chestradiographs in these patients.Results: Chest radiographs were obtained in 88.5% of the patients at the time ofdiagnosis of febrile neutropenia but only 22.8% of the patients had chest signs/symptoms. If chest signs/symptoms were present, 37.5% had abnormal chestX-rays and this influenced change in clinical management. In the group wherechest signs/symptoms were absent, radiographs were normal and no change inmanagement resulted from a chest radiograph. The survey of haematologistssuggested that majority of them (58%) requested chest radiographs in acute neu-tropenic sepsis irrespective of presence or absence of chest signs or symptoms.Conclusion: In neutropenic patients with no chest signs/symptoms, a chest radi-ograph on admission is not likely to be abnormal and is unlikely to change themanagement. On the basis of our study we suggest that the chest radiographs inthese patients in the absence of clinical signs or symptoms, are of little value.This would however not exclude the possibility that other imaging approacheswould be of clinical value.

C-304Low dose thin-section CT by multidetecor-row CT: Determination ofmalignancy or benignancy and differential diagnosis in 73 cases with smallsolitary pulmonary nodulesT. Johkoh, S. Yamamoto, N. Tomiyama, O. Honda, T. Kozuka, M. Koyama,M. Tsubamoto, S. Hamada, H. Nakamura; Osaka/JP

Purpose: To evaluate the usefulness of low dose thin-section CT by multidetec-tor-row CT (MDCT) for lung cancer screening in both the determination of malig-nancy or benignancy and the differential diagnosis.Methods and Materials: 73 cases with pathologically proved solitary pulmonarynodules, which sizes were less than 3 cm in diameter, were entered into thisstudy. After the routine full dose thin-section CT (1.25 mm collimation, FOV 20 cm,pitch 3:1, 120 kVp, 200-mA/rotation, 0.5 second/rotation, high-spatial frequencyalgorithm), additional two kinds of low dose helical thin-section CT (2.5 mm col-limation, pitch 6:1, 40- (in initial 36 cases), 20- (all 73 cases), 10- (in remaining37 cases) mA/rotation) were scanned using a MDCT scanner (LightSpeed QXi,GE, Milwaukee, Wi). Using ROC analysis, an observer performance study, inwhich three observers indicated the confidence level for the determination ofmalignancy or benignancy for each nodule, was done. In addition, three observ-ers recorded the final diagnosis of each case. Accuracies of the final diagnosiswere compared by McNemer's test.Results: In the determination of malignancy or benignancy, there was no signif-icant difference among these four kinds of thin-section CT (Full dose, 40-, 20-,and 10-mA/rotation; mean Az = 0.896, 0.874, 0.872, and 0.894, respectively).Accuracy of the final diagnosis by low dose thin-section CT (40-, 20-, and 10-mA/rotation; 68%, 69%, and 69%, respectively) was significantly lower than that offull dose thin-section CT (81%) (p < 0.005).Conclusion: Efficacy of low dose thin-section CT by MDCT is comparative tothat of full dose thin-section CT in determining whether small nodules are malig-nant or not.

C-305Lung cancer screening using low-dose spiral CT: Preliminary results in 404asymptomatic smokersS. Giunta, M. Crecco, F. Facciolo, L. Carpanese, V. Cilenti, M. Caterino,P. Visca, M. Mottolese; Rome/IT

Purpose: To evaluate the feasibility of lung cancer screening using low-dosespiral CT and to present initial baseline data from a non randomized screeningtrial using low-dose spiral CT.Methods and Materials: 404 asymptomatic smoker volunteers, aged 55 yearsor older who had smoked 20 packs-year or more, underwent baseline low-dosemultislice spiral CT (Volume Zoom Siemens) of the chest without contrast mate-rial enhancement following the ELCAP protocol. Annual repeat screening wasperformed on 62 participants. Lesions up to 5 mm were deemed non suspiciousand low-dose CT was repeated after 12 months.Results: At baseline, 559 non calcified nodules were identified in 204 partici-pants. 21 nodules were larger than 10 mm. Biopsy of 14 lesions revealed NSCLCin 8 cases (5 adenocarcinoma, 1 squamous cell carcinoma, 1 large cell carcino-ma, 1 adenoid cystic carcinoma). Of these 3 were stage I (37.5%); 2 stage II(25%); 2 stage III (25%) and one stage IV (12.5%). 6 were benign lesions (3

hamartomas, 1 lymph node, 2 fibrosis). In 2 cases the PET was negative, in 3cases the nodules resolved after antibiotics; 2 participants refused biopsy.Conclusion: Low-dose spiral CT seems to be a promising method for screeninglung cancer. Our preliminary cancer screening results with low-dose spiral CT,demonstrated a prevalence of asymptomatic cancers in 1.98% of a smoking pop-ulation including a high proportion of early tumor stages.

C-306Pathological mismatched findings of specimens between CT guided biopsyand resection in Noguchi's classifications of small peripheral lungadenocarcinomaS. Yoshida, H. Ue, S. Itou, Y. Murata; Nankoku/JP

Purpose: We sometimes experience mismatched pathological findings of spec-imens between preoperative CT guided biopsy and resection in the Noguchi'sclassification of small peripheral lung adenocarcinoma. In this study we discussthe mismatched pathological findings in each case and explored the possibility ofreducing the incidence of mismatch.Materials and Method: We selected 9 cases, in which preoperative CT guidedbiopsy and consecutive resection were performed. Tumors were peripheral lungadenocarcinoma of 2 cm or less in diameter. The final diagnosis by resectedspecimen of these cases were 3 type B, 4 type C and 2 type F peripheral aden-ocarcinoma. We compared HRCT findings of them to identify the CT density ineach tumor.Results: Though the final pathological findings show 3 type C tumors, the spec-imen by CT guided biopsy show only type A or B tumors. Further more, thoughthe final pathological findings show 2 type F, not having a replacement growthpattern, the specimen also show type A or B, having a pure replacement growthpattern.Conclusion: Pathological mismatched findings between CT guided biopsy andresection were observed. Additional CT image comparison between mediastinaland lung window settings gave us probable information about the tumors havingreplacement growth patterns or not. Before performing CT guided biopsies, im-age recognition about the solid density helped us choose the most suitable biop-sy site. With more thorough information derived from HRCT and biopsy on thetypes of tumors patients have, physicians can offer patients more accurate prog-nosis.

C-307Correlation of bronchial wall thickness between HRCT and microscopicfindings in asthmatic patientsS.-H. Paik1, J.-S. Park1, J.-H. Hwang2, J.-K. Cha1, H.-S. Hong1, J.-H. Joh1,S.-J. Park1, D.-H. Kim1, H.-K. Lee1; 1Bucheon/KR, 2Seoul/KR

Purpose: To analyze high-resolution CT (HRCT) findings in asthmatics and con-trol subjects, and to evaluate the relationship between HRCT findings and pul-monary function tests in asthmatic subjects. To try to evaluate the correlationbetween the bronchial wall thickening (BWT) with pathologic findings and reflectthe thickness of epithelial basement membrane on basis of the HRCT findings.Materials and Methods: Using HRCT, the author analyzed the ratio of BWT, thefrequency of bronchial dilatation, the extent of air trapping and centrilobular nod-ules. In addition, the author assessed HRCT findings of 52 asthmatic patients forcorrelation with pulmonary function tests and then obtained bronchoscopic biop-sy at the second divisional branch of 12 patient among the 52 asthmatics. Theauthor measured the thickness of the epithelial layer and basement membraneafter H-E stain and then statistically compared with BWT on HRCT.Results: Among the total 52 asthmatics, BWT on HRCT showed significant cor-relation with FEV1 (p = 0.006) and TLC (p = 0.012). PEFR (p = 0.04) shows sig-nificant correlation with the air trapping on HRCT statistically. Among the 12 patientof 52 asthmatics, BWT on HRCT shows statistically significant correlation withbasement membrane thickness on pathology, but not with epithelial layer thick-ness on pathology (p = 0.023, r = 0.642).Conclusions: The ratio of BWT between asthmatics and control subjects aresignificantly different on HRCT. The grade of BWT shows significant different FEV1and TLC statistically, and that of extent of air trapping reveal significant differentPEFR statistically. The BWT on HRCT reflect the thickness of epithelial base-ment membrane.

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C-308Computer-aided diagnosis: A shape classification of pulmonary nodulesimaged on high-resolution CTS. Iwano, T. Nakamura, T. Ishigaki; Nagoya/JP

Purpose: The purpose of this study was to decide whether the computer imageanalysis could classify shape of pulmonary nodules like radiologists.Materials and Methods: Based on the high-resolution CT (HRCT) findings, tworadiologists classified 70 pulmonary nodules (5-35 mm in diameter) into 7 typesof shape: Round (n = 20), lobulated (n = 12), polygonal (n = 8), tentacle (n = 7),spiculated (n = 7), ragged (n = 8), and irregular (n = 8). On the other hand, animage processing computer software extracted several quantitative measures ofthe shape of each nodule from DICOM data of HRCT images. To identify thecontour of the pulmonary nodules, -300 HU was used as the predefined thresh-old values. These quantitative measures were contrasted to the classification byradiologists.Results: As quantifiable features to characterize nodule shape, the circularity(= 4π*Area/ Perimeter2) and the second moment were suitable. The combinationof the circularity and the second moment could classify round, tentacle, spiculat-ed, ragged, and irregular nodules. However, it was difficult to separate lobulatedfrom polygonal nodules.Conclusion: Computer image analysis of HRCT could classify round, tentacle,spiculated, ragged, and irregular pulmonary nodules like radiologists. This meth-od may be useful for the differentiation between malignant and benign nodules.

C-309HRCT of the lungs in cystic fibrosis: More sensitive marker of CF lungdisease than LFTM. Polakovic, H. Kayserová, P. Boruta; Bratislava/SK

Purpose: Our study was aimed at determining the usefulness of HRCT in evalu-ating pathomorphological changes of lung parenchyma, the reversibility of thesechanges, and correlation of these changes to pulmonary function and mutationsin CFTR gene.Methods and Materials: Two HRCT examinations of the chest were performedon 63 CF patients (36 males, 27 females) with LFT (maximal interval: two weeks)in the period of 1999 to 2003. Follow-up studies were evaluated by a modifiedBhalla scoring system and compared with initial studies. Lung function testingwas performed on a Mir spiro-bank, using ERS 1993 (Zapletal) predicted values.Results: In group with dF508/dF508 genotype (22 pts) the first examination meanscore reached 8.7 (RL)/8.7 (LL), second 10.7 (RL)/9.7 (LL). Lung function testswere: First examination - FVC 73%, FEV1 74%, MEF50 69% and second oneFVC 81%, FEV1 78%, MEF50 66%. For groups with dF508/other genotype (28 pts)and other/other genotype (13 pts) similar results were obtained.Conclusion: HRCT is a more sensitive method of evaluating pathologic processin lungs of CF patients than LFT. LFT is a more complex examination, and theresults of pulmonary functions are modified by the physical status of the CF pa-tient (nutrition, strength of muscle, acute exacerbation) and his/her ability to co-operate with spirometry (age). Severe mutations of CFTR gene in genotype areaccompanied by an increasingly high HRCT score in spite of therapy applied andstable lung functions.

C-310High resolution computed tomography in the diagnosis of bronchiolitisobliterans syndrome after lung transplantationA.E. Berstad, T.M. Aaløkken, A. Kolbenstvedt, Ø. Bjørtuft; Oslo/NO

Purpose: To evaluate the clinical value of high resolution computed tomography(HRCT) of patients after lung transplantation.Materials and Methods: HRCT with insp- and expiratory scans was performedin 36 patients (19 women, 10 single- and 26 double lung-, including two heart-lung transplanted) who had survived for 11 months or more. The median follow-up time was 36 months (range 11 to 72 months). Air trapping was evaluated onexpiratory scans constructed from two short spiral scans in two levels with mini-mum intensity projection (MINIP)-reconstruction. The degree of air trapping wasclassified on a 0 to 16 scale according to the affected surface area. A score of 3or more was defined as significant air trapping.Results: 13 patients developed the bronchiolitis obliterans syndrome (BOS) asdefined by reduction of pulmonary function test results to less than 80% of thebest postoperative values after a median time of 12 months. 10 of these had anair trapping score of 3 or more. Among patients without BOS (n = 23), 7 patientsshowed significant air trapping. The sensitivity, specificity and accuracy of a scoreof 3 or more in the diagnosis of BOS were 77, 70 and 72% respectively. Bron-

chiectasis developed more frequently in BOS than in non-BOS patients (69 and39%, respectively).Conclusions: HRCT, including expiratory scans with MINIP-reconstruction, ordevelopment of bronchiectasis was of limited accuracy in diagnosing BOS afterlung transplantation.

C-311HRCT indices and pulmonary function tests in patients with chronicbronchial asthmaC. Kalogeropoulou, D. Kalampoka, P. Zampakis, I. Tsota, K. Spyropoulos,T. Petsas; Patras/GR

Purpose: To quantitatively evaluate the presence and extent of low attenuationareas on chest high-resolution CT (HRCT) in patients with chronic bronchial asth-ma and correlate such findings with the pulmonary function tests (PFT).Material and Method: We examined 15 patients (M: 6 and F: 9, age 48.5 ± 11.55yrs) with chronic bronchial asthma. All patients underwent inspiratory and expir-atory HRCT as well as forced spirometry, maximum voluntary ventilation, somat-ic plethysmography and cardiopulmonary exercise test. HRCT images wereevaluated for the presence and distribution of low attenuation areas. Objectivequantification of low attenuation areas was obtained by determining the relativearea of pixels representing lung tissue with a density below -910 HU (Pixel In-dex). The resulting pixel index was determined for a single slice at the uppermiddle and lower zone.Results: Pulmonary function parameters correlated well with pixel index duringexpiratory scan. There was significant correlation between the upper part of thelung and forced vital capacity (FVC),%FVC, forced expiratory volume in 1 sec(FEV1), maximum voluntary ventilation (MVV) and total lung capacity (TLC). Themiddle part of the lung correlated with FVC, FEV1, FEF25-75 and resistance.The lower part of the lung was also correlated with FEV1, FEF25-75, residualvolume (RV) and total resistance. Pixel index during inspiratory HRCT scans didnot correlate with pulmonary function tests.Conclusions: Expiratory HRCT in asthmatics correlates well with pulmonaryfunctions, which suggests that in asthmatics substantial gas trapping may occurduring expiration because of severe airway narrowing and/or airway closure.

C-312Thoracic imaging during treatment with pergolideR. Dore, A. Gervasio, M. Braschi, V. Vespro, G. Meloni, C. Nascimbene;Pavia/IT

Purpose: Pergolide is a dopaminergic agonist widely used in the treatment ofParkinson's disease. Toxicity has been described in the form of fibrosis, inflam-mation of the pleura, retroperitoneal fibrosis, constrictive pericarditis and inflam-matory lung infiltrates. We analyzed thoracic abnormalities in patients who havebeen taking Pergolide long term and the possible differential diagnosis.Method and Materials: Between October 2002 and September 2003, at ourHospital, "S.Matteo" IRCCS, a group of neurological patients treated with Per-golide underwent chest CT, because of clinical and chest X-ray abnormalities.We scanned each patients before and after intravenous injection of contrast me-dium; the lung parenchyma was evaluated with high resolution algorithm; threepatients with pulmonary opacities also underwent FNAB.Results: All patients had round atelectasis associated either with pleural plaquesof vary entity or with atypical and reactive pleural effusion. The thickest pleuralplaques were located in the costovertebral angles, followed by the diaphragmaticpleura without effusion. In all the cases the pleural plaques in the parietal sidewere definetly irregular, linear in the lung side. Association with lung interstitialseptal thickening was inconstant.Conclusions: Although our cases are few in number and need further validation,pleural involvement, either fibrotic or inflammatory, always seem to be associat-ed with pulmonary abnormalities. CT pleural signs are non specific; differentialdiagnosis may include tumors, asbestos exposure and inflammatory disease;however the association with relevant lung round atelectasis is significant. TheseCT findings must be held in mind and thought to be due to toxicity in patientstreated with pergolide.

C-313The chest radiological appearances of severe acute respiratory syndrome(SARS): Analysis of 54 casesT. Yu, Y. Zhang, W. Li, N. Ye, Y. Cai, Q. Xu; Tianjin/CN

Purpose: To investigate the chest radiological characteristics and classificationof severe acute respiratory syndrome (SARS).

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Methods and Materials: 54 patients with SARS confirmed clinically had serialchest plain films, 23 of whom also underwent chest CT scans. The radiologicalappearances and evolution patterns of SARS were analyzed retrospectively. Basedon the extent and duration of the lesions on the chest plain films, the patientswere classified into three types: Simple type (type I) in which the lesions werelimited, progressive type (type II) in which more than three lungs fields were in-volved, and prolonged type (type III) in which the lesions remained for more thansix weeks. The follow-up chest plain films and CT scans were analyzed compar-atively in 18 patients of this group discharged from the hospital after clinical cure.Results: In 54 cases, on the chest radiography, 15 cases showed predominatelypulmonary parenchymal lesions in the form of ground-glass opacity and consol-idation, 5 cases showed predominately interstitial infiltration and 34 cases showedboth parenchymal and interstitial lesions. The radiological appearances werenonspecific with good patient prognosis in type I (n = 12), and the radiologicalappearances were relative specific with high patient fatality rate (16%) in type II(n = 25). All of the patients (100%) in type III (n = 17) had residual lesions. CTwas superior to the chest plain film on detecting residual lesions.Conclusion: The radiological appearances of SARS were relatively specific. Theexact diagnosis of SARS must combine radiological appearances with the clini-cal, epidemiological and laboratory findings.

C-314HRCT findings in patients with near-fatal asthma: Comparison of mild tosevere asthma patients and normal controls and changes in airwayabnormalities following steroid treatmentJ.-S. Park1, S.-H. Paik1, J.-H. Hwang2, C.-S. Park1; 1Bucheon/KR, 2Seoul/KR

Purpose: To identify HRCT features that indicated predisposition to potentiallyfatal asthma and to evaluate serial follow-up HRCT scans of patients with near-fatal asthma (NFA).Methods and Materials: Abnormalities of the large airways (bronchial wall thick-ness) and small airways (centrilobular thickening and air trapping) were meas-ured semi-quantitatively on HRCT scans of 24 non-NFA, 16 NFA, and 16 controlsubjects. In addition, these abnormalities were re-evaluated after intensive andrelatively long-term (> 6-month) treatment with inhaled steroids.Results: Centrilobular thickening was observed in 36% of mild asthma cases, in70% of moderate to severe asthma cases, and in 100% of NFA cases. Centrilob-ular thickening, but neither bronchial wall thickness nor the area of air trapping,was significantly increased in NFA, as compared with mild or moderate to severeasthma (p < 0.05, respectively). In the 7 non-NFA and 5 NFA patients who under-went follow-up HRCT scans, only bronchial wall thickness was decreased signif-icantly in the NFA cases (p < 0.05), while bronchial wall thickness and centrilobularthickening were significantly decreased in the non-NFA cases. These small air-way abnormalities were partially reversible in the both groups. Residual centri-lobular thickening after long-term steroid treatment was significantly higher inNFA than non-NFA patients.Conclusion: The results of our study indicate that extensive small airway abnor-malities may be associated with NFA, and that these abnormalities are partiallyreversible after the successful control of asthma symptoms.

C-315Pneumocystis carinii pneumonia (PCP): The different HRCT pattern in AIDSand non-AIDS immunocompromised patientsA. Kalogera-Fountzila, A. Haritanti-Kouridou, A. Lefkopoulos, G. Sevas,A. Tzinas, A. Sarafopoulos, A.S. Dimitriadis; Thessaloniki/GR

Purpose: We prospectively studied AIDS and non-AIDS immunocompromisedpatients with lung infection in order to evaluate the HRCT findings, to character-ize the infection and seek for differences in appearance of PCP in the two groups.Methods and Materials: 19 HIV positive patients were referred to the specialinfectious diseases unit and 11 non-AIDS immunocompromised patients werereferred to the oncology unit of our hospital with a diagnosis of clinically suspect-ed pulmonary infection. All patients were evaluated with HRCT (1.5 mm collima-tion, 10 mm interval, 140 kvp, 175 mAs, and 1-s scan time). All non-AIDSimmunocompromised patients had bronchoalveolar lavage, sputum culture, orCT guided biopsy as well as did 10 of the HIV-positive patients which revealedPCP. In the rest of the patients PCP was confirmed after successful anti-PCPtreatment. The data were calculated using the chi square test.Results: All patients in both groups had the typical findings of PCP, such aspresence of ground glass appearance (patchy or diffuse), consolidation (focal ordiffuse), bronchiectasis or bronchioloectasies, septal thickening, cysts and nod-ules. The incidence of consolidation, especially diffuse, was a significantly higherfinding in non-AIDS patients (p = 0.029). On the contrary, presence of ground

glass in a central/perihilar distribution (p = 0.017), septal thickening (p = 0.032)and bronchioloectasis (p = 0.032) was significantly higher in AIDS patients.Conclusion: HRCT findings of PCP in non-AIDS immunocompromised patientsare more aggressive, with diffuse consolidation as the cardinal sign and are as-sociated with a more advanced disease.

C-316Primary and secondary lung malignancies treated with percutaneous radio-frequency ablation: Evaluation with follow-up helical CTG.-Y. Jin, Y.-M. Han, Y.-C. Lee, S.-W. Kim, Y.-S. Lim, K.-H. Chung; Chonju/KR

Purpose: To describe the important CT findings to evaluate for therapeutic effi-cacy on follow-up CT after RF ablation for the lung cancer.Material and Methods: The study group included 17 lung cancers and 4 meta-static nodules in 21 patients. All patients underwent follow-up helical CT exami-nations immediately, one month later, and then every three months afterpercutaneous RF ablation. Two reviewers interpreted the CT findings with con-sensus. The serial changes in the enhancement pattern, size, peripheral ground-glass opacity, and other findings in the treated area were assessed on the follow-upCT. Sensitivity, specificity, and the positive predictive value for evaluating the com-plete ablation using enhancement pattern on immediate follow-up CT were de-termined using the Chi-square test.Results: In the completely ablated group (n = 9), the ablated lesions demon-strated absolutely no contrast enhancement on follow-up CT and the mean per-centage of ablated lesion size decreased at 3, 6, 9, 12, and 15 months (5.5%,14.8%, 43.2%, and 43.2%, respectively) compared with immediate follow-up CT.In the partially ablated group (n = 12), the ablated lesions demonstrated varyingpatterns of enhancement and the mean percentage of ablated lesion size showeda gradual increase after the 6-month follow-up CT scans. Enveloped ground glassopacity surrounding the tumor was seen in 5 (23.8%) of 21 lesions on immediatefollow-up CT.Conclusion: Of the CT findings of lung malignancy after RF therapy, the en-hancement pattern and the change in size of the ablated lesion are the mostimportant factors in determining whether complete ablation can be achieved.

C-317Clinical evaluation of multidrug resistance associated protein expression byFDG PET and MIBI SPECT in lung cancerY. Kodama, K. Higashi, Y. Ueda, J. Guo, S. Taki, M. Oguchi, I. Yamamoto,H. Seki, T. HIguchi; Ishikawa/JP

Objectives: The aim of this study is to evaluate whether FDG PET and MIBISPECT can be markers for p-glycoprotein (Pgp), multidrug resistance-associat-ed protein (MRP), lung resistance protein (LRP) expression in lung cancer tis-sues.Methods: 88 patients with 92 lung cancer lesions were enrolled in this study.Before surgery, FDG PET imaging was performed 40 min after injection ofFDG185 MBq, and SUVs were obtained. MIBI SPECT was performed 15 minand 3 hours after injection of MIBI 370 MBq. Early ratio (ER), delayed ratio (DR),and washout rate (WR) were obtained. Pgp, MRP, and LRP expression in lungcancer tissue were determined by immunohistochemical staining.Results: No significant correlations were observed between MIBI uptake andexpression of Pgp, MRP and LRP. FDG uptake significantly correlated with ex-pression of Pgp and LRP. The lung cancer with high degree of Pgp and LRPexpression had significantly low FDG uptake. Pgp and LRP expression of aden-ocarcinomas were significantly higher than that of squamous cell carcinomas.FDG uptake of adenocarcinomas were significantly lower than that of squamouscell carcinomas. In lung adenocarcinomas, Pgp and LRP expression of bronchi-oloalveolar carcinomas were significantly higher than that of poorly differentiatedadenocarcinomas. In contrast, FDG uptake of bronchioloalveolar carcinomas weresignificantly low when compared with that of poorly differentiated adenocarcino-mas.Conclusion: The current study suggest that FDG uptake may be a marker forPgp and LRP expression. Both Pgp, LRP expression and FDG uptake correlatewith cellular differentiation and histological type.

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C-318Inflammatory pseudotumor of the thorax: Evaluation with chest CT findingsY.-H. Kim, J. Oh, T.-W. Chung, J.-G. Park, H.-K. Kang; Gwangju/KR

Purpose: Inflammatory pseudotumor (IP) is an uncommon benign lesion char-acterized by an irregular growth of inflammatory cells. The purpose of this studywas to evaluate CT findings of the thoracic inflammatory pseudotumor.Methods and Materials: Chest CT findings of pathologically proven seven tho-racic IP were reviewed retrospectively. Mean age of the patients was 52 years old(35-62 years). Pre- and post-contrast enhancement CT were performed in allpatients. Location and contour with margin of the lesion, pattern of contrast en-hancement, calcification in the lesion, lymphadenopathy, associated parenchy-mal or pleural lesion were reviewed. Clinical findings of the patients were alsoevaluated.Results: Six were in the lung parenchyma (five in peripheral, one in central; fourin upper lobe, two in lower lobe), and one was in the anterior mediastinum. Aver-age size of the lesions was 6.7 cm (3-14 cm). Of the six parenchymal lesions,three revealed as ill-defined mass-like consolidation, two as well defined mass-es, and one as speculated mass. One mediastinal mass showed ill-defined mar-gin. All lesions showed heterogeneous contrast enhancement. Three had eccentriccalcification. None had satellite nodule. Four cases had adjacent pleural thicken-ing or effusion. Lymphadenopathy was noted in one patient. They complained ofmild fever (n = 3), hemoptysis (n = 2), coughing (n = 1), weight loss (n = 1). Fourpatients had past history of pulmonary tuberculosis.Conclusion: Thoracic IP showed variable CT findings. However, when dealingwith a peripheral pulmonary mass with heterogeneous contrast enhancementwithout remarkable lymphadenopathy, the radiologists should always include IPamong the entities of the differential diagnosis.

C-319Early detection of lung cancer: Prevalence in 506 asymptomatic smokersG. Bastarrika, J.C. Pueyo, R. Gil Marculeta, L. Montuenga, M.D. Lozano,J.J. Zulueta; Pamplona/ES

Purpose: To present prevalence data from a screening trial using low-dose spiralcomputed tomography (LDCT) and positron emission tomography (FDG-PET).To highlight the potential benefit of including FDG-PET in an early lung cancerdetection protocol.Materials and Methods: From September 2000 to October 2002, 506 asympto-matic smokers (mean age 54.5 years, SD 8.65, mean tobacco consumption 42.55pack-years) were studied with LDCT. Repeat short-term high-resolution CT fol-low-up was done for non-calcified pulmonary nodules (NCPN) < 10 mm to ex-clude growth. NCPN 10 mm or more were considered as potentially malignantand complementary FDG-PET scanning was recommended. Biopsy was recom-mended for NCPN found to be positive on the FDG-PET.Results: 144 NCPN were found in 101 (20%) asymptomatic subjects. The diam-eter of the largest NCPN was: 5 mm or less in 49 (48.5%) participants, > 5 -< 10 mm in 36 (35.6%) and 10 mm or more in 16 (16%). 13 subjects underwentFDG-PET exam (7 positive, 6 negative). Among the FDG-PET positive NCPN 5were resected (lung cancer), 1 underwent fine needle aspiration cytology (FNAC)(non-specific / necrosis). The remaining subject refused further work-up. CT fol-low-up was decided for the other NCPN. Results will be updated after inclusion ofmore participants.Conclusions: This LDSCT based screening programme demonstrated a preva-lence of 5 lung cancers in a population of 506 (0.99%) asymptomatic subjects athigh risk, all with surgical stage T1N0M0. Addition of FDG-PET to the protocolmay reduce the number of invasive procedures for histologically benign nodules.

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C-320Postprocessing procedures after MDCT for airway and lung diseasesA.-L. Brun, C. Beigelman-Aubry, Y. Badachi, P.A. Grenier; Paris/FR

Learning Objectives: To be familiar with the postprocessing procedures aftermulti-detector row CT (MDCT) which can optimize the assessment of airway andlung disease.Background: Axial slices are considered as the gold standard for analysis ofairways and lung diseases. Since the era of MDCT, excellent reformations, and3D reconstructions have become available and frequently used in case of airwaydisease. Infiltrative and cystic lung diseases may also benefit from these tech-niques, provided that they are optimally used.Procedure Details: All 2D and 3D reconstruction techniques available were ret-rospectively applied on MDCT volume data set from patients with airway and/orlung disease, using various parameters. Optimized multiplanar volumetric recon-struction and 3D CT bronchography are particularly well adapted for assessingtracheobronchial stenosis and bronchiectasis. Maximum intensity projection isrecommended for assessing small nodular and mosaic perfusion patterns. Mini-mum intensity projection is helpful: 1) To detect and assess ground glass opacity;2) To visualize the airways within any lung parenchymal lesions, helping guideselective bronchial aspiration and bronchoalveolar lavage; and 3) To depict bron-chial adenolectasia in patients with COPD or bronchiectasis. Virtual endoscopyis particularly helpful in depicting tiny nodulation of the tracheobronchial mucosain granulomatous and malignant diseases. Highly selected cases will be used toillustrate the most striking additional information provided by postprocessing tech-niques in airway disease, infectious lung disease, and diffuse infiltrative lung dis-ease.Conclusion: Postprocessing procedures in addition to axial slices allow an ex-cellent assessment of tracheobronchial and parenchymatous diseases, particu-larly concerning their depiction, characterization and extent assessment.

C-321Volume rendering: Less-time consuming and accuracy technique indiagnosis of rib fracturesE. Chavarri, C. Trinidad, E. Guerra, G. Fernandez, C. Delgado, P. MorenoDe La Santa; Vigo/ES

Learning Objectives: To asses the useful of volume rendering 3D images (VR)in the evaluation of rib fractures using a 16-slice multidetector CT. To compare VRand conventional images in determining the number and location of fractures. Todescribe the advantages of VR over conventional images.Background: Multislice CT has improved the resolution in evaluation of traumat-ic patients because it permits thinner slices and multiplanar reconstructions withnear isotropic voxel. However, the number of images to be evaluated is greaterand the diagnosis of rib fractures remains difficult due to the obliquity of costalarches in the axial view. We evaluated chest CT examinations in 54 patients withrib fractures. In this exhibit, we describe CT technique, reconstruction parame-ters and the advantages of VR over conventional images to ensure number andlocation of rib fractures.Procedure Details: A 16-slice multidetector CT was performed using the follow-ing parameters: 90 mAs, 120 Kv, 16 x 1.5 mm collimation, during a single breathhold. Images were reconstructed with 3 mm thickness, 50% overlapping and softtissue kernel filter (B40). Two experimented radiologists analysed axial, multipla-nar and VR images. The number of fractures, location and part of arch fractured(anterior, medium and posterior) was described.Conclusion: Volume rendering is more accurate than conventional images indetermining the presence and location of rib fractures, particularly when archesare fractured in more than one site. Also, it is a less time consuming techniquewith better diagnosis confidence. We recommend its use in a routine practice forchest-CT in traumatic patients.

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C-322Volume rendering 3D bronchography imaging of the airways with 16multidetector row CTC. Trinidad, G.C. Fernandez, M. Rodriguez-Castilla, C. Martinez, E. Guerra,F. Tardáguila; Vigo/ES

Learning Objectives: To describe the technique of 3D volume rendering bron-chography (VR-B) with 16 multidetector row CT. To evaluate the usefulness ofVR-B of the tracheobronchial tree in clinical practices comparing with axial andmultiplanar reconstructions.Background: Multidetector row CT allows superior imaging resolution in axialand multiplanar images, and also contributes to advances in 3D-volume render-ing that can now be feasible in clinical routine practice. In this exhibit, we willdescribe the CT technique and VR-B parameters to obtain good quality 3D imag-es for visualization of central and small airways. In addition, we will evaluate therole of this technique in clinical practice and in different pathologies of the trache-obronchial tree.Procedure Details: 50 patients with airways pathology due to different etiologieswere prospectively studied with 16-row multidetector CT. Images were acquiredat end-inspiration during a single breath-hold with 16 x 0.75 collimation detectorand reconstructed with 1 - 2 mm collimation, 0.5 - 1 mm increment (overlapping50%) and soft tissue kernel filter (B30). VR-B images were showed using -150 to-750 UH window with, -526 to -250 UH window level, 35% opacity and unshaped.Conclusion: Good quality VR-B images are feasible in daily practice. In patientswith benign stenosis of the central airways additional information in assessinglength and degree is provided. This technique improves confidence diagnosis inextrinsic compression by malignancies. However, no additional benefit in the eval-uation of endobronchial lesions and bronchiectasis is shown.

C-323Clinical applications of multislice computed tomography of the centralairwaysY. Herrero, M. Bret-Zurita, S. Hernández, E. Cuesta-López, L. Gorospe,M. Pardo; Madrid/ES

Learning Objectives: To show image postprocessing methods of central air-ways studies with multislice computed tomography (MSCT). To illustrate the ad-vantages of this imaging modality in the assessment of central airways disorders.Background: Several limitations are associated with single detector CT (SDCT)for the detection of central airways disorders such as the limited ability to detectsubtle airway stenoses or the underestimation of the craniocaudad extent of dis-ease.Procedure Details: All scans covered from the vocal cords to the mainstem bron-chi. CT parameters included a slice thickness of 2 mm, a reconstruction intervalof 1 mm, a pitch of 3.5 mm, and a table speed of 7 mm per rotation. Data wereobtained during a single-breath-hold acquisition in a craniocaudal direction. Two-dimensional reformation images including multiplanar reconstructions (MPR),multiplanar volume reconstructions (MPVR), and three-dimensional reconstruc-tions (external and internal rendering) were obtained at a workstation (Vitrea 2;Vital Imaging). The main applications of MSCT in airways disease as well as itslimitations and pitfalls are emphasized. Specific topics addressed include con-genital airways anomalies (anomalous origin of bronchi, vascular rings, tracheo-malacia, bronchopleural fistula), extrinsic airways compression, tracheal andbronchial wall infiltration (bronchogenic carcinoma, angiosarcoma), intraluminalairways masses (carcinoid tumor), inflammatory diseases and posttraumatic andiatrogenic airways injuries.Conclusion: MSCT provides very high-quality image postprocessing (multipla-nar and three-dimensional images), overcoming limitations inherent to SDCT.Additional benefits include preprocedural planning for bronchoscopy and sur-gery, and a more comprehensive spatial anatomy for both radiologists and refer-ring physicians.

C-324Ultrasound: Guided aspiration of supraclavicular lymph nodes in patientswith suspected lung cancerM. Kumaran, R. Benamore, R. Vaidhyanath, J. Entwisle; Leicester/UK

Learning Objectives: To illustrate the utility of ultrasound-guided supraclavicu-lar lymph node aspiration in the cytological diagnosis of lung carcinoma. We de-scribe our preliminary experience in 19 patients over the last 4 months.Background: Lung carcinoma is the leading cause of cancer death in the UK.Histological diagnosis traditionally requires invasive techniques to obtain tissue,such as bronchoscopy, mediastinoscopy or image-guided lung biopsy. We have

introduced this technique in patients who have at least N2 disease on staging CT.If positive, this helps both to stage the patient and provide a cytological diagno-sis. It may prevent the need for more invasive techniques, such as percutaneouslung biopsy or mediastinoscopy.Procedure Details: All patients were scanned and nodes over 10 mm in sizewere aspirated under ultrasound guidance, using a 21 gauge green needle. Acapillary "coring" technique was employed, without suction and aspiration. Thesamples were then expelled from the needle into cytospin fluid, for cytologicalexamination. The procedure could be performed without local anaesthetic and asan out patient. Of the 19 patients examined, 16 had significant lymphadenopathy.Of these, 12 had positive malignant cytology, although 2 had indeterminate celltype. 4 samples showed no evidence of malignancy and PET confirmed no evi-dence of supraclavicular nodal involvement in 1 case.Conclusion: This is a promising non-invasive technique in the staging and diag-nosis of patients with lung cancer.

C-325Simulated low radiation dose CT angiography of pulmonary arteriesD. Tack1, V. De Maertelaer2, C. Suess3, P. Muller4, P. Scillia2, W. Petit2,P. Gevenois2; 1Baudour/BE, 2Brussels/BE, 3Forchheim/DE, 4Charleroi/BE

Purpose: To compare standard dose and simulated low-dose CT angiography ofpulmonary arteries (CTPA).Methods and Materials: Raw data of CTPA acquired in 21 consecutive patientswith pulmonary emboli (PE) were included. CT acquisitions (Volume Zoom, Sie-mens) were: 4 x 1 mm, 120 KV, 90 effective mAs. From the native raw data, foursets of simulated raw data were generated with 60, 40, 20 and 10 effective mAs,respectively. From each raw data set, CT slices were reconstructed with 1.25 mmthickness and 0.8 mm increment, and with a soft tissue kernel. Three readerswho were blinded to the patients names and to the simulated mAs levels ana-lyzed the CT series twice, in random order. PE in 6 central pulmonary arteries(PA) and 20 segmental PA were graded with a four-point scale. Agreements (Ka-ppa statistics) and readers performances using 90 mAs as the gold standardwere calculated.Results: All PE seen at 100 mAs were depicted at all lower radiation dose levels.Intraobserver agreements were independent from the radiation dose but stronglydepended on the reader's experience. Agreements were good for central PE butonly moderate for peripheral PA branches. Accuracy of low- and lower dose CTPAranged from 95 to 100%, and were independent from the radiation dose (p < 0.001)but not on the reader.Conclusion: Reducing the radiation dose during CTPA is feasible with high ac-curacy, and may have less influence on CTPA interpretation than may have chang-ing the reader or repeating a reading.

C-326Receiver operator characteristic analysis of observer performance in virtualbronchoscopyP. Maniatis, C. Triantopoulou, H. Labrakis, K. Malagari, I. Tsalafoutas, I. Siafas,J. Papailiou, D. Kelekis; Athens/GR

Purpose: To evaluate the observer performance with the combined interpreta-tion on a workstation of VB, axial, coronal and sagittal images against hard-copyfilms of thin section CT in low grade bronchial abnormalities using receiver oper-ating characteristic (ROC) curves.Patients and Methods: 369 bronchial sections in 41 patients were evaluated ina prospective observer study using spiral CT data. Exclusion criteria includedocclusions, high-grade bronchial stenoses (> 50%) and tracheal lesions. All pa-tients underwent a spiral CT acquisition with 3 mm collimation. Two reconstruc-tion intervals were used: 1 mm for virtual bronchoscopy and 2 mm for thin sectionCT. Both examinations were reviewed by two independent radiologists. The find-ings were correlated with those of flexible bronchoscopy and the statistical anal-ysis was done with receiver operating characteristic curves.Results: A total of 62 lesions were identified by flexible bronchoscopy. Areasunder curves for virtual bronchoscopy and multiplanar reconstructions were 0.972and 0.949 for the two observers respectively, while areas 0.913 and 0.896 wereprovided from thin axial CT images (by the two observers respectively). Theseresults differed at statistical significant level (p < 0.05 for the first observer andp < 0.01 for the second observer).Conclusion: The combination of multiplanar reconstructions and virtual bron-choscopy in simultaneous viewing on a workstation is particularly useful for theevaluation of low grade bronchial abnormalities at statistical significant level whencompared to thin section axial CT images alone.

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C-327Wavelet denoising with generalized cross validation: Property of thresholdfunctionH. Kubota, N. Tanki, T. Nanjo, K. Kawakami, Y. Yamazaki, K. Murase; Suita/JP

Purpose: To investigate the property of threshold function for wavelet denoisingwith generalized cross validation.Methods and Materials: As noise-free image, we used the image database"Standard Digital Image Database: Chest Lung Nodules and Non-nodules" cre-ated by Japanese Society of Radiological Technology in 1998. Zero mean Gaus-sian noise was added to the noise-free image varying SNR (Signal-to-Noise Ratio)from about 0 to 80 [dB]. Wavelet shrinkages were performed using the optimalthreshold obtained by the GCV calculation for each level and component. Fourtypes of threshold functions (hard, soft, garrote and firm) were applied to choosethe optimal threshold.Results: The most effective threshold function was soft. When soft was used, theimprovement of 10.1 [dB] was found at 7.5 [dB] of noised image, and the im-provement of 3.9 [dB] was found at 19.6 [dB]. However, when the SNR of a noisedimage exceeded 30 [dB], an artifact was produced. For the other threshold func-tions, neither prominent improvements nor artifacts were seen. As for the largedifference between soft and the other functions, bias is considered to be one ofthe causes. Only the soft threshold has a large bias at high wavelet coefficients.Conclusion: If the SNR of the noised chest image is under 30 [dB], some im-provement will be expected by using soft threshold combined with the GCV method.But for an over 30 [dB] noised image, the soft threshold causes an artifact.

C-328Optimization of voltage combination for chest radiography in a new dual-energy subtraction systemN. Bandai1, H. Tagashira1, M. Yoshimoto1, T. Kiriyama2, T. Maruyama2;1Onsen-gun/JP, 2Matsuyama/JP

Purpose: The new dual-energy subtraction system allows the fast (200 millisec-ond) acquisition of two, high and low voltage images using CsI:Tl amorphoussilicon flat-panel technology. The purpose of this study was to determine the bestcombination of the voltage for the soft tissue of the chest radiography.Methods and Materials: The dual-energy subtraction imaging increases the sen-sitivity and specificity of the pulmonary nodule detection in the chest radiographyby reducing the contrast of overlying the bone structures. The range of the highvoltage is from 120 kVp to 150 kVp and the low voltage is from 60 kVp to 80 kVp,respectively. The physical factor such as contrast, density and graininess and theanatomical factor such as visibility of the vessel were evaluated by five radiolo-gists using the normalized-rank approach. All rank orders were transformed tothe distance scale by the statistical method.Results: The ranking in the low voltage was better in the order corresponding to60 kVp, 70 kVp and 80 kVp (p < 0.05). The ranking in the high voltage showedbetter in the order corresponding to 140 kVp, 150 kVp, 130 kVp and 120 kVp.There were significant differences (p < 0.05) except the distance scale between140 kVp and 150 kVp.Conclusion: The best combination for the soft tissue of the chest in a new dual-energy subtraction system was 140 kVp (high voltage) and 60 kVp (low voltage).

C-329Spiral low-dose CT of the chest: A "one-stop-shop" modality for earlydetection of the leading causes of deathG. Bastarrika, O. Cosín, J.C. Pueyo, Á. Alonso, D. Cano, J.J. Zulueta;Pamplona/ES

Purpose: Spiral low-dose CT (LDCT) can identify very small lung cancers inhigh-risk individuals. The purpose of this study is to assess feasibility of quantify-ing coronary calcium using non ECG-gated LDCT exams performed in individu-als participating in an early lung cancer detection programme (ELCDP).Methods and Materials: A comparative study was performed in 48 asymptomat-ic smokers included in an ELCDP (44 male, 4 female; mean age 59.7 years; SD8.2). Subjects consecutively underwent a LDCT of the chest and an ECG-gatedcardiac CT with a four-row MSCT scanner (Volume Zoom, Siemens, Erlangen,Germany). Standard parameters were employed: LDCT: 120 kV, 20 mAs, 1 mmslice, 1 mm coll., 6 mm table feed, 0.7 mm rec. interval; ECG-gated cardiac CT:120 kV, 133 mAs, 3 mm slice, 2.5 mm coll., 3.75 mm table feed, 1.5 mm rec. in-terval. Retrospective reconstruction using the raw data from the LDCT was per-formed reproducing the specific ECG-gated CT parameters. Intraclass correlationcoefficient (ICC), paired-sample t-test and Bland and Altman plot were employedfor the statistical analysis.

Results: The paired sample t-test showed there was not a systematic bias in themeasures of calcium (p = 0.31). The ICC for the overall calcium score and for thedifferent main coronary arteries showed and excellent agreement (overall ICC0.958, 95% CI 0.927-0.976).Conclusion: A clear correlation when evaluating quantification of coronary calci-um with both CT techniques is observed. A single LDCT exam may be useful forearly detection of leading causes of death: Lung cancer and coronary artery dis-ease.

C-330Dual energy in digital chest X-ray: First clinical experiencesV. Bricot, A. Moumouh, J.-M. Charonnet, J. Hennequin, O. Delval, J.-P. Tasu;Poitiers/FR

Purpose: Dual energy digital chest imaging is a subtraction technique based onthe different attenuation characteristics of soft tissue and bone. The acquireddata yields three images: A standard chest radiograph, a soft-tissue image withthe bones removed, and a bone image. In this work, this new technique is pre-sented and first applications are illustrated.Materials and Methods: Dual energy imaging enables the acquisition of twoposterior-anterior X-ray images of the chest separated by approximately 200 mil-liseconds. Information from the high-energy image (110-150 kVp; the same im-age as a standard posterior-anterior chest X-ray exam) is combined withinformation from the low energy image (60-80 kVp) to generate bone and soft-tissue images.Results: Two main applications are shown: Evaluation of calcified or non-calci-fied lesions by comparing the soft tissue image with the bone image, and detec-tion of pleural diseases on the soft tissue image. Occasionally, traumatic costallesions can also be accurately detected. These points are illustrated by severalclinical cases.Conclusion: The dual energy technique gives more information than a standardchest X-ray, and can be useful in some clinical applications.

C-331Improvement of image quality in low dose MSCT of the chest by ECG-triggered acquisitionC.H. Weber, U.G. Mueller-Lisse, C. de Lorenzo, E. Coppenrath, T. Fischer,M.F. Reiser; Munich/DE

Purpose: To assess whether ECG-triggered acquisition improves image qualityof low dose, unenhanced multislice chest CT (LD-MSCT) by elimination of cardi-ac motion artifacts.Material and Methods: Patients scheduled to undergo routine chest LD-MSCTwere examined either without (10 mAs, 120 kV, 1.3 mm slice width fused to 3 mmeffective width, spiral acquisition, n = 10) or with ECG-triggering (10 mAs, 2.5 mmslice width, axial incremental acquisition, n = 10, age-, sex- and BMI-matched)on a Philips MX8000 4-row MSCT scanner. Three independent radiologists scoredaxial slices at four different levels (carina, apical, mid-cardiac, basal), using afour-point scale for discrimination of pulmonary structures in the hilar region, thelung core and the subpleural region. Mediastinal structures were scored on athree point scale. Scores were compared using Wilcoxon's test.Results: For the more experienced CT radiologist, delineation of pulmonary struc-tures did not improve significantly with ECG-triggering (p = 0.08), while improve-ment in the delineation of mediastinal structures was highly significant (p = 0.004).For the less experienced CT radiologist, there were no significant differencesbetween LD-MSCTs with and without ECG-triggering for either pulmonary ormediastinal structures (p = 0.39 resp. p = 0.34). Although not formally evaluatedin this study, both radiologists reported a higher quality of sagittal and coronalMPRs from non-triggered data due to lower susceptibility to breathing artifact.Conclusion: Results indicate that ECG-triggering improves delineation of mov-ing structures (heart, mediastinum) in LD-MSCT of the chest. ECG-triggeringimproves delineation of pulmonary structures only in paracardial lung tissue.

C-332Evaluation of chest motion and volumetry during the breathing cycle bydynamic MRIC. Plathow, S. Ley, C. Fink, M. Puderbach, M. Heilann, H.U. Kauczor;Heidelberg/DE

Rationale and Objectives: To investigate diaphragm and chest wall motion dur-ing the breathing-cycle using MRI and a volumetric model in correlation withspirometry.Materials and Methods: Breathing cycles of fifteen healthy volunteers were ex-

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amined using a trueFISP sequence ((TE/TR: 1.7/37.3 ms; flip angle: 65°; receiv-er bandwith: 977 Hz/pixel; field of view (FOV): 375 x 400; matrix 149 x 256; slabthickness: 10 mm; voxel size: 2.5 x 1.6 x 10 mm3), five slices in three planes, threeimages per second). Time-distance curves were calculated and correlated tospirometry. A model for vital capacity (VC), continuous time-dependent vital ca-pacity (tVC) and to investigate the influence of horizontal and vertical parameterson tVC was introduced.Results: Time-distance curves of the breathing-cycle using MRI correlated high-ly significantly with spirometry (p < 0.0001). VC calculated by the model was sim-ilar to VC measured in spirometry (5.00 L vs 5.15 L). tVC correlated highlysignificant with spirometry (p < 0.0001). Vertical parameters had a more profoundinfluence on tVC change than horizontal parameters.Conclusions: Dynamic MRI is a simple non-invasive method to evaluate localchest wall motion and respiratory mechanics. It widens the repertoire of tools forlung examination with a high temporal resolution.

C-333Influence of reconstruction filters on image quality in chest CTO. Šveljo1, Z. Markovic2, B. Reljin2, O. Adic1, M. Lucic1, R. Semnic1,M. Prvulovic1; 1Novi Sad/YU, 2Belgrade/YU

Purpose: The aim of this study was to investigate influence of reconstructionfilters on image quality in CT chest exams.Methods: 20 patients were examined with standard chest scanning protocol. Af-ter scanning, images were reconstructed with smoothing filter. Both set of imag-es were filmed under the same conditions. In blinded assessment, threeradiologists independently rated films for overall image quality and chest ana-tomic details (1 - unacceptable, 2 - substandard, 3 - acceptable, 4 - above aver-age, and 5 - superior). For all exams and reconstruction filters image noise weremeasured in relation to the descending thoracic aorta.Results: For all three readers overall image quality was higher for standard filter.Image quality for standard protocol was 3.75 and for images reconstructed withsmoothing filter 2.97. Average image noise for images reconstructed with stand-ard filter was 36.4 and for images reconstructed with smoothing filter the noisewas 15.8. All three radiologists rated greater chest anatomic details for standardprotocol images. For both protocols the best-rated detail was that of the tracheaand main bronchi (4.15 standard, 3.18 smoothing), and the worst was that of theesophagus (2.87 standard, 2.20 smoothing). The greatest difference betweenrates of the two protocols was for paratracheal tissue (3.41 standard, 2.27 smooth-ing) and the smallest for carina and lymph node area (3.31 standard, 2.67 smooth-ing).Conclusion: Standard filter is better in visualization of all anatomic detail in gen-eral chest exams including mediastinal structure and lymph node area. Greaterimage noise for image reconstructed with standard filters does not influence vis-ualization of anatomic detail.

C-334Usefulness of multislice CT in the detection and quantification of lungemphysema: Initial experienceP.M. Carrascosa, C. Capuñay, E. Martin Lopez, R. Pissinis, J. Carrascosa,J. Gamberale, J. Leston; Buenos Aires/AR

Purpose: To evaluate the usefulness of multislice CT (MSCT) in the quantifica-tion of pulmonary emphysema (E), in comparison with spirometric functional tests(SFT).Materials and Methods: 20 patients were evaluated. MSCTs were performedwith an Mx 8000. Images were reprocessed in 3D in 4 windows: a) Normal lung:W 650; L - 575. b) Centrilobullillar E: W 100; L - 950. c) Panlobulillar and parasep-tal E: W 36; L - 983. d) Total lung volume (TLV): W 1000; L - 750.The SFT perfomed were: 1. Forced expiratory volume in 1 sec (FEV1). 2. Forcedvital capacity (FVC). 3. The ratio FEV1:FVC. 4. Total lung capacity (TLC). 5. Theratio RV:TLC. 6. Inspiratory C. 7. Slow vital C. 8. Diffusing capacity of the lungcarbon monoxide (DLCO).Spirometric diagnosis of E was determined by: elevated 4, elevated 5 decreased8. The TLC spirometric volumes were correlated with the CT results of TLV.by Spearman rank order.Results: The mean pulmonary volume (MPV) for MSCT was 6913.25 mL andthe standard deviation (SD) 680.07, whereas PT were 7583.65 mL and 1621respectively. rS = 0.64Conclusion: These initial results showed that MSCT could be a promising toolfor the evaluation and quantification of E.

C-335New quality assurance systems for the evaluation of detectability of lungnodules on the digital chest radiographY. Fujiwara, K. Higashimura, H. Kimura, H. Itoh; Fukui/JP

Purpose: The goal of this study is to develop a new quality assurance system forevaluating detectability of lung nodule of the digital chest radiograph.Method and Materials: First, we made an oval shaped phantom, which simulat-ed lung tissue such as muscle, fat, and pulmonary field. Then several noduleswith variable CT values were inserted into the center of the phantom. Second, wetook images of the phantom using CT and digital radiography (DR) with a flatpanel detector.The contrast of the nodules relative to the pulmonary field weremeasured both on chest CT and DR. The relationship between contrast from CTand DR was analyzed in regression using 3rd order polynomial. Finally, the sameanalysis was also performed on nodules from clinical cases with lung cancer(n = 70), and clinical data was fitted into the same polynomial line.Results: All nodules with the CT value less than 250 in the difference betweennodules and lung field could not be detected on DR. The relationship betweenthe contrast from CT and DR in clinical cases was also regressed with the same3rd order polynomial line from the phantom data.Conclusion: The current result is very useful for the evaluation of the detectabil-ity on chest DR. When one want to check it using variable nodules with known CTvalues, if the contrast of the nodules on DR is not regressed on above line, theassurance of DR might be problematic and/or DR system may need to be recon-ditioned.

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Vascular

C-33616-MDCT in the study of thoracic veinsC. Delgado, M. Rodriguez-Castilla, E. Chavarri, E. Santos, C. Martinez,C. Trinidad; Vigo/ES

Learning Objectives: To describe 16-MDCT indications with three dimensionalvolume rendering (3D-VR) in the thoracic venous system. To illustrate its anato-my and recognize its most frequent pathology.Background: With the development of the angio-CT techniques the pulmonaryand systemic arterial systems of the thorax has been appropriately focused. Lessattention has been paid to the venous systems, because the disorders of thesevenous systems usually have an indolent clinical presentation. In this exhibit wedescribe the use of 16-MDCT and 3D-VR imaging in the study of the venousthoracic structures.Procedure Details: 42 patients with several thoracic diseases underwent rou-tine CT angiography with a 16-MDCT (Somaton Sensation 16) using a 16 x 0.75collimation were studied. Venous opacification was provided by automated injec-tion of 100 mL of contrast material at 3 - 4 mL/s. Scan delay was 24 -30 seconds.Slice reconstruction was performed at 1 mm thickness and increment 0.5 mm.VR images were reconstructed at a workstation (Wizard, Siemens). Jugular, sub-clavian, brachiocephalic, thoracic, superior and inferior vena cavae, azygos, hemi-azygos, cardiac and intercostals veins were the structures most easily observed.Congenital variants and pathologic disorders were also studied.Conclusion: 16-MDCT and 3D-VR images are excellent techniques to study invivo the anatomy and the pathology of the systemic veins in the thorax.

C-337Imaging findings of superior vena cava (SVC) obstruction: A pictorialreviewP.R. Healey, A.E. Healey, E. O'Grady, J. Curtis; Liverpool/UK

Learning Objectives: The superior vena cava syndrome is characterised byoedema of the face, neck, thorax and upper limbs associated with an intractableheadache. It is often associated with tortuous dilated veins across the chest wall.The causes can be subdivided into extrinsic and intrinsic causes of occlusion,thrombosis and infiltration. Many of these clinical findings are evident on radio-logical imaging.Background: The superior vena cava is the main route of drainage of blood fromthe head, neck and the upper limbs. There are other routes of drainage shouldthe superior vena cava become obstructed. These depend on the site of obstruc-tion and the length of vessel occlusion. The azygos system is a common path ofcollateralisation. Other rarer collateral roots include the pericardial veins, the neckand subcutaneous veins.Imaging Findings: We demonstrate some common causes of superior vena cavaobstruction, their findings on CT and angiography. Examples of the radiologicaltreatment of superior vena cava obstruction are also shown.Conclusion: The finished poster illustrates the imaging findings and the radio-logical treatment of superior vena cava obstruction.

C-338Pulmonary thromboembolism: Acute versus chronic (Pictorial review)A. Oikonomou1, C.J. Dennie2, J.M. Seely2, F.R. Matzinger2, F.D. Rubens2,P.K. Prassopoulos1; 1Alexandroupolis/GR, 2Ottawa, ON/CA

Learning Objectives: To present the spectrum of imaging findings that allow thedifferentiation of acute pulmonary embolism (APE) from chronic thromboembolicpulmonary artery hypertension (CTEPH) based on chest radiography and helicalcomputed tomography (CT).Background: Patients with a prompt diagnosis of APE may recover completelyfollowing anticoagulation therapy. In a minority, pulmonary emboli do not com-pletely resolve leading to organization, artery obstruction and ultimately to CTEPH.Although the evolution process of APE to CTEPH has not been fully elucidated,the distinction of the two entities is critical since the treatment of APE is conserv-ative, while CTEPH warrants pulmonary thromboendarterectomy.Imaging Findings: Radiographic findings of APE are nonspecific and includeatelectasis, peripheral consolidation and pleural effusion. Localized lung oligemiawith associated dilatation of a central artery is extremely rare. Right ventricularand central pulmonary enlargement, patchy oligemia and peripheral scars maybe seen in CTEPH. The cardinal signs of APE on CT angiography are central or

completely occluding arterial filling defects, which may be associated with pe-ripheral airspace disease and pleural effusion. Eccentric filling defects adherentto the vessel wall, irregular intimal thickening, abrupt vessel narrowing or tortu-osity are features of CTEPH. Dilatation of central arteries, abrupt vessel cut-offand peripheral scars are more common in CTEPH than in APE but arterial webs,bands and mural calcifications are only observed in CTEPH. If arterial findingssuggestive of CTEPH are present, the addition of mosaic oligemia on HRCT ispathognomonic of CTEPH.Conclusion: CT allows differentiation of APE from CTEPH.

C-339Pulmonary hypertension: CT of the chest in pulmonary veno-occlusivediseaseA. Resten, S. Maître, M. Humbert, F. Capron, G. Simonneau, D. Musset;Clamart/FR

Purpose: Pulmonary veno-occlusive disease is a rare cause of pulmonary hyper-tension and often difficult to distinguish from severe primary pulmonary hyperten-sion. Unfortunately, medical treatment of the primary pulmonary hypertension byprostacyclin (PGI2) can be fatal in veno-occlusive disease and an early pre-thera-peutic diagnosis of this uncommon condition is critical. So, the aim of the studywas to evaluate CT of the chest as a non invasive approach of this disease.Methods and Materials: We reviewed cross-referenced records from 1996 to2001 in our departments of radiology and pathology and identified 15 patientswith an initial pre-therapeutic CT and a pathologically confirmed pulmonary veno-occlusive disease. CT scans were compared with the CT scans of 15 consecu-tive patients with a pathologically confirmed primary pulmonary hypertension.Results: Ground glass opacities were significantly more frequent in pulmonaryveno-occlusive disease (p = 0.003), abundant, with a random repartition, and apreferentially centrilobular distribution (p = 0.03). Sub-pleural septal lines, andadenopathy were also significantly more frequent (p < 0.0001). The associationof these three findings appeared to be quite pathognomonic of pulmonary veno-occlusive disease as the cause of pulmonary hypertension (specificity = 100%)with a 66% sensitivity.Conclusion: On the initial pre-therapeutic chest CT, association of ground glassopacities (particularly with a centrilobular distribution), septal lines, and adenop-athy are indicative of pulmonary veno-occlusive disease in patients displayingpulmonary hypertension. Caution must be taken before initiating vasodilatatortherapy in the presence of such radiological abnormalities.

C-3403D pulmonary perfusion MRI and MR angiography of pulmonary embolismin pigs after single injection of a blood pool MR contrast agentC. Fink, S. Ley, M. Puderbach, C. Plathow, M. Bock, H.-U. Kauczor;Heidelberg/DE

Purpose: To assess the feasibility of contrast-enhanced 3D perfusion MRI andMR angiography (MRA) of pulmonary embolism (PE) in pigs using a single injec-tion of the blood pool contrast Gadomer.Materials and Methods: PE was induced in 5 domestic pigs by injection of autol-ogous blood thrombi. Contrast-enhanced first-pass 3D perfusion MRI (TE/TR/FA: 1.0 ms/2.2 ms/40°; voxel size: 1.3 x 2.5 x 4.0 mm3; TA: 1.8 s per data set) andhigh-resolution 3D MRA (TE/TR/FA: 1.4 ms/3.4 ms/40°; voxel size: 0.8 x 1.0x 1.6 mm3) was performed during and after a single injection of 0.1 mmol/kg bodyweight of Gadomer. Image data was compared to pre-embolism Gd-DTPA-en-hanced MRI and post-embolism thin-section Multi-Slice CT (n = 2). SNR meas-urements were performed in pulmonary arteries and lung.Results: One animal died after induction of PE. In all other animals, perfusionMRI and MRA could be acquired after single injection of Gadomer. At perfusionMRI, PE could be detected by typical wedge-shaped perfusion defects. While thevisualization of central PE at MRA correlated well with CT, peripheral PE wereonly visualized by CT. Gadomer achieved a higher peak SNR of the lungs com-pared to Gd-DTPA (21 ± 8 vs. 13 ± 3).Conclusion: Contrast-enhanced 3D perfusion MRI and MRA allow the assess-ment of PE using a single injection of the blood pool contrast agent Gadomer.

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C-341Detection of pulmonary emboli with thin slice (3 mm) maximum intensityprojection reconstructions of multi-detector CT pulmonary angiographyS.K. Venkatesh, S. Wang, P. Goh; Singapore/SG

Purpose: To compare thin-slice (3-mm) maximum intensity projection (MIP) re-constructions with 3 mm axial scans for detection of acute pulmonary emboli.Materials and Methods: Multi-detector CT pulmonary angiography (4 x 1 mm,1.5 pitch; 0.5 sec) was performed in 18 patients. From each raw data set, axial1 mm and 3 mm scans were reconstructed. Thin-slice (3 mm) MIPs in axial, coronaland rotational planes were reconstructed from 1 mm axial data using a 3D Work-station. The 90 data sets were reviewed for evidence of embolus on a per vesselbasis by 2 radiologists with discrepancies resolved by consensus. Emboli dem-onstrated on the axial 1 mm images were taken as standard for comparison.Results: Pulmonary emboli were detected in 336 vessels (mean of 18.7 emboliper patient) with 35.8% in subsegmental arteries. The thin-slice MIP images dem-onstrated more emboli as compared to axial 3 mm images. Axial and rotational3 mm MIP images detected most of the emboli (95.2% and 92%). Significantadvantage of axial and rotational 3 mm MIPs over axial 3 mm images was seenat subsegmental artery level (92.5% and 89.2% versus 41.7%) (P < 0.05). Amongthe MIPs, axial MIPs detected the most number of emboli in upper and middlelobes, whereas the rotational MIP detected slightly higher emboli in the lowerlobes.Conclusions: Thin slice MIPs are superior to axial 3 mm for pulmonary embolusdetection. The advantage of MIPs is most significant at the level of subsegmentalartery level and beyond. We recommend routine use of axial 3 mm MIPs in thedetection of pulmonary embolus.

C-342Primitive angiosarcomas of the pulmonary arteries: Difficulties in CTdiagnosisR. Dore, M. Mantelli, V. Vespro, D. Savulescu, G. DiGiulio; Pavia/IT

Purpose: Primitive angiosarcomas of the pulmonary arteries are very uncom-mon tumors. The radiologist should consider them in the differential diagnosiswith thromboembolic disease, in patients with clinical suspicion of pulmonaryembolism, as early surgical treatment may be beneficial.Methods and Materials: Between 1993 and 2003, at our Hospital, "S.Matteo"IRCCS, we identified three cases of primitive angiosarcomas of the pulmonaryarteries, subsequently confirmed at surgical examination, on chest CTs of pa-tients with clinical suspicion of thromboembolism. We used a single-slice spiralCT scanner (24 sec., 3-5 mm collimation), with iv contrast injection at high flowrate. Both pulmonary parenchyma and vasculature were evaluated, along withthe enhancement pattern of the endoluminal lesions.Results: In all 3 cases, the left main pulmonary artery was affected (the distalsegment in one case and proximal segments in two). In one patient, the rightmain pulmonary artery was also involved.All the vascular lesions were occlusive, without anterograde flow and extravasaldiffusion. In two patients, contrast enhancement of the endoluminal mass wasbetter detected in the delayed scan. In one patient, contrast enhancement had aperiferical distribution. In all the patients, there were no parenchymal signs ofthromboembolic disease.Conclusions: Primitive angiosarcomas of the pulmonary arteries are associat-ed with occlusion of the main pulmonary artery and lack of parenchymal signs.As the differential diagnosis between massive thromboembolic disease and prim-itive angiosarcoma may be difficult with monophasic CT scan, the evaluation ofthe contrast enhancement of intraarterial lesion in the delayed phase becomesfundamental.

C-343CT findings in chronic thromboembolic pulmonary hypertension andcorrelation between mosaic pattern of lung attenuation and pulmonaryvascular resistanceM. Heinrich, A. Grgic, D. Tscholl, C. Placzek, B. Kramann, H.-J. Schafers,M. Uder; Homburg a.d. Saar/DE

Purpose: To demonstrate the imaging features of chronic thromboembolic pul-monary hypertension (CTPH) on chest CT scans and to evaluate the correlationbetween the extent of mosaic pattern of lung attenuation and hemodynamic meas-urements.Methods and Materials: Chest CT scans of 50 patients with CTPH were re-viewed to assess vascular and parenchymal changes. In all patients diagnosiswas confirmed by surgery. The diameter of the main pulmonary artery (PA) and

the ratio of the diameters of the main pulmonary artery to the ascending aorta(rPA) were correlated with mean pulmorary artery pressure and pulmonary vas-cular resistance. Mosaic attenuation was quantitated by adding the number ofabnormal lobes (including lingula, score 0-6). This score was correlated with thehemodynamic measurements. Results were analysed by regression analysis andSpearman's correlation.Results: Thrombi were observed in the central pulmonary arteries in 79% ofcases. In all CT scans a mosaic pattern of lung attenuation was found. Scarsrelated to the pleural surface were identified in 69% of cases, bronchial arterycollaterals in 60%. CT scans showed dilated PA in 98% and rPA ≥ 1 in 90%.Mean pulmonary artery pressure correlated more strongly with rPA than withdiameter of PA. The score of mosaic attenuation showed a strong correlation withpulmonary vascular resistance (r = 0.66; p < 0.0001).Conclusion: In patients with CTPH it is not sufficient to evaluate thrombi in themain pulmonary arteries since pulmonary hemodynamics are strongly correlat-ed with pathologic changes of the pulmonary parenchyma. Further studies arerequired to assess parameters which may predict surgical outcome.

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Miscellaneous

C-344Intrathoracic manifestations of breast cancer: A pictorial reviewA. Gimenez1, T. Franquet1, A. Hidalgo1, R. Pineda1, M. Madrid1, S. Rossi2;1Barcelona/ES, 2Buenos Aires/AR

Learning Objectives: 1. To be able to recall the most common CT and MR in-trathoracic manifestations in patients with breast cancer. 2. To be able to describethe radiologic features of this entity. 3. To be able to recall helpful clues for nar-rowing the differential diagnosis and appropriately directing patient managementdecisions.Background: Breast cancer is a common cancer in women and is second only tolung cancer as a cause of cancer-related deaths in women. The thorax is a com-mon site of metastasic disease and complications related to surgery, chemother-apy, radiotherapy and autologous bone marrow transplantation.Imaging Findings: The purpose of this exhibit is to review the CT and MR find-ings of the various intrathoracic manifestations occurring in patients with breastcancer. These include complications related to direct extension of tumor, to met-astatic spread, and complications secondary to treatment. The complications canbe divided into those that affect the chest wall (chest wall invasion, chest wallmetastases, axillary and internal mammary lymphadenopathy, local recurrence,postradiotherapy sternal and costal tumors, surgical complications), mediastinaland hilar manifestations (lymphadenopathy, abscess formation, lymphatic obstruc-tion), pulmonary manifestations (lymphangitic carcinomatosis, pulmonary me-tastases, endobronchial metastases, neoplastic emboli, lung infections relatedto immunosuppressive therapy, obliterative bronchiolitis post bone marrow trans-plantation) and pleural manifestations (pleural effusion, pleural metastases).Conclusions: Knowledge of the full spectrum of radiologic manifestations of thethoracic complications of breast cancer is useful in diagnosis and in preventingdiagnostic errors.

C-345Bronchogenic cysts: Range of radiological appearancesF. Almolani, P.M. Logan; Dublin/IE

Learning Objective: To review and illustrate the range of plain film, CT and MRIappearances of bronchogenic cysts.Background: Bronchogenic cysts are one of the congenital cystic lesions in thechest. It has variable appearances on imaging and overlapping features with oth-er mediastinal lesions. It is often identified incidentally.Imaging Findings: We reviewed the imaging on 30 proven bronchogenic cysts.Plain radiographs and CT images were available for all cases. MRI images wereavailable in 8 cases. Most of bronchogenic cysts have a classic mediastinal loca-tion and well defined margin on plain films, with homogeneous low density ap-pearance on CT. However they can be found within the lung parenchyma, becystic or cavitary, have thick walls and be seen to expand. On MRI, fluid levelscan be demonstrated. Occasionally, they can be multiple or co-exist with signifi-cant unrelated pathology.Conclusion: Bronchogenic cysts have a wide range of imaging appearancesand familiarization with these appearances is essential for appropriate inclusionof the diagnosis within a list of differential diagnoses.

C-346Imaging appearances of mediastinal cystic lesionsS.P. Prabhu, K. Burney, P. Goddard; Bristol/UK

Learning Objectives: To illustrate the radiological appearances of various medi-astinal cystic lesions using various imaging modalities.Background: Cysts of the mediastinum constitute a small but important diagnos-tic group, representing 12 to 18% of all primary mediastinal tumors. Mediastinalcysts can be classified based on their aetiology, and include bronchogenic,oesophageal duplication cysts of foregut origin, mesothelial derived pericardialand pleural cysts, cystic thymic lesions, and other miscellaneous cysts. Neuroen-teric cysts may develop by abnormal septation of the embryogenic germ cell lay-er, which closely associate with the vertebral column. In addition, mesothelial cysts,including pericardial and pleural cysts, and thymic cysts also occur in the medi-astinum, as well as other rare cysts.Imaging Findings: Characteristic location and internal architecture of differentmediastinal cystic lesions are used to aid the clinician in formulating a diagnosticplan. Plain chest radiographs can identify mediastinal cysts in a large proportion

of cases. CT usually reveals well-circumscribed rounded masses of water densi-ty or a little higher and is useful in delineating the size, shape, and extent of themediastinal masses. Characteristic fluid signal on MRI performed in selectedpatients differentiates the benign cystic lesion from solid mediastinal masses.MRI has therefore succeeded in providing valuable pre-operative specific diag-nostic confirmation in regard to mediastinal cysts in selected cases.Conclusion: In this pictorial review, we review the radiological appearances onplain radiographs and cross-sectional imaging for the entire spectrum of cysticlesions of the mediastinum.

C-347Non-infectious radiographic manifestations of bone marrowtransplantation: A pictorial reviewD. Beckett, J. Oliff; Birmingham/UK

Learning Objectives: To illustrate the radiological manifestations following stemcell transplantation for haematological malignancy. To outline the incidence, clin-ical presentation and role of imaging within this patient sub-group.Background: Bone marrow transplantation (BMT) is a critical therapeutic inter-vention for a variety of pathological conditions. The complications of BMT includechemotherapy and radiation toxicity, graft versus host disease, recurrent malig-nancy and miscellaneous conditions. Complications of allogenic BMT manifest ina variety of clinical settings affecting all organ systems. Plain radiography, con-trast enhanced studies, sonography, CT, MRI and interventional techniques areessential in diagnosing these complications and evaluating their response to ther-apy.Imaging Findings: Pulmonary manifestations include drug and radiation toxici-ty, bronchiolitis obliterans, bronchiolitis obliterans organizing pneumonia, lym-phocytic interstitial pneumonitis and diffuse alveolar haemorrhage. Gastrointestinalpresentation with veno-occlusive disease, typhlitis and pneumatosis intestinalisare also reviewed, as are central nervous, musculoskeletal and cardiovascularsystem manifestations.Conclusion: The spectrum of imaging findings following BMT is diverse. A firmunderstanding of the clinical presentations and incidence in combination withtypical radiological findings is essential in the successful management of thispatient sub-group.

C-348Thoracic manifestations of chronic renal failureA.M. Barnacle, P.G. Gishen, S.J. Copley; London/UK

Learning Objectives: To review the radiological spectrum of thoracic manifesta-tions of chronic renal failure, including the more unusual imaging appearances.Background: The effects of chronic uraemia are evident in a multitude of organsystems, including the pulmonary, cardiovascular and musculoskeletal systems.Imaging Findings: The poster illustrates common thoracic manifestations suchas pulmonary oedema and uraemic pericarditis. More unusual manifestations ofchronic renal failure such as metastatic pulmonary calcification, renal osteodys-trophy, amyloidosis and peritoneal dialysis fluid collection within the mediasti-num are highlighted. Plain radiographic and CT imaging findings of both thesecommon and more unusual pulmonary manifestations are reviewed.Conclusion: The study illustrates the diversity of thoracic manifestations encoun-tered in chronic renal failure patients and the less well recognised sequelae thatshould not be overlooked when imaging such patients.

C-349Pictorial review of imaging findings in sarcoidosisS.B.M. Brennan, M.E. Hurley, E. Breatnach; Dublin/IE

Aim: To document the spectrum of radiological findings in patients with sarcoidosis.Methods: The hospital radiology database and patient records were reviewed toidentify patients in whom sarcoidosis was diagnosed.Results: A wide spectrum of patients was identified and their imaging findingsreviewed. This consisted of a variety of presentations including pulmonary, neu-rological, skeletal, abdominal (hepatic, bowel and splenic) as well as testicularmanifestations. Both typical and atypical presentations and imaging findings ofsarcoidosis are illustrated and discussed.Conclusion: Sarcoidosis displays a wide spectrum of presentations, most of whichhave characteristic imaging features, but atypical manifestations may mimic andconfuse.

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C-350Imaging findings of complications post bone marrow transplantationS. Ford, C. Johnston, E. Laffan, J. McCann, M.T. Keogan; Dublin/IE

Learning Objective: To describe and illustrate the radiological features of thewide spectrum of complications experienced by patients who have undergonebone marrow transplantation.Background: While the availability of bone marrow transplantation is improvingand increasing numbers of adults and children are undergoing the procedure forthe treatment of a wide variety of malignant tumours and haematological disor-ders, it remains a procedure which carries with it a very significant complicationrisk. Despite prophylactic therapy, patients remain at particularly high risk forbacterial, viral and fungal infection in the post-procedure time period. Infectiouscomplications are diagnosed and monitored using plain radiography, ultrasound,CT, MRI, image-guided biopsy and less often, nuclear medicine. Other common-ly encountered complications requiring radiological investigation include hepato-biliary complications, veno-occlusive complications and graft-versus-host disease.Imaging Findings: This educational exhibit demonstrates the radiological ap-pearances of the spectrum of common and unusual complications encounteredby patients who have undergone bone marrow transplantation, as depicted usinga wide variety of imaging modalities.Conclusion: While bone marrow transplantation is a life saving procedure it stillretains a high degree of morbidity and unfortunately a wide range of complica-tions can arise following the procedure. The role of the radiologist in using anumber of imaging modalities to accurately diagnose and follow these complica-tions remains an important one.

C-351Air-space pattern lung metastasisL. Herraiz, A. Cima Fernandez, S. Dieguez, M. Grande, M. Sanchez Nistal;Madrid/ES

Learning Objectives: To identify and describe the imaging findings on air-spacepattern in lung metastasis.Background: Lepidic pattern growth in lung metastasis is an uncommon mani-festation of disseminated malignancies, mainly described in gastrointestinal ad-enocarcinomas. On CT, differentiation from other lung diseases as multifocalpneumonia, bronchiolitis obliterans organizing pneumonia (BOOP) and brochi-oloalveolar carcinoma (BAC) may be difficult, and diagnosis of BAC cannot bemade with confidence if a primitive extrapulmonay adenocarcinoma has not beenruled out.Imaging Findings: We reviewed X-ray films and CT studies of 8 patients withproven air-space pattern lung metastasis. Metastasis was classified as air-spacedisease when it showed one or more of the following CT findings: Air-space nod-ules, including cavitating and pseudocavitating nodules; parenchymal consolida-tion containing air bronchogram and focal or diffuse ground-glass opacities.The primary tumors were colorectal adenocarcinoma in 5 patients; pancreaticadenocarcinoma in 1; adenocarcinoma of the ampulla of Vater in 1 and infiltratingduct breast carcinoma in 1. In 1 patient the diagnosis of pulmonary disease pre-ceded the discovery of primary malignancy and was synchronous in 2 other pa-tients. Cavitating nodules were seen in 5 patients; parenchymal consolidation in3; ground-glass opacities were seen in 3; pseudocavitated nodules in other 3patients; solid nodules in 3; nodules with air bronchogram in two; mass with airbronchogram in 2 and lymphangitic carcinomatosis in 1 patient.Conclusions: Air-space pattern is an uncommon manifestation of lung metasta-sis. Differentiation from BOOP, multifocal pneumonia and bronchioloalveolar car-cinoma can be difficult because this can be the onset of the disease.

C-352Imaging of chest wall disordersJ. Lee, K.-N. Lee, S. Kim, J. Lee, M. Roh; Busan/KR

Purpose: To illustrate the radiologic features of a wide spectrum of chest walldisorders according to anatomic location.Method and Materials: We have retrospectively reviewed the radiologic findingsof patients with chest wall lesions pathologically proven by biopsy or surgerybetween January 1999 and July 2003. We excluded cases of pleural effusion orthickening, chest wall invasion by lung cancer or mediastinal malignant tumor,and secondary metastatic lesions. All patients had plain films and spiral CT scanwith intravenous contrast enhancement. Several patients underwent supplemen-tary MR with gadolinium enhancement.Results: Pleural lesions include empyema, tuberculous empyema, empyemaneccessitatis, localized fibrous tumor of pleura, malignant mesenchymal cell tu-

mor, malignant mesothelioma, pleuroblastoma, fibrosarcoma, angiosarcoma andasbestos-related pleural plaques. Muscle and subcutaneous fat are involved inPoland's syndrome, inflammation, abscess, tuberculous abscess, empyema nec-cessitatis, post-operative hematoma, epidermal cyst, intramuscular hemangioma,elastofibroma dorsi, pectoralis muscle fibromatosis, neurofibromatosis, malignantschwannoma, muscle involving NHL, subcutaneous T-cell lymphoma and ex-traskeletal Ewing's sarcoma. Rib lesions include chronic inflammation, osteo-chondroma, enchondroma, eosinophilic granuloma, and plasmacytoma. Sternallesions include chronic inflammation and pigeon breast. A case of chondrosarco-ma of the T7 vertebral body is also included.Conclusions: A wide of spectrum of disease processes affect the chest wall.The CT and MR imaging has enabled precise localization and differential diagno-sis of chest wall lesions. Therefore, familiarity with these radiologic features willmake accurate diagnosis possible and and allow for optimal patient treatment.

C-353Standardized MSCT examination protocol in detection of thoracic injuries inpolytraumatized patientsU. Stessel, P. Reittner, A. Ruppert-Kohlmayr, M. Tillich, H. Schöllnast, G. Fritz,W. Kau; Graz/AT

Purpose: To investigate the usefulness of a standardized MSCT examinationprotocol in the assessment of thoracic injuries in polytraumatized patients.Methods and Materials: Between 01/2000 and 01/2003, 335 polytraumatizedpatients (age range 19-67) with suspected thoracic injuries were subjected toMSCT examination of the chest in the acute trauma setting. MSCT scans wereperformed on a Lightspeed QX/i – Scanner (GE) using 4 x 2.5 mm collimation,pitch 1.5, increment 2. In all patients 120 mL contrast-agent was injected with aflow-rate of 3.5 mL/sec, scan delay was 25 sec.Results: In 231 (69%) of 335 patients chest injuries were detected. The followingposttraumatic thoracic injuries were revealed: In 97 patients (42%) emphysema,in 23 (10%) hematoma of chest wall; in 50 patients (21.6%) fracture of the thorac-ic spine, 177 (76.7%) fractures of the ribs, 29 (12.6%) of clavicle, 15 (6.5%) ofsternum, 26 (11.3%) of scapula; 127 (55%) patients had a pneumothorax, 68(29.4%) a hematothorax, 2 (0.9%) a tension pneumothorax; 93 patients (40.3%)had a lung contusion, 12 (5.2%) a lung laceration; 23 patients (10%) had a pneu-momediastinum; 4 (1.7%) a rupture of thoracic aorta; 1 (0.5%) rupture of a su-praaortal ar tery and 4 (1.7%) a rupture of diaphragm. No injuries oftracheobronchial system, esophagus or the heart were detected.Conclusion: A standardized MSCT examination protocol represents the preferredscreening method in the evaluation of patients who have sustained chest trauma.

C-354Thymoma: A survival analysis with logrank test for various CT findings in45 casesN. Tomiyama, A. Inoue, O. Honda, M. Tsubamoto, H. Sumikawa, S. Murai,S. Hamada, T. Johkoh, H. Nakamura; Suita/JP

Purpose:To find out important CT findings for the prediction of prognosis of thy-moma with a survival analysis.Materials and Methods: 45 patients with thymoma, who underwent surgical re-section, were retrospectively analyzed. Clinical data were collected from chartreview. Preoperative plain and contrast enhanced CT was performed in all pa-tients. Two independent chest radiologists evaluated CT images paying specialattention to diameter, contour, shape, cystic or necrotic portion, calcification,mediastinal fat obliteration, invasion of adjacent mediastinal structure, thickeningof adjacent pleura, infiltration of adjacent lung, infiltration of adjacent chest wall,pleural effusion, pericardial effusion, mediastinal lymphadenopathy, enhancementpattern, and degree of enhancement. Kaplan-Meier survival curves were gener-ated. Influence on survival for each CT finding was analyzed by logrank test.Results: Cystic or necrotic portion, calcification, mediastinal fat obliteration, in-vasion of adjacent mediastinal structure, thickening of adjacent pleura, infiltra-tion of adjacent lung, infiltration of adjacent chest wall, pleural effusion, pericardialeffusion, mediastinal lymphadenopathy, homogeneous enhancement pattern andhigh degree of enhancement were seen in 40%, 43%, 71%, 39%, 12%, 6%, 10%,6%, 6%, 2%, 70% and 56% of patients respectively. The CT finding that weremost predictive of survival was calcification (logrank test: p = 0.001). Cystic ornecrotic portion (p = 0.01), infiltration of adjacent chest wall (p = 0.001), and pleuraleffusion (p = 0.003) were independent predictors of long-term survival. There wereno differences in survival for the other findings.Conclusion: Calcification, cystic or necrotic portion, infiltration of adjacent chestwall, or pleural effusion on CT suggest poor prognosis of thymoma.

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C-355Low attenuation splenic lesions found at chest CT: Differential diagnosisand investigationA.K. Choudhary, E.L. Senior, N.J. Screaton; Cambridge/UK

Learning Objectives: 1. To illustrate the causes of low attenuation splenic le-sions. 2. To discuss clinical and imaging features which aid diagnosis in patientswith known or suspected malignancy.Background: Abnormalities of the spleen are commonly encountered during CTof the thorax and abdomen in patients with suspected thoracic disease, posingdiagnostic difficulty particularly in patients with otherwise operable malignancy.We present a pictorial review of low attenuation splenic lesions in patients withsuspected thoracic disease. The most common causes are benign (includingpseudocysts caused by trauma, infection or infarction), infections (mycobacteri-al, fungal, hydatid), sarcoidosis, haemangiomata, and lymphangiomatosis. Ma-lignant causes include lymphoma and metastases (lung, breast, melanoma,stomach, liver, colon). In patients with known malignancy, splenic metastasesare rare in the absence of widespread metastatic disease. Although the morpho-logical pattern on CT may suggest malignancy (multiplicity of lesions, irregularmargins, enhancement and splenomegaly), other imaging studies may be com-plementary. On ultrasound focal anechoic lesions are typical of benign cysts whilemultifocal or diffuse solid lesions are suggestive of malignancy. On MRI hetero-geneous lesion signal is suggestive of malignancy. In cases where morphologi-cal imaging is non-specific, FDG-PET may play an important role. The accuracyof splenic biopsy in indeterminate lesions approaches 90% but significant com-plications occur in 10.3%.Conclusion: Isolated low attenuation splenic lesions must not be consideredsynonymous with metastases even in patients with known cancer. Awareness ofthe differential diagnosis and further imaging permit accurate diagnosis and man-agement.

C-356Evaluation and management of high-risk acute polytrauma patients withmultislice CT (MSCT)R. Stern Padovan, M. Lusic, J. Marinic, K. Potocki, M. Hrabak; Zagreb/HR

Purpose: To present management of acute polytrauma patients with MSCT andpathological findings acquired in short time in high-risk patients.Methods and Materials: Selected 75 polytrauma patients (age range 4-83, 48[64%] male and 27 [36%] female) were examined with MSCT (LightSpeed Ultra 8Slices, GE). Whole-body MSCT scan were performed using the following proto-col: 1) Native head and neck: 5 mm slice thickness, UM mode, reconstruction2.5 mm; 2) Administration of 50-120 mL nonionic contrast media using automaticinjector at flow rate of 4 mL/sec and Smart Prep feature; 3) Thorax, abdomen andpelvis scan: 3.75 mm slice thickness, US mode, reconstruction 1.8 mm; 4) Scantime under 1 minute; 5) Images were used for MPR and 3D-VR.Results: In management of polytrauma patients, time is of the essence. In 75high-risk patients who were selected for MSCT examination following injurieswere found: 12 cranial (sub and epidural hematoma, contusion, fracture etc); 63thoracic (hematothorax, lung contusion, pneumothorax etc); 40 abdominal (con-tusion and hematoma of parenchymal organ, retroperitoneal bleeding); 34 aortic(rupture, dissection, periaortal hematoma); 68 fractures (mostly ribs -17 [22%]and pelvis -14 [18%])Conclusion: In our hospital MSCT represents the major diagnostic tool in themanagement of high-risk polytrauma patients, reducing time spent outside ofemergency unit. It is a fast and reliable method for diagnosis of skeletal trauma,parenchymal organs and aortic injuries. The radiologist becomes important mem-ber of the trauma team in management of acute polytrauma patients.

C-357The value of diagnostic imaging (CT, MR, US) in Askin tumors in childrenU. Zaleska-Dorobisz, E. Czapiga, B. Jankowski, K. Moron; Wroclaw/PL

Purpose: To consider the value of radiological methods in establishing diagnosisof Askin tumors at diagnosis and to analyse the radiological changes accurringas a consequence of treatment and during follow-up.Material/Methods: We treated 11 children (7 girls and 4 boys) aged from 5 to 17years (mean 11.4 years) with Askin tumors. In all cases first diagnosis was es-tablished based on clinical exam and radiological findings on X-ray, US and CT ofthe chest. In 6 children MRI of the chest wall was performed. Radiological examswere taken at all stages of disease, during and after finishing therapy.Results: The most important radiological sign was pulmonary opacity with atel-ectasis and/or fluid effusion in pulmonary cavity. Osteolytic changes in bones

were observed in 6 cases, especially ribs, and paralysis of diaphragm in 2 cases.Mediastinal and hilar lymph nodes enlargement were recognized in 4 children.On CT scan we found large nonhomogenous mass arising from chest wall, grow-ing within the chest cavity and infiltrating soft tissues and bones. MRI examswere more sensitive in detection of nerves, vessels, heart; US was more superiorin demonstration of pleural and diaphragm infiltration.Conclusions: Radiological examination plays very important role in recognition,during therapy monitoring, as well as recurrence. High resolution methods likeMRI and CT help us in precise identification of tumor size, localization and infil-tration of nerves, bones and vessels, which is very important in treatment planning.

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Computer Applications

C-358The fundamentals of digital images, image compression and image filteringG. Luccichenti1, N. Ngo Dinh1, F. Cademartiri2, G. Evangelisti1, A. Paolillo1,S. Bastianello1; 1Rome/IT, 2Rotterdam/NL

Learning Objectives: To illustrate the fundamentals of digital imaging, the basicoperations of image display and manipulation, the principles of image compres-sion and filtering.Backgound: Radiological scanners generate digital images and image interpre-tation is performed using dedicated workstations. The knowledge of digital imag-ing, image compression and filtering is crucial to understand the new technologiesand the post processing operations.Procedure Details: The structure of a digital image, the encoding algorithm, theoperations for image display and manipulation, and the compression algorithmsare described. A phantom and clinical cases are used to show the influence ofthese aspects on the quality and information of the images.Conclusion: Several aspects affect the information and the quality of digital im-ages. The basic criteria for assessing image quality are defined.

C-359Web-based radiology-teaching library for board examination of radiologistswith object-oriented database systemN. Matsunaga1, S. Kido1, H. Moriyama1, Y. Hamamoto1, Y. Hiramatsu2,O. Matsui3, K. Endo4; 1Ube/JP, 2Tokyo/JP, 3Kanazawa/JP, 4Mebashi/JP

Objective: We have developed a web-based radiology-teaching library for a boardexamination of radiologists in Japan. This library receives imaging cases from allof Japan via the Internet.Materials and Methods: The web-based radiology-teaching library is developedwith an object-oriented database, and it is readily available with a simple opera-tion to radiologists. The submission process makes full use of the Internet. Thereviewers, who are expert radiologists, carefully review the submitted cases. Whenthe reviewed case is sent back to the submitter with the reviewers' comments,the submitter should correct their text and images according to the reviewers'comments in order to obtain the reviewers' approval. The computer assists theseprocesses automatically, and it enables submitters and reviewers to do collabo-rative work in registering cases without temporal or spatial restriction. Finally,approved cases can be registered to our library.Results: Up to August 2003, our radiology-teaching library has collected 1264imaging cases in all subspecialties. In these cases, 616 cases have been regis-tered. In August 2002, the board examination of radiologists in Japan has beenperformed with selected cases from this library in all subspecialties.Conclusion: Our library is readily available to radiologists who do not have muchcomputer knowledge. Our web-based radiology-teaching library will be useful forthe education of all radiologists.

C-360PACS: Ergonomic considerationsC.L. Arnoldus, C.J. Zylak, M. Flynn; Detroit, MI/US

Learning Objectives: Ergonomic issues associated with picture archivial andcommunication systems (PACS) should be addressed during the early phase ofincorporation in the radiology department. This reviews how a large tertiary careteaching hospital addressed these issues.Background: Existing computer and alternator workstations in the radiologydepartment were observed for six months. The radiologists were surveyed onworkstation issues related to space, noise, lighting, and repetitive motion. A PACSergonomic work group consisting of radiologists, physicists, and administratorsaccepted the task of addressing these issues and recommending solutions.Procedure Details: On non-ergonomic workstations, repetitive strain occurred.Of the forty-one radiologists on staff, four who used computer workstations ex-tensively had elbow and shoulder tendinitis from extended periods of reach whilemanipulating images with the mouse. Carpal tunnel symptoms, neck strain fromperiods of flexion or extension, and eye fatigue were also experienced.Alternators placed near monitors reflected light and ghost images on monitorscreens. Eye level evaluation of films was not possible with fixed monitor height.Crowded workstations and alternators were observed.Based on the findings, adjustable workstations with articulating keyboards, mous-ing surfaces with gel wrist rests, flat screen liquid crystal display (LCD) monitors,and multi-adjustable posture support chairs were evaluated. Placement of view

boxes and ambient lighting issues were addressed. Adjustable height worksta-tions for small group consultation and conferencing will be strategically located.Voice amplification is being considered.Conclusion: Ergonomic issues should be identified early before PACS transitionto allow a workplace design to maximize workflow and minimize repetitive strain.

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C-362Our experience with 148 patients with PET-CT and PET-MRI fusion imagesfrom different scanners using dedicate softwareM.A. Eleta, F.A. Eleta, J.L. San Roman, F. Ogresta; Buenos Aires/AR

Learning Objectives: To illustrate our experience with 148 patients with PET-CTand PET-MRI studies with fusion imaging dedicated software.Background: It is well known that fusion imaging is better than PET, CT or MRIalone for anatomical location of lesions, artifacts and diagnostic accuracy. Thereare several imaging fusion techniques. We describe our experience with dedicat-ed software using anatomical parameters. Between March 2003 and August 2003,148 patients (oncology: 95.27%, neurology: 3.38%, cardiology: 1.35%) were ex-amined in our Department.Procedure Details: Images obtained from different scanners and modalities (CT,MRI and PET) were coregistered. In any single patient we use the same positionduring each scan to get proper images coregistration. During body scans pa-tients were instructed to breath freely, but not deeply, and not to move. We useda dedicated system for image fusion that combines volumetric information fromPET, CT and MRI to get proper coregistration in all cases.Conclusion: Metabolic and anatomical information can be combined preciselyto asses anatomic locations of lesions and artifacts with proper coregistrationobtained with separate scanners using dedicated software.

C-363International standardization of image quality E. Avraham1, E.W. Samei2, C.W. Cornelius3, A. Rowberg4; 1Plano, TX/US,2Durham, NC/US, 3Rochester, NY/US, 4Seattle, WA/US

Learning Objectives: To demonstrate limitations of current image quality stand-ards. To elucidate needs and opportunities to improve image quality standardiza-tion via international professional and technical efforts. To describe recent imagequality proposals. To encourage international participation in evolving image qualitystandards.Background: Current limitations with regard to medical image quality controland consistency have been discussed previously. We have recently suggestedproposals to several American industrial and scientific bodies aimed to improveimage quality performance criteria for both clinical and diagnostic images. Al-though some regional and national guidelines and regulations exist, practicaluniversal standards have not yet been achieved.Procedure Details: This exhibit shows how international radiology and technicalsocieties, regulatory groups, and standards agencies may collaborate in order toimprove medical image quality performance and standards, including but not lim-ited to (1) performance criteria for softcopy and hardcopy, (2) extending commu-nication and control standards for the performance of output devices, and (3)initiation and support for research into the relationship between display physicalmetrics and diagnostic performance, to assess clinical consequences of varia-tions in image quality metrics, and to define what constitutes image quality froma diagnostic perspective.Conclusion: The exhibit has presented some initial steps that will improve theconsistency and reproducibility of medical images in electronic imaging systems.The international medical community has an opportunity to build upon the workof many regional and national efforts in a collaborative effort to improve medicalimage quality with anticipated benefits to patient care, medical practitioners, andthe medical industry.

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C-364Modeling and simulation of the blood flow using multi-slice CT: Applicationof computational fluid dynamicsS. Yamamoto1, S. Hamada1, T. Johkoh1, S. Murai1, S. Yoneyama2,S. Maruyama1, N. Tomiyama1, M. Komizu1, H. Nakamura1; 1Osaka/JP,2Tokyo/JP

Learning Objectives: To understand the prediction based medicine model usingcomputer fluid dynamics (CFD). To support the informed consent of the patientusing four-dimensional display. To describe the technical procedure of CT scan-ning for blood flow analysis.Background: Aortic aneurysms or dissecting aneurysms are serious and life-threatening conditions that requires early diagnosis and prompt surgical treat-ment. It is difficult to directly measure the blood flow and pressure without invasiveexamination. Computer simulation is one of the solutions for non-invasive diag-nosis, or for comparison of pre- and post-operative measurement of the bloodflow and pressure. In this exhibit we will describe the application of CFD basedon four-dimensional vessel reconstructions from multi-slice CT data.Procedure Details: The volume data (0.5-2 mm slice thickness) was acquiredfrom half-second multi-slice CT (Aquilion, Toshiba, Tokyo, Japan). Segmentedvessels were converted surface display by Marchine Cubes Method. Input pa-rameters of blood were applied as an ideal incompressible fluid. Steady and tran-sient analysis of CFD was performed using commercially available software(AcuSolve, ACUSIM Software, Mountain View, CA) by a finite element method.Original program modules for image processing of both vector and medical (DI-COM) data was implemented on a commercially available workstation (Amira3.0, TGS, San Diego, CA). Variable dynamic display of both steam line of bloodand blood pressure was superimposed on the three-dimensional CT data (multiplaner reformat, maximum intensity projection and volume rendering etc)Conclusion: Modeling and simulation applications to the blood flow could ena-ble us to build rapid prototypes of the models for quick visual validations.

C-365Using remote ASP and internet-2 for integrating digital radiological imageswith a regionalinformation system in a new population-based purchasingsystem for public healthcare provisionO. Barbero1, J. Guanyabens1, C. Rúbies1, J. Fernández1, J. Maideu2, I. Cerdà2;1Sabadell/ES, 2Vic/ES

Learning Objectives: To learn about the improvements in health care manage-ment due to the implementation of several integrated HIS/RIS and PACS in aregional area.To learn how new technologies like Java, Internet 2, ASP and re-mote image archival can be used to improve health care management and provi-sion.Background: A pilot project to evaluate the possibilities of digital radiology in theimprovement of health care is underway within the framework of the CatalanHealth Service's strategic plan to establish a system in the county of Osona(*),not far from Barcelona (Spain). The sharing of information forms the backbone ofthe project, the aim being to enable all authorized healthcare personnel to have24-hour-a-day access to all digital information and images from examinationsperformed in all healthcare centers in the county, whether private or public.Procedure details: For the evaluation and analysis: 1. Improvements broughtabout in healthcare services; 2. Organizational impact; 3. Cost-benefit analysis;4. Elements to take into account for the system's implementation and extension.From the technological point of view: 1. Remote ASP archive; 2. High-speed In-ternet-2 links; 3. Information systems integration based on Web, Java, XML andDICOM.Conclusions: The analysis and evaluation of the results of this innovative projectand health care provision strategy will be presented in ECR.(*) The Health Care Ministry will pay a fixed amount of money per person and peryear to all the health care providers of the area in exchange for public health careservices.

C-366A new parameter enhancing breast cancer detection in computer aideddiagnosis of X-ray mammogramsK. Murase1, N. Tanki1, M. Iinuma1, H. Kubota1, M. Nagao2; 1Osaka/JP,2Matsuyama/JP

Purpose: To introduce a new parameter enhancing breast cancer detection incomputer aided diagnosis (CAD) of X-ray mammograms.Methods and Materials: We used the database of mammograms generated byJapan Society of Radiological Technology. This includes 17 patients with benign

masses and 17 patients with malignant masses. The age ranged from 33 to 71years (56.9 ± 11.0 years). The new parameter called 3-dimensional fractal di-mension (3D-FD) was obtained from the slope of the graph with the logarithm ofthe cutoff value on the horizontal axis and that of the number of pixels with a graylevel above the cutoff value on the vertical axis. In addition to 3D-FD, the conven-tional image features such as eccentricity (E) and curvature (C) were extracted.The conventional fractal dimension (C-FD) was also calculated using the box-counting method. The artificial neural networks were used as a classification al-gorithm, and a receiver operating characteristic (ROC) curve and the area underthe ROC curve (Az) were calculated to evaluate the diagnostic accuracy in thetask of differentiating between benign and malignant masses.Results: When using E, C, C-FD and age as inputs, the Az value was 0.87 ± 0.07.On the other hand, when 3D-FD was added to inputs in addition to the aboveparameters, the Az value was significantly improved to be 0.93 ± 0.09.Conclusion: The 3D-FD is a new parameter which can enhance breast cancerdetection in CAD of mammograms, because it is effective for discriminating be-tween benign and malignant masses.

C-367Web computed radiography: A solution for X-ray examinations in AfricaD.J. Gardeur1, E.H. Niang2; 1Paris/FR, 2Dakar/SN

Purpose: The population of Senegal have access to less than 4% of the numberof X-ray examinations of the european population. A major limitation is the rela-tive cost of radiolgical film in Africa. We have evaluated the feasibility of a lowcost solution combining CR with web PACS for no-film radiology in the hospitalsof Dakar.Method and Material: A CR (Konica) and a web-PACS-teleradiology solution(Global Imaging Paris) have been installed in July 2003 in the hospital Le Dan-tec, Dakar, Senegal.The goal is total substitution of film.Results: The web CR was quickly installed. It dramaticaly increases the numberof emergency exams, especialy in the orthopedic ward. Previously the film budg-et has limited the number of chest X-rays. Now all the suspected tuberculosisand cancer cases can be documented. Thanks to an internet connection, there isno need for expansive LAN. A connection with Hotel Dieu, Paris has been estab-lished for teleexpertise and ward radiology. Cost effectiveness analysis will bepresented.Conclusion: Thanks to new generation, affordable CR and web PACS, it is nowpossible to implement such solutions for X-ray examinations in Africa, withoutthe previous limitations of film budget.This is a great hope for African hospitals. Itis a NEPAD-NTIC pilot project.

C-368Soft tissue tumor distributed decision support systemM. Robles, L. Marti-Bonmati, J. García-Gómez, C. Vidal; Valencia/ES

Purpose: To provide distributed decision support services in soft tissue tumor(STT) to assist the radiologist. Previous studies have shown the capability ofpattern recognition techniques to classify between benign/malignant characterand different histological groups.Methods and Materials: Radiologist access to the STT distributed decision sup-port services is achieved using a graphical interface, with four windows that of-fers the main system functionalities areas: 1. Access to local or distributed STTregisters that contain the features to study. New data can be imported from Mi-crosoft Access formatted files or other databases. 2. Statistical analysis that pro-vides the graphical representation and reports of statistical and evaluationinformation like probability distributions per class, correlation studies, ROC curves.3. Graphical representation of STT registers provides graphical representation ofSTT features from the protocol, using PCA-transformation, or feature selection.4. Automatic classification access to STT classifiers distributed web-services,developed with pattern recognition technology.Results: A location independent and multi-platform system has been developedto provided decision support services for radiologists dealing with STT diagno-sis. The system architecture considers the access from hospitals using local ordistributed data and connections to clinical decision support servers. The nodesmaintenance and upgrade are automatically controlled by the architecture.Conclusion: This system helps radiologists with novel and powerful methods inSTT diagnosis and characterization. It provides access to distributed data, statis-tical analysis, graphical representation and pattern recognition classification. GRIDtechnology will incorporate more facility, security and powered communicationsto the STT distributed decision support services.

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C-369Clinical validation of a tele-operated mobile ultrasound scanner using alight weight robot (OTELO project)R. Gilabert1, M. Vannoni1, F. Courreges2, C. Delgorge2, C. Novales2,G. Poisson2, P. Vieyres2, C. Bru1; 1Barcelona/ES, 2Bourges/FR

Purpose: To report the results of the clinical validation tests of a robotic tele-echography system, that allows a real time ultrasound study (US) on a remotelylocated patient by an ultrasound expert (USExp).Methods and Materials: The OTELO network includes: A) An expert station whereUSExp controls the robot ultrasound probe movements/orientation by moving afictive probe; B) A patient station with the robot ultrasound probe holder which isplaced on the subject by a paramedic; C) Communications links: US data trans-mission (terrestrial/satellite) and videoconference ambient images.The clinical validation tests have been performed between two hospitals separat-ed by 3 Km. The study group included 16 controls and 16 patients. US equipmentwith 3.5 MHz transducers were used. The abdominal study included liver, portalvein, gallbladder, pancreas, spleen, kidneys, aorta, bladder, uterus, prostate, andDouglas. Parameters evaluated were organ visualization, size, contour, paren-chymal echogenicity and presence of abnormalities. The USExp diagnosis wascompared with the final diagnosis performed by other radiologist with latest gen-eration US equipment.Results: Complete organ visualization was as follows: liver, 91%; spleen, kid-neys and gallbladder, 85% and pancreas 64% of cases. USExp was able to iden-tify 38 out of 57 lesions detected. The lesions non-identified were < 1 cm in 15cases. Twelve patients presented acute abdominal disease and tele-echographyenabled to obtain the diagnosis in 10 (83%).Conclusion: The Otelo tele-echography system results are promising and it couldoffer a reliable US diagnosis by an USExp on patients located far from mainhospital centers.

C-370Visualization of the auditory and vestibular system: Image fusion of CT andMRT data setsJ. Beltle, M. Heuschmid, H.-J. Graf, J. Schaefer, C.D. Claussen,M.D. Seemann; Tübingen/DE

Purpose: The aim of this study was to perform a realistic visualization of theauditory and vestibular system using volume data sets from high-resolution com-puted tomography (HR-CT) and high-resolution magnetic resonance tomogra-phy (HR-MRT).Methods: In 10 consecutive patients with conductive and/or sensorineural hear-ing loss a HR-CT and HR-MRT of the petrous bone was performed. CT wereperformed with a 16-slice computed tomography scanner with a slice thicknessof 0.3 mm. MRT were performed with a 3.0-T scanner with a three-dimensional-constructive interference in steady state (3D-CISS) gradient-echo and a T2-weight-ed and unenhanced and gadolinium (GD)-enhanced T1-weighted turbo spin-echosequence. The middle ear structures were interactively segmented and visual-ized with a color-coded shaded-surface rendering method using the HR-CT vol-ume data sets. The inner ear structures were interactively segmented andvisualized with a color-coded shaded-surface rendering method using the HR-MRT volume data sets. Finally, both shaded-surface rendered models were su-perimposed to visualize the auditory and vestibular system.The representation of the auditory and vestibular system with image fusion usesthe advantages of both the high bony contrast of HR-CT and the high sensitivityto fluids of HR-MRT and the high spatial resolution of both modalities. In compar-ison to the axial source images, the 3D visualization facilitates a more clear rep-resentation and better assessment of the complex topographical relationships.Conclusion: The auditory and vestibular system consists of bony and soft tissuestructures and fluid-filled spaces so that an optimal visualization is only possibleby image fusion of volume data sets from HR-CT and HR-MRT.

C-371Integration of broadband teleradiology into picture archiving andcommunication system (PACS)Y. Zhao, K. Chen, Z. Yao, D. Wu, Z. Pan, B. Guo; Shanghai/CN

Purpose: The availability of broadband wide-area networks (WANs) facilitates arange of new applications in healthcare. Teleradiology is increasingly integratedinto picture archiving and communication system (PACS). This paper introducesa broadband telemedicine system for transmitting interactive audio and videosignals, and high-quality medical images directly acquired from a hospital-widePACS.

Methods: A high-performance telemedicine system was developed over the ex-isting metropolitan broadband multimedia network in Shanghai to exploit the pos-sibilities offered by Internet Protocol (IP) over Synchronous Digital Hierarchy (SDH)technology to support real-time tele-consultation for medical imaging. A trial ses-sion was held with two channels of fiber-optic connection transmitting real-timeduplex audio/video signals and high-quality DICOM images between Rui JinHospital and Shanghai International Convention Center, 10 kilometers apart. Thesystem enabled direct retrieval of DICOM images from the PACS, and allowed touse interactive telediagnosis tools for image visualization and processing.Results: During the teleradiology session, DICOM images archived at the PACSwere readily accessed without any loss of information. A number of functionali-ties of visualization software were utilized and tested, combined with real-timevideoconference session. The system was proven robust, efficient and providingfor high performance.Conclusion: The broadband telemedicine system under study has given us auseful insight about the potential of applying broadband technology in health-care, especially the performance of videoconferences with telediagnosis of radi-ological images. With the close integration of teleradiology into a hospital-widePACS, it yields sufficient sound and image quality for remote educational andclinical collaboration.

C-372Performance assessment of a wavelet contrast enhancement method indense parenchyma based on simulated lesionsS. Skiadopoulos, L. Costaridou, P. Sakellaropoulos, C. Kalogeropoulou,E. Likaki, G. Panayiotakis; Patras/GR

Purpose: Evaluation of an adaptive wavelet-based contrast enhancement meth-od in dense parenchyma based on simulated radiopaque lesions.Methods and Materials: Sixty normal mammographic images of dense breastswere selected from the DDSM database. Simulated radiopaque lesions of knownimage characteristics, such as low contrast (0.8%-5%) and unsharp contour (0%-80%), were generated and superimposed in dense breast areas. This resulted ina case sample that is difficult to achieve and verify with real lesions. All imageswith simulated lesions were processed by the wavelet-based method. Evaluationwas carried out by an observer performance comparative study between thewavelet-processed images and original ones. The sample was presented to threeexperienced radiologists, classifying each simulated lesion with respect to con-tour type, using a five-point rating scale. A binormal ROC curve was individuallyfitted to the scores of each observer with a maximum-likelihood procedure andthe area under the ROC curve (Az) as well as the 95% confidence interval werecalculated, for each technique.Results: Combining observers' responses, the Az values are 0.930 and 0.813and their corresponding confidence intervals are (0.882, 0.961) and (0.743, 0870)for wavelet method and original one, respectively. This difference in Az values isstatistically significant (Students' t-test, p < 0.05), indicating the effectiveness ofthe wavelet method.Conclusion: Improved contour characterization of low contrast simulated lesionssample is achieved with the use of the wavelet-based contrast enhancementmethod. Use of simulated lesions sample servers for verification purposes, re-quired to assess the performance of various digital image post-processing tech-niques.

C-373Estimating the arterial compliance in early stages of atherosclerosis:Evaluation of a new index on the curve-fitted Doppler sonogramsN. Erdogan, S. Kara, F. Dirgenali, M. Okandan; Kayseri/TR

Purpose: To develop a computational method to define a new index to estimatethe arterial compliance in early stages of atherosclerosis.Methods and Materials: The Doppler data was obtained from a nonstenotic ar-terial site (carotid artery) in patients with femoropopliteal atherosclerosis (n = 10)and healthy volunteers (n = 8) using the audio output of a commercial color Dop-pler ultrasound unit. The signals were transferred to a personal computer and twodimensional sonograms were plotted by fast Fourier transformation. Smoothingand curve-fitting operation is performed on the sonograms. A moving averagemethod was used for smoothing and Interpolant-Cubic Spline was processed tomake curve-fitting. The time interval between the first transmitted peak (t1) andthe second compliance peak (t2) in the arterial waveform was evaluated as a newindex.Results: Our preliminary data showed no significant difference between healthysubjects and the patients with regard to the acceleration, resistivity and pulsatil-ity indices, although a significant difference exists for the new index(11.0 ± 1.9 msec for patients vs. 33.0 ± 2.5 msec for healthy people).

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Conclusion: The proposed new index on the the curve-fitted fast Fourier trans-formation sonograms seems to be promising in assessing the cardiovascular riskby detecting the degree of compliance in atherosclerotic vessel walls before theovert clinical symptoms develop. However, its efficacy and prognostic implica-tions need to be confirmed by large scale studies.

C-374The contribution of virtual endoscopy (VE), in the imaging of the upperairways and tracheobronchial treeA. Morichovitou, A. Manolitsas, S. Stratilati, I. Tsitouridis; Thessaloniki/GR

Purpose: The purpose of our study is to demonstrate the contribution of virtualendoscopy in the imaging of the upper airways and tracheobronchial tree.Methods and Materials: We studied 43 cases, (26 male and 17 female, aged 32to 71 years old, mean 51 yrs), with tracheobronchial diseases. The virtual endos-copy images were compared with those of actual endoscopy in 13 patients. Theexaminations were performed using a Picker PQ5000 spiral CT scanner and aPicker Voxel Q visualization workstation. Thickness: 3 mm, pitch: 1.5, overlap:66% (1 mm).Results: CT virtual endoscopy depicted the anatomical structure of nasophar-ynx, larynx, trachea, and main bronchi in all patients as the actual endoscopy.The results show that virtual endoscopy can study the tracheobronchial tree asfar as the segmental bronchi, and sometimes the subsegmental bronchi (in 6patients). In addition, it can evaluate the extraluminal location of the lesions. 39lesions in 36 patients were shown by virtual endoscopy (12 occlusions, 21 sten-osis, 6 compressions) and in 7 patients the examinations were negative. Thefindings were always in agreement with those of the actual endoscopy and surgi-cal findings. We studied the results of the two methods and describe the advan-tages and disadvantages of each of them.Conclusion: Virtual endoscopy can be used in the primary evaluation of the pa-tient before actual endoscopy is performed. It can be used for preparing, guidingand controlling actual endoscopy or in the postoperative follow-up when immedi-ate biopsy is not necessary.

C-375Pancreatic duct imaging using the curved thin-slab minimum intensityprojection methodT. Ogura1, T. Ikari2, T. Tachikawa2, A. Kamei2, K. Takano2, S. Asahara2,N. Fujita2, M. Shimizu2; 1Maebashi/JP, 2Tokyo/JP

Purpose: The recent wide use of curved MPR was applied for pancreatic ductimaging, but curved MPR requires a great deal of skill for the trace of narrowedand tortuous pancreatic duct. Mis-tracing on pancreatic duct has led to variousartificial images such as false pancreatic stenosis. So novel curved thin-slab min-imum intensity projection methods have been employed to obtain correct pancre-atic duct image. The purpose of this study is to explain the protocol, reconstructionmethod, and describe the potential advantages and various problems of thismethod in the diagnosis of pancreatic diseases.Materials and Methods: Pancreatic duct image was reconstructed from threedimensional volume data using multidetector-row CT (QX/i, GEMS) scans. Axialimages were taken with 1.25-mm collimation, a table speed of 3.75 mm/rot and0.5 mm image reconstruction intervals. Image processing was performed withthe Virtual place (M.I.Lab).Results: This method was successful in depicting a wide range of tortuous pan-creatic ducts. Also the narrowed pancreatic duct is easily visualized, and evenbranch ducts. The characteristic of this method is that we can easily make apancreatic duct image quickly and with little dependence on expert technique.Conclusion: In abdominal studies, this method enabled the visualization of thenarrow, bending pancreatic duct, reducing false pancreatic stenosis, and alsocould be applied for screening examination for anomalous union of pancreatic-biliary ductal system in the future.

C-376Evaluation of the optimal scanning protocol for CT virtual endoscopy usinga 16-slice scannerW. Wojciechowski1, W. De Wever2, A. Urbanik1, G. Marchal2, R. Chrzan1,J. Kozub1; 1Krakow/PL, 2Leuven/BE

Purpose: The objective of this study was evaluation of optimal scanning protocolfor CT virtual endoscopy using a 16-slice scanner in a phantom study.Methods and Materials: Using the MDCT scanner SOMATOM Sensation16 (Sie-mens, Germany), CT-images of a phantom were performed, with diferent combi-nations of slice-thickness (0.75, 1, 2, 3, 5 mm), pitch (0.5, 1, 1.5), slice-collimation

(16 x 0.75 and 16 x 1.5) and reconstruction increment (50% and 100%). The phan-tom consists of simulated round lesions of different size (diameter between 1 and10 mm) placed into a thin-walled plastic tube of 6-cm diameter. Quantitative anal-ysis was assessed by evaluation of changes in size and shape of the lesions andcalculation of sensitivities. Qualitative analysis was perfomed by evaluation oflesion's blurring of stairstep artifacts and rippling artifacts.Results: Overall sensitivity was 100% with slice thickness 0.75, 1 and 2 mm andnot dependent on pitch. The smallest lesions (diameter 1 mm) were not detectedwith slice-thickness of 3 and 5 mm. Image quality of endoluminal images wasgraded as optimal for slice-thickness 0.75 mm and 1 mm. There was no statisti-cal significant difference in quality using a different pitch in these images. Howev-er mild rippling artifacts were documented together with an increase in pitch value.Conclusion: Slice-collimation and slice-thickness are the most important pa-rameters in selection of on optimal scan-protocol for VE: slice-collimation of16 x 0.75 and slice-thickness of 1 mm seem to be optimal. Pitch and incrementare less important, although values of 1 and 50% seem to be optimal. Selectionof optimal parameters is also depended on lesion size.

C-377Automatic flow measurement of cerebrospinal fluid by MR in aqueduct ofSylviusY.N. Florez Ordoñez, L. Marti-Bonmatí, E. Arana, D. Moratal-Perez,J. Millet Roig; Valencia/ES

Purpose: To develop an automated measurement method of cerebrospinal fluid(CSF) through the cerebral aqueduct.Methods and Materials: Fully automatic and manual methods were developedand compared using in vivo studies. This tool allowed automatic determination ofa region of interest (ROI) with background correction. By means of this tech-nique, a ROI was set, corrections performed and calculation of different parame-ters (flow, stroke volume and velocity) and flow curves made. This tool wasdesigned using MATLAB 6.5 (Mathwork, Inc, Natick, USA) with a friendly Graph-ical User Interface. Comparisons were performed by means of intraclass correla-tions (ICC). This model was validated in 20 patients, 11 men and 9 women, agerange: 45-79 years-old. MR examinations were performed on a 1.5-T system(Gyroscan NT Intera, The Netherlands) with a phase contrast sequence. Imageparameters were as follow 256 x 512 matrix; FOV, 160 mm; 3 mm slice thick-ness; TR 53 msec, TE 11, 2 excitations, flip angle 15° and 20 cardiac phases withuse of peripheral retrospective gating.Results: The automatic method performed significantly better than the manualanalysis, ICC of 0.72-0.98 and 0.30-0.81, respectively. At the same time partialvolume effect caused by inclusion of stationary tissue was corrected.Conclusion: Automatic setting of ROI flow measurements at the cerebral aque-duct is feasible with an adequate reproducibility. It makes the measurements in-dependent of the radiologist, generalizing the calculus of flow parameters.

C-378Virtual duodenoscopy on the basis of high-resolution MRCP data for thesimulation of ERCP proceduresT. Yamagishi1, K.H. Höhne2, K. Abe1; 1Tokyo/JP, 2Hamburg/DE

Purpose: ERCP has been regarded as one of the most difficult endoscopic pro-cedures for a trainee because of a high possibility of technical failures. Therefore,it is considered useful to prepare a rehearsal of ERCP. We present a virtual duo-denoscopy for practical ERCP simulation.Methods and Materials: The HR-MRCP data sets are imported into the VOXEL-MAN program (Institute of Medical Informatics, University Hospital Hamburg-Eppendorf, Germany). An interpolated movie of the duodenal inner surface iscomputed by tracing where the endoscopic tip goes through to the duodenalpapilla following the actual ERCP procedure. Three orthogonal radiological planesof the source MRCP are integrated into the movies, which are showing the conicextent of the endoscopic viewing field. The usefulness of making a prior simula-tion for a successful ERCP was evaluated.Results: The post-processed endoscopic view is precise and realistic enough toexecute a practical simulation of ERCP, following the actual procedures step bystep, e.g., which angle and position of the endoscopic tip is best for the cannulainsertion into the common bile duct. The movie created can indicate an idealapproach to the duodenal orifice in exactly the same way performed by ERCPexperts. The radiological planes are useful as external images like X-ray fluoros-copy.Conclusion: A practical simulation of ERCP can be performed by a combinationof HR-MRCP data and the VOXEL-MAN interactive visualization program. Thepresented method can provide useful information prior to actual ERCP.

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C-379Ultasound contrast agents (USCA) in chronic liver disease and portalhypertension: Physics, technology, technique, and resultsK. Chatzimichail, I. Mastorakou, I. Theotokas, D. Schizas, D. Leli, E. Tako,P.S. Zoumpoulis, A. Karampinis; Athens/GR

Learning Objectives: To understand the physics and technology concerningcontemporary USCA. To review the physics of the interaction between the USbeam, the "bubble" and the corresponding US image of the liver and portal sys-tem. To estimate the degree of portal hypertension through better visualization ofcollateral pathways using USCA.Background: A short historical review of the evolution of USCA is followed by adetailed presentation of the physics and technology of recent USCA. The interac-tion between the "bubbles" and the US beam is explained with analytical draw-ings and real-time US videos.Procedure Details: The technique and the protocol of the hemodynamic exam-ination of the hepatic veins and the portal system are explained. A detailed ana-tomical review of the portal venous system is presented with special attention tothe main collateral pathways present in cases of portal hypertension. The find-ings of imaging methods (US, CT, MR) as well as endoscopic methods are pre-sented and their limitations are underlined. New non-invasive hemodynamic USimaging of the main collateral pathways (gastric and esophageal varices, spleno-renal, splenogastric, retroperitoneal anastomoses, recanalization of the paraum-bilical vein) are described and presented in images and videos after administrationof second generation USCA.Conclusion: The benefits as well as the limitations of USCA, including thosecaused by artifacts, are thoroughly discussed so that an unbiased conclusion onnew diagnostic possibilities in the study of the portal hypertension can be drawn.

C-380Clinical impact of liver specific contrast agents in liver imagingA. Ba-Ssalamah, M. Uffmann, S. Mehrain, S. Schweighofer, W. Schima;Vienna/AT

Learning Objectives: To illustrate the usefulness of liver specific contrast agentsin identifying morphological and functional features of focal liver lesions. To edu-cate radiologists about new MR liver specific contrast agents and MR imagingtechniques. To demonstrate the value of the combined use of liver specific andnon liver specific contrast agents as a problem solving tool.Background: Liver specific contrast agents used in combination with non-spe-cific gadolinium chelates may serve as a problem solving tool in the diagnosis offocal liver lesions. Hepatic focal lesions with atypical imaging appearances usu-ally need further assessment, namely biopsy, particularly in patients with historyof malignant disease. Liver specific contrast agents offer new opportunities forliver imaging and provide information about the functional and morphological fea-tures of focal liver lesion. Currently a variety of contrast agents, subdivided indifferent categories are available for clinical use in MRI of the liver.Procedure Details: In this exhibition, we describe the use of reticuloendothelialsystem-specific iron oxide particulate agents, hepatocyte-selective agents, non-specific gadolinum chelates and the combined use of these contrast agents for alarge variety of liver diseases.We distinguish between specific imaging charac-teristics for various liver diseases and nonspecific imaging characteristics thatmay be found in both malignant and benign focal liver diseases.Conclusion: The combined use of liver specific and non liver specific contrastagents is a valuable tool for the diagnostic work up of special focal liver lesionsand may replace the invasive biopsy in the vast majority of cases.

C-381Doppler rescue: A review of the use of ultrasound microbubble contrastagents in the visualisation of the large vesselsK. Satchithananda, M.E.K. Sellars, S.M. Ryan, P.S. Sidhu; London/UK

Learning Objectives: Understanding of the types of ultrasound contrast agentsavailable and nature of enhancement. Understand when these agents could beused to improve diagnostic images and cost effectiveness. An appreciation of theclincial appearances of "Doppler rescue" in different areas of vascular imaging.Background: Ultrasound (US) assessment of the vascular system remains anaccurate imaging modality despite the advancement of Magnetic ResonanceAngiography. US allows real-time, multi-planar and safe assessment of the vas-culature which is convenient to both operator and patient. Limitations of US, es-

pecially in the vascular system are well documented. Full diagnostic Dopplerassessment is not always possible for a variety of reasons. Color Doppler as-sessment greatly improves vascular imaging and recent technical advances havefurther improved the capabilities of Doppler US. A further important developmentis the introduction of microbubble contrast, which allows previously non-diagnos-tic studies to become interpretable and avoids further imaging: termed "Dopplerrescue".Image Findings: The use of microbubble contrast will be illustrated in the cere-bral circulation using trans-cranial US, the extra-cranial carotid system, the livervasculature, renal artery and the peripheral arterial system.Conclusion: Both color Doppler enhancement and low mechanical index B-modenon-linear imaging will be demonstrated.

C-382One-stop shop trauma scan with 16-channel multi-detector-row-CT (MDR-CT) and optimized multi-phase contrast applicationF.T. Schmid, M.H.K. Hoffmann, B.L. Schmitz, S. Fenchel, H.-J. Brambs,A.J. Aschoff; Ulm/DE

Learning Objectives: Initial work-up of trauma patients is time-critical. Diagnos-tic demands require different examination techniques including unenhanced andseveral contrast enhanced scans for musculoskeletal, angiographic and paren-chymal diagnosis. 16-channel MDR-CT overcomes previous technical limitations,which used to require thickening of slices or segmenting for whole body cover-age. We therefore developed a multi-phase contrast protocol allowing acquisitionof musculoskeletal, angiographic and parenchymal organ information in a singlescan. CT technique and contrast protocol, advantages and limitations of this pro-cedure are described and illustrated.Procedure Details: 12 consecutive trauma patients were examined on a 16-channel MDR-CT (Philips, Mx8000IDT). After exclusion of cerebral hemorrhageapplication of iodine contrast media (400 mg iodine/ml, Imeron 400, Altana, Ger-many) was started with a bolus of 40 mL at a flow of 2.0 mL/sec, followed by apause of 40 sec. Subsequently, a second 60 mL contrast bolus (3.5 mL/sec) isfollowed by a saline chaser. The CT-scan is initiated with a delay of 85 sec usinga collimation of 16 x 1.5 mm, slice thickness of 2 mm and an increment of 1 mm.Results: This protocol provides excellent diagnostic image quality covering allissues of trauma work-up. Within a table time of less then 10 minutes all relevantpathologies were assessed as proved by further clinical follow-up. All fracturesincluding two petrosal ones were detected. Parenchymal pathology included lac-erations of liver, spleen, and kidneys. All arterial and venous hemorrhages werediagnosed without the need of additional diagnostic work-up.

C-383Intravenous, oral and, rectal contrast media for abdominal spiral CTexaminations: When to use, how much, how fast, and when to scanA.N. Chalazonitis1, J. Tzovara2; 1Athens/GR, 2Ioannina/GR

Leaning Objectives: To optimise the choice of contrast media initiation parame-ters for abdominal single slice spiral CT examinations, tailored to each specificorgan and to the most common clinical conditions.Background: Introduction of multi-slice spiral CT permitted greater flexibility inabdominal examinations. However single slice spiral CT still remains a powerfultool in routine imaging practice.Procedure Details: The aim of this exhibit is to describe lesion or organ behav-iour before and/or after contrast material initiation in order to help the participantto understand why, when and how these agents should be administrated for op-timal abdominal single slice spiral CT evaluation. Contrast volume, flow rate andscan delay before initiation, are discussed. The influence of patient weight andcirculatory parameters such as cardiac output and inflow obstructions on con-trast enhancement will be also analysed. Special techniques in order to achieveoptimum GI opacification will be also discussed. Finally a wide variety of differentabdominal clinical examples that require a specific contrast media protocol willbe illustrated.Conclusion: Optimal spiral CT scanning requires imaging protocols very pre-cisely tailored to the clinical question and to the patient's condition by adequateselection of administrated contrast media parameters.

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C-384Usefulness of superparamagnetic iron oxide-MR imaging in patients withhepatic dysfunction: Correlation between hepatic signal intensity changeand hepatic function assessed by 99mTc-GSA hepatic scintigraphyT. Tounan1, K. Fujimoto2, M. Uchida2, M. Ishibashi2, H. Nishimura2,N. Hayabuchi2, J. Akiyoshi1, N. Ono1, S. Matsushita1; 1Chikugo/JP, 2Kurume/JP

Purpose: To compare hepatic signal intensity change using superparamagneticiron oxide (SPIO)-enhanced MR imaging with scintigraphy using Technetium-99m-galactosyl human serum albmin (99mTc-GSA) and a visual grading score, inpatients with hepatic dysfunction.Methods and Materials: Forty-six patients with hepatic dysfunction who under-went SPIO-enhanced MR imaging and scintigraphy with 99mTc-GSA were ex-amined prospectively. In terms of clinical cirrhosis severity, 46 patients wereclassified into four group; 16 patients were classified as non-cirrhotic, 18 wereclassified as group A, 10 as group B, and 2 as group C (Child-Pugh classifica-tion). On MR imaging, T2-fast field echo (T2-FFE) images were obtained beforeand after the administration of SPIO. To assess the effect of SPIO, post contrastrelative reduction in signal-to noise ratio (reduction-SNR) was calculated. Thefindings of 99mTc-GSA-scintigraphy were classified into 5 types according tovisual grading score. The clinical cirrhosis severity, reduction-SNR, and visualgrading score were analyzed with nonparametric methods.Results: The clinical cirrhosis severity was positively correlated with visual grad-ing score (Spearman rank test, P < .0001). There were significant differencesbetween the clinical cirrhosis severity and the reduction-SNR on T2-FFE andbetween the visual grading score and the reduction-SNR (Kruskall-Wallis test,P < 0.0005, all comparisons). The index of blood clearance (HH15) was positive-ly correlated and the receptor index (LHL15) was negatively correlated with thereduction-SNR on T2-FFE (Spearman rank test, P < 0.0001, all comparisons).Conclusion: To evaluate the reduction-SNR on SPIO-MR imaging is helpful inpredicting not only Kupffer cell function but also hepatic function as assessed by99mTc-GSA-scintigraphy.

C-385Are efficient contrast agents available for use with ultra-high field MRimaging?R.N. Muller, P.A. Rinck, L. VanderElst, A. Roch; Mons/BE

Purpose: Molecular MR imaging requires specific markers exhibiting high relax-ivities at ultra-high fields (3-11 Tesla). Although there are theories on the designof optimal paramagnetic centers, actual relaxivities are still below expectations.Methods and Materials: Measurements of relaxivites s-1 mM-1) to establish nu-clear magnetic relaxation dispersion profiles of existing and possible future con-trast agents were performed on two field cycling relaxometers and on a 4.7 T MRresearch machine.Results: At high field, r1 and r2 of small Gadolinium complexes are low and de-crease; high-field relaxivities can be increased through reduction of molecularmotion. To some extent, it is possible to increase the r2

of small Dysprosium com-

plexes. NMRD profiles of superparamagnetic particles reveal a high r2/r1 ratio atultra-high fields. However, one particle of 5nm contains around 2,500 iron ions,whereas one macromolecular complex contains one or a few gadolinium ions.Assuming equivalent relaxivites, the Gd complex should carry approximately 2,500ions to present, per molecule, the same relaxivity as the magnetic particle whichleads to a molecular weight increase of 400,000.Conclusion: For small complexes of Dy, r2 can be modestly increased at highfields. Both r1 and r2 of Gd complexes can be enhanced at high fields by an increaseof the molecular size, however, only r2 keeps increasing. Superparamagneticparticles seem clearly more efficient. This fact will be of paramount importance inthe context of molecular imaging. They will act as negative agents.

C-386Experimental evaluation of vascular enhancement in rats using a newextracellular contrast agent for MR imaging: Comparison of NMS60 withGd-DTPAK. Yoshikawa, M. Shimada, Y. Inoue, S. Itoh, A. Senoo, S. Seri, S. Hayashi;Tokyo/JP

Purpose: The aim of this animal study was to evaluate vascular enhancement inrats and rabbits by the extracellular contrast agent, NMS60, a novel gadolinium-containing trimer of molecular weight 2.1 kd (Nihon Medi-Physics Co. Ltd., ChibaPref, Japan) compared with Gd-DTPA.Methods and Materials: Six sets of pre- and post-contrast three-dimensionalcoronal fast-SPGR images (TR/TE/flip angle/slab thickness/slab partition/acqui-

sition time/FOV = 7.5 msec/ 2.1 msec/ 30 degrees/ 25 mm/ 14/ 1/ 10 cm) of ratabdomen were obtained at 30, 75, 120, 210, 300 sec after IV injection of 50, 100,200 micromolGd/kg of each agent. The contrast ratios (CRs) of abdominal aorta,portal vein, liver, renal cortex, and renal medulla were calculated by followingequation: CR(t) = (SIpost/SDnoise-post)/SIpre/SDnoise-pre).Results: The contrast ratios of rat abdominal aorta and portal vein on the first tofifth contrast imaging were higher for NMS60 than those for Gd-DTPA with everyinjection doses. The peak contrast ratios of aorta and portal vein for NMS60 were1.4-1.7 and 1.7-2.2 times as high as those for Gd-DTPA. The renal excretion ofNMS60 was as fast as Gd-DTPA.Conclusion: NMS60 showed stronger contrast enhancement for the rat vascularsystem, especially the portal vein and provided MR angiograms of higher imagequality when compared with Gd-DTPA at the same injection dose.

C-387MR lymphography using various new hepatobiliary agents: Comparison ofGd-EOB-DTPA, Gd-BOPTA, Gd-DTPA-DeA with Gd-DTPAM. Shimada1, K. Yoshikawa1, Y. Inoue1, S. Itoh1, T. Suganuma2, M. Watanabe1,A. Senoo1, K. Ito1, S. Hayashi1; 1Tokyo/JP, 2Kanagawa/JP

Purpose: To examine the possible use of the new hepatobiliary agents Gd-EOB-DTPA, Gd-BOPTA and Gd-DTPA-DeA in MR lympangiography and to comparewith Gd-DTPA.Methods: 26 rats were used. Items were Gd-DTPA group (50, 125, 250, 500 ì)each two rats, Gd-DTPA-DeA (50, 125), Gd-BOPTA (50, 125, 250, 500) and Gd-EOB-DTPA (50, 125, 250). 0.08 mL intracutaneous injection was made each time.3D-FSPGR imaging was performed before and after 5, 15, 30, 60, 120 min. De-lineation of popliteal lymph node (PLN) and lymph duct (LD) (extremity region,iliac, para aorti, thoracic duct) was examined.On the evaluation of LD, visual eval-uation ("good visualization": ++, "visualization": +, "poor visualization": ±, "no vis-ualization": -) was carried out. On PLN, SNR was calculated as follows: SNR =SI (PLN)/SD (noise).Results: In Gd-DTPA (125, 250, 500), Gd-EOB (125, 250) and Gd-BOPTA (125,250, 500), grading of LD from lower extremity region to para-aortic region was"good visualization" or "visualization". In Gd-DTPA (50), grade of LD from lowerextremity region to para-aortic region was "poor visualization". On the other hand,using Gd-EOB (50), Gd-BOPTA (50), we could see LD from lower extremity re-gion to iliac region.We found only LD of lower extremity region in Gd-DTPA-DeA(50, 125).These grades were "good visualization" or "visualization". Each con-centration besides Gd-DTPA (50), contrast enhancement of PLNs were very well.The PLN almost showed peak value after enhancement for most cases (24/26) infive minutes. We saw PLN very well after enhancement 30 minutes later, and, atthe time of Gd-DTPA (500), Gd-EOB-DTPA (125, 250), Gd-BOPTA (250, 250,500), Gd-DTPA-DoA (50, 125), SNR value was more than 20.Conclusion: Using hepatobiliary agents and extracellular agent we were able todo good MR lymphography.

C-388Optimized IV contrast administration protocols for diagnostic PET/CTimagingT. Beyer, G. Antoch, S. Rosenbaum, L. Freudenberg, T. Fehlings, J. Stattaus;Essen/DE

Purpose: We compared different IV-contrast injection protocols for PET/CT-ex-ams (dual-slice) to assess their efficacy in avoiding high-density artifacts on CTand subsequent false positives on corrected PET.Methods: Four groups of 10 PET/CT-referrals (370 MBq FDG at 90 min pi) eachwere investigated with/-out iodinated contrast (300 mg/mL) application: (A) with-out, (B) multi-phase 90/50 mL (3/1.5 mL-1) cranio-caudally with 30 s delay, (C)90/40/40 mL (3/2/1.5 mLs-1) cranio-caudally with 50 s delay, and (D) 80/60 mL(3/1.5 mLs-1) caudo-cranially with 50 s delay. CT-based attenuation correction (AC)of the PET was applied routinely. CT image quality (Iq) was graded 1 (very good),2 (good), or 3 (insufficient) by three radiologists. Image quality and artifacts werereported for head/neck, thorax, and abdomen. Two nuclear medicine physiciansreviewed the AC- PET images for potential artifacts from IV-contrast without knowl-edge of the CT, and reported lesion-to-background (L/B) values for potentiallyrelated uptake on PET. All reviewers were blinded to the contrast protocol andpatient names.Results: Average CT Iq was poorest (3.0) for protocol A across all regions, butimproved to 1.4 (B), 1.0 (C), and 1.1 (D). High-density (> 1200 HU) CT artifactswere introduced only in the upper thorax in 73% (B) and 53% (C) of the patients.Mean L/B in corresponding artificial lesions was 1.8 and 2.0, respectively, thusresembling false positives. Protocol D resulted in artifact-free images.

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Conclusion: PET/CT Iq increased in the presence of IV-contrast agents. High-density artifacts from bolus injection may lead to false positives on AC-PET. Theartifacts can be avoided by alternative contrast administration protocols (e.g. D).

C-389Contrast enhanced ultrasound in the evaluation of hepatic metastasestreated using radiofrequency ablation: 24 hours, 1 and 3 months follow-upassessmentG.A. Vorkas, I.A. Chryssogonidis, C.A. Papadopoulos, E. Syndouka, K. Lytras,L. Grassos; Thessaloniki/GR

Purpose: This study evaluates the importance of periodic follow-ups in the as-sessment of hepatic metastases treated with radiofrequency ablation (RF) usingcontrast-enhanced sonography.Materials and Methods: 36 hepatic metastases in 17 selected patients wereincluded in our study. All lesions were studied with CE-US using real-time, con-tinuous scanning with Esaote Esatune equipment with the CnTI software, ena-bling non-destructive imaging at low MI, following intravenous bolus administrationof 2.4 mL of a second-generation agent (Sonovue-Bracco). The enhancementpatterns of lesions were assessed during the arterial, portal and late phases. Theexamination was conducted pre-ablation, 24 hours, 1 month and 3 months afterthermoablation.Results: Complete necrosis was identified in 31/36 (86%) lesions at 24 hourspost-ablation CE-US and in 5/36 (14%) CE-US showed presence of viable re-sidual tumor. At 1 month, 5/31 (16%) lesions that were considered tumor-freeshowed local residual disease. At the 3 months follow-up, local persistence wasrevealed in 2/31 lesions (6%).Conclusion: Given the advantages of using CE-US for the follow-up of hepaticmetastases treated with RF, the examination 24 hours post-ablation is essentialin evaluating the immediate results. Follow-up at 1 month reveals the cases ofincomplete necrosis not detected with CE-US in the first 24 hours, because ofthe small amount of residual viable tumor. The 3 months follow-up is efficient ofshowing local persistence.

C-390Evaluation of therapeutic response to radiofrequency ablation of colorectalhepatic metastases with contrast-enhanced sonographyI.A. Chryssogonidis, G.A. Vorkas, C.A. Papadopoulos, E. Syndouka, K. Lytras,L. Grassos; Thessaloniki/GR

Purpose: To evaluate the usefulness of contrast-enhanced sonography in moni-toring therapeutic response to radiofrequency ablation (RF) of colorectal hepaticmetastases.Materials and Methods: 20 patients diagnosed with 47 hepatic metastases ofcolorectal origin, either by multimodality imaging (CT-MRI) or biopsy, were en-rolled. All patients were examined with contrast enhanced U/S by using real-timecontinuous scanning with a low mechanical index after bolus injection of 2.4 mLof a second generation agent (Sonovue, Bracco) before and 24 hours after ther-moablation.Results: Pre-treatment U/S examination showed rim enhancement of hypovas-cular metastases during the late phase of the study in all cases. After ablationCE-US revealed residual rim enhancement in 7/47 (15%) metastases, indicatingthe presence of viable residual tumor and in 40/47 (85%) lesions showed com-plete necrosis.Conclusion: CE-US is an effective method for the immediate evaluation of RFresults, assessing treatment margins and revealing local persistence.

C-391Cost effectiveness of SonoVue-enhanced ultrasonography (CE-US) in thecharacterization of benign liver lesions (BLL)L. Romanini1, P. Cabassa1, M.R. Cristinelli1, I. Colangelo2, E. Archiati1,A. Borghesi1, L. Grazioli1; 1Brescia/IT, 2Milan/IT

Purpose: To evaluate the cost effectiveness of contrast enhanced US (CEUS) inthe characterization of BLL versus enhanced CT or MR.Materials and Methods: 112 patients have been studied with US and CE-USand the diagnosis obtained with the two methods was compared with CE-CTand/or CE-MR as gold-standards. The costs of the US, CE-US, CE-CT, and CE-MR exams have been calculated considering both fixed costs (amortization ofthe equipment/min) and variable costs (materials and cost/min of the staff in-volved).Results: After US 59/112 patients needed further tests (32 CT and 45 RM wereperformed). After CE-US only 26/112 patients needed further tests (11 CE-CT

and 25 CE-MR performed).This means that the difference between US and CE-US in terms of correct diagnosis is 33 pts in favour of CE-US.Conclusions: Considering that US costs 39.0€, CE-US 80.0€, CE-CT 145.0€and CE-MR 250.0€, the costs of CE-US in all the patients enrolled (n = 112) is8960€, and this cost is compared with the costs of CE-CT plus CE-MR plus US inthe subpopulation of patients (n = 33 pts) that would not need any further testsafter CE-US; this costs is 10164.0€.This means that we could have saved 1204€with an average cost-save per patient of 10.75€. In this study we did not considerthe indirect costs related to the patients discomfort, radiation exposure, iodineexposure and time-save, (in fact we normally perform CE-US jointly with US exam)that might increase the cost saving in favour of CE-US.

C-392Effects of radiographic contrast media on isolated porcine renal arteries:A comparison of dimeric iotrolan and monomeric iohexol and iomeprolM. Heinrich, A. Grgic, G. Schneider, U. Humke, B. Kramann, M. Uder;Homburg a.d. Saar/DE

Purpose: An up-to-date study showed that for high-risk patients the nonionic,dimeric radiographic contrast medium (RCM) iodixanol had less nephrotoxicitythan the nonionic, monomeric RCM. The lower incidence of secondary effects isoften attributed to the lower osmolality of the dimeric RCM. To compare the effectof dimeric iotrolan to monomeric iohexol and iomeprol independently of their os-molality, we have modelled the vascular activity of the RCM.Methods and Materials: In an organ bath, isolated segments of porcine renalarteries, uncontracted or precontracted by 10 micromol/L phenylephrine, wereincubated with increasing concentrations of iotrolan-300, iohexol-300, iomeprol-150 and mannitol solution iso-osmolal to the RCM.Results: Expressed in terms of concentration of iodine in the buffer as well as interms of concentration of the RCM-molecule in the buffer, iotrolan induced a sig-nificantly lower relaxation than the monomeric RCM (p < 0.05). There was nosignificant difference between the two monomeric RCMs iohexol-300 and iome-prol-300 (p > 0.05). The iso-osmolal formulation iotrolan-300 induced a smallerrelaxation than the iso-osmolal formulation of iomeprol-150 (p < 0.05). Precon-tracted segments were strongly relaxed by all the RCMs as compared to manni-tol (p < 0.05). Iotrolan had no significant effect on the basal tone of the vesselwhereas iohexol and iomeprol induced a small relaxation effect.Conclusion: Independently of its osmolality and dilution effect, dimeric iotrolancauses less relaxation of isolated, precontracted segments of porcine renal ar-teries than monomeric iohexol and iomeprol. This effect can be attributed to thedifferent biological properties of the monomeric and dimeric RCM-molecules.

C-393Ultrasound contrast agent in the study of traumatic splenic ruptureG. Caruso1, G. Salvaggio1, G. Bellissima1, V. Ricotta1, G. Ascenti2, R. Lagalla1;1Palermo/IT, 2Messina/IT

Purpose: To evaluate the role of ultrasound contrast agent (UCA) in the identifi-cation of traumatic splenic lesion.Materials and Methods: From May to July 2003, 20 consecutive patients wereadmitted to the emergency department for blunt abdominal trauma. Ultrasoundexaminations were performed with an ATL-HDI 5000 machine with a 5-2 MHzconvex trasducer capable of fundamental and harmonic imaging. Patients werestudied before and after UCA (2.5 mL of SonoVue®). Multi-detector computedtomography was used as the gold standard. All examinations were performedwithin 24 hours.Results: Ninety seconds after UCA administration, homogeneous contrast en-hancement of the whole of the splenic parenchyma was observed in 16 patients.In four patients, no contrast enhancement was observed in a subcapsular splenicarea: inferior splenic pole (n = 3) and mid-portion of the spleen (n = 1). Multi-detector CT performed in the portal venous phase confirmed traumatic splenicrupture in four patients, and showed an unremarkable spleen in the remaining 16patients.Conclusion: Ultrasound after SonoVue administration is useful in showing trau-matic splenic rupture.

C-394Contrast-enhanced, wide-band phase-inversion harmonic power Dopplerimaging of hepatocellular carcinomaJ.R. Janica; Bialystok/PL

Purpose: To determine whether examination of hepatocellular carcinoma by wide-band, pulse inversion sonography offers excellent accuracy in depiction of spe-cific characteristics of these pathologies.

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Methods and Materials: Eighteen patients were examined. The presence of HCCwas confirmed by ultrasound-guided biopsy or surgical resection. All patients,prior to enhanced sonography, had undergone B-mode gray scale sonography,color Doppler, and power Doppler examinations. After injection of 2.5 g of Levo-vist intravenously, analysis of contrast agent arrival was performed by wide-band,pulse inversion power Doppler sonography.Results: The B-mode gray scale sonography, color and power Doppler sonogra-phy were non-specific for HCC in 4 cases in our examination. However, based onthe wide-band, phase inversion power Doppler sonography findings, all patientswith HCC were diagnosed. All typical anatomical features of HCC as chaoticappearance with irregular paths, breaks in calibre and arteriovenous shunts wereclearly visible. In 2 cases, computed tomography had failed to disclose pathologywhile pulse inversion sonographic images were completely suggestive, whichwas later finally confirmed by histologic examination.Conclusions: Our data demonstrates the usefulness of wide-band, phase inver-sion power Doppler sonography in the diagnosis of hepatocellular carcinoma byvisualizing all characteristic anatomical details.

C-395Characterization of small liver lesions with contrast enhanced harmonicsonography (CEUS) in patients with chronic liver diseaseP. Cabassa, R. Taranto-Montemurro, A. Borghesi, E. Fogazzi, F. Simeone,L. Romanini, L. Grazioli; Brescia/IT

Purpose: Characterisation of small nodules (2 cm) in patients with liver cirrhosisor chronic hepatitis is a major problem. EASL (European Association for the Studyof the Liver) suggests biopsy of all lesions 1 cm and 2 cm in the survelliancealgorithm for HCC. The purpose of this presentation is to evaluate the possiblerole of CEUS in the characterisation of these lesions.Methods and Materials: At b-mode ultrasonography 31 nodules up to 2 cm (range7-20 mm, mean15.6 mm) in 31 consecutive patients (12 female, age range 39-80years) were detected. All patients had contrast enhanced ultrasound (CEUS)with a second generation contrast media (Sonovue, Bracco, Milan, Italy) usingcontinuous real-time low MI scanning (CCI: Acuson-Siemens). The standard dosewas of 2.4 mL. Mini video clips were recorded during arterial portal and equilibri-um phase and than reviewed. Final diagnosis was obtained by biopsy or CT/MR.Results: Final diagnosis was HCC (n = 21), displastic/regenerative nodules(n = 7), hemangioma (n = 3).CEUS characterized correctly 29/31 lesions. OneHCC didn't show the typical enhancement during arterial phase both at CEUSand CT. Final diagnosis was obtained by liver biopsy. One hemangioma showedhomogeneous enhancement during arterial phase and wash-out during portalvenous phase at CEUS - a diagnosis of HCC was hypothesized. Diagnosis ofcapillary hemangioma was obtained with MR.Conclusions: CEUS can play a role in the characterisation of small liver lesionsin patients with chronic liver disease. Liver biopsies could therefore decrease innumber, if these results are confirmed in larger series.

C-396Human comparative study on zinc and copper excretion via urine afteradministration of magnetic resonance imaging contrast agentsJ. Kimura, T. Ishiguchi, J. Matsuda, A. Nakamura, S. Kamei, K. Ohno,K. Murata; Aichi/JP

Purpose: To evaluate the in vivo kinetic stability of magnetic resonance (MR)imaging contrast agents, excretion of zinc and copper via urine were studied forthree gadolinium (Gd) chelate complexes.Methods and Materials: Urine samples were taken before, three hours, and sixhours after intravenous administration of Gd-DTPA-BMA, Gd-DTPA, and Gd-DOTAat 0.1 mmol/kg to each of five patients who underwent contrast-enhanced MRimaging. Five patients who had non-contrast MR imaging were evaluated as con-trols. Urine was assayed for quantitative analysis of zinc and copper using atomicabsorption analysis.Results: Gd-DTPA-BMA caused the highest increase in zinc excretion amongthe three agents, 1795 ± 1273 µg at 3 hours and 985 ± 434 µg at 3 to 6 hours.Gd-DOTA did not cause a significant increase in zinc excretion, 75 ± 39 µg at 3hours and 78 ± 65 µg at 3 to 6 hours. Gd-DTPA caused moderate increase inzinc excretion, 665 ± 240 µg at 3 hours and 378 ± 173 µg at 3 to 6 hours. Excre-tion of copper did not show a significant difference between the three agents.Conclusion: The difference in zinc excretion among the MR contrast agents re-flects in vivo transmetallation of the Gd chelate complexes and correlates withthe respective stability of the contrast agent. Gd-DOTA was found to be the mostkinetically inert among the three agents tested.

C-397Effect of contrast material pushed with saline solution using a dual injectoron enhancement of abdominal aorta, portal vein, and liver parenchyma inmultidetector row CT of the liverF. Tatsugami, M. Matsuki, H. Kani, I. Narabayashi; Takatsuki/JP

Purpose: To evaluate the effect of enhancement value of abdominal aorta, portalvein and liver parenchyma using a saline flush technique.Methods and Materials: One hundred and eight patients underwent 4DAS MDCTof the liver. The contrast material and saline solution were administered at a rateof 5 mL/sec. Double arterial phase images and the portal venous phase imageswere obtained after the injection of 100 mL of contrast material (300 mgI/ml) only(A) or with 50 mL of saline solution (B) or 100 mL of contrast material (350 mgI/ml) only (C) or with 50 mL of saline solution (D). We examined: 1) CT values ofthe abdominal aorta during the first arterial phase, 2) CT values of the portal veinduring the second arterial phase and those of the liver parenchyma during theportal phase, 3) The 3D-angiography of the hepatic artery at the first arterialphase and portal vein at the second arterial phase.Results: The mean enhancement of the abdominal aorta in (B) was greater by27.8 HU than that in (A), and that in (D) was greater by 23.1 HU than that in (C).Statistically significant increased enhancement of portal vein was demonstratedusing the saline flush technique. The enhancement of the liver parenchyma dem-onstrated no significant difference among the four groups. 3D-angiography dem-onstrated the hepatic artery and portal vein in more detail using the saline flushtechnique.Conclusions: CT arteriography and portography were improved using the salineflush technique.

C-398Low-high and high-low biphasic injection forms in CT examinations of theupper abdomenL. Martí-Bonmatí, E. Tobarra, E. Arana, S. Costa; Valencia/ES

Purpose: Our objective was to analyze the influence of different biphasic injec-tion rate protocols in abdominal CT.Methods and Materials: A double-blind, randomized, parallel group study wasdesigned and conducted in 60 patients without differences regarding gender,age and weight. All of them were studied with the same CT helical protocol. Pa-tients were randomly distributed into three groups: A) monophasic (120 mL at2.5 mL/s); B) low-high biphasic (120 mL, the first 60 mL at a rate of 2 mL/s andthe other 60 at 2.5 mL/s); and C) high-low biphasic (120 mL, the first 60 mL at arate of 2.5 mL/s and the other 60 at 2 mL/s). All the patients were injected, throughan antebrachial route, with 300 mg I/ml non-ionic contrast media. All CT scanswere obtained at the portal phase with a fixed delay time of 55 seconds. Contrastenhancement was evaluated by attenuation coefficients measurements at liver,inferior cava and portal veins, renal cortex, superior aorta and aortic bifurcation.Results: The biphasic protocols obtained statistically higher enhancement at theaortic bifurcation (Anova, p = 0.003). However, there was no other statisticallysignificant difference (Anova, p > 0.05) among the three protocols at the differentlevels. Although non- significative, enhancements following monophasic protocolwere always higher than those obtained with biphasic protocols, with the excep-tion of aortic bifurcation.Conclusion: Monophasic injection of contrast agents on helical CT of the upperabdomen gives higher enhancement of parenchymal and venous structures. Nosignificant difference was observed between low-high and high-low biphasic pro-tocols.

C-399New MR findings: Decrease of signal intensity of mymetrium after iv USPIOadministrationP. Paolantonio, A. Laghi, C. Miglio, R. Ferrari, F. Iafrate, I. Sansoni,R. Passariello; Rome/IT

Purpose: To evaluate diagnostic advantages of intravenous Sinerem administra-tion on T-staging of uterine carcinoma.Materials and Methods: Twelve patients, 10 referred for corpus uterine cancerand two with cervical carcinoma, underwent pelvic MR scan. All patients wereenrolled in a phase-III-study still in progress for the evaluation of Sinerem in lymphnode staging. GRE T2*W sequences (TR/TE/FA/matrix/acq. time: 1800 msec/15mesc/30°/230 x 512/13.51 min) were acquired on multiple planes before and 24hours after iv administration of 2.6 mg/kg/BW of Sinerem (Guerbet, Paris, France).Image analysis included qualitative and quantitative analysis of signal intensity(SI) of normal myometrium and neoplastic lesions before and after Sinerem ad-

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ministration. S/N and C/N were calculated. Modification of T-staging on Sinerem-enhanced-MR was also evaluated. Statistical analysis was performed using t-test (p < 0.05).Results: Qualitative analysis showed a significant decrease of SI of normal my-ometrium after Sinerem administration leading to a better lesion conspicuity.Quantitative analysis showed a statistically significant difference between SI ofmyometrium on plain and Sinerem-enhanced MR images assessed by means oft-test. C/N between lesion and normal myometrium significantly increased fol-lowing Sinerem administration. In four patients Sinerem-enhanced images pro-vided additional information leading to more accurate T staging.Conclusions: Intravenous injection of Sinerem provides a significant decreaseof SI of normal myometrium with higher C/N between neoplastic lesion and nor-mal myometrium. Sinerem-enhanced MRI provides better evaluation of myome-trial neoplastic invasion increasing the conspicuity of neoplastic lesions in patientswith endometrial and cervical carcinoma. Further studies are necessary in orderto realize the physiologic mechanism of myometrial uptake of Sinerem.

Molecular Imaging

C-400Quantitative 3D-reslicing essentially improves comparison of histologicalimages with radiological dataF.M.A. Kiessling, M. Le-Huu, T. Kunert, M. Thorn, S. Vosseler, K. Schmidt,W. Semmler, H.-P. Meinzer, N. Fusenig; Heidelberg/DE

Purpose: Verification of radiological methods with histology has always beendifficult due to poor correlation of slice thickness, orientation and confinement totwo dimensions. A method for a quantitative three-dimensional reslicing of histo-logical sections is introduced (Patent pending EPA03008877.7) permitting exactmatching of slice geometry. This will enable proper correlation with radiologicaldata.Materials and Methods: A subcutaneously grown Morrison-Hepatoma (rat) andHaCaTRas tumor (mouse) were examined by acquiring dynamic T1-weightedMR images and MR microangiography. The tumors were subsequently seriallysectioned (5 ìm slice thickness) and vessels stained with immuno-fluorescencemarkers. Slices were digitally captured with a microscope, assembled in the sec-tioning plane and co-registered in the vertical axis. A ray-tracing algorithm per-formed three-dimensional visualization allowing the virtual re-slicing of thehistological sections to create thick-slices (1.5 mm) in accordance with MRI slicegeometry. Thick-slices were processed as parameter-maps of marker volumedensity, giving information beyond the area density signal of immuno-fluores-cence images.Results: 3D-reconstructions of immuno-fluorescence images displayed diffuseangioarchitecture which is typical for malignant tumors. Resliced images revealedthe exact architecture of vessel structures seen on MRA. Also, large single ves-sels could be clearly delineated on reconstructions. Parameter maps of vesseldensity in virtual thick slices matched well with MR-parameter maps.Conclusion: The quantitative 3D approach to histology essentially improves cor-relation of histological and radiological data due to proper matching of slice ge-ometry. As this new method can be used with any histological stain, it provides atool for verification of new molecular imaging techniques by means of histology.

C-401Monitoring of tumor response to anti-angiogenic treatment by iron oxideenhanced MRIT. Persigehl, L. Matuszewski, A. Wall, R. Bieker, T. Kessler, W. Berdel,W. Heindel, R. Mesters, C. Bremer; Münster/DE

Purpose: To evaluate iron oxide enhanced MRI for non-invasive early detectionof tumor response to anti-angiogenic therapy.Materials and Methods: A human fibrosarcoma (HT 1080) was implanted innude mice and grown up to a size of 5-10 mm. Tumor bearing animals were intra-venously injected with a vascular targeting agent (VTA) inducing selective throm-bosis of tumor neovasculature (treatment group) or saline (controls) respectively.MRI (1.5 T) was performed using an ultrasmall superparamagnetic iron oxideagent (USPIO, SHU 555 C, Schering®) 4 hours after initiation of treatment. Ironoxide-induced change in R2* (∆R2*) was measured using a T2 w dual Echo-EPIsequence. ∆R2* values of tumor tissue were calibrated by ∆R2* of muscle fordetermination of the vascular volume fraction (VVF). Parametric ∆R2*-maps werecalculated for visualization of tumor perfusion patterns. Correlative immunhisto-chemistry was performed for assessment of the treatment effects in both groups.Results: ∆R2*-maps revealed a clear reduction of tumor perfusion in treatedanimals compared to controls. Anti-angiogenic tumor treatment resulted in anapproximate 80% decrease of iron oxide induced susceptibility effects. VVF wassignificantly reduced after injection of the thrombogenic peptide (2.18 ± 1.22%versus 0.43 ± 0.39%; p < 0.05). MRI results were confirmed by immunohistochem-istry showing extensive tumor thrombosis after treatment.Conclusion: Iron oxide-enhanced MRI using USPIO is a useful method for non-invasive early monitoring of tumor response to anti-angiogenic treatment. Withlong circulating iron oxides being available for clinical application, this techniquecan readily be adapted for patient use.

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C-402Optical cell tagging for in vitro and in vivo cell detectionA. Wall, L. Matuszewski, T. Persigehl, B. Tombach, W. Heindel, C. Bremer;Münster/DE

Purpose: Optical contrast techniques allow for high signal-to-noise ratio (SNR)in vivo and should therefore offer high sensitivity for cell migration studies. Thepurpose of this work was to assess membrane selective fluorochrome cell label-ling for in vitro and in vivo cell detection.Methods and Materials: Tumor cells were labelled with membrane selectivecarbocyanine fluorochromes (DiO, DiL and DiR, Molecular Probes, Inc, Eugene)operating in the green, red and near infrared spectrum. Cell viability and durationof label retention were studied in vitro. The detection threshold of labelled tumorcells was determined in a cell phantom in vitro and in a tumor xenograft model invivo.Results: All fluorochromes provided efficient cell labelling with SNR values be-tween 50-150 (5 x 105 cells). Viability of labelled cells was virtually identical tonon-labelled controls. Cellular fluorescence decreased with cell division but wasstill detectable beyond 8 mitotic cycles. As few as 5000 labelled cells could bedetected in vitro (10 sec acquisition). While DiO and DiL labelling only allowed forcell detection in subcutaneous tissue (2 mm) DIR-labelled cells could even bedepicted in deeper tissue sections (6-8 mm).Conclusion: Membrane selective cell tagging with lipophilic fluorochromes is aneffective procedure providing a stable optical cell label. Non - invasive monitoringof transplanted cells as well study of cancer spread in vivo can be envisionedusing this technique.

C-403Arthritis diagnosis by autofluorescence in an animal modelA. Hansch, D. Sauner, I. Hilger, O. Frey, M. Haas, R. Brauer, W.A. Kaiser;Jena/DE

Rationale and Objectives: The in vivo detection of arthritis by autofluorescenceusing an antigen-induced arthritis (AIA) model was investigated.Material and Methods: For autofluorescence investigations of joints, a mobilefluorescence-detector was designed consisting of a lens/mirror system attachedto a conventional spectrofluorometer and of optimized fiber optic cables leadingto and from the site of investigation. Measurements were performed in 7 arthriticand 7 healthy mice. 15 AIA- and 3 healthy mice were used for histological exam-inations.Results: At the exudative stage (day 1) of AIA, a decrease of fluorescence signalintensities (arbitrary units, a.u.) for excitation wavelengths of 300 nm (emissionat λ = 355 - 365 nm; mean signal intensity 11.8 ± 2.0 a.u.) and excitation at 360 nm(emission at λ = 475 - 485 nm; mean signal intensity 24.7 ± 3.2 a.u) were ob-served. Signals increased on day 7 (maximum of cellular infiltration; mean signalintensity 20.32 ± 7.59 for λexc = 300 nm and 52.97 ± 12.0 for λexc = 360 nm). Chron-ic inflammation (day 14 and 21) led to a signal decrease again. Signal intensitiesof NAD(P)H differed significantly (p ≤ 0.05) from controls at days 1 and 7.Conclusion: Arthritis influences autofluorescence signals in-vivo. The detectedexcitation/emission pairs can be assigned to collagen/elastin and NAD(P)H.Autofluorescence of NAD(P)H can be a helpful tool for detecting arthritis non-invasive and in real-time.

Genitourinary

Female

C-404MRI atlas of post surgical appearances for pelvic floor dysfunctionM. Pouquet1, B. Caire-Gana1, J. Villeval2, Y. Aubard1, J. Rouanet2,A.J.M. Maubon1; 1Limoges/FR, 2Montpellier/FR

Learning Objectives: To illustrate the usual appearances of the female pelvis atMRI before and after surgical procedures for correction of pelvic floor dysfunc-tion. To illustrate appearances of post surgical failures and recurrences.Background: Pelvic floor dysfunction in the female is a common condition, fa-vored by dystocia, menopause and ageing. The scope of interventions to treatpelvic floor dysfunction in its different compartments is rapidly expanding withnew surgical techniques and new materials. Magnetic resonance imaging, withstatic and dynamic sequences, is now commonly used in the preoperative as-sessment of the different pelvic compartments. More generally radiologists per-forming pelvic MRI are commonly faced with post surgical aspects. It is then ofutmost importance that radiologists be able to identify those post surgical normaland abnormal (failures and recurrences) patterns.Material and Methods: Through a prospective and retrospective review of 450pelvic MRI examinations performed before and after surgical treatment of pelvicfloor disorders, the authors identify and illustrate the normal and abnormal ap-pearances after a variety of treatments: Intravaginal devices, tension free vaginaltape with its various approaches (retro pubic, prepubic, trans obturator), suspen-sions, fixations, use of different types of meshes, surgical correction in the ante-rior, middle and posterior compartments.Conclusion: Post therapeutic magnetic resonance appearances of the femalepelvis are not well known; their recognition is essential for proper patient care.

C-405Postpartum uterus: What is normal? What is pathological? Evaluation withultrasound and CTI. Escape, J. Martinez, F. Bastart, L. Ortega, C. Solduga; Barcelona/ES

Learning Objectives: To know the normal findings, mean diameters and evolu-tive changes in postpartum uterus and uterine cavity, in early, middle and latepuerperium with ultrasound and CT. To differentiate them from pathological con-ditions.Background: The majority of postpartum patients undergo an unremarkable clin-ical course. A small percentage of patients develop serious complications in theabdomen and pelvis. Endometritis, the most common cause of fever in the post-partum period, complicates 2-3% of vaginal deliveries and up to 85% of cesar-ean sections. Post partum hemorrhage is most often caused by uterine atonyand retained products of conception, and complicates 1-2% of vaginal deliveries.Imaging Findings: In early puerperium, uterus is most often retroverted andempty with fluid and debris in the cervical area. Intrauterine cavity increases ondays 7-14 post partum with fluid and debris in the whole cavity and it may benormal to see an intracavitary echogenic mass. AP diameter of the uterus dimin-ishes progressively in 6-8 weeks. Endometrial gas is occasionaly visualized afternormal vaginal delivery in the immediate puerperium and disappears within 1-2weeks. It can be difficult to differentiate from endometritis, which can progress topelvic inflamatory disease. Endometrial stripe decreases during puerperium; if itremains thickened, complications such as retained products of conception orhypotonic uterus may be suspected. Doppler US can be useful for differentiatingbetween them. We describe these features with ultrasound and CT.Conclusion: It is important to recognize normal postpartum uteral findings inorder to differentiate them from pathological conditions.

C-406Pelvic floor dysfunction: Interest of MR imaging of ortheses and prosthesesJ. Villeval1, M. De Graef1, R. Guillon1, C. Courtieu1, A. Maubon2, J. Rouanet1;1Montpellier/FR, 2Limoges/FR

Learning Objectives: To display the MRI appearance in static and dynamic con-ditions of intra-vaginal device and post surgical procedures used for the treat-ment of pelvic floor dysfunction.Background: We retrospectively analysed 26 MR exams performed before andafter surgical treatment and 20 MR exams without and with intra vaginal device of23 patients with pelvic floor dysfunction: Urinary incontinence (Tension-free vag-inal tape n = 3, artificial urinary sphincter n = 4, intra vaginal device n = 10) andpelvic prolapse (intra vaginal device n = 2, promontofixation n = 2, prosthetic

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plaques Permacol and Polypropylène in recto-vaginal and uretro-vaginal walln = 2). MRI consisted of T2 turbo spin echo, T1 turbo spin echo and dynamicsingle shot sequences.Imaging Findings: We will show the MRI appearances of the devices in staticand dynamic conditions. Prosthetic plaques and Tension-free vaginal tape ap-pear as low signal intensity structures which are difficult to visualize compared topromontofixation, artificial urinary sphincter and intra vaginal device. MR imag-ing represents a good functional post operative evaluation for prosthetic plaquesand intra-vaginal device in pelvic prolapse with dynamic studies especially incases of suboptimal post treatment outcome.Conclusion: A radiologist involved in pelvic MRI should be aware of the varioussurgical treatments of pelvic floor dysfunction in order to avoid misinterpretationand evaluate their functional results. MRI allows detection of complications for abetter collaboration between radiologist and pelvic floor surgeon.

C-407Pathologies of the uterine endometrial cavity: Usual and unusualmanifestations and pitfalls on magnetic resonance imagingM. Takeuchi1, K. Matsuzaki1, S. Yoshida1, H. Nishitani1, H. Shimazu2,H. Uehara1; 1Tokushima/JP, 2Oe-gun/JP

Learning Objectives: To recognize usual and unusual magnetic resonance im-aging (MRI) findings of the uterine endometrial cavity with pathologic correlation.Background: The endometrial cavity may demonstrate a spectrum of imagingmanifestations ranging from normal, to that of a reactive, inflammatory, and be-nign and malignant neoplastic cause.Imaging Findings: Thickened endometrium or endometrial mass included be-nign endometrial hyperplasia or polyps, endometrial carcinomas or carcinosar-comas, and gestational trophoblastic diseases. Hyperintensity similar to theendometrium suggested rather benign hyperplastic lesions. Hyperplasia or pol-yps associated with adjuvant tamoxifen therapy tended to be large masses withcystic changes and prominent stromal proliferation. Myometrial thinning suggest-ed malignancy but was occasionally overestimated because of the fragility of themyometrium with adenomyosis. Submucosal leiomyoma with edematous changemay mimic endometrial mass, and demonstration of the continuity to the myo-metrium was the clue to its myometrial origin. Uterine sarcomas may involve en-dometrial cavity, and endometrial stromal sarcomas often showed endometrialmasses with characteristic myometrial invasion. Adenomyomatous endometrialpolyp may simulate endometrial stromal sarcoma due to arborescent smoothmuscle components which resemble the preserved bundles of myometrium with-in the tumor on T2-weighted images. Fluid collection in the cavity was well visual-ized on MRI to distinguish between hydro-, pyo-, and hematometra.Conclusion: To recognize various imaging findings of the uterine endometrialcavity; it is important to make a correct preoperative diagnosis to avoid unneces-sary or excessive surgical intervention and to preserve the fertility of the patients.

C-408Obstetric MRIR. Manfredi, B. Gui, M. Antoniol, T. Tartaglione, A. De Gaetano, P. Marano;Rome/IT

Learning Objectives: To evaluate the usefulness and accuracy of MR imaging indiagnosing fetal abnormalities in the 2nd and 3rd trimester of pregnancy.Background: 29 pregnant women underwent MR imaging because of abnormalfindings on sonography. The mean gestational age of the 30 fetuses was 29 weeks(range 21-38 weeks). MR imaging was performed with a 1.5 T unit using a phasedarray coil. Axial, coronal and sagittal half-Fourier RARE T2-WI were performedorthogonal to the body of the mother, with the following parameters: TR/TE ¥/95 msec, 6-8 mm thick, FOV 40 mm. Subsequently a series of images were per-formed, orthogonal to the fetal body, according to the clinical indication, with thefollowing parameters: TR/TE ¥/95 msec, 3 mm thick, FOV 33-35 mm. In 3 pa-tients diffusion-WI were performed on the CNS. All diagnoses were confirmedafter delivery by radiographic imaging, surgery or autopsy.Imaging Findings: Central nervous system: 5/30 myelomeningoceles, 2/30 in-tracranial hemorrhages, 3/30 partial or complete callosal agenesis, 4/30 ventri-colomegalies, 1/30 Dandy-Walker cyst, 1/30 intracranial extra-axial cystic tumor.Chest: 1/30 cystic adenomyomatoid hyperplasia of the lung. Abdomen: 3/30 re-nal disease, 1/30 subdiaphragmatic cyst. 9/30 fetuses did not show any abnor-mality.Conclusion: MR imaging is helpful to clarify diagnoses suggested by equivocalsonographic findings, and to obtain additional information for prenatal counselingand management.

C-409Differential diagnosis of the fluid collection in the female pelvis: Radiologic-pathophysiologic correlationK. Matsuzaki, M. Takeuchi, S. Yoshida, H. Nishitani, M. Harada, H. Uehara;Tokushima/JP

Learning Objectives: To demonstrate wide variations of the fluid collection inthe female pelvis with pathophysiologic correlation and evaluate the diagnosticclues to the differential diagnosis.Background: There are various situations with fluid collection in the female pel-vis. Although physiologic ascites is often observed in the reproductive era, otherpathophysiologic fluid collection with both benign and malignant conditions mayoccur.Imaging Findings: Mucinous ascites with organ scalloping in pseudomyxomaperitonei is characteristic. Hemorrhagic ascites, which shows high attenuationon computed tomography (CT) and is well visualized on magnetic resonanceimaging (MRI) may be observed with malignant tumors, adnexal torsion or rup-tured endometriosis. Lactate detection on magnetic resonance spectroscopy(MRS) may suggest its malignant condition. Non-neoplastic diseases such asovarian hyperstimulation syndrome, pelvic inflammatory diseases, endometrio-sis, adnexal torsion and massive ovarian edema may cause accompanying fluidcollection with adnexal enlargement. Benign tumors may cause ascites, such asMeigs' and pseudo-Meigs' syndrome, and malignant tumors may cause carcino-matous peritonitis with fluid collection. Ascites in postmenopausal woman is anunnatural finding and may suggest adhesion due to old inflammation or surgicalprocedure, or existence of hidden neoplastic disease. Ascites in a tumor-bearingwoman may suggest an advanced stage of disease with occult tumor implants.Localized fluid collection like peritoneal retention cyst is observed in adhesivepelvis after surgery, inflammation or endometriosis with characteristic contourshape.Conclusion: To evaluate the nature or biochemical components of ascitic fluid byMRI and MRS may be helpful for the differential diagnosis.

C-410Recurrent ovarian cancer: Patterns and spectrum of imaging findingsM. Moon, S. Kim, J. Cho, Y. Lee; Seoul/KR

Learning Objectives: To illustrate the spectrum of imaging findings of the recur-rent ovarian cancer.Background: Ovarian cancer is the most common cause of death among thegynecological malignancies. The treatment of ovarian cancer has traditionallybeen initial surgical staging and cytoreduction, followed by adjuvant chemothera-py. Then, a second look operation is performed to reassess the tumor status afterfirst line chemotherapy. Once pathological complete response is defined, themanagement of ovarian cancer depends on non-invasive methods such as serol-ogy and cross sectional imaging. On the follow-up evaluation, identifying patientswith minimal recurrent disease is important as it provides the best chance forcomplete clinical response and long-term survival following second-line chemo-therapy.Imaging Findings: Recurrent ovarian cancer usually manifests as local recur-rence, peritoneal seeding and nodal recurrence. Vaginal stump recurrence is themost common manifestation of the local recurrence. Peritoneal seeding presentsas ascites, peritoneal enhancement, peritoneal nodularity, and/or mesenteric in-filtration on cross sectional imaging. Nodal recurrence is most commonly seen inthe external iliac group, which is not the presumed site based upon anatomicstudies. Although hematogenous dissemination is less frequently seen in the re-current ovarian cancer, hepatic or pleuropulmonary involvement is a relativelycommon manifestation of hematogenous spread. The unusual manifestations ofhematogenous dissemination include metastases in the extrahepatic abdominalsolid organs, bone, central nervous system, and abdominal wall involving subcu-taneous fat or muscle.Conclusion: Familiarity with the patterns and spectrum of imaging findings ofrecurrent ovarian cancer will facilitate accurate diagnosis and prompt treatment.

C-411MR imaging features of cervical carcinomaS. Ford, C. Johnston, J. McCann, E. Laffan, M.T. Keogan; Dublin/IE

Learning Objectives: To illustrate the MR imaging features of cervical carcino-ma. To describe the correlation between imaging findings at MRI and pathologi-cal staging. To depict the spectrum of imaging findings of recurrent cervicalcarcinoma and of the wide range of complications caused by the disease.Background: MRI is the imaging modality of choice for the diagnosis and stag-

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ing of cervical carcinoma. The particular advantages of MRI over CT include itsmultiplanar imaging capability and its superior depiction of soft tissue planes.Accurate staging of cervical carcinoma at presentation is essential from the pointof view of prognosis and also for management planning, as patients who presentwith stage IIa or lower grade carcinoma proceed to surgery, and those with high-er grade tumours are treated primarily with radiotherapy. Recurrent disease isalso best depicted using MRI. Patients can present with or develop a wide varietyof complications as a result of their tumour and MRI can be of particular advan-tage in the investigation of local complications.Imaging Findings: This educational exhibit illustrates the MR imaging findingsof cervical carcinoma of all grades. We also demonstrate the MR imaging fea-tures of a wide variety of local and distant complications, including local invasion,fistula formation, small bowel obstruction and obstructive hydronephrosis.Conclusion: MRI is the imaging modality of choice for the diagnosis and stagingof primary cervical carcinoma. It is also of benefit for the investigation of diseaserelated complications and for the investigation of recurrent disease.

C-412CT and MR characteristics of solid epithelial tumors of the ovaryS. Kim, D. Yang, Y. Koh, H. Kim; Incheon/KR

Learning Objective: To know which subtypes of ovarian epithelial tumors canshow solid appearance. To illustrate characteristic CT and MR findings of thesetumors.Background: Epithelial tumors of the ovary are well known for their cystic nature.However, tumors of some subtypes of this entity can show solid appearance, andthe differentiation from other solid ovarian tumors (germ cell tumors, stromal tu-mors, or metastasis) is difficult in these cases.Imaging Findings: The most common is serous papillary carcinoma. These tu-mors can show totally solid appearance, but mainly solid mass with some cysticportions is more common. They have unique imaging findings especially on MRin that papillary masses with branching pattern are frequently accompanied byperitoneal seeding masses. Serous surface papillary carcinoma of the ovary, adistinct subtype of these tumors, is mainly located on the surface of the ovary.Sometimes normal ovaries can be found inside papillary masses on MR, which isa very unique and striking appearance. Brenner tumor and endometrioid carcino-ma are another subtypes of epithelial tumors that can show solid appearance.Extensive calcifications can be found in some solid Brenner tumors. Endometrio-id carcinomas are sometimes accompanied by endometrial pathologies includ-ing endometrial carcinoma.Conclusion: Knowing these characteristics can help make correct diagnosis onCT and MR, especially differential diagnosis with metastatic tumors.

C-413Wide spectrum of uterine leiomyomas MR imaging: Radiologic andpathologic correlationH.K. Kim; Seoul/KR

Learning Objective: To provide an in-depth review of uterine leiomyomas withtheir epidemiology, histopathology, clinical manifestations and the most up-to-date therapy. To describe radiologic feature of usual and unusual appearance ofuterine leiomyomas on MR image and histopathologic correlation. To discuss dif-ferential diagnosis of uterine leiomyomas from gynecologic and non-gynecologicdisorder.Background: Leiomyomas are the most common uterine neoplasm and are com-posed of smooth muscle with varying amounts of fibrous connective tissue. Im-aging features of uterine leiomyomas vary depending on tumor size, location,degeneration and other histologic findings, and specific types of unusual leiomy-omas. Uterine leiomyomas are classified as submucosal, intramural or subsero-sal. The common types of degeneration are hyaline (> 60% of cases), cystic,myxoid, red and hemorrhage. Degenerated leiomyomas have variable appear-ances on T2-weighted and contrast-enhanced images.Specific types of unusual leiomyomas include lipoleiomyoma and myxoid leiomy-oma, which have characteristic MR findings enough to differentiate from othergynecologic and nongynecologic disease.The differential diagnosis of leiomyomas includes adenomyosis, solid adnexalmass, focal myometrial contraction, and uterine leiomyosarcoma. The purpose ofthis exhibit is to provide in-depth review of epidemiology, histopatholoy, clinicalmanifestations and differential diagnosis. This exihibit will also reflect our experi-ence in radiologic evaluation of patients with leiomyomas, with emphasis on thetypical and atypical findings on pelvic MRI. Examples of unusual uterine leiomy-omas, pathologic correlation as well as the most up-to-date therapy will be in-cluded.

Conclusion: After interacting with this exhibit the radiologist will have enhancedunderstanding of uterine leiomyomas including histopathology and radiologic fea-tures.

C-414Experience of MRI in women with suspected and known endometriosis:A pictorial reviewR. Benamore, L. Grosvenor, A. Liddicoat; Leicestershire/UK

Learning Objectives: Review of imaging features in women with endometriosissince introduction of a 1.5 T Magnetic Resonance (MR) scanner. Women werereferred when they did not wish to undergo laparoscopy or where surgical inter-vention and visualisation was difficult.Background: Endometriosis affects women during the reproductive years be-tween 25 and 29, with an estimated prevalence of 5-10%. Presentation rangefrom pain (symptoms and severity do not correlate) to asymptomatic (diagnosedduring infertility investigations). Endometriosis (functional glands and stromaoutside normal endometrium) is characterised by deposits, endometriomas (cysts)and adhesions, commonly ovarian but is documented to involve any site withinthe peritoneum and extraperitoneum. MR is noninvasive with high sensitivity andspecificity, small foci appearing hyperintense on T1 and variable signal on T2weighted images. Endometriomas (> 1 cm) appear hyperintense on T1 and hy-pointensity on T2, with hyperintense foci on T2 dependant on age of haemor-rhage. Fat saturation sequences are essential to improve lesion conspicuity onT1. We reviewed all women referred for investigation of suspected endometrio-sis, and for evaluation of disease extent and sites (notably recto-vaginal pouch)in known cases of endometriosis.Procedure Details: Sequences used were axial T1, sagittal T2, axial oblique fatsaturation (tirm) and narrow section coronal T2 imaging. MR identified endome-triosis involving ovaries, bilateral thick walled and unilateral endometriotic cysts,extra-ovarian disease within peritoneum and soft tissue. Fibroids and simple ovar-ian cysts were common, with evidence of concurrent endometriosis.Conclusion: MR detected small foci of endometriosis outside of the ovaries. Therewas a high incidence of other gynaecological pathologies allowing early reviewand treatment.

C-4153D transvaginal sonography in uterine leiomyomas with hysteroscopic andpathomorphological correlationV. Gazhonova, K. Sokolskaya, T. Kurganskaya, A. Zubarev; Moscow/RU

Purpose: To determine the possibilities of 3D transvaginal (TV) sonography inpreoperative assessment of uterine leiomyomas and to correlate the findings withhysteroscopic, laparoscopic and macroscopic data.Method and Materials: 31 women with symptomatic uterine leiomyomas wereevaluated before myomectomy and hysterectomy. Multiplanar images of the uter-us were created in 3D TVS. Preoperative location of the leiomyomas, and inter-actions with uterine cavity, cervix and iliac vessels were assessed in each case.US results were compared with hysteroscopy in 6 pts, laparoscopy in 7, opensurgery in 5 and pathomorphology data in 13 pts.Results: Surgical management was changed after 3D TVS examination in 8 cas-es. 3D coronal images allowed better location of the submucous and centripetalleiomyomas especially in multiple closely lying fibromyomas. 3D TVS results cor-related with hysteroscopy in 91% (10/11) of cases vs. 64% (7/11). 3D PowerDoppler TVS provided precise evaluation of the pedunculated submucous andsubserous leiomyomas thus enabling adequate myomectomy. In comparison tomacroscopic data of the uterus, 3D TVS were superior to 2D TVS in differentia-tion of the type of leiomyomas in 92% vs. 69% of cases, and in assessment of theinteractions with the cervix in 100% vs. 62%. Multiplanar reconstruction of thecoronal planes on 3D TVS improved determination of the uterine cavity interactionswith large subserous-interstitial leiomyomas before laparoscopic myomectomy.Conclusion: 3D TVS is a useful complement to 2D TVS in preoperative assess-ment of leiomyomas. Accurate evaluation of the leiomyomas on 3D MPR candecrease the possibilities of intraoperative hemorrhage and uterine trauma.

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C-416Treatment of the symptomatic large and multiple uterine fibroids by uterineartery embolizationS. Speca, A.M. Costantini, C. Di Stasi, G. Tropeano, V. Summaria, P. Marano;Rome/IT

Purpose: To evaluate the potential usefulness of uterine artery embolization asan alternative to traditional surgery (hysterectomy or myomectomy) for the treat-ment of symptomatic large or multiple fibroids.Material and Methods: 38 premenopausal women, aged 33-55 years (meanage 42.7), who presented with menorrhagia, pelvic pain, and/or mass-relatedsymptoms due to large (< or = 12 cm) or multiple fibroids (> or = 3 cm) and wereunwilling to undergo surgery or had an increased surgical risk, underwent bilat-eral uterine artery embolization. Before embolization all pts underwent to a com-plete clinical examination, a basal FSH and estradiol dosage, a vaginal and ureteraltampon, a Papanicolau test, a trans abdominal and trans vaginal ultrasonogra-phy and color Doppler flowmetry. For embolization we used polyvinyl alcool par-ticles, Embosphere or Spongostan. Detailed clinical and ultrasound follow-up wereobtained at regular intervals (1-31 months).Results: The procedure was technically successful in 37/38 patients. A meanclinical follow-up of 14 months for pain, mass-related symptoms and menorrhagiawas done. 95% of the patients treated reported a marked to complete sympto-matic improvement. Only 1 patient experienced no changes in her symptoms.Nobody had immediate or late complications. A median reduction of 65% in theuterine volume and a median decrease of 78% in the dominant fibroid volumewere observed in 28 patients who had follow-up ultrasounds for up to 6 months.Conclusions: In our experience artery uterine embolization may provide an im-portant therapeutic alternative for women with symptomatic large or multiple fi-broids who desire to avoid surgery.

C-417How to conduct quantitative evaluation of uterine neoplasms using Gd-dynamic contrast-enhanced MRIK. Hayasaka, Y. Tanaka, T. Saitoh; Tokyo/JP

Objective: To conduct quantitative evaluation of uterine tumors using Gd-en-hanced dynamic MRI.Materials and Methods: 87 patients with 91 tumors underwent Gd-enhanceddynamic MRI with a Magnetom Vision using 3D-FLASH (20 s) before and threetimes (30, 50, 70 s) after a standardized bolus of Gd-DTPA. For quantitative pa-rameters, the following were examined by a consensus of two radiologists: ER(enhancement ratio) 1: (SI1-SI0)/SI0, ER2: (SI2-SI0)/SI0, ER3: (SI3-SI0)/SI0, ER2-1: ER2-ER1, ERmax, SAT: SI1/SI max. Analysis of variance was used to identifysignificant differences in quantitative parameters among tumors.Results: The tumors were specified as leiomyoma (38) (T2w-hyper [LM-hyper]:11, T1w-hypo [LM-hypo]: 27), leiomyosarcoma (LMS)(7), adenomyosis (ADM)(3),fibromyoma (FM)(1), cervical squamous cell carcinoma (SCC) (17), endometrialadenocarcinoma (EC) (18), postmolar gestational trophoblastic disease (GTD)(6), malignant melanoma of the cervix (MM) (1). The types of dynamic curveswere early enhancement and washout (GTD, MM), early enhancement and nowashout (EC, SCC, LMS), delayed enhancement (LM-hyper, LM-hypo, ADM, FM).In these tumors, there were statistically significant differences in various param-eters between the following tumors (p < 0.05): GTD vs other tumors (ER1, ER2,ER3, ER2-3), SCC vs EC (ER3), SCC vs LM-hyper (ER2-3), SCC vs LM-hypo(ER1, ER2, ER2-3, SAT), EC vs LM-hyper (ER2-3), EC vs LM-hypo (ER2-3, ER1-3, SAT), EC vs LMS (ER1), LM-hypo vs LMS (ER1, ER2-3, ER1-3, SAT).Conclusion: Analysis of various parameters using Gd-enhanced dynamic MRIwith 3D-FLASH technique was useful to determine the characteristics of uterinetumors. However, the usefulness was limited to make differentiation among myo-genic tumors of the uterus.

C-418The usefulness of dynamic MR imaging in evaluation of cervical cancer andadequate enhancing timeJ.-H. Yoon, S.-S. Cha, Y.-M. Park, Y.-J. Lee, S.-S. Han; Busan/KR

Purpose: For the evaluation of usefulness of dynamic MR imaging in assessingtumor visualization and parametrial invasion of cervical carcinoma and adequateenhancing time.Materials and Methods: 53 women with histopathologically proved cervical car-cinoma underwent preoperative T2-weighted fast spin-echo, dynamic imagingusing gradient-echo and postcontrast T1-weighted spin-echo MR imaging with aphased-array surface coil. The axial plans in each sequence were reviewed atseparate sessions by three radiologists blind to the histopathologic data.

Results: For the conspicuity of tumor, dynamic and T2-weighted images showedhigh detectability more than postcontrast T1-weighted images. Most appropriateenhancing time in dynamic study was 90 seconds. In assessing parametrial inva-sion, the accuracy of T2-weighted, dynamic and contrast-enhanced T1-weightedMR imaging was 76.1%, 79.9% and 78%, respectively; no statistically significantdifference was observed.Conclusion: Dynamic imaging is useful in assessing tumor visualization, andthe most adequate enhancing time in dynamic study is 90 seconds. But in diag-nosis of parametrial invasion, the addition of dynamic MR images does not im-prove the accuracy compared with T2-weighted images alone.

C-419Magnetic resonance imaging patterns of recurrent cervical carcinomaS. Babar, A. Goode, A. Rockall, R. Reznek; London/UK

Purpose: MRI appearances of recurrent cervical carcinoma may be difficult torecognize due to treatment effects. We aim to describe the patterns of recurrentcervical carcinoma on MRI following treatment.Methods: Patients with recurrent cervical carcinoma, between 1996 and 2003,were identified. MRI was available in 45 patients (mean age 49.5 years). Tworadiologists reviewed images, by consensus.Results: Recurrence was confirmed histologically (16), on clinically progressivedisease (8) or patient death (21). 15 patients had undergone previous surgery(14 radical hysterectomy, 1 trachelectomy). 30 patients had non-surgical treat-ment (chemo and/or radiotherapy). A recurrent mass was identified in 45 patients(mean size 5 cm, 1.4-9 cm). On T2W, the recurrence was hyperintense in 87%. Inthe post-surgical group, the recurrence was in the vaginal stump in 12 patients(80%) with parametrial involvement in 13 (87%). In the non-surgical group, therecurrence was in the cervix in 20 patients (67%) with involvement of vagina in57% and uterus in 40%. Uterosacral ligament and/ or pelvic sidewall involvementwas present in 18 patients (40%). Bladder invasion was suspected in 22% andrectal in 20%. Nodal enlargement was seen in 53%. Bone metastases were presentin 4 patients while 13 had DXT changes (3 sacral insufficiency fractures). Recur-rence in the pelvic muscles was also seen.Conclusion: Recurrent disease in patients with cervical carcinoma usually in-volves the cervix or vagina, however can present with varied manifestations. Knowl-edge of the site and pattern of disease recurrence can help in early and accuratedetection of recurrence.

C-420Hysterosalpingography: Is still useful in the diagnosis of peritubalpathology?S. Deftereos, J. Manavis, G. Alexiadis, G. Kafetzis, P. Prassopoulos;Alexandroupolis/GR

Purpose: To reevaluate the role of hysterosalpingography in the diagnosis ofadhesions related to infertility and in patients managment.Materials and Method: 54 consecutive patients with more than two years infer-tility underwent hysterosalpingography (HSG), followed by laparoscopy. Patientswith infertility related to uterine abnormality were not included. Diagnosis of per-itubal adhesions was based on the presense of the following six imaging find-ings: Convoluted tubes, vertical tubes, loculation of contrast medium in peritoneum,halo effect, ampullary dilatation or fixed laterodeviation of the uterus.Results: In total, 92 tubes were delinated. No abnormality was detected in 7tubes on both HSG and laparoscopy. Laparoscopy disclosed adhesions in 51tubes. Diagnosis of adhesions was made in 46 tubes (18 correct, 28 false posi-tive), when the presence of one abnormal sign on HSG was considered as crite-rion; and in 40, when two or more signs are present (33 correct, 7 false positive).Ten live births five to eight months after hysterosalpingography occured.Conclusions: Accurate diagnosis of adhesions on HSG requires the presenceof at least two abnormal signs. The six-month interval between HSG and laparos-copy might be shortened when adhesive peritubal involvement is radiologicallysuspected. Laparoscopy is less indicated when no abnormality is detected onHSG.

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Kidney

C-422Radiologic-pathologic correlation of different macroscopic and microscopiccomponents in solid and cystic renal tumoursE. Quaia, M. Belgrano, L. Calderan, S. Cernic, G. Tona, R. Pozzi Mucelli;Trieste/IT

Learning Objectives: To describe different macroscopic and microscopic com-ponents observed in solid and cystic renal tumours which present a correlationwith imaging procedures.Background: The identification of macroscopic and microscopic features in re-nal tumours is essential for correct characterization. Macroscopic features suchas site, morphology, margins, pseudocapsule, gross necrotic and cystic changespresent a clear impact on staging and therapeutic approach. Microscopic intratu-moural components, often commisted, present a more complex correlation withultrasound (US), computed tomography (CT) and magnetic resonance imaging(MRI). Different microscopic intratumoral components: 1) Cellular (high cellulari-ty and high nucleus cytoplasm N/C ratio with low quantity of extracellular matrix;mid or low cellularity, mid or low N/C and high quantity of extracellular matrix); 2)Stromal (fibrotic, fibrovascular, fibromyxoid); 3) Necrotic (coagulative, colliqua-tive, haemorrhagic); 4) Vascular related to neoangiogenesis; 5) Calcific; 6) Adi-pose; and 7) Cystic, may be identified on the basis of their appearance on US, CTand MRI.Procedure Details: In 26 solid renal tumours, 21 malignant (15 clear cells, 3papillary cells and 2 granular cells type and 1 sarcomatoid carcinoma) and 5benign (3 angiomyolipomas and 2 oncocytomas); and in 15 cystic renal tumours,10 malignant (5 clear cells and 5 papillary cells type) and 5 benign (multilocularcystic nephroma), the radiologic-pathologic correlations of different macroscopicand microscopic patterns are shown.Conclusion: Different macroscopic and microscopic intratumoural components,both in benign and malignant, solid and cystic renal tumours, showed correlationwith imaging.

C-423Urinary tract neoplasms: Multi-detector row computed tomographic (CT)urography evaluationG. Cardone, P. Mangili, D. Fiecchi, A. Cestari, G. Balconi; Milan/IT

Learning Objectives: To evaluate multi-detector row CT-urography for detectionof urinary tract neoplasia. To illustrate CT-urographic patterns of neoplasia of thecollecting system.Background: Conventional excretory urography and conventional computed to-mography (CT) were considered the standard techniques used to examine pa-tients with urinary tract neoplasia. Multi-detector row CT offers high speed ofacquisition and high resolution images, allowing axial and 3D urographic acquisi-tions.Imaging Findings: 15 pts with transitional cell carcinomas were analysed. Allpatients underwent unenhanced and post-contrast CT axial scans, followed by aurographic acquisition in the excretory phase (2 mm collimation, 1.5 mm recon-struction interval). 3D reconstructions of excretory phase images were createdwith on an independent workstation using a MIP algorithm. Neoplastic lesionswere visualised as solid papillomas in 3/15 cases, as wall thickening of the col-lecting system in 11/15 cases and as solid tissue in the renal sinus in 1/15 case.Lesions were more evident on the source axial images of the excretory phaseurographic acquisition. In the post-contrast images, the lesions resulted quitevascularized. Urinary tract dilation was evaluated in 13/15 patients. Dilation wasbetter evaluated on the 3D MIP CT-urographic images in the case of normal renalexcretory function and on the source axial images of urographic acquisition inthe case of functionally excluded kidneys.Conclusion: CT-urographic axial and 3D images combined with conventional CTimaging allowed good evaluation of urinary tract neoplasia. The more frequentpattern was the wall thickening of the collecting system (74% cases), associatedto urinary tract dilation (87% cases).

C-424Renal lesions treated with laparoscopic cryoablation (LC): MRI patternsG. Cardone, P. Mangili, C. Iabichino, A. Cestari, G. Balconi; Milan/IT

Learning Objectives: To demonstrate the spectrum of MR findings of renal le-sions treated with LC. To illustrate the evolution over time of the signal intensities

of renal lesions treated with LC. To demonstrate the more significant MR criteriaof absence of recurrence in the follow-up of renal masses treated with LC.Background: LC is a minimally invasive surgical technique for patients with smallrenal masses; MR provides an effective tool for imaging follow-up of renal lesionstreated with LC.Methods and Materials: 32 pts with 41 renal masses underwent renal LC. Allpatients underwent follow-up MRI 24 hrs after surgery, and at 1, 3, 6 and 12months. MR examinations were performed using GRE T1w, TSE T2w and ce FS-GRE T1w sequences. Two radiologists reviewed MR images for i) signal intensity,ii) size, iii) vascularization, and iv) perinephric changes after treatment.Imaging Findings: a) T1w images showed 25 isointense cryolesions, and 16cryolesions isointense to renal parenchyma with hypo- or hyper-intense foci. OnT2w images all cryolesions were hypo-intense with iso- or hyper-intense foci; b)24 hrs after treatment all cryolesions were more than 1 cm larger than the origi-nal masses; cryolesions decreased in size of an average of 38% at 1 month, 46%at 3, 64% at 6, and 80% at 12 months; c) ce-FS-GRE T1w images showed com-plete ischemia of cryolesions in 38 cases; d) 6 cases showed a perinephric hae-matoma at 1, 3 and 6 months.Conclusion: The more significant MR pattern in the follow-up of renal lesionstreated with LC were the decrease in size of the cryolesions over time and thecomplete ischemia of the cryolesions.

C-425Percutaneous nephrostomy: Our experienceJ. Quintero1, S. Ruiz1, E. Alba1, M. Cos1, C. Pozuelo2, F. García1; 1Hospitaletde Llobregat/ES, 2Badalona/ES

Learning Objectives: To present our experience with percutaneous nephrosto-my and to discuss the role of percutaneous nephrostomy in the urinary obstruc-tion. To summarize the possible and potential indications of nephrostomypercutaneous and to describe our experience with guidance radiology mecha-nisms.Background: From March 1999 to July 2003 we attempted 190 consecutive per-cutaneous nephrostomy (18 bilateral) in 140 patients (59 females, 81 males) withan average age of 62 years. The causes for obstruction were: Malignant obstruc-tion (94), obstructing stones (47), benign obstruction (24), not obstructed (7) andtransplanted kidneys (18).Procedure Details: We used ultrasound-guidance in 139 cases and CT-fluoros-copy-guidance in 51 cases. The technique was standard Seldinger. Most patientsreceived 6- or 10 F. nephrostomy catheters. We had 10 access failures, usually inpatients with nondilated systems. We encountered 5 major complications (bleed-ing and two big urinomas) and only 20 minor complications. Catheter dislodge-ment was relatively frequent (32 cases).Conclusion: Urinary diversion at renal level is necessary in the following clinicalsituations: As short-term palliation in a terminal case, as a temporary measureprior to definitive diversion, to relieve obstruction where immediate surgical inter-vention is not feasible and for prolonged drainage where surgical intervention isnot indicated. Since its first description in 1955, percutaneous nephrostomy hasdeveloped into a technique that is now routinely used for a wide range of clinicalapplications.

C-426MR urography with VIBE 3D sequence: All in one examR.C. Domingues, A.C. Coutinho, P.A. Daltro, L.H. Da Cruz, R.C. Domingues;Rio de Janeiro/BR

Learning Objectives: Illustrate a complete approach to the urinary system inone exam.Background: MR urography with VIBE 3D sequence can demonstrate in oneexam the anatomy, with multi-planar imaging and high soft tissue contrast; arteri-al and venous angiography; detailed information about urinary tract, detectingthe level and extension of the obstruction; characterization of renal lesions; pre-operative staging of malignant tumors, like metastatic lymph nodes and venousinfiltration; urinary system function, concentration and excretion of the kidneys.VIBE 3D sequence can also be used to perform virtual endoscopy of the urinarytract and vascularity. MR urography was performed in 48 patients. The techniqueand indications are described and illustrated.Procedure Details: MR imaging was performed in 1.5 T scanner (MagnetomVision, Magnetom Maestro Class with iPAT capability, Siemens) with phased-array body coil. Intra-venous (I.V.) administration of furosemide (0.1 mg/Kg) wasperformed before examination. After the I.V. application of a bolus of 0.1 mmol/Kg of gadopentetate dimegume DPTA (30 mL medium), images were obtained inthe arterial, venous and excretory phase. The images were postprocessed at the

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workstation with maximum intensity projection, maximum projection reformata-tion and volume rendering technique reconstructions.Conclusion: The complete approach to kidneys, arteries and veins was suc-cessful in all patients and the urinary tract 90% of the them.

C-427Imaging of angiomyolipoma focused on the clinical issuesK.-S. Cho, Y. Jung, S. Kim, J. Kim; Seoul/KR

Learning Objectives: To discuss the role and findings of US, CT and MRI in thedetection and diagnosis of angiomyolipoma. To discuss the complication of angi-omyolipoma and confusion in differentiation from other malignant neoplasm. Todiscuss the clinical issues of angiomyolipoma including the natural history con-cerning growth, efficacy of biopsy for diagnosis, and association with tuberoussclerosis.Background: Angiomyolipoma is the most common benign neoplasm of the kid-ney and consists of mature adipose tissue, smooth muscle and thick-walled bloodvessels derived from perivascular epithelioid cells. Although most angiomyolipo-mas are asymptomatic and cause no problem, some cases raise important clin-ical issues. (1) Angiomyolipomas may be complicated by risk of hemorrhage andcause confusion in differentiation from malignant neoplasm when they containminimal amount of fat. (2) Angiomyolipomas are often related with the stigmata oftuberous sclerosis. (3) The natural history of this benign neoplasm has been con-troversial, with regard to growth on follow-up images. (4) The efficacy of biopsyfor diagnosis is controversial when image findings are indeterminate.Procedure Details: In this illustration, we evaluate the role and findings of ultra-sonography, computed tomography and magnetic resonance imaging in the de-tection and diagnosis of angiomyolipoma. Discussion will be focused on theimportant clinical issues.Conclusion: Multi-detector row CT is the most accurate diagnostic modality forevaluation of angiomyolipoma especially in cases with minimal amount of fat intumor or associated with complication. MR can differentiate minimal fat angiomy-olipoma from small renal cell carcinoma.

C-428Characterization of small renal masses incidentally found on CTH.-J. Jang, M.E. O'Malley, M.A. Haider; Toronto, ON/CA

Learning Objectives: To understand the criteria used to categorize renal mass-es found on CT.To understand how to further characterize incidentally detected renal massesfound on CT by using the appropriate modality with optimal techniques.Backgrounds: Due to advances in CT technology and its wide spread use forimaging a variety of abdominal conditions, small renal masses are being inciden-tally detected more frequently on CT. Since at least half of renal cell cancers aredetected incidentally by imaging, the cost and time for further imaging of smallrenal masses may increase. In addition, some renal cell cancers may be cysticand it is important to have a strategy for dealing with cystic renal lesions that donot meet the CT criteria for simple cysts.Imaging Findings: We will discuss and show a variety of small incidental renalmasses detected on unenhanced and single phase contrast-enhanced CT. Top-ics discussed will include the following: CT criteria for distinguishing lesions thatdo not need further imaging for characterization from lesions that require furtherimaging for characterization; technical considerations affecting imaging findings;updated Bosniak classification for cystic lesions; pitfalls in interpretation; and analgorithmic approach for "indeterminate" masses by using ultrasound, dedicatedrenal CT, MRI, or percutaneous biopsy.Conclusion: The majority of small renal masses incidentally found on CT can becharacterized or managed through an appropriate diagnostic pathway.

C-429Color-duplex imaging (CDI) and magnetic resonance angiography (MRA) inreno-vascular diseaseL. Olivetti1, G. Rozzi1, P. Pecchini1, P. Ravani1, L. Grazioli2, E. Botturi2,I. Moraschi2; 1Cremona/IT, 2Brescia/IT

Purpose: To compare color-duplex imaging (CDI) and magnetic resonance ang-iography (MRA) as screening tests of reno-vascular disease (RVD) which is apotentially treatable cause of hypertension and/or kidney disease.Materials and Methods: 42 of 152 consecutive patients referred for suspectedRVD received both CDI and MRA before angiography (gold standard technique).Likelihood ratios (LR+, LR-) and accuracy based on specificity and sensitivitywere calculated. Logistic regression was used to test the predictive role of CDI

and MRA versus angiography and - 2 Log likelihood statistics was calculated tocompare the badness of fit of the models. Different cut-off levels of renal arterystenosis were selected: > 40% for diagnosis of RVD and ≥ 60% for indication tostenting.Results: In renal artery stenosis > 40% the accuracy, LR+ and LR- of CDI andMRA were 91 and 94.9%; 10 and 10.6; and 0.09 and 0.04, respectively. In steno-sis ≥ 60% the accuracy, LR+ and LR- of CDI and MRA were 83.3 and 91%; 3 and11.1; and 0.03 and 0.1, respectively.Conclusions: CDI and MRA performed similarly in the diagnosis of RVD. MRAshowed the highest LR+ in all cases and a better goodness of fit of the model ascompared to CDI (p < 0.001). CDI had a low LR- particularly in patients withindication to renal artery stenting. CDI appears useful as first screening test aswell as during follow-up of patients with stenosis < 60%.

C-430Contrast-enhanced MR angiography with parallel imaging after renaltransplantationH. Gufler, L. Reiner, R. Weimer, A. Breithecker, W.S. Rau; Giessen/DE

Purpose: To test the reliability of contrast-enhanced MR angiography in detect-ing stenoses of the renal allograft artery after renal transplantation.Patients and Methods: 57 patients from one dialysis center underwent kidneytransplantation between October 2001 and July 2003. Contrast-enhanced MRangiography using the BolusTrack technique (real-time imaging) and parallel im-aging, was performed on a 1.5 T system and with a phased array body coil for allpatients 10 to 25 days after transplantation. MR-images were analyzed on theoriginal data sets and reconstructed images. In 7 patients with hemodynamicallyrelevant changes in the arterial vessels on MRA, digital subtraction angiography(DSA) was performed.Results: In 7 of 57 patients, severe changes of the allograft artery was diag-nosed with MRA. In 4 patients, diagnosis of either severe stenosis or dissectionwas confirmed by DSA. In 1 patient DSA showed moderate stenosis; however,transstenotic pressure difference measurements were not significant. In 2 pa-tients, moderate stenoses detected by MRA turned out to be mild on DSA. In 22patients, MRA showed mild narrowing of the vessel at the anastomotic regiondue to tissue swelling. The follow-up of patients with normal MRA and those withmoderate swelling on the anastomosis was uneventful with the exception of 2patients who developed chronic graft nephropathy/rejection.Conclusion: Immediately after renal transplantation, swelling of the arterial anas-tomosis is a common finding. Although there is a tendency to overestimate mod-erate and severe stenoses, the results from contrast-enhanced MRA are reliable.

C-431Laparoscopic cryoablation of small renal cell carcinoma: Medium termoutcome.G. Cardone, P. Mangili, A. Cestari, G. Balconi; Milan/IT

Purpose: To determine safety and efficacy of laparoscopic cryoablation in themanagement of small renal cell carcinoma and to assess its medium term out-come.Methods and Materials: 27 patients underwent laparoscopic cryoablation of 29tumors between July 2000 and June 2003. All treatments were delivered underlaparoscopic US guidance. Patients were followed up clinically, biochemicallyand by MR imaging 24 hrs after surgery, and subsequently at 1, 3, 6, 12, 18 and24 months.Results: 24 hrs after treatment all cryolesions were more than 1 cm larger thanthe original masses; cryolesions decreased in size by an average of 38% at 1month, 46% at 3, 64% at 6 and 80% at 12 months following cryoablation. Earlypost-procedure MR images showed complete ischemia of all cryolesions. Fol-low-up (mean 16 months) revealed no evidence of recurrence in 24/27 patients.One patient showed local recurrence at 12 months, one patient demonstrated anmetachronous nodule in the same kidney at 12 months and another patient showeda pancreatic metastatic nodule at 6 months. No significant rise in creatinine wasnoted post-procedurally. After surgery, retroperitoneal effusion was found in allcases; 6/29 cases showed an intralesional haematoma, 28/29 cases showed lowsignal intensity foci due to haemostatic material and 3/29 cases showed a perile-sional haematoma at 1 and 3 month follow-up.Conclusions: Our medium term experience suggests that laparoscopic cryoab-lation is a safe, well tolerated and minimally invasive therapy for small renal cellcarcinoma, and MR is an effective imaging technique in the follow-up of renallesions treated with laparoscopic cryoablation.

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C-432Percutaneous real-time ultrasound-guided renal biopsy (USGPRB): Ourexperience in native and transplanted kidneysR. Gil Marculeta, I. Gonzalez Crespo, O. Cosín Sales, E. De Luis, A. Benito,M. Elorz; Pamplona/ES

Purpose: To show our experience at USGPRB using a different approach toobtain specimens. We discuss technical aspects and advantages, comparing re-sults between native and transplanted kidneys.Methods and Materials: We reviewed results of USGPRB performed from Jan2000 to Dec 2002, in transplanted and non transplanted kidneys. We performed130 biopsies (38 in native kidneys and 92 in renal allografts). The technique usedwas with patient in supine position, local anaesthetic and making 2-3 passes withan 18 G automatic biopsy gun (Biopince, Sollentuna, Sweden). We show the bi-opsy procedure, and correlation with ultrasound findings, pathologic results andcomplications.Results: Echographic findings postbiopsy were normal, or with loss of cortico-medullary differentiation, enlargement and gross edema. Clinical indication intransplanted kidneys was deranged renal function, and in native kidneys, neph-rotic syndrome. Acute rejection was the most frequent diagnosis in transplanted,and focal glomerulosclerosis in non transplanted kidneys. We observed 17 cases(13% of all procedures) of postbiopsy complications (5 haematomas, 5 perirenalcollections, 3 decreased vascularization, 2 arterio-venous fistulaes and 2 de-ranged renal function), but none of them were significant. 3 of them (7.8%) werein native kidneys, and the remaining 14 cases (18.59%) were in renal allografts.Conclusion: We show an alternative way to perform the procedure in order tominimize patient risks and maximize results. We conclude that complications maybe more frequent in renal allografts than in native kidneys.

C-433The complex preoperative assessment of patients with renal masses withcomplex MRI-studyI. Platitsyn, E. Zaytseva, A. Zubarev, V.V. Gazhonova; Moscow/RU

Purpose: To study possibilities of complex MRI-study in patients with renal massesin preoperative planning of renal surgery.Material and Methods: 30 patients with renal masses detected by US were eval-uated with complex MRI-study. Complex MRI-study included MRI before and af-ter CE, 3D CE-MRA and 3D CE-MRU using fast 3D MRA GRE sequence wereperformed with 1.0 T system (Magnetom Harmony, Siemens). DSA was used asdiagnostic correlation as a gold standard. The obtained MR-data were comparedwith the results of surgical operation and histopathology.Results: The renal tumors were identified with MRI-study in 26 patients; 4 pa-tients had cystic lesions. Hypervascular masses were found in 20 patients, hy-povascular masses in 6 patients. In one cases of cystic lesion detected withMRI-study the patient had hypovascular cysto-solid masses. Next, renal vascularvariants were revealed: Unilateral ARA were detected with 3D MRA in 9 cases,with DSA in 10 cases; Bilateral ARA - in 2 and 2 cases (consequently); tripleunilateral ARA - in 1 and 1cases (consequently); multiple ARA - in 1 (4 arteries)and 1 (5 arteries) cases (consequently); the sensitivity of 3D CE-MRA was 92%.3D CE-MRU provided high-quality images of the urinary tract in all cases. MR-study showed an almost complete correlation with results of operative treatment,histopathology and DSA.Conclusion: Complex MRI-study allows noninvasive preoperative assessmentof renal tumors localization, morphology and vascularisation, renal arterial sys-tem, renal parenchyma, urinary tract and perirenal region. It is valuable for plan-ning of renal surgery.

C-4343D MR urography of obstructive renal transplantsE. de Kerviler1, P. Bourrier1, F. Martinez1, A.-M. Zagdanski1, A. Stemmer2,J. Frija1; 1Paris/FR, 2Erlangen/DE

Purpose: To compare breathhold 2D MR urography techniques (HASTE, RARE,TruFISP) with free-breathing 3D turbo spin echo sequences in renal transplantrecipients.Material and Methods: MR urography was performed in 15 patients with dilata-tion of the renal transplant cavities. The examination included single thick-sliceand multiple thin-slice breathhold RARE sequences, a multislice breathholdHASTE sequence, a multislice breathhold TruFISP sequence and a 3D free breath-ing turbo spin echo sequence. This sequence is a high-resolution (1.5 mm-thickslices, 384 matrix, voxel size = 1 x 1 x 1.5 mm3) heavily T2-weighted (restoremagnetisation pulse) sequence.

Results: In all cases, the 3D free-breathing sequence was superior to the breath-hold RARE sequences in terms of spatial resolution, with equivalent contrast,and without significant motion artifacts. As a result, the level and length of sten-oses were always better demonstrated with the 3D sequence than with the breath-hold RARE sequences. MIP reconstructions allowed analysis of the entire urinarytract with different projections. The duration of the 3D sequence (3 minutes) wascomparable to the overall duration of the RARE sequence, which requires sever-al slice positioning to explore the entire urinary tract. Less T2-weighted sequenc-es (HASTE and truFISP) were superior to 3D sequences to analyse the cause ofobstruction, as they visualised the ureteric wall and the adjacent structures.Conclusions: The 3D turbo spin echo sequence is robust and especially usefulin case of tortuous ureters. This sequence has now replaced the RARE sequenc-es in our protocol. HASTE and TruFISP sequences remain useful to analyse theureteric wall and the adjacent structures.

C-435Prenatal ultrasonographic findings of multicystic dysplastic kidney:Emphasis on cyst distributionM. Moon, J. Cho, M. Song, Y. Lee; Seoul/KR

Purpose: We retrospectively analyzed multicystic dysplastic kidneys to evaluatethe prenatal sonographic characteristics, emphasizing the distribution of cysts.Methods and Materials: A total of 43 cases was included in this study. The sono-graphic assessment included the site of the involved kidney, the size of the mul-ticystic dysplastic and the contralateral normal kidney, the distribution of cysts,and associated anomalies. According to the distribution of cysts, multicystic dys-plastic kidneys were categorized as subcapsular and random distribution, andinterobserver agreement was determined using cross table analysis. The largestlongitudinal diameters of the multicystic and the contralateral normal kidney weremeasured and data were plotted on the normal reference chart.Results: Multicystic dysplastic kidney was left sided in 55.8%, right sided in 34.8%and bilateral in 9.3%. Subcapsular distribution of cysts was observed in 68.2%(n = 15) for radiologist 1, 59.1% (n = 13) for radiologist 2. Interobserver agree-ment was excellent (k = 0.697). The longitudinal diameter of the multicystic dys-plastic kidney was above the 95% in 68% and that of the contralateral normalkidney was normal in 70%. There were major anomalies in 2 cases and fetalkaryotyping was offered in 18 cases including 2 cases with associated majoranomalies. The results were always normal.Conclusion: Subcapsular distribution of cysts in multicystic dysplastic kidney ismore common than random distribution, so the distribution of cysts may be help-ful in the prenatal diagnosis of multicystic dysplastic kidney.

C-436Vesicoureteral reflux and kidney transplantation in adult recipient:A comparison between the imaging modalities for the diagnosis and thesurgical approachA.-L. Valentini, A. De Gaetano, L. Minordi, G. Nanni, F. Citterio, C. Destito;Rome/IT

Purpose: To compare voiding urosonography (VUS) with voiding cystourethrog-raphy (VCUG) in the diagnosis and grading of vesicoureteral reflux (VUR) in trans-planted adult patients who received a transvesical (Politano-Leadbetter, PL) oran extravesical (Lich-Gregoire, LG) antireflux technique for the ureteral implanta-tion. To verify what surgical approach was most frequently related to VUR.Methods and Materials: 37 patients transplanted according to PL (18) or LG(19) were included on the basis of previous urinary tract infections (UTI) and thetime after the transplant. Exclusion criterion was a current UTI. VUS was per-formed by an injection of saline and Levovist® suspension. Diagnosis of VUR byVUS was assessed by two sonologists in consensus. Two radiologists in consen-sus evaluated VCUG findings. VUS and VCGU results were compared by a con-tingency table. Agreement between VUS and VCGU was determined by Kstatistics.Results: Using VCUG, VUR was diagnosed in 15 patients while no VUR wasfound in 22. VUS agreed with VCUG in 14 patients with VUR and in 21 withoutVUR. VUS sensitivity and specificity were 93% and 95%, respectively. Agree-ment between VUS and VCGU was 95% (K score = 0.89; p < 0.001). VUS andVCGU agreed on VUR grading in 11 cases; in 3 cases VUS showed a highergrading than VCGU. VUR rate was 39% in the PL and 42% in the LG cases.Conclusion: The rate of agreement between VUS and VCUG justifies the use ofVUS without the burden of radiation. VUR rate was high for both PL and LGcases.

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C-437Distinguishing pelvic phleboliths from distal ureteral calculi: Thin slice CTfindingsM. Arac, H. Celik, A.Y. Oner, S. Gultekin, T. Gumus, S. Kosar; Ankara/TR

Purpose: To evaluate the appearance of phleboliths and distal ureteral stones bydetermining their roundness and presence of central lucency on thin slice CT.Methods and Materials: 77 patients underwent unenhanced CT. Suspicious pelvicradioopacities were selected and those patients consequently underwent thinslice CT, with 1 mm collimation, a FOV of 10 cm, a pitch of 1:1 and a bone recon-struction algorithm. Three radiologists reviewed all images for roundness and thepresence of central radiolucency.Results: No calculi showed central lucency on either imaging technique used.Thin slice CT revealed central lucency in 60% of phleboliths with a 100% specif-icity. 3 of 40 ureteral stones showed round contour. Thin slice CT revealed around contour in 97% of phleboliths with a 93% specificity.Conclusion: Central lucency is a characteristic finding of pelvic phleboliths onthin slice CT. This finding can therefore be used in combination with roundnessas a problem solving tool in differentiating phleboliths from distal ureteral stones.

C-438Role of duplex Doppler and power Doppler sonography in transplantedkidneys with acute renal parenchymal dysfunctionM.S. Sandhu, R. Datta S. Suri, A. Saxena, K. Sud, M. Minz; Chandigarh/IN

Purpose: The limited work published on comparison of power Doppler sonogra-phy [PDS] and duplex Doppler sonography [DDS] in assessment of renal allo-graft dysfunction has shown contradictory results. We compared the role of DDSand PDS in renal transplant recipients developing acute renal parenchymal dys-function and correlated these findings with kidney biopsy, which was taken as thegold standard.Methods and Materials: 30 post renal transplant patients with acute graft dys-function underwent gray scale sonography, DDS and PDS using HDI 5000 ATLmachine. Patients who developed graft dysfunction due to vascular, obstructiveor other non-parenchymal causes were excluded. All patients underwent an allo-graft biopsy within 72 hours of the sonography.Results: Based on biopsy findings, 24 patients were categorized as having acuterejection and 6 as having no rejection. The overall sensitivity, specificity and ac-curacy of DDS for evaluation of graft dysfunction was 54.17%, 33.33% and 50%and that for PDS was 87.5%, 33.3% and 76.67% respectively. The low specificitycan be partially attributed to the small number of cases without rejection in ourstudy population.Conclusion: We conclude that PDS is superior to DDS in screening patientswith acute parenchymal renal dysfunction post transplantation. However, a nor-mal PDS examination does not exclude an acute rejection. PDS is a useful screen-ing test for acute rejection but a renal allograft biopsy remains the gold standardfor diagnosing acute rejection.

C-43999m-Tc DMSA dynamic scintigraphy in the estimation of perfusion andfunction of transplanted kidneyS. Beatovic, E. Jakšic, R. Han; Belgrade/YU

Purpose: To evaluate transplant perfusion and function by two parameters ofDMSA dynamic scintigraphy: Fractional renal blood flow (RBF) and extractionefficiency of DMSA (EE).Materials and Methods: Investigation was done in 27 subjects: 10 pts with well-functioning transplant (group A), 7 pts with acute rejection (B) and 10 kidneydonors (C). RBF was calculated from the first-pass activity plateau and EE fromthe slope of kidney curve. DMSA is extracted in two phases, glomerular and tu-bular. Hence, two parameters are calculated: Extraction efficiency in the first phase(EE1) and in the second phase (EE2).Results: Mean values of RBF were: 13.99 (A), 6.73 (B), 9.14 (C, one kidney) and18.28 (C, both kidneys). In group B, RBF was 66% lower than in C (p < 0.0001)and 56% lower than in A (p < 0.005). Correlation between RBF and kidney Lab(BUN, Cr, CCr) was significant: RBF/BUN r = -0.70; RBF/Cr r = -0.73; RBF/CCrr = 0.90. Values of EE1 were: 5.89 (A), 4.15 (B) and 16.5 (C). Results of EE2were: 0.88 (A), 0.85 (B) and 3.86 (C). Values of EE1 and EE2 were significantlylower in groups A and B than in C (p < 0.005).Significant difference was foundbetween A and B (p < 0.05) in the values of EE1, but EE2 showed no differencebetween A and B.Conclusion: RBF is a sensitive method for quantifying transplant perfusion. Itssensitivity was higher in comparison with kidney Lab. The sensitivities of EE1

and EE2 in renal insufficiency were decreased and comparable with sensitivitiesof BUN and Cr.

C-440Tubular extraction rate of MAG3 in patients with impaired renal functionS. Beatovic, E. Jakšic, R. Han; Belgrade/YU

Purpose: To analyze whether clearance of mercaptoacetyltriglycine (MAG3),which is equal to its tubular extraction rate (TER) could serve as a sensitive pa-rameter of renal function impairment.Methods and Materials: Investigation was carried out in 107 patients, who weredivided into nine groups, according to the diagnosis and the degree of renal fail-ure. Dynamic renal scintigtraphy was performed 20 minutes after i.v. injection of150-220 MBq of MAG3. TER was determined by single-sample, volume distribu-tion method using the standard solution of labeled MAG3.Results: Results of TER were correlated with blood urea nitrogen (BUN), serumcreatinine (Cr) and creatinine clearance (CCr). Significant linear correlation be-tween TER and CCr was found (r = 0.76; p < 0.0001). Correlation between TER/BUN and TER/Cr was exponential (r = -0.78 and r = -0.82, respectively;p < 0.0001).Conclusion: Analysis of our results show that TER is a more sensitive parame-ter than CCr, Cr and BUN, especially in mildly deteriorated function. In advancedrenal failure, the sensitivity of TER is similar to the sensitivity of BUN and Cr.

C-441Daily monitoring patients with renal transplant: A way to better understandthe relationship between Doppler indices and renal functionS.D. Bolboaca, M.D. Lucan, C. Botar-Jid, C. Reit, C. Lapusan, S. Dudea;Cluj Napoca/RO

Purpose: The aim of this study was to evaluate the correlation between Dopplerindices and renal function of patients with kidney transplant.Methods and Materials: We studied a sample of 122 patients with kidney trans-plant. Doppler measurements and renal function were monitored over 20 days.We had 5 groups of post transplant evolution: Normal (N), nephrotoxicity (NF),tubular necrosis (ATN), rejection (AR) and renal dysfunction (RD). Using Pear-son coefficient we evaluated the correlation between Doppler indices and renalfunction for all patients.Results: We found some significant correlation between pulsatility indices (PI),resistance indices (RI) and renal volume (TRV), with creatinine blood level (Cr) inthe patients with normal evolution, if we correlated the parameters using 12-daydata. There was significant correlation between RI and Cr in patients with NF (12days, p = 0.04). In the patients with ATN there was significant correlation be-tween TRV and Cr (12 days, p = 0.02). Significant correlation between TRV andCr was found in RD evolution (12 days, p = 0.032) and between PI and Cr (20days, p = 0.029) in patients with rejection.Conclusion: Correlation between Doppler indices and renal function parametersvary in different post transplant evolution and is dependent on days of monitoring.

C-442Pelvic extension of the renal fasciae: A CT studyT. de Perrot, J.-C. Dembe, J. Fasel, F. Terrier; Geneva/CH

Purpose: The inferior extension of the renal fasciae is subject to controversies.The space below the inferior pole of kidneys is called the infrarenal or infraconalspace, a term which does not prejudge on the caudal continuity of the renal fas-ciae. Based on CT-scans obtained in patients with retro-extraperitoneal diseas-es, the pelvic extension of the renal fasciae can be demonstrated.Materials and Methods: Abdomino-pelvic CT scans of 18 patients with acutepancreatitis, diverticulitis or retroperitoneal bleeding were retrospectively ana-lysed. The cases presented a pathologic process of the retro-extraperitoneal spacewith extension in both the retroperitoneal space and the pelvis. The selectionwere based on the demonstration of the renal fasciae on the CT images by thick-ening or by propagation of fluid along the fascial planes.Results: The perinephric space is closed caudally. At the bottom of the cone, theanterior and posterior renal fasciae merge weakly to form a single fascia at thelevel of the iliac fossa, which extends to the minor pelvis. This fascia proceedsdown medially to the iliac vessels and anteriorly towards the deep inguinal ring.These results confirm the findings obtained by dissection in five cadavers.Conclusions: The analysis of CT scans of retro-extraperitoneal pelvic process-es demonstrates the inferior extension of the renal fasciae to the pelvis. Thesefascial planes serve as pathway for the spread of retro-extraperitoneal processesfrom the abdomen to the pelvis and vice versa. One can so explain, for example,the occurrence of an abcess in the prevesical space in case of sigmoid diverticulitis.

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C-443Color Doppler ultrasonography in scrotal traumaL. Rocher, A. Giuria, A. Miquel, P. Eschwege, S. Droupy, M. Bléry, Y. Menu;Le Kremlin-Bicêtre/FR

Learning Objectives: To illustrate the ultrasonographic technique and findingsin patients with scrotal trauma. To be able to help in surgical decision making.Background: Scrotal injuries are usually related to blunt trauma. Penetratingscrotal trauma is less common. Scrotal injury may also occur in polytrauma andmight be overlooked in these patients. The main concern is the identification ofpatients requiring emergency surgical exploration. Between January 1998 andSeptember 2002, 26 consecutive patients with scrotal trauma were examined. 13underwent surgical exploration. Technique for gray-scale and Doppler ultrasonog-raphy, main findings and keys for making surgical decision are presented.Procedure Details: A high frequency linear transducer (7.5-12 MHz) was used.Gray-scale and color Doppler analysis of both testis, with volume measurementwere performed. Much attention was paid to gray-scale and Doppler settings.Main findings to be recognized were the following: Irregular testicular margins,heterogeneous testicular pattern, foci with no vascular signal corresponding toan intratesticular haematoma, perfusion defects, hypervascularized testis or epidi-dymis, echoic peritesticular fluid corresponding to haematocoele and sometimesrelated to tunica albuginea rupture. Indication for surgery included suspicion oftunica albuginea rupture, severe ischemia, and intatesticular large hematoma.Evaluation of vascularization could also help to assess the outcome.Conclusion: Color Doppler ultrasonography is the cornerstone examination inpatients with suspected scrotal trauma. Correct technique and knowledge of ele-mentary lesions are crucial as imaging findings might be subtle even in case ofsevere injury.

C-444Ultrasound diagnosis of testicular tumours and potential pitfallsS.H. Chang, Y. Rees; Leicester/UK

Learning Objectives: To illustrate the spectrum of testicular tumours and theconditions that can mimic such tumours. To analyse the sensitivity, specificity andlimitations of our ultrasonography in diagnosing testicular tumours. To follow theoutcome of the false positive cases.Background: Intratesticular lesions are considered malignant until proven other-wise by most surgeons. However, there are certain benign conditions that mimicthe features of testicular tumours and can cause unnecesarry orchidectomies. Inthis study, we provide ultrasound images of a range of testicular tumours and theconditions that were misdiagnosed as tumours, encountered in Leicester, Eng-land between January 2001 and March 2003.Procedure: This is a retrospective study of all surgical scrotal / inguinal proce-dures (208) between January 2001 and March 2003. There were 95 preoperativetesticular ultrasounds carried out and these were compared with post orchidec-tomy pathology reports. 54 ultrasound reports stated the presence of tumour /neoplasm in the report. Analysis revealed 48 true positives, 6 false positives andno false negatives. There was a sensitivity of 100% and specificity of 87%. Theclinical and radiological features of all 6 false positive cases are discussed indetail to help both clinicians and sonographers in future management of testicu-lar lesions.Conclusion: Ultrasound is a good indicator of testicular tumour. A negative ultra-sound virtually rules out a testicular tumour. Inflammation and infarction can bothmimic testicular tumours.

C-445An efficient way to reach the correct diagnosis on prostate lesions withtransrectal ultrasound: A DVD-Rom based teaching file with image andvideo databaseP.S. Zoumpoulis, I. Theotokas, A. Plagou, K. Pahou, A. Roulias, D. Schizas;Athens/GR

Learning Objectives: 1. To teach a trainee how to describe the main US charac-teristics of a focal prostate lesion. 2. To help facilitate sonographic diagnosisthrough correct algorithms. 3. To provide comparison of an US image of diagnos-tic difficulty with galleries of similar US images with proven diagnosis.Background: The purpose of this DVD-Rom is to suggest diagnostic algorithmsin order to characterize focal prostate lesions seen by TRUS in the peripheral,

central and transitional zones of the prostate, starting from an US image and itsmain morphologic and hemodynamic features.Procedure Details: The user can start using this teaching file by submitting theUS characteristics of a focal prostate lesion, which he has difficulty in character-izing (i.e. hypo-echoic, hypovascular lesion in the peripheral zone). The systemguides him through a specific algorithm to all possible hypoechoic and hypovas-cular prostate lesions (i.e. cancer, infection, infarct). A large collection of classi-fied US images (galleries) and videos are available in each diagnostic categorygiving the possibility of comparison with the user's image. The user's image canalso be linked to the contents of corresponding interesting cases, which are briefcase reports with clinical, biochemical, imaging and pathological data.Conclusion: The user can be aided in the differential diagnosis of a prostatelesion by comparing it to other "similar" sonographic images, which are availablein Galleries, Videos as well as Interesting Cases.

C-446Hypoechoic intratesticular masses: The non malignant optionsS. Puppala, D. Cochlin; Cardiff/UK

Objective: To understand the occurrence and significance of benign intratesticu-lar masses.Background: Hypoechoic intratesticular masses can occur in both benign andmalignant conditions. Most hypoechoic intratesticular masses are malignant.However, a small but significant proportion is benign, and it is important to iden-tify these in order to save an unnecessary orchidectomy. The benign causes arerare and are identified only if there a high index of suspicion.Imaging Findings: This poster aims to give a pictorial review of the lesser knownbenign hypoechoic testicular masses seen on an ultrasound scan. They rangefrom infections, granulomatous diseases, epidermoids, Leydig cell tumours, ad-renal rest tumours to other ectopic tissues.Conclusion: All hypoechoic masses are not malignant. It is important to knowthe benign causes to be able to identify them.

C-447Prostatic and seminal vesicles cystic lesions: Transrectal ultrasoundfeaturesM. Zarcero, V. Garriga, M. Martinez, S. Medrano, N. Roson, S. Carbo,M. Cuadrado, X. Pruna; Granollers-Barcelona/ES

Purpose: To describe prostatic and periprostatic cystic lesions and to reviewtheir origin, related complications and differential diagnosis.Background: Transrectal sonography of the prostate gives us an accurated ana-tomic definition of the prostate and its anatomic relationships with adjacent struc-tures. Its ability enables good characterization of echotexture, localization andvascularization of these lesions. Our study is a review of cystic lesions which areclassified depending on its location (medial or lateral cysts), origin (congenital oracquired cysts) and related complications.Materials and Methods: Sonograms were obtained by using real-time, directtransrectal scanning with a 6 MHz convex endorectal transducer. Examinationswere conducted with patients in the left lateral decubitus position with the hipsfully flexed. Detailed examinations of the prostate and the seminal vesicles wereroutinely performed in both the sagittal and axial planes and also using color andpower Doppler.Results: Of 200 transrectal sonographic examinations performed between Janu-ary 2001 and February 2002, 21 were found to have cystic lesions: 7 of themwere congenital cysts (2 müllerian duct cysts and 5 utricular cysts) and 14 wereacquired cystic lesions (10 cyst > 1 cm related with changes of benign prostatichyperplasia, 2 prostatic cystic carcinoma, 1 prostatic abscess and 1 sperma-tocele).Conclusion: Transrectal high-resolution examination is a very useful and accu-rate method for the diagnosis and characterization of prostatic and periprostaticcystic lesions. Sonographic description determines adequate management andenables fine-needle aspiration whenever diagnosis is not clear.

C-448The role contrast enhanced MRI in patients with penile induration(Peyronie's disease)M.A. Sharia, Y.G. Alyaev, S.K. Ternovoy, O.I. Belichenko, N.A. Grigoriev,A. Popko; Moscow/RU

Purpose: To evaluate the diagnostic possibilities of enhanced MRI in correctlocalization of plaques and to detect early changes in La Peyronie's disease.Material and Methods: 21 patients (mean age 44 years) were studied with 1.5 T

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MRI systems (Horizon LX, GE Medical Systems). A patient with clinical Peyro-nie's disease underwent palpation, ultrasound and MRI after intracavernous in-jection of papaverine. MRI images were obtained before and after intravenousapplication of Gd-DTPA.Results: On MRI, 16 of 21 palpable plaques (76%) were detected. Non palpableor sonographically visible indurations could be shown in 5 cases (24%). In 2, thenon palpable lesions are seen to infiltrate the septum. Enhanced MR imagesshowed focal contrast enhancement around or within the plaques in 15 patients,thus indicating local inflammatory activity. Images in 3 patients with plaquesshowed no enhancement. Images in 3 patients showed focal areas of contrastenhancement without evidence of plaques.Conclusion: Gd-DTPA enhanced MR imaging is very useful in the assessmentof the activity of the inflammatory reaction and for evaluating the response toconservative treatment; it may help to determine the exact time for the surgicalintervention. After administration of gadolinium, it becomes possible to demon-strate plaques of the albuginea that are not palpable.

C-4493D power Doppler TRUS in the follow-up study of the radiotherapy in theprostate cancerV. Gazhonova, M. Kislyakova, O. Epova, S. Potkin, E. Malofievskaya,T. Chuprik-Malinovskaya, G. Matyakin, A. Zubarev; Moscow/RU

Purpose: To detect and monitor response to hormonal and radiation therapy (RT)in localized prostate cancer (PC) using 3D power Doppler (3D PD) TRUS.Methods and Materials: 238 patients with biopsy proven PC (stage T1, n = 71[29.8%], T2, n = 112 [47.1%], T3, n = 39 [16.4%], T4, n = 16 [6.7%]) were en-rolled in the follow-up study. All patients received a prospective dose-escalationRT in monofractionated or multifractionated regiments to a total radiation dose of68-74 Gr in combination with hormonal treatment, and underwent DRE, serumPSA level, bone scintigraphy, CT and 3D PD TRUS before, after, 3, 6, 12, 24 and48 months later. The tumor echogenicity, degree of vascularity and blood flowpattern were assessed. TRUS results were compared with clinical and laboratorydata in each patient throughout the follow-up study.Results: In cases of positive response in 198 patients (83%) to treatment, thedecreased tumor volumes and increased tumor echogenicity were revealedthroughout follow-up. Postradiation hypervascularity gradually decreased duringthe follow-up period. In cases of negative response in 40 patients (17%) the tu-mor volumes and echogenicity did not change significantly; increase in degree ofvascularity was detected during the first year after RT. Bone metastases wererevealed in 11 cases (27.5%) during 18-48 months after RT. 3D PD TRUS datacorrelated with clinical and laboratory data in 95% of cases.Conclusion: 3D TRUS is an effective tool for monitoring early response to RT inPC.

C-450Possibilities of MRI and H+ MRSI in diagnosis of the prostate diseasesE.N. Shelkoplyas, L.A. Tjutin, L.A. Stukov; St. Petersburg/RU

Purpose: To investigate diagnostic possibilities of MR-spectroscopy and MR-imaging in diagnosis of diseases of the prostate.Materials and Methods: A total number of 52 persons were examined. 12 caseshad proven cancer of the prostate; there were 10 cases with chronic prostatitis;12 cases with benign hyperplasia. A control group comprise 16 patients (consid-ering the age criteria). The study was performed with Magneton "Vision" MR-tomograph of Siemens make (1.5 T) using the following sequences: SVS_STEAM10 (TR 5000, TE 10), aq-80 and SVS_SE 135 (TR 5000, TE 135), aq 64. Spectraldata were aligned with the MRI data and compared with serum prostatic specificantigen (PSA) levels and biopsy results.Results: Metabolic and morphologic changes preceded significant alterations inprostatic volume. Residual prostate cancer (choline+ creatine/citrate peak arearatio of 3.7 + 1.5) could still be distinguished from regions of normal prostate(0.82 + 0.61) and BRH (0.9 + 0.6).Conclusion: H+ MRS can detect early metabolic and morphologic alterations inprostatic tissues. The results of MRI and MRS examinations may be useful forguiding biopsies or planning additional therapy.

C-451Quantification of drug related prostatic blood flow changes by transrectalpower Doppler ultrasoundA. Schuster1, G. Pinggera2, L. Pallwein2, W. Recheis2, H. Strasser2,F. Frauscher2; 1Feldkirch/AT, 2Innsbruck/AT

Objective: To investigate the effect of alpha-blockers on prostatic blood flow andby means of power Doppler image quantification.Materials and Methods: 11 patients suffering from lower urinary tract symptoms(LUTS) were treated with alpha-blocker for 5 weeks. Transrectal power Dopplerultrasound (TRPDUS) of the periurethral prostate as well as comparative cystom-etry were performed before and after therapy. For TRPDUS an Acuson Sequoia512 (Acuson, Mountainview, USA) fitted with a high frequency transrectal probe(EC10-C5) was used at standardized machine settings. Color pixel density (CPD)was calculated with computer assistance from transrectal power Doppler imagesusing Scion Image image analysis software. CPD and standard urodynamic pa-rameters were recorded in each run at filling volumes of 0 mL, 100 mL and max-imum cystometric capacity.Results: In presence of NaCl, mean CPD rose by 8% at 100 mL and by 27% atfull distension, whereas with KCl filling, mean CPD rose by 30% at 100 mL andby 42% at full bladder capacity. After therapy, mean CPD was significantly in-creased at empty bladder by 44% compared to mean CPD before therapy. DuringNaCl filling, mean CPD rose by 50% at 100 mL and by 77% at full distension,while in the presence of KC1, mean CPD rose by 77% at 100 mL and by 103% atfull bladder capacity.Conclusions: Using TRPDUS and CPD, relative changes of periurethral prostat-ic blood flow could be quantified. Alpha-blocker lead to a significant increase ofprostatic blood flow. These results may explain the therapeutic effects of alpha-blockers on LUTS.

C-452Superselective embolization for patients with high-flow priapism: Over fiveyears follow-upY. Baba, H. Hokotateyya, M. Nakajo; Kagoshima/JP

Purpose: We present long-term results of embolization for patients with high-flow priapism.Methods and Materials: Six patients with high-flow priapism were treated withsuperselective embolization of internal pudendal artery at our institution. The causeof priapism were traumatic in five and idiopathic in one patient (12-66 years,average 31.8 years). Over five years follow-up was made with all cases.Results: Total of nine sessions of embolization were performed in six patients.Two sessions of embolization was performed in three patients. Embolic materialswere gelatin sponge in ten times and microcoil in two times. Selective emboliza-tion of bilateral internal pudendal arteries was performed in two patients. Compli-cation which originated in the maneuver wasn't recognized. Five years aftersuccessful embolization, detumescence was achieved in five patients except onepatient. The period from the symptomatic appearance to the treatment of thiscase was long with about two months.Conclusion: Superselective embolization of internal pudendal artery is the pro-cedure of choice for treatment of high-flow priapsim.

C-4533D power Doppler TRUS in the evaluation of the response to hormonaltreatment of prostate cancer (work-in-progress)M. Kislyakova, V. Gazhonova, A. Zubarev, L. Atabekova, A. Arutjunov;Moscow/RU

Purpose: To reveal the effectiveness of 3D power Doppler (3D PD) TRUS in theassessment of the response to hormonal treatment of prostate cancer (PC).Methods and Materials: 41 patients with hormonal treated PC (T1-T2) under-went TRUS before and during 3, 6 and 12 months of treatment. The tumor echo-genicity, degree of vascularity and blood flow pattern were assessed. TRUS resultswere compared with clinical and laboratory data in each patient throughout thefollow-up study.Results: Using grey-scale TRUS, 32 prostate tumors were hypoechoic beforetreatment. Using 3D PD TRUS, 19 tumors (46%) were hypervascular before treat-ment. During treatment the tumors' echogenicity increased gradually, focal fibro-sis was detected; the degree of vascularity decreased gradually. In 12 monthsthe fibrosis was not revealed in 15 (36.5%) tumors and the hypervascularity wasrevealed in 5 (12.1%) patients that correlated with negative clinical response tohormonal treatment in 5 patients.Conclusion: 3D TRUS is an informative method in the assessment of the re-sponse to hormonal treatment of PC.

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C-454Magnetic resonance assessment of inter-fraction prostate localizationvariability in intensity modulated radiotherapy for prostate cancerG.M. Villeirs, W.J. De Neve, K.L. Verstraete, G.O. De Meerleer; Gent/BE

Purpose: To evaluate prostatic motion with MR-imaging during IMRT.Methods: Seven patients with adenocarcinoma of the prostate were scannedsupine on a 1.5 T system. Prior to IMRT and during the 7-week treatment course,5 mm transverse, coronal and sagital HASTE-T2-weighted images of the pelviswere acquired weekly. The bladder and rectal volumes, position of the prostaticmargins, and center of prostate (COP) relative to the bony pelvis were meas-ured.Results: All pre-treatment positions were within a 3.6 mm range from the on-treatment mean position in each patient. The COP variability in the AP, CC andmL directions were 2.6, 2.4 and 1.5 mm, respectively. The largest prostatic mar-gin variability was 3.2 (posterior) and 2.6 mm (cranial and caudal). Beyond arectal volume of 57.1, a strong correlation was found between rectal volume andanterior COP movement (p = -0.90). A weak correlation (p = -0.31) was foundbetween bladder volume and cranial COP movement. Beyond 160.8 mL, the meanvariability of the cranial and caudal margins increased up to 1.3 mm, between300 and 400 mL 4.4 mm, and above 400 mL 6.6 mm.Conclusions: The pre-treatment prostate positions were representative of on-treatment positions. A 5.3 mm CTV expansion in any direction was sufficient toascertain 95% coverage of the CTV within the PTV, assuming a rectal volume< 57.1 mL (rectal suppository) and bladder volume around 150 mL (voiding fol-lowed by drinking 500 mL of water to keep small bowel away from treatmentfield).

C-455Local anesthesia before TRUS-guided prostate biopsy: How to perform.Technical results and side effects on image quality. Indications and sideeffects on patients.A. Plagou, P.S. Zoumpoulis, I. Theotokas, S. Prapavessis, A. Gyftopoulos, I.Kapralos, E. Samouti, K. Pahou; Athens/GR

Purpose: To demonstrate the technique of performing TRUS-guided local an-esthesia before prostate biopsy. To discuss the indications, efficacy and the sideeffects of TRUS-guided local anesthesia before prostate biopsy.Materials and Methods: During the period 2000-2002, 1200 TRUS-guided pros-tate biopsies were performed. Local periprostatic anesthesia was administeredprior to the biopsies by injecting 8-15 cc of Xylocaine and 2% adrenaline mixturethrough the biopsy needle. The technique, the consequences on the US imageand the complications and side effects were compared to 4500 TRUS-guidedbiopsies performed between the years 1994-2002, without local anesthesia.Results: There was no significant difference between the number and severity ofcomplications in the group with local anesthesia compared to the group withoutanesthesia. There were no significant side effects caused by the infusion of theanesthesic drug. However the infusion of the drug may cause a degradation ofthe TRUS image. Air bubbles are sometimes infused with the drug causing a"fuzzy" image, which results in a degree of difficulty in guiding the needle. Athorough TRUS examination of the prostate prior to the anesthesia helps theradiologist in planning the biopsies in advance and thus guiding the needle to theappropriate area, even through a "fuzzy" image.Conclusion: US-guided local anesthesia, before TRUS biopsy, is useful for as-suring patient cooperation during this often painful procedure and essential ifTRUS findings call for a large (more than 10) number of biopsies.

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Miscellaneous

C-456Urinary tract neoplasms: Conventional and pyelo-urographic magneticresonance (MR) patternsG. Cardone, P. Mangili, D. Fiecchi, A. Cestari, G. Balconi; Milan/IT

Learning Objectives: To illustrate conventional and pyelo-urographic MR pat-terns in the evaluation of urinary tract neoplasia. To evaluate the effectiveness ofurographic and pyelographic MR sequences in the diagnosis of urinary tract ne-oplasia.Background: Conventional excretory urography (CU) and computed tomogra-phy (CT) were considered the standard techniques used to examine patientswith urinary tract neoplasia. Recently, conventional, urographic and pyelographicMR exams have been performed in patients with urinary tract disease.Imaging Findings: 20 pts with 21 transitional cell carcinomas were analysed.13/20 patients underwent CU and 10/20 a CT scan. All patients underwent MR-pyelographic (3D-TSE T2w), MR-urographic (ce 3D-GRE T1w) and conventionalmorphologic sequences (GRE T1w, TSE T2w and ce dynamic FS-GRE T1w). A)Neoplastic lesions were visualised as solid papillomas in 12/21 cases, as thick-ening of the wall of collecting system in 7/21 cases and as solid tissue in therenal sinus in 2 cases; B) Lesions were more evident on TSE T2w, ce FS-GRET1w and MR-urographic images; C) Lesions resulted quite vascularized; D) Uri-nary tract dilatation was evaluated in 17/20 patients. Dilatation was better evalu-ated on both the TSE T2w and the MR-urographic images in the case of normalrenal excretory function, and on both the TSE T2w and the MR-pyelographicimages in the case of functionally excluded kidneys.Conclusion: Conventional MR images combined with pyelo-urographic techniquesallowed a good evaluation of urinary tract neoplasia. More frequent patterns weresolid papillomas or wall thickening of the collecting system (90% cases), associ-ated with collecting system dilatation (85% cases).

C-457Adrenal tumors: Radiological findings with histological correlationW.K. Lee1, E. Bekhit2, M. Pang1, K. Gordon1, N. Trost1, P. Smith1; 1Fitzroy/AU,2Parkville/AU

Learning Objectives: 1. To understand the key diagnostic CT and MR imagingfeatures that allows differentiation of a typical adrenal adenoma from other adre-nal tumors. 2. To understand the key imaging features that allows definitive diag-nosis of benign adrenal tumors. 3. To understand the use and correlation offunctional imaging with anatomic imaging in the diagnosis of hyperfunctioningadrenal tumors. 4. To correlate the histopathology and the imaging findings ofadrenal tumors.Background: Adrenal tumors are common. The widespread use of cross sec-tional imaging has increased the detection of asymptomatic adrenal masses. Dif-ferentiation of adrenal adenomas from non-adenomas presents a diagnosticchallenge.Imaging Findings: Over a 4 year period MR imaging was performed on 63 pa-tients for further characterization of an indeterminate adrenal mass or for furtherstaging of an adrenal tumor. A pictorial review of the imaging features, with anemphasis on MR and CT, of benign and malignant adrenal tumors, is presentedincluding adrenal adenoma, pheochromocytoma, adrenal cortical carcinoma,metastasis, lymphoma, myelolipoma and neuroblastoma.Conclusion: Knowledge of the imaging features of characteristic adrenal tumors,such as a typical adrenal adenoma or myelolipoma, will allow the identification ofthose adrenal lesions that require confirmatory histology.

C-458Abdominal ultrasound of ureteral obstructionS. Kapustin; Vitebsk/BY

Learning Objectives: To illustrate possibilities of abdominal sonography in diag-nosis of ureteral disorders. To describe the inspection technique of a ureter.Background: Diagnosis of ureteral disorders is still based on intravenous urog-raphy and invasive examinations. According to our 10-year experience, abdomi-nal sonography is a superb method to diagnose ureteral stones, tumors, polypsand other causes of ureteral obstruction.Procedure Details: Sonography of normal ureters is possible during slight ure-teral dilation due to the height flow rate and/or urinary bladder overfilling. Stableureteral dilation improves the visualization and facilitates the inspection of the

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ureter. There is a "difficult zone" located 2-5 cm below the iliac vessels. Examina-tion with mild compression is used to solve this problem. Color Doppler sonogra-phy is valuable to distinguish the ureter from vessels.Conclusion: Abdominal sonography is a cheap and informative method in thediagnosis of ureteral disorders and may replace traditional technologies.

C-459Trauma of the urinary system: Spectrum of findings at helical CTA.J. Madureira, C. Tavares, L. Melao, I. Ramos; Porto/PT

Learning Objectives: To review and illustrate the spectrum of imaging findingsassociated with blunt and penetrating trauma to the urinary system on helical CT.To discuss the importance of an appropriate technique and the major pitfalls en-countered.Background: Injury of the urinary system is a common complication of majorabdominal trauma. Helical CT is a powerful imaging modality in the evaluation ofpatients with suspected injuries of the adrenal gland, kidney, ureter and bladder.The renal injury CT classification system is valuable and clinically important as itserves as a guide for patient management.Procedure Details: The authors present a comprehensive review of the imagingfindings in common and rare traumatic lesions of the adrenal gland, kidney, ure-ter and bladder based on the experience of a Level 1 Trauma Center. The indica-tions for helical CT are discussed and a special emphasis is placed in the use ofan appropriate technique and discussion of the major pitfalls that may be en-countered.Conclusion: Helical CT is a useful modality in the diagnosis, grading and follow-up of patients with trauma to the urinary system. Helical CT protocols should beoptimized and adapted to the clinical situation in question.

C-460Characterization of adrenal incidentalomas discovered on computedtomographyM.-A. Gomez, M. Besson, B. Scotto, D. Alison; Tours/FR

Learning Objectives: To describe the CT features of adrenal incidentalomas forcharacterization. This exhibit illustrates CT features of adrenal incidentalomas(myelolipoma, adrenal haemorrhage, adrenal adenomas and adrenal metastasis)Procedure Details: The detection of an incidentaloma at abdominal computedtomography (CT), except in the presence of CT features that permit a specificdiagnosis, becomes a problem in the differentiation of benign from malignantincidentalomas. A value of 10 Hounsfield units or less on nonenhanced CT rep-resent essentially lipid-rich adrenal adenomas. There are two limitations to thischaracterization: Incidentalomas initially detected on enhanced CT and lipid-pooradrenal adenomas. The relative enhancement washout on enhanced CT permitthen the lesion to be characterized as benign or malignant by using a threshold of50% washout on a 10-minute-delayed enhanced CT.Conclusion: Limitations of this characterization are only for benign pheochro-mocytomas and atypical adrenal cortical carcinomas.

C-461Urogenital anatomy, as seen in the anatomic waxes of the museum "LaSpecola"L.E. Bacigalupo1, I. Menchi2, M. Poggesi2, S. Bambi2, P. Pavlica3, A. Rotondo4,R.S. Pozzi Mucelli5, L.E. Derchi1; 1Genoa/IT, 2Florence/IT, 3Bologna/IT, 4Bari/IT,5Trieste/IT

Learning Objectives: This poster will present the anatomical waxes dedicatedto urogenital anatomy which are displayed at the museum "La Specola" of Flor-ence.Background: Teaching gross human anatomy is traditionally based on demon-stration and study of the different organs and systems directly on corpses. How-ever, availability of specimens for this purpose can be difficult for a variety ofproblems and, at present, anatomical models made of plastic material and elec-tronic files are used in most schools of medicine. These problems have beenalways present in the history of medicine. To overcome this, in 1771, a speciallaboratory was established at the "Imperial Regio Museo di Fisica e Storia Natu-rale" of Florence to create a collection of anatomical waxes, copied from anatom-ic dissections, to enable three-dimensional anatomic studies with schematicdrawings and captions indicating anatomical details.Imaging Findings: From 1771 to 1893, the laboratory prepared a large numberof models, and the collection in Florence consists of about 1500 pieces. In thecollection there are over 200 preparations, showing the complete urogenital sys-tem in the male and the female. Special models have been created to demon-

strate sectional anatomy, the internal structures of the kidney, the relationships ofthe prostate with the bladder base and the seminal vesicles, the penis, the vaginaand the uterine cavity. Many waxes depict the gravid uterus and the foetus, withits vasculature and its relations with placental vessels.Conclusion: This allows the collection to be considered as the first 3D "text-book" of anatomy in medical history.

C-462Characterisation of adnexal masses with magnetic resonance imagingA. Saini; London/UK

Learning Objectives and Background: The accurate assessment of adnexalmasses remains a challenge. To determine key differentiating features of adnexalmasses, we retrospectively reviewed the magnetic resonance (MR) characteris-tics in 45 patients and correlated their appearances with the findings at histopa-thology.Imaging Findings: Benign solid lesions were characterised by fat, haemorrhageor fibrous components. Mature teratomas (n = 4) possessed high fat content.Haemorrhage was a predominant feature of endometriomas (n = 7) but also seenin some malignant tumours. Fibromas (n = 2), cystadenofibromas (n = 3), benignBrenner tumours (n = 2) and fibrothecomas (n = 1) that have a similar fibrouscomponent shared a distinctive short T2 relaxation. Benign cystic lesions com-prised serous or mucinous cystadenomas (n = 5), were recognised as thin walleduni- or multilocular cysts. Borderline (n = 4) and malignant epithelial tumours(n = 8) were predominantly cystic and distinguished by papillary projections andthe secondary features of malignancy, such as ascites, rather than their tissuesignal intensity. Malignant solid primary ovarian masses were less common. Clearcell carcinomas (n = 2) were recognised by a predominantly solid mass with moremodest cystic elements. Granulosa cell tumours (n = 2) had variable amounts ofcystic change and intratumoural haemorrhage. Immature teratomas (n = 1) con-tained circumscribed foci of variable signal-intensities. Inflammatory masses(n = 3) also presented as complex adnexal cysts. In these cases, the clinicalhistory and examination was key in making the diagnosis.Conclusion: The ability to manipulate tissue contrast with MR imaging makes itan invaluable tool in the assessment of complex adnexal masses enabling char-acterisation and identification of features associated with less common pathology.

C-463A pictorial review of ureteric pathologies causing obstructionB. Rajashanker, A. Bradley; Manchester/UK

Learning Objectives: To present a pictorial review of pathologies causing uret-eric obstruction along with a brief description of latest techniques available toimage the ureters. A review of recent literature is made to support the imagesappropriately.Background: A list of interesting pathologies causing ureteric obstruction hasbeen carefully chosen after a retrospective review of images performed between2000 - 2003 in a central teaching hospital with dedicated uro-radiologists. CTtechniques involve pre and post intravenous contrast thin slice images throughthe ureters on Siemens Sensation 16 Slice and Philips GE light speed scanners,CT nephrostogram and CT urography. MR technique involves conventional axialsections and MR urography which involve heavily T2W HASTE sequences ob-tained on a 1.5 T Philips Intera Scanner.Image Findings: Congenital anomalies like ureterocoele, CT reconstructed im-ages from obstruction due to stone disease, primary and secondary ureteric tu-mours, rare images of tuberculosis of the ureter with ureteric calcification pre andpost chemotherapy, retroperitoneal fibrosis, physiological hydronephrosis of preg-nancy due to ureteric obstruction caused by iliac artery (MR urography), periaor-titis related to aortic graft and malignant obstruction secondary to pelviclymphadenopathy. Images are supported by review of recent literature. Imagingpitfalls are highlighted.Conclusions: This educational material would be useful to trainees, radiogra-phers and general radiologists as it summarises the techniques, pathologies andpitfalls in imaging the ureters.

C-464Cadaveric study of abdominal and pelvic extraperitoneal spaces:Comparison of perirenal and pelvic injections and communicationsA.-M. O'Connell, L. Duddy, F. Thornton, M.J. Lee; Dublin/IE

Background: Clinical settings have helped elucidate the anatomy of the extra-peritoneal spaces. The extraperitoneal spaces are divided into separate anatom-ic compartments thus assisting in the understanding of containment and spread

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of disease. The anatomy of the abdominal retroperitonem is well documented.However less is known about the pelvic extraperitoneal spaces.Learning Objectives: To determine perirenal communication with pelvic extra-peritoneal spaces, and pelvic extraperitoneal communication with themselvesand with abdominal retroperitoneal spaces.Procedure Details: Under CT guidance contrast was injected into 8 embalmedcadavers into the perirenal space. In a second study contrast was injected intopelvic extraperitoneal spaces (prevesical in 4, perivesical in 2 and perirectal in2). CT parameters included: Axial imaging, 3 mm slice thickness, pitch 2, mAs 240,kVp 120, allowing sagittal and coronal reconstruction. Axial images and recon-structions were reviewed to determine flow pathways of contrast material andcompared with anatomic dissection. Post perirenal injection communication wasseen between the perirenal and pelvic extraperitoneal spaces in all cadavers.Post pelvic extraperitoneal space injection communication between pelvic extra-peritoneal spaces readily occurs. In particular the perirectal space communicateswith the other pelvic extraperitoneal spaces. Free communication between thepelvic extraperitoneal spaces and the abdominal retroperitoneal spaces alsooccurs.Conclusion: Intercommunication occurs both between the various pelvic extra-peritoneal spaces and with abdominal retroperitoneal spaces.

C-465Urachal adenocarcinomas: Spectrum of imaging findings with radiologic-pathologic correlationJ.-P. Akakpo1, M.-F. Bellin2, S. Merran1, N. Grenier3, L. Lemaitre4, O. Helenon1,A. Delcourt1, P.-A. Grenier1; 1Paris/FR, 2Villejuif/FR, 3Bordeaux/FR, 4Lille/FR

Learning Objectives: To illustrate the spectrum of CT and MR features of urach-al adenocarcinoma. To discuss the imaging features so that when this tumor isencountered the diagnosis may be considered. To correlate the pathologic char-acteristics with the imaging findings. To discuss the key elements to be includedin the differential diagnosis and to provide examples of them.Background: Urachal adenocarcinoma is an extremely rare malignant neoplasmthat develops from embryonic remnants and has a variable clinical course. Clin-ical, pathologic and imaging findings were retrospectively evaluated for 6 pa-tients with urachal adenocarcinoma referred from 4 centers. Imaging studies (CT,n = 6; MRI, n = 2) were reviewed for morphologic features, such as tumor size,homogeneity, margins and degree of enhancement.Imaging Findings: The mean tumor size was 3.5 cm. The tumors were hetero-geneous in 4/6 patients, with irregular margins in 6/6, calcifications in 1/6 andstrongly enhanced in 6/6. All tumors extended anteriorly from the bladder dome;endoscopy was normal in all cases. Enlarged lymph nodes were visible in 2/6patients. Histologically proven invasion of the bladder dome was detected in 2/6patients and invasion of the anterior abdominal wall in 1. 3D reconstructions inthe sagittal plane (n = 2) evoked a urachal mass and assessed its relationshipwith the urinary bladder, umbilicus and rectus muscles. All tumors were resected.Conclusion: Multimodality imaging is essential to obtain an early and accuratediagnosis of urachal adenocarcinoma. Multiplanar CT and MR give the best as-sessment of the extent of tumor invasion.

C-466Reduction of ionising radiation exposure to patients due to new imagingtechnology for medical diagnostics of the urinary tract: A retrospectivestudy covering 20 years in a Norwegian referral hospitalA. Nyquist1, I. Børretzen2, H. Olerud2, B. Bjørnarå1, T. Gudmundsen1;1Drammen/NO, 2Oslo/NO

Purpose: To examine possible changes in ionising radiation doses to patients(collective effective dose) undergoing diagnostic imaging procedures of the uri-nary tract over the last 20 years in view of shift in modalities from conventionalX-ray examination to ultrasonography (US).Methods and Materials: Retrospective study of all patient files for the periodfrom 1983 to 2002. The number of plain radiographs, intravenous pyelography(IVP), ultrasonography (US), computer tomography (CT) and magnetic resonanceimaging (MRI) examinations were registered. For each type of examination themean effective radiation dose were obtained from the Norwegian Radiation Pro-tection Authority (NRPA) as published in 1997.Results: The number of plain radiographs of the lower abdomen covering theurinary tract increased by approximately 50%, IVPs were reduced by 70%, andCT examination decreased by 40%. MRI examinations did not play any signifi-cant role in examining the urinary tract. US of the urinary tract increased from 8 in1993 to 1129 in 2002. This shift in modalities from totally X-ray based proce-dures, to nearly exclusively US often supplemented with one plain radiograph,

caused a decrease in the annual collective effective dose for this group of pa-tients with 66% from 6.8 manSv in 1983 to 3 manSv in 2002.Conclusion: The shift in modalities used for diagnostic imaging of the urinarytract from conventional X-ray to almost exclusive use of US, resulted in a signif-icant reduction in exposure to ionising radiation of patients, and need to be con-sidered when discussing further development and structure of diagnostic imaging.

C-467Comparison of the adrenal vein sampling value between primaryaldosteronoma and nonfunctioning adrenal adenoma: Evaluation withreceiver operating characteristic (ROC) analysisY. Baba, H. Hokotate, H. Inoue, M. Nakajo; Kagoshima/JP

Purpose: To investigate the adequate criteria of adrenal vein sampling value inpatients with primary aldosteronoma.Methods and Materials: Between 1988 and 2002, 59 referred hypertensive pa-tients (15 men and 44 women, age 47.58 ± 9.45 yrs) were diagnosed with prima-ry aldosteronoma (PA) based on established criterias. During the same period,23 patients with nonfunctioning adrenal adenoma (NAA) (11 men and 12 women,age 53.56 ± 11.76 yrs) were diagnosed based on computed tomography, andlaboratory data. All 82 patients were enrolled in this study. Bilateral adrenal veinsampling (AVS) for measurement of plasma aldosterone (A) and cortisol (C) wasperformed. A receiver operating characteristics (ROC) analysis was performedto establish the best adequate criteria from AVS-derived index in patients with PA.Results: A (PA side) / A (contralateral side) was confirmed the best diagnosticaccuracy {(> 2.5: right PA, sensitivity 83.3%, specificity 79.5%)}, (> 3: left PA,sensitivity 84.2%, specificity 76.9)}. The Az value for A (PA side) / A (contralateralside) were 0.8948 for right PA, and 0.9260 for left PA.Conclusion: A (PA side) / A (contralateral side) value was the best compromiseof sensitivity and false positive rate for lateralization of the PA.

C-468Contrast-enhanced sonourethrography in the evaluation of complexurethral stricturesN. Markina, A. Zubarev, V.V. Gazhonova, N. Zaytsev; Moscow/RU

Purpose: To evaluate the role of contrast enhanced sonourethrography [CE SUG]in severe cases of urethral strictures.Material and Methods: 23 male patients (pts) with urethral stricture underwentretrograde urethrography [RUG], voiding cystourethrography, urethroscopy andbiopsy. Combined retrograde and voiding SUG with saline and echocontrast mediaLevovist® were used in 16 pts with urethral obliteration and chronic suprapubiccatheters. The transperineal or transrectal ultrasound was performed to evaluateanterior and posterior urethra respectively. The images obtained allowed detailedmorphology assessment of the urethra at different levels.Results: Compared with RUG, the SUG more accurately measured stricture lengthand diameter that was confirmed by measurements at optical urethrotomy (11 pts)and urethroplasty (12 pts). The introduction of contrast agents enhanced the vis-ibility of the flow in the most strictured segment (less than 0.4 mm), which wasdiagnosed by RUG as urethral obliteration in 5 pts. The CE SUG accurately diag-nosed diverticula (5), false passages (3), which were confirmed by urethroscopyin all pts.Conclusion: Our preliminary results show, that the combined retrograde and thevoiding power Doppler sonourethrography with ultrasound contrast media mightbe an effective support in diagnostics and in the planning of treatment of patientswith complex strictures and urethral obliteration. CE SUG is an informative meth-od in the differential diagnostics of patients with urethral obliteration and complexstrictures.

C-469Differentiation of adrenal adenomas from metastases with unenhanced CTusing a scoring systemH. Gufler1, G. Eichner1, A. Grossmann2; 1Giessen/DE, 2Rostock/DE

Purpose: To test if a combination of criteria increases the diagnostic accuracy ofunenhanced CT in the differentiation of adrenal adenomas from metastases.Patients and Methods: Unenhanced CT scans of 56 patients with adrenal massand a history of extraadrenal malignancy were analyzed for adrenal tumor size,attenuation, border and structure characteristics. Multiple logistic regression anal-ysis yielded coefficients that can be used for the construction of a simple, butefficient additive total score (a score parameter including all diagnostic criteria).The quality of this total score was tested by ROC analysis. The final clinical diag-nosis in all patients was determined at follow-up CT (40 patients), percutaneous

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biopsy (15 patients) or surgery (one patient). 24 adenomas and 32 metastaseswere diagnosed.Results: Attenuation values on unenhanced CT were significantly lower for ade-nomas than for metastases (9.8 ± 12 HU versus 32.8 ± 24.9 HU, p < 0.05). Thecombined score parameter including all CT criteria showed the largest area un-der the ROC curve. The highest predictive power suggested by the model wascalculated with a cut-off point at 7.05 for benign lesions with a sensitivity of 1.0and a specificity of 0.9688. At 6.75 points the scoring system yielded a sensitivityof 95.8% and a specificity of 96.9%.Conclusion: Compared to densitometry alone, diagnostic accuracy in the differ-entiation between adrenal adenomas and metastases is improved by includingall CT criteria in the evaluation. The presented scoring system is simple but effi-cient and easy to use in the clinical routine.

C-470ESWL of the unusually located stones in pediatric patientsZ. Siric, M. Radovanovic, A. Slavkovic; Nis/YU

Aim: To show the possibilities of lithotripsy in the treatment of bladder and ure-thral stones in pediatric patients.Patients and Methods: In a twelve year period, we treated 92 pediatric patients,aged from 8 months to 14 years, by ESWL. In 3 children, stones were located inthe urinary bladder, and in the urethra in another 2. All of them were male pa-tients; we decided to use ESWL instead of invasive methods of treatment. ESWLprocedures were performed under general anesthesia in 4 and under sedo-anal-gesia in 1 patient. During treatment, the patients were placed in the prone posi-tion (patients with bladder stones) or in a modified supine position (perinealapproach for urethral stones). An average 3000 shock waves were applied perpatient with a maximal energy of 3.0 kV. Average duration of treatment was 35minutes.Results: Successful fragmentation was achieved during the first session in 4patients. In 1 patient with a urethral stone, the fragmentation was not satisfactoryand the treatment was repeated 7 days later. Complete elimination of stone frag-ments was achieved during the first 3 days in the patients with successful firsttreatment, but was not achieved at all in the patient with repeated treatment.Cystoscopy was performed and the stone was found within a urethral diverticu-lum. There were no complications in our patient group.Conclusion: ESWL in our experience seems to be useful as a non-invasivemethod in the treatment of stones with in unusual locations. It could be recom-mended in male patients without anatomical variations of bladder and urethra.

C-471Evaluation of IVC and renal vein thrombus of renal tumors by MR imaging:Comparison of true FISP (fast imaging with steady state procession) andcontrast-enhanced imagesH. Okizuka1, S. Ichikawa1, T. Koizumi1, K. Sugimura2; 1Himeji/JP, 2Kobe/JP

Purpose: IVC / renal vein thrombus is an important factor in the decision of thesurgical method and prognosis in the patients with renal tumors. The purpose ofthis study is to determine the accuracy of true FISP, contrast-enhanced image fordetection of IVC and renal vein thrombus.Methods and Materials: 27 patients (right = 15, left = 12) with renal / perirenaltumor who underwent surgery, including for renal cell carcinoma (n = 24), renalpelvic carcinoma (n = 3), and lymph node metastasis (n = 1), were assessed.IVC thrombus was observed in 4 patients. Right renal vein thrombus was ob-served in 3 patients; and in 2 patients, on the left. All patients underwent thesame standardized study protocol including true FISP and contrast-enhancedFLASH imaging in both axial and coronal using phased array coil.Results: True FISP correctly diagnosed all cases of IVC invasion. Contrast-en-hanced images revealed 3/3 true positive (TP), but 2 false positive (FP), with asensitivity and specificity of 100% and 92% respectively. In right renal vein throm-bosis, true FISP revealed 3/3 TP, but 1 FP, with a sensitivity and specificity of100% and 93% respectively. Contrast-enhanced images revealed 3/3 TP, but 2FP, with a sensitivity and specificity of 100% and 85% respectively. In the leftrenal vein thrombosis, both true FISP and contrast-enhanced image revealed 3/3 TP, but 1 FP, with a sensitivity and specificity of 100% and 90% respectively.Patients who were FP on both true FISP and contrast-enhanced imaging for throm-bus in the renal vein, had huge tumor (> 10 cm).Conclusion: True FISP is a reliable sequence to detect IVC and renal vein throm-bus.

C-472Enhanced and unenhanced MR-urography in the evaluation of urinary tractobstructionL. Zugaro1, A. Catalucci1, G. Limbucci1, C. Vicentini1, E. Di Cesare2,C. Masciocchi2; 1Teramo/IT, 2L'Aquila/IT

Purpose: To evaluate the diagnostic capability of the MR-urography (MRU) in theevaluation of urinary tract obstruction.Methods and Materials: 64 patients with obstructive uropathy underwent MRexamination (1.5 T Philips Intera and GE Horizon). Saline solution (NaCl 9%,250 mL) was administrated about 10 min before beginning the MR examination.Unenhanced-MRU (heavily T2-w fat-sat sequences) was followed by enhanced-MRU (coronal 3D T1 FFE sequences after Gd-BOPTA, 0.1 mmol/kg); diuresiswas induced by e.v. administration of low-dose furosemide before Gd injection; inall cases standard MRI was also performed. MIP reconstruction was obtained ofboth unenhanced and enhanced-MRU. All patients previously underwent US ex-amination, 55 had excretory urography, 21 had CT. MR examination was evaluat-ed to detect urinary tract dilatation, cause and level of the obstruction. Excretoryurography and the final clinical diagnosis were used as reference.Results: The obstruction site and cause were detected in all cases by MR exam-ination.Unenhanced-MRU was capable of demonstrating 61/64 dilated urinary tracts,including 5 cases of non functioning kidneys. 20 patients had urinary tract ob-struction by urinary stones, 11 by intrinsic neoplasm, 18 by extrinsic neoplasm, 8by uretero-pelvic junction benign stricture, 6 congenital ureteral stricture, and 1of iatrogenic cause.Conclusion: MRU, providing both morphological and functional information byunenhanced-MRU and enhanced-MRU respectively, may replace conventionalurography in determining the level of obstruction in cases where iodinated con-trast is contraindicated or ionizing radiation should be avoided. MRU performedin combination with standard MRI can detect both intrinsic and extrinsic causesof urinary tract obstruction.

C-473Iliopsoas compartment disorders: Value of helical computed tomographyR.M. Cozcolluela, L.A. Sanz, L. Sarría, M. Martinez-Berganza, H. Gómez,S. García, A. Forradellas; Tudela/ES

Purpose: Iliopsoas compartment lesions frequently go undiagnosed at clinicalpresentation. The purpose of this study is to determine specific helical CT find-ings that might help differentiate abscesses, neoplasms and hematomas.Methods: This is a retrospective study of helical CT of 42 patients that showediliopsoas abnormalities (11 neoplasms, 12 abscesses, 14 hematomas, 2 casesof atrophy and 3 of calcifications). The study group included 33 men and 9 wom-en, 9-90 years old (mean 58 years). All studies were obtained over a 10-yearperiod. Final diagnosis were correlated with different CT features to determinefindings that could be used to differentiate these abnormalities. These includedenlargement of the iliopsoas muscle, irregular margins and fat infiltration, attenu-ation of the lesion, calcification, bone fracture and associated adenopathy.Result: Psoas pathology is more frequent in men (p < 0.05). Low attenuationand heterogeneity are the most reliable CT features of iliopsoas abscesses(p < 0.05). The sensitivity and specificity of low attenuation for the diagnosis ofabscesses are 24% and 92% respectively. The specificity of heterogeneity for thediagnosis of abscesses is 100%. Bone fracture is useful for the diagnosis of he-matoma (p < 0.05). Bone fracture is 53% sensitive and 85% specific for diagno-sis of hematoma.Conclusions: Low attenuation, heterogeneity and bone fracture are helical com-puted tomography features useful for differentiating iliopsoas pathology.

C-474Chemical shift subtraction MR imaging in characterization of adrenalmassesG. Savci, N. Sahin, R. Yalcin, Z. Yazici, E. Tuncel; Bursa/TR

Purpose: To determine the value of chemical shift subtraction MR imaging incharacterization of adrenal tumors.Materials and Methods: 34 patients with 38 adrenal masses were evaluatedwith chemical shift MR imaging. Subtracted MR images were obtained by sub-tracting out-phase images from in-phase images by using the standard MR soft-ware. Both qualitative and quantitative analysis were performed on the subtractionimages. While the quantitative analysis was performed by measuring the signalintensity on the subtraction images, the qualitative analysis was performed by aradiologist who tried to differentiate the adrenal adenomas from other masses on

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the basis of high signal intensity reflecting lipid content within the adrenal adeno-mas. The chemical shift MR imaging was used as the gold-standard modality foradrenal adenomas where as the diagnosis of nonadenomas were made by eithersurgical excision or biopsy.Results: All masses were classified correctly by both analysis. The mean per-centage of signal intensity on subtraction images were 200 ± 63 (means ± SD)and nonadenomas 29 ± 7 (means ± SD), respectively. The difference betweentwo groups was statistically significant (t test, p = 0.000).Conclusion: Our results show that chemical shift subtraction imaging is an ob-jective technique that allows the adrenal adenomas to be differentiated from theother tumors. The objectivity of the technique may help the unexperienced radiol-ogists to improve their interpretation.

C-475Accuracy of quantitative power Doppler ultrasound for measuring urinarybladder neck blood flow changesA. Schuster1, G. Pinggera2, W. Recheis2, L. Pallwein2, H. Strasser2,F. Pallwein2; 1Feldkirch/AT, 2Innsbruck/AT

Purpose: To assess the accuracy of power Doppler image quantification for meas-uring relative changes of urinary bladder neck blood flow by comparison to laserDoppler flowmetry (LDF) in an animal model.Materials and Methods: Transrectal power Doppler ultrasound (TRPDUS) andLDF of the urinary bladder neck were performed in two anesthetized pigs duringcomparative cystometry. Normal saline (NaCl) was used for the first run, followedby a second run with 0.2 M potassium chloride (KCl). Standardized machinesettings (Acuson Sequoia 512®, Mountainview, USA) were used for power Dop-pler imaging. Color pixel density (CPD) was calculated with computer assistancefrom sagittal power Doppler image maps using Scion Image® image analysissoftware. Tissue perfusion units (TPU) were measured using a BLF21 LaserDoppler Flowmeter (Transonic Systems Inc.®, USA).Results: In the presence of NaCl, mean CPD increased from 18.65 ± 1.78 to37.8 ± 1.84 at 100 mL and to 88.32 ± 1.35 at full capacity, whereas with KCl fill-ing, mean CPD increased from 18.65 ± 1.78 to 59.63 ± 0.5 at 100 mL and110.82 ± 2.98 at full capacity. With NaCl filling, bladder neck blood flow increasedfrom 22 TPU to 46 TPU and 62.5 TPU, compared to 50 TPU and 102.5 TPU withKCl.Conclusion: TRPDUS and LDF showed an corresponding increase of urinarybladder neck perfusion with increasing bladder distension. Based on the goodcorrelation of CPD with TPU, TRPDUS may be particularly useful to measuredrug related changes of bladder neck blood flow in clinical trials.

C-476Excretory urography compared with MR urography in patients with urinarytract obstructionJ. Branera, A. Malet, A. Malet Munte, P. Bermudez, A. Quiles; Sabadell/ES

Purpose: To compare the excretory urography and the MR urography (MRU) inthe assessment of urinary tract obstruction.Material and Methods: 23 patients with suspected urinary tract obstruction werestudied with excretory urography and MRU. The MRU was performed with anequipment of 1.0 Teslas using the following sequences: (a) Half Fourier singleshot disturb spin throw (HASTE) and (b) Disturb espin echo based on the se-quence rapid aquisition with relaxation and enhancement (RARE). Four radiolo-gists evaluated the images, two read the excretory urography in consensus andtwo read the MRU in consensus. The percentages of enlargements and stenosiswere measured and Mcnemar's test was used to compare the two techniques.Results and Discussion: The average duration was 15 minutes for MRU and363 minutes for excretory urography. 21 patients (91%) had pyelocalyceal sys-tem dilatation. The MRU demonstrated the dilatation of the pyelocalyceal systemin 21 cases (100%) while the excretory urography showed it in 15 cases (65%).13 patient (56%) had uretheral dilatation. The MRU visualized the dilatation anddetermined the obstruction level in 13 cases (100%). The excretory urographydetected uretheral dilatation and determined the obstruction level in 10 cases(77%).Conclusion: The MRU detects with great accuracy the dilatation and also, ob-struction level in patients with obstructive uropathy and could be used as analternative to excretory urography in specific cases.

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C-477Imaging strategies, evaluation, and management of congenitalneurosensorial hearing lossM. de Juan-Delago, J. Ruscalleda Nadal, C. Meda Bolunya,L. San Roman Manzanera, E. Guardia Mas, C. Castaño Duque; Barcelona/ES

Learning Objectives: To define and analyze the radiological spectrum of innerear anomalies in patients with congenital neurosensorial hearing loss (NSHL)Background: According to the literature, 20% of patients with NSHL have radio-logical visible abnormalities of the inner ear. Based on radiological findings, it ispossible to make a classification of the type of malformation and the moment atwhich such malformation occurred. CT gives great definition of the changes inthe osseous otic capsule, whereas MR allows evaluation of the membranous oticcapsule as well as the status of the acoustic nerve, very important if a cochlearimplant is contemplated. We have studied 200 patients with NSHL by CT and/orMR, finding a whole spectrum of malformations of the inner ear, except for com-plete aplasia.Imaging Findings: We intend to show the normal anatomy of the inner ear withCT and MR, as well as classification of all types of malformations found in 50patients (25% of 200). The most frequent one is dilatation of the vestibular aque-duct (20 patients). Different kinds of cochlear anomalies were found in 16 pa-tients. The remaining 14 patients presented anomalies of the posterior labyrinth,round window and modiolus.Conclusion: CT and MR are complementary studies that allow exact diagnosisof inner ear malformations and the status of the acoustic nerve which explainsthe associated hearing loss. These findings are important to establish a progno-sis and the possibility of a cochlear implant.

C-478The diagnostic value of diffusion coefficient in the characterization ofparotid tumorsA. Kalai, F. Petit, Y.K. Maratos, F. Guerfala, N. Bely, P. Halimi; Paris/FR

Learning Objectives: How to measure apparent coefficient diffusion (ADC) inparotid tumors. Characterize in function of ADC value: solid benign and malig-nant parotid tumors and epidermoid lesions.Background: MR is mandatory in evaluation of parotid masses. Characteriza-tion is not always possible using classical sequences. The aim of this work is toevaluate the interest of the apparent diffusion coefficient (ADC) in the character-ization of parotid gland tumors.Procedure Details: Based on echoplanar MR imaging sequences with a diffu-sion gradient (b = 1000), the ADC was calculated for 30 parotid lesions. The cor-relation R was calculated corresponding to the relation between the ADC of thetumor and the ADC of the parotid gland. This correlation was compared to thehistological findings. The relation R was high in pleomorphic adenomas com-pared to malignant tumors (2.27 compared to 1.75). The relation R was variablefor cystic adenolymphomas. Epidermoid cysts had characteristic value.Conclusion: A high relation R (> 2) in a solid parotid tumor is predictive for abenign lesion. A relation inferior to 1 cannot differentiate between a malignanttumor and a transformed cystic adenolymphoma.

C-479Oro-maxillo-facial anatomy after reconstructive surgery: MR imagingV. Martines, G. Morana, A. Fior, A. Baltieri, P. Nocini, C. Procacci; Verona/IT

Learning Objectives: To illustrate the spectrum of magnetic resonance imaging(MRI) after surgical demolition and reconstruction with flaps in the oro-maxillo-facial region.Background: The use of flaps in restoring continuity of various structures afterdemolitive surgery in neoplastic patients offers the possibility of radicality. MRIcan be helpful in evaluating early and late complications of flap surgery, but it isnecessary to have an in depth knowledge of the new anatomical situation. Thevirtual infinity of reconstructive possibilities does not allow a systematic exposi-tion. In this exhibit we will illustrate different patterns of reconstructive surgerywith flaps, with special emphasis on examples of muscular, myocutaneous, fasci-ocutaneous and bone flaps.Procedure Details: Ten patients who had undergone prior demolitive and recon-structive surgery and eventually radiation therapy for malignant neoplasms of theoro-maxillo-facial region were studied with MRI. Examination was performed us-

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ing a Siemens 1.5 T Simphony magnet with dedicated head and neck coils. Trans-verse, coronal and sagittal SE-T1-weighted and TSE-T2-weighted images wereobtained in all patients. Before and after administration of paramagnetic contrastagent, SE-FS-T1-weighted images were performed.Conclusion: Recognition of anatomical modifications after reconstructive sur-gery is essential in postoperative evaluation in order to differentiate normal ap-pearance from complications.

C-480Histological diagnosis of palpable parotid lesions: Fine needle aspiration orcore biopsy?M. Williams1, K.K. Lewis2, D.C. Howlett2, T. Crossman1; 1Brighton/UK,2Eastbourne/UK

Background: It is mandatory to establish the diagnosis of a parotid mass prior tosurgery. Histology dictates what surgery is required and surgery can be avoidedin non-neoplastic conditions. Open biopsy of parotid lesions is no longer under-taken due to the risk of tumour seeding. Fine needle aspiration biopsy (FNAB) isthe current accepted means of cytological assessment. This technique has re-ported accuracy of 90% when performed by an experienced operator, under ul-trasound guidance, with an experienced cytologist present. If one of these factorsis removed, sensitivity and specificity falls off sharply. Ultrasound-guided corebiopsy (CB) offers a potential alternative.Procedure Details: We have experience of CB in 100 patients over a 5 yearperiod, including focal and diffuse parenchymal lesions. Initial ultrasound exami-nation was performed using 5-10 MHz high frequency transducer. Biopsies weretaken under local anaesthesia (single operator) with a spring loaded variablethrow (15 mm/22 mm) biopsy gun using 18 or 20 G needles, with an average of 2passes per patient. In our series, 54 patients had surgery with a 96% correlationwith core biopsy results. Additionly, 8 patients with parenchymal disease e.g.Sjogren's, sarcoidosis; had diagnosis established with CB and 6 lymphoma pa-tients were graded with CB alone.Conclusion: Core biopsy is an accurate and safe means of evaluating palpableparotid lesions. It offers advantages over fine needle aspiration biopsy: 1. No cy-tologist needed. 2. Provides core of tissue which can be used for immunohisto-chemical analysis and tumour grading. 3. Diagnose parenchymal disease. 4. Hasimproved sensitivity, specificity compared to published FNAB results.

C-481Inner ear anomaly of congenital sensory neural hearing loss: CT and MRimaging findingsH.-S. Hong, S. Paik, J. Cha, S. Park, J. Joh, J. Park, D. Kim, H. Lee;Bucheon/KR

Objective: Many congenital dysplasias of the osseous labyrinth have been iden-tified. Differentiation of these dysplasias is essential for patient management.The purpose of this study is to describe the imaging findings which can be foundin anomaly of the inner ear.Materials and Methods: We retrospectively reviewed imaging findings of 11 chil-dren with congenital sensory neural hearing loss (8 male, 3 female, mean age5.0 years, age range 1-14 years) who had CT (n = 8) and MR imaging (n = 10).CT was performed on a GE Hispeed/i scanner (General electric medical sys-tems, Milwaukee, Wis, USA). 1.0 mm thick direct coronal axial sections wereobtained with bone algorithms. MR was performed on a GE Signa MR/i with tem-poral T2 FSE thin section 1 mm scan and routine brain axial, coronal, FLAIR,FSE T2, SE T1, coronal FSE T2, sagittal SE T1 weighted images.Results: There were cochlear aplasia with large vestibule (n = 1), cochlear hy-poplasia (n = 1), Mondini malformation with large vestibular aqueducts (n = 1),Mondini dysplasia with large vestibule (n = 1), large vestibular aqueduct and en-dolymphatic sac (n = 5), small internal auditory canal (n = 1) and large vestibule(n = 1). Four cases were involved unilaterally. Seven cases had combined de-formities. Five cases had cochlear implant.Conclusions: Both CT and MR can be used to look at inner ear malformations,but often both techniques are complementary. CT is preferred when associatedmiddle or external ear malformations must be excluded. MRI is preferred whensubtle changes in the membranous labyrinth or abnormalities of the nerves in theinternal auditory canal must be visualized.

C-482Virtual endoscopy of the nasal cavity and paranasal sinuses withmultidetector CT: Normal anatomy and pathologic findingsE. Fanucci, G. Di Costanzo, C. Sansò, M. Leporace, E. Squillaci, G. Simonetti;Rome/IT

Learning Objectives: To describe normal anatomy and pathologic conditions ofthe nasal cavity and paranasal sinuses, also in relation to dental pathologies. Tooutline the advantages and limits of the technique. To describe the best recon-struction algorithms for virtual endoscopy.Background: Virtual endoscopy can clearly display the anatomic structure of theparanasal sinuses, nasopharyngeal cavity and upper respiratory tract, revealingdamage to the sinus wall caused by a bone tumor or fracture and permitting aneasy view of oro-sinusal pathologies. We have described the different aspects ofsinusal pathologies. One hundred patients had inflammatory-obstructive rhinos-inus disease, 58 had a history of rhinosinus surgery and 42 had orosinusal pathol-ogies of dental origin.Procedure Details: Thin-section helical scan of the nasal cavity, nasopharynxand paranasal sinuses was performed on a multidetector 8 row CT scanner. CTexaminations were obtained using 1.25 or 1.5 mm slices, 3.75 mm table feed,120 kV, 100 mA, 23 sec.total scan time, standard and high resolution algorithmsfor bony structures with a field of view of 14-16 cm. A threshold value ranging -300 to -550 UH was applied.Conclusion: Virtual endoscopy is a new method which produces very clear im-ages. It is reliable to provide detailed information for optimal operative planning.The main limitations are the arbitrary choice of threshold values and the homog-enization of different tissue densities, which reduce contrast resolution.

C-483Multiple masses in the parotid spaceH. Sato1, K. Takahashi2, M. Mineta1, T. Yamada1, W. Yamamoto1, K. Nagasawa1,T. Inaoka1, H. Hirota1, T. Aburano1; 1Asahikawa/JP, 2Iowa, IA/US

Learning Objectives: To demonstrate radiologic findings of multiple masses inthe parotid space.Background: The parotid space is formed by the divided leaves of the superficiallayer of the deep cervical fascia and is located posterior to the masseter muscleand bilaterally in the suprahyoid neck. Contents of the parotid space include theparotid gland, Stenson's duct, the facial nerve, intraparotid lymph nodes, bloodvessels (external carotid artery, retromandibular vein) and fat.In evaluation of masses within the parotid space, it is important to identify if it issolitary or multicentric. Diseases presenting as muliple masses in the parotidspace are varied and may be the result of benign or malignant etiologies. Theyinclude inflammatory and infectious disease (sarcoidosis and reactive lymph nodeswelling), tumoral lesions (Warthin tumor, acinic cell tumor, benign lymphoepi-thelial lesion, neurinoma, malignant lymphoma and metastasic lymph nodes) andother conditions (hemangioma). The purpose of this exhibit is to show the char-acteristic radiological findings (US, CT, MRI and nuclear medicine) of variousmuliple masses in the parotid space.

C-484Dental-maxillary disorders: Indication, technique, radiological findings ofCT with multiplanar reconstructions (MPR). Personal experienceP. Rinaldi, M. Politi, R. Foschi, F. Maggi, C. Giangregorio, T. Pirronti; Rome/IT

Learning Objectives: Indications, technique and usefulness of upper and lowerjaw CT with MPR (CT-Dentascan) in our personal experience; to describe majorradiological signs of different disorders.Background: From 1998 to current, we reviewed 400 patients dividing them intogroups of seven according to the clinical indication: 1. Implantology (160 patients);2. Focal bone lesions (50); 3. Fractures (20); 4. Dental inclusion (100); 5. Infiltratingoral carcinoma (40); 6. Temporomandibular disorders (20); 7. Orthodontics (10).CT Findings: CT-Dentascan of upper/lower jaw or of temporomandibular jointwas performed in all patients. In our patients, we evaluated statistically the recur-rence of different examination requests, up-dating indications for CT-Dentascan.Comparing our results with literature, we analyzed major radiological findings inthe different categories.Results and Conclusions: In addition to implantology (37% of our requests)and pre-surgical evaluation (23%), an increasing number of CT-Dentascan havebeen requested to study focal lesions (12%), oral carcinomas (9%), fractures(5%) and orthodontics (2%). Nowadays CT-Dentascan not only plays a crucialrole in implantology but is also useful to achieve a correct diagnosis of dental-maxillary disorders and to plan correct therapeutic approaches especially in thoselesions involving osteovasculonervous structures such as the mandibular canal.

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C-4853D-NMR of the vestibular labyrinth in BPPV patientsC. Wagner-Manslau1, B. Schratzenstaller2; 1Dachau/DE, 2Fürstenfeldbruck/DE

Purpose: Benign paroxysmal positional vertigo (BPPV) is probably the mostcommon cause of vertigo and the most common peripher vestibular disorder.BPPV has been postulated to be the result of freely floating debris of degenera-tive otoconia in the endolymph of a semicircular canal (SC), canalolithiasis ordebris that becomes adherent to the cupula of the semicircular canal. The key indetermining the diagnosis of BPPV is still examination performing positioningmanovers and the use of Frenzel glasses. Differential diagnosis can be difficult.The aim of this study was therefore to provide a new diagnostic approach by 3D-NMR technique. Our special interest has been if there was a structural change inthe SC or the cupula, which could be identified in patients with incurable vertigocompared to those with self-limited disease.Methods and Materials: We investigated 10 normal and 10 BPPV subjects us-ing a 1.5 T GE MRI with 3 D data set: TR 4320, TE 238, 1 mm slices, 512 x 512matrix, 22 x 22 FOV, 1.0 NEX.Results: All BPPV patients had pathological filling defect of the SC before ther-apy which must be considered as an anomaly canalolithiasis. We postulate theremust be structural changes in its lumen which makes the endothelium adhesivewhich is recognizable in HR-3D-MR as a filling defect.Conclusions: The authors are suspicious of canalolithiasis of the superior sem-icircular canal and recommend the performance of HR-3D-MR.

C-486MRI of the inner ear structures: 1.5 T versus 3.0 TH. Graf, F. Schick, C.D. Claussen, M.D. Seemann; Tübingen/DE

Purpose: To compare high resolution MRI of the inner ear structures at 1.5 T andat 3.0 T using completely re-phased gradient-echo sequences (CISS).Material and Methods: A pilot study was carried out in 3 healthy volunteersusing whole body MR units with 40 mT/m gradient systems and the standardhead coils. At 1.5 T, the sequence parameters were: 3D-CISS, flip angle 70°,TR = 9.27 ms, TE = 4.64 ms, read-out bandwidth: 197 Hz/pixel, resolution:0.39 x 0.39 x 0.4 mm3 (256 x 256 matrix with 100 mm FOV, 50% phase over-sampling, no k-space filter), slab thickness 25.6 mm / 64 slices, 1 average, meas-uring time: 7:37 min. At 3.0 T, the flip angle had to be reduced to 42° in normalSAR mode. SNR was determined from the original axial slices. MIP reconstruc-tions were performed.Results and Discussion: The signal characteristics of the inner ear require ahigh flip angle (T2-->T1, flip angle--> 90°). Despite the sub-optimal flip angle at3.0 T, considerably better SNR (1.34-fold) was achieved in the same measuringtime. Negative effects of field inhomogeneities were not observed at 3.0 T. Thus,an excellent delineation of the internal structures was achieved.Conclusion: A significant improvement in quality of high-resolution MRI of theinner ear using CISS could be obtained at 3.0 T despite potential drawbacks. Toobtain at 1.5 T, the same SNR would require approximately double measuringtime, optionally increasing the risk for an accidental head movement which mayprove detrimental at high resolution.

C-487Radiological and clinical findings in large vestibular aqueductB. Amaya1, E. König2, C. Rasinski1, S. Kösling1; 1Halle/DE, 2Leipzig/DE

Purpose: To present radiological and clinical findings in patients with large ves-tibular aqueduct (LVA)Methods and Materials: We retrospectively analyzed HRCT and/or MRI (CISS-sequence) of all patients with suspicion of an inner ear malformation between1994-2003. All identified cases with LVA were studied for associated inner earmalformations and clinical features.Results: Among 169 diagnosed cases, we found 17 patients with LVA (12 bilat-eral, 5 unilateral), average age 18.2 (1-66 yrs), 5 male and 12 female. Nine isolat-ed LVA were diagnosed. Eight patients presented associated malformations ofinner ear structures: malformation of all inner ear structures (2), dysplasia of thevestibule with or without abnormality of the lateral SCC (2), Mondini-deformation(2), cochlear dysplasia and absence of cochlear nerve (1) and dysplasia of themodiolus (1). One patient showed labyrinth hemorrhage at the time of MRI. Tencases presented typical clinical features of a progressive hearing loss. In 6 pa-tients a constantly moderate or profound sensorineural hearing loss was presentsince early childhood. One patient was deaf. One patient suffered from a Pen-dred syndrome.Conclusion: A large vestibular aqueduct is a common finding in patients with

suspected inner ear malformation. Nevertheless, especially in isolated LVA, it issometimes missed in routine work. Even if there is no therapy, an early diagnosisis needed to explain to the patient, the cause of hearing loss, the prognosis andbehaviour which can possibly delay progression.

C-488Color Doppler examination of ocular vessels in patients with traumaticoptic neuropathyA. Ustymowicz, I. Obuchowska, Z. Mariak; Bialystok/PL

Traumatic optic neuropathy (TON) is an optic nerve dysfunction after head trau-ma. It may occur in as many as10% of patients. The etiology of TON is not clear.Two factors are probably the cause of neuropathy development: primary (direct)like nerve laceration / partial disruption, or secondary (indirect) namely vascularfactors.Purpose: The aim of the study was to evaluate blood flow parameters in ocularvessels (ophthalmic artery, central retinal artery, short posterior ciliary arteries)in patients with traumatic optic neuropathy.Material: Examined group consisted of 34 patients (4F, 30M), aged 14-70.Method: All patients were examined ophthalmologically. Radiological proceduresincluded: X-ray, CT, US (B-mode and color Doppler). For ultrasound examina-tions 7.5 and 9 MHz linear array transducers were used.Results: Blood flow parameters in the ophthalmic artery and posterior ciliaryarteries were similar compared to the control group. Abnormalities were observedin the central retinal artery: In 8 patients (25%) blood flow was not detected andin 18 (56%) blood flow velocities were signifficantly decreased. Normal bloodflow parameters in the central retinal artery were found only in 6 patients.Conclusions: 1. Color Doppler sonography is a useful technique in diagnosingtraumatic optic neuropathy. 2. Our results confirm that vascular factors may playa main role in the pathogenesis of traumatic optic neuropathy.

C-489Digital radiography density measurements in differentiation of periapicalgranulomas and radicular cystsI.K. Rozylo-Kalinowska; Lublin/PL

Purpose: The differentiation of periapical granulomas and radicular cysts is cru-cial for decision on conservative or surgical treatment and therefore influencesthe success and long-term results of the treatment. Although radiograms are avaluable diagnostic tool, relying solely on the evaluation of these images maylead to mistakes in the choice of treatment. The aim of the study was determina-tion of possibile applications of digital radiography density measurements in dif-ferentiation of periapical granulomas and radicular cysts of inflammatory origin.Method and Materials: The material consisted of 355 digital periapical radio-grams obtained using Digora, RVG and Dixi 2 digital radiography systems in pa-tients aged 20 to 84, divided into two groups: 259 granulomas and 102 radicularcysts. By means of Digora 2.0 software, maximum and minimum densities weremeasured along a line and the difference between these densities was calculat-ed. The largest dimensions of the lesions were measured both perpendicular andparallel to the root canal axis.Results: The differences between the results for granulomas and cysts werestatistically significant. When the difference of densities exceeded 85.6, the le-sion was a cyst and when it was below 45.9, a granuloma was diagnosed. Com-bined application of two criteria, namely the calculated difference betweendensities and the largest dimension, increased diagnostic possibilities of radio-logical differentiation of granulomas and radicular cysts.Conclusion: It was proved that to some extent it was possible to differentiategranulomas and radicular cysts by means of digital radiography software.

C-490Ameloblastomas of the maxillofacial region: Diagnostic and therapeuticconsiderations after the treatment of 13 casesM. Stasinopoulou, A. Attard, D. Andressakis, S. Valsamis, A. Rapidis,A. Tavernaraki; Athens/GR

Purpose: The ameloblastoma is an uncommon benign odontogenic neoplasm ofthe maxillofacial region. The method of surgical approach, radical or conserva-tive, has been a point of dispute for several decades due to a high rate of localrecurrences that follow incomplete resection.Material and Methods: During the years 1995-2003, thirteen cases of amelob-lastoma of the jaw were treated in our department. In 9 cases the lesions werelocated in the mandible, 3 cases in the maxilla, while in one case the tumor oc-curred extraosseously. Pre-operative radiographic examinations included plain

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X-rays, CT and MRI. The use of 3D-CT and Dentascan proved especially helpfulin determining tumor dimensions. Histological examination of the lesions showedthat 6 were of the follicular type, 3 presented as mural ameloblastomas, 2 weresquamous type, 1 plexiform and 1 was a malignant ameloblastoma.Results: In 1 patient the extension of disease was proven inoperable. In 7 pa-tients various types of mandibulectomies along with immediate reconstructionwere performed. In 3 cases of mural ameloblastomas local excision only wasperformed, whereas in 2 patients the mandibular defect was reconstructed with atitanium plate.Conclusion: In large monolocular lesions treatment can be conservative sur-gery, whereas in large multilocular lesions radical surgical treatment that includessegmental ostectomies with immediate reconstruction of either vascularized orautogenous bone grafting is the treatment of choice and produces the best postoperative results. The interpretation of the 3D reconstruction images and theDentascan are of great importance when such an operation is decided upon.

C-491Differential growth in vestibular schwannomaG.C. Bockeler, V. Nandapalan, T. Lesser, H. Lewis-Jones; Liverpool/UK

Purpose: MRI plays a pivotal role in the management of patients with vestibularschwannoma (VS), yet there are no universally agreed guidelines on the use ofthis expensive investigation. This study analyses the site, size and morphology ofVS referred for possible intervention. Where clinically a wait-and-watch approachwas chosen, growth of VS was determined on subsequent imaging.Methods and Material: MR images of 78 patients with unilateral VS referred to atertiary centre were classified according to the site of VS with respect to theinternal acoustic canal. A variety of measurements were obtained to determinethe most sensitive method of measurement. Growth was expressed as absoluteand relative change in the direction of the largest increase in size.Results: VS showed growth in 35% of patients, 63% remained static and 3%regressed. Growth was most frequent in VS with an intra- and extracanalicularcomponent whereas purely intracanalicular VS showed no growth. The initial sizedid not predict growth. Growth rates were largest in predominantly extracanalicu-lar VS.Conclusion: Our findings confirm previous findings of infrequent and smallergrowth in purely intracanalicular VS and more frequent and larger growth in pre-dominantly extracanalicular VS. An incremental delay in follow-up imaging of theformer VS appears justifiable in the absence of new symptoms. Conversely mostVS require close monitoring as even small changes in size may lead to symp-toms necessitating invasive treatment.

C-492Sonographic assessment of the submandibular spaceD.C. Howlett1, K.T. Wong2, K.K. Lewis1, M. Williams3, A.B. Moody1,D.V. Hughes1, D.F. Sallomi1, A.T. Ahuja2; 1Eastbourne/UK, 2Hong Kong/CN,3Brighton/UK

Introduction: High resolution ultrasound is the modality of choice for evaluationof the submandibular space. In this pictorial review normal anatomy and patholo-gy that may involve this region are discussed and examples demonstrated.Materials and Methods: The ultrasound features of patients presenting over afive year period with varying submandibular pathologies are included.Results: Normal appearances: The sonographic features of the normal sub-mandibular gland and adjacent anatomical landmarks are illustrated.Neoplasms: Including the benign lesions pleomorphic adenoma and oncocyto-ma. Malignant neoplasms are more common in the submandibular than parotidglands and malignant features are well demonstrated sonographically. Metastas-es may occur and the submandibular glands can be involved by lymphoma, par-ticularly on a background of Sjögren's syndrome.Sialadenitis/sialolithiasis: Ultrasound is accurate in the assessment of acute andchronic inflammation and abscess formation. It has replaced sialography in manycentres for evaluating suspected stone disease and duct dilatation.Granulomatous disease: Sarcoidosis and Sjögren's syndrome may both involvethe submandibular glands. Ultrasound is able to delineate the phases of diseaseprogression in Sjögren's and is also used in lymphoma surveillance in these pa-tients.Other lesions of the submandibular space: Including adenopathy, cystic hygro-ma, brachial cleft cyst, ranula and lipoma may mimic submandibular gland le-sions and are readily identified sonographically.Conclusion: Ultrasound represents a safe, widely available and accurate meansof assessing the submandibular space and is able to delineate and characterizelesions. Ultrasound can be used to guide aspiration or biopsy and reduce theneed for surgical excision.

C-493Ultrasound-guided core biopsy of the parotid gland: Results of 100 patientsK.K. Lewis1, M. Williams2, D.C. Howlett1, G. Manjaly1, A.B. Moody1, N. Violaris1;1Eastbourne/UK, 2Brighton/UK

Purpose: To evaluate the role of ultrasound-guided biopsy in the management ofpalpable parotid lesions.Materials and Methods: One hundred patients were included in this prospectivestudy over a 5-year period. Initial ultrasound examination was performed using a5-10 MHz high frequency transducer. Guided biopsies were taken under localanaesthesia (single operator) with a spring loaded variable throw (15 mm/22 mm)biopsy gun using 18 or 20 G needles with an average of 2 passes per patient.Results: In 100 patients, biopsy revealed 50 benign neoplasms, 24 malignantlesions (including 6 primary and 6 secondary lesions as well as 12 lymphomas)and 26 other pathologies including sarcoidosis, tuberculosis, reactive lymphade-nopathy, Sjogren's and actinomycosis. Only 6 lymphoma patients needed sur-gery for further histological grading. Diagnostic accuracy was 100% for benignversus malignant pathology in the 54 patients who underwent subsequent sur-gery. There was 96% correlation between biopsy and operative histology withonly two non-correlates. These involved misdiagnosis of squamous cell carcino-ma and mucoepidermoid carcinoma. These would have required further histo-chemical staining for differentiation. Surgery was avoided in forty-six patientsafter biopsy diagnosis. There were no immediate complications of biopsy.Conclusion: Ultrasound guided biopsy gives 100% benign versus malignantpathological differentiation. It also has 96% correlation with operative histology.Correct pre-operative diagnosis influences the decision to undertake conserva-tive or radical surgery and unnecessary surgery can be avoided. A core of tissueallows histopathological analysis where assessment of tissue architecture, tu-mour grading and immunochemical staining is possible. This is invaluable foraccurate diagnosis.

C-494Contrast enhancement of the cochlear aqueduct in MR imaging:Its frequency and clinical significanceT. Nakamura1, S. Naganawa1, H. Fukatsu1, Y. Sakurai1, I. Aoki2, A. Ninomiya2,T. Nakashima1, T. Ishigaki1; 1Nagoya/JP, 2Tochigi/JP

Purpose: There have been no previous reports on contrast enhancement of thecochlear aqueduct in magnetic resonance (MR) imaging. The purpose of thepresent study was to evaluate the frequency and significance of this finding.Methods and Materials: Thirty-one patients (15 men and 16 women; age range18-81 years) with otologic symptoms (sudden sensorineural hearing loss, vertigoor tinnitus) were examined using contrast-enhanced imaging on a 1.5 T MR scan-ner. The normal ear served as the control. Two radiologists evaluated contrastenhancement in the area of the cochlear aqueduct.Result: Forty-eight of 62 ears (77.4%) showed contrast enhancement of the co-chlear aqueduct, but no significant differences in the frequency of contrast en-hancement were observed between patients with and patients without vertigo,tinnitus, sensorineural hearing loss, cerebellopontine angle tumors or a high-riding jugular bulb. In addition, no gender or age-related differences were noted.Conculusion: Contrast enhancement of the cochlear aqueduct was frequentlyobserved, but the frequency of enhancement in symptomatic ears was not signif-icantly higher than in control ears. The results of this study may prove helpful inavoiding unnecessary examinations and potential diagnostic confusion.

C-495High-resolution MR imaging of basaliomas of the facial soft tissue with amicroscopy coilH. Gufler, C. Zörb, W.S. Rau; Giessen/DE

Purpose: To correlate the tumor extension measured on high-resolution MR im-ages with histology.Patients and Methods: Five patients with basaliomas of the facial soft tissuewere examined before surgery with high-resolution MRI using a 1.5 Tesla systemwith a 47 mm microscopy coil. Axial T1- and T2- weighted TSE images wereobtained from all patients before Gd-DTPA application and additional axial and/or sagittal T1-weighted sequences with and without fat suppression after CMapplication (FOV 60 mm, matrix 256 x 256, slice thickness 1.5 mm, acquisitiontime 5-7 minutes). Qualitative analysis of MR images was performed by two radi-ologists who measured the extension of the tumor and decided whether boneerosion or infiltration of the orbit or of the nasal cartilage was present.Results: T1- weighted unenhanced axial images proved to be the most usefulsequences in predicting the extension of the basaliomas. For the evaluation of

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orbital invasion, additional sagittal T1-weighted unenhanced images were help-ful. The extension of the lesions correlated well with the results on histology. Inone case, however, nasal cartilage infiltration was not correctly diagnosed on thebasis of high resolution MR.Conclusion: High-resolution MR imaging using a microscopy coil is a promisingmethod to predict the exact extension of basaliomas of the facial soft tissue.

C-496Three-dimensional volumetric visualization of the eyebulb and the orbitI. Nasnikova, S. Kharlap, A. Zubarev; Moscow/RU

Purpose: Non-invasive examination of the state and spatial location of the ana-tomical elements of the eyebulb and the orbit using US-volumetric visualization.Material and Methods: Forty-six patients (55 eyes) with different orbital and opticaldiseases.Results: US-examination of the eyebulbs was done using gray-scale US withcolor and power Doppler, 3D power Doppler angio-reconstruction and 3D volu-metric US. In all patients with detached retina, the combination of 3D regimesallowed assessment of the form and spatial topography of the detached retina.The adjacency of retina at the place of the scleral sealing was revealed at thepostoperative period. In the case of detached choroid, volumetric topographywas studied, the sites of subchoroidal hemorrhages were detected and the spa-tial correlation of choroid and retina was observed. Choroid melanoma was as-sessed in terms of location, the vessel inside, the connection between the lesionand the choroid and the type of the "vessels map".Conclusion: The US spatial methods of eyebulb examination give the possibilityto study the clinical topography of complex pathological lesions. They allow as-sessment of the interrelation of the optical and orbital tissues, estimation of thestate of the blood supply and postoperative monitoring.

C-497Imaging of the orbital wall's alloplastic prosthesisM. Olszycki, M. Kozakiewicz, P. Arkuszewski, A. Przygonski, A. Rotkiewicz,L. Stefanczyk; Lodz/PL

Purpose: To evaluate the visualization of the alloplastic material–polypropylenetexture and titanic mesh implanted within the orbital wall in post traumatic pa-tients. To investigate the usefulness of CT and MR image fusion of these exami-nations.Methods and Materials: Spiral CT (sCT) and MR postsurgery images were ob-tained in 27 patients after orbital wall fractures. The globe was supported withpolypropylene texture or titanic mesh. Volumetric acquisition of spiral CT and MRimages were obtained in the same coronal planes. Images of both the modalitieswere analysed separately by two experienced radiologists according to the qual-ity of visualisation of the implanted grafts. The second focus of evaluation was toassess image artefacts caused by the alloplastic material within the surroundingstructures. The sCT and MR images digital fusion of all the examinations wasapplied.Results: In all the patients the sCT scans showed titanium mesh clearly with nosignificant artifacts. The MR images in all those cases revealed only an area ofmetal-artifact, but surrounding tissues could be satisfactorily evaluated. The fusedCT and MR images well depicted an implant on the background of soft tissues.The polypropylene texture was not well visualized either by sCT or MR examination.Conclusion: Titanium implant could be only visualized using CT but the intraor-bital soft tissues were better depicted in MR. Their digital fusion unified the ad-vantages of both the modalities. The polypropylene texture was not well visualizedeither by sCT or MR.

C-498Orbit MRI of the superior oblique muscles to measure the asymmetry inpatients with IV nerve paresisM.A. Eleta, F. Shokida, F. Seclen, J. Gabriel, C. Zanchez, F.A. Eleta;Buenos Aires/AR

Purpose: To evaluate the section of the superior oblique muscles (SO) in pa-tients with unilateral congenital or acquired pareses to detect asymmetry and therelationship between the degree of vertical deviation and MRI measurements.Method and Materials: From March 1999 to September 2002, 32 patients un-derwent orbits MRI. Seventeen patients had unilateral SO muscle paresis: 13congenital and 4 acquired. Fifteen patients had normal SO. The area of the supe-rior oblique muscle in the section of maximun width was obtained in primary gazeposition, supra and infraversion. Asymmetry of the superior oblique muscles wasdefined arbitrarily as the difference between both SO in the same patient and the

measurement was compared with the values obtained in the normal group ofpatients.Results: Mean maximal difference was 14.2 ± 3.3 mm2 (p < 0.01) between thehealthy and paretic eye. In the normal group of patients it was 4.3 ± 1.6 mm2

(p < 0.02). Eleven out of the 13 patients with congenital paresis showed asym-metry of the superior oblique (84. 6%). Asymmetry determination of the superioroblique muscles disclosed 76.5% sensitivity and 97% specificity. The relation-ship between vertical deviation and the maximal difference between the sectionof the normal versus the paretic eye was p > 0.05.Conclusion: Imaging of the superior oblique muscles in patients with congenitalIV nerve paresis showed significant asymmetry in the section area with regard tothe contralateral muscle. However, no correlation was found between the degreeof vertical deviation and interocular asymmetry.

C-499Superiority of distended cheek CT studies in detecting the presence andextention of malignant tumors of the oral cavityN. Erdogan, E. Bulbul, B.D. Vidinli, M. Apaydin, E. Uluc, O. Demirtas; Izmir/TR

Purpose: To compare the effectiveness of distended cheek CT and conventionalCT in the detection of oral cavity tumors.Materials and Methods: Eleven patients (6 female) with oral cavity malignan-cies underwent CT examination, first conventional, followed by blown-up cheeks(air contrast) study. Mean age of the patients was 64.5 (ranging from 32 to 85).Results: Tumors involving the buccal area in 4, buccal and retromolar trigon in 2,retromolar trigon 1 and the floor of the mouth in 4 patients were found. In 3 pa-tients, tumors could be seen only by using distended cheek CT. Furthermore, thistechnique gave additional information regarding the size and the extent of thetumors when compared to the conventional study.Conclusion: When malignant lesions involving the oral cavity are suspected, CTexamination with distended cheeks should be used routinely as a suppplemen-tary procedure.

C-500Anatomy of the eye: A practical guide of high resolution ultrasonographicfeaturesD. Spitzer, J. Novák; Pardubice/CZ

Purpose: (1) To review the anatomy of the eye and to become familiar with thisregion. (2) To recognize the main structures of the eye on ultrasound examina-tion. (3) To assess the role of ultrasonography (US) on initial evaluation of therepresentative pathologies in this region. (4) To achieve a practical and didacticmethod of viewing the normal anatomy of the eye.Material and Methods: High resolution gray scale and color Doppler imagingwas performed in more than 100 patients using a high frequency linear arraytransducer. Various planes of imaging of the eye correlating with drawings ofnormal anatomy are shown. Views are used to illustrate the complex anatomicalrelationships. An overview of the normal anatomy and pathologic conditions ispresented with clinical correlation.Results: Evaluation with high resolution gray-scale and color Doppler ultrasoundcan often determine diagnosis without further imaging procedures. US is some-times insufficient to evaluating a deep structures of the orbit. Paradigmatic USimages from different pathologic entities of the eye (for instance: intraocular for-eign bodies, haematoma, cataract, vitreal pathology and ablation of the retinaetc.) are shown.Conclusion: Adequate knowledge of the anatomy of the eye and orbit is neededto correctly limit the differential diagnostic possibility of pathology of the eye andorbit. US is an available method for an accurate diagnosis of the eye with CT, andpreferably MR, being reserved for cases which require additional information aboutdeep structure, or those with in which there is discrepancy between the sono-graphic and clinical diagnosis.

C-501Common crus aplasia: Diagnosis by 3D volume rendering imaging using3DFT-CISS sequenceH.J. Kim, L.S. Kim; Pusan/KR

Purpose: To determine the effectiveness of 3-dimensional (3D) volume render-ing (VR) imaging in diagnosing common crus aplasia (CCA) of the inner ear.Methods: Using 3D VR imaging of temporal bone CISS MR images, we retro-spectively reviewed 7 inner ears of 6 children who were candidates for cochlearimplants and who had been diagnosed with CCA. As controls, we used the samemethod to examine 402 inner ears of 201 patients who had no clinical symptoms

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or signs of sensorineural hearing loss. Temporal bone MRIs were performed witha 1.5 T MR scanner using a CISS sequence and VR of the inner ear was per-formed on a workstation. Morphologic image analysis was performed on rotationviews of 3D VR images.Results: In all 7 cases, CCA was diagnosed by the absence of the CC. Theremaining superior semicircular canal (SSC) was normal in 5 and hypoplastic in2 inner ears, while the posterior SSC was normal in all 7. One patient showedbilateral symmetrical CCA. Complicated combined anomalies were seen in thecochlea, vestibule and lateral SSC.Conclusion: 3D VR imaging findings with MR CISS sequence can directly diag-nose CCA. This technique may be useful in delineating detailed anomalies ofSSCs.

C-502Nasopharyngeal angiofibroma: The role of angiography in diagnosis andtreatmentA. Szymanska, R. Pietura, A. Drelich-Zbroja, M. Szymanski,M. Szczerbo-Trojanowska; Lublin/PL

Background: Nasopharyngeal angiofibroma (NA) is a rare, benign, unencapsu-lated tumour affecting adolescent males. Surgery and radiotherapy are main treat-ment modalities. We evaluated typical angiography findings of NA, its role indefining tumour blood supply and treatment planning.Material and Methods: Forty patients with JNA (38 males and 2 females aged12 to 57) underwent angiography. We assessed tumour vascular composition, itslocation in relation to the maxillary artery (MA), feeding vessels and feasibility ofpreoperative embolization. Relationship between stage of tumour, presence ofintracranial extension and internal carotid artery (ICA) blood supply were statis-tically evaluated.Results: On angiograms, all tumours presented intensive inhomogenous blush.97.5% of tumours were supplied by MA, 15% by ascending pharyngeal and 7.5%by the facial artery. In 30% of tumours, feeding vessels originated from the ICAand in 1 (2.5%) case from the vertebral artery. The relationship between ICAblood supply and tumour stage was statistically significant. ICA blood supply hadno correlation with the presence of tumour intracranial extension. Two patientswith abundant ICA supply were disqualified from surgery and underwent irradia-tion. In 2 patients with previous external carotid atery ligation, preoperative em-bolization of vascular recurrent tumour was not feasible. In 33% of cases MA wasdisplaced by tumour lateral extension.Conclusions: Angiography shows typical features of NA (nasopharyngeal, high-ly vascular tumour supplied by MA), confirms diagnosis of this tumour and ena-bles preoperative embolization. Analysis of tumour blood supply is useful indetermining best therapeutic approach. Angiography visualises displaced MA,which helps the surgeon identify and ligate it during tumour removal.

C-503Comparison between clinical examination and MRI findings oftemporomandibular joint effusionF. Tognini1, D. Manfredini1, G. Montagnani1, M. Bosco1, G. Tognini2, V. Zampa1;1Pisa/IT, 2Parma/IT

Purpose: The aim of this work was to evaluate the predictive value of clinicalsymptoms from magnetic resonance (MR) findings of temporomandibular joint(TMJ) effusion.Methods and Materials: Sixty-one consecutive patients with temporomandibu-lar disorder (TMD) signs and symptoms were assessed by means of a standard-ized clinical examination and MR imaging. A calibrated investigator evaluated thepresence of eight clinical indicators of TMJ effusion. A logistic regression analy-sis was performed to detect significant associations between clinical symptoms(predictors) and MR findings of TMJ effusion (outcome variable). The accuracy ofthe final logit to predict effusion was compared with that derived from univariateanalysis.Results: A clinical examination based upon the assessment of pain in the TMJwith lateral and posterior palpation during mandibular movements and duringmaximum assisted opening, and the presence of click and crepitus sounds hasan accuracy of 78.7% to predict TMJ effusion. Among the single clinical symp-toms, the most reliable predictor of TMJ effusion is the presence of pain withlateral palpation (accuracy 76.2%; K = 0.525).Conclusions: The use of a multiple regression approach demonstrated that anextensive clinical assessment which considers six main indicators consents topredict accurately the presence of MR TMJ effusion.

C-504Clinical assessment vs MRI: Findings in the diagnosis oftemporomandibular joint internal derangementF. Tognini1, D. Manfredini1, G. Tognini2, V. Zampa1, M. Bosco1; 1Pisa/IT,2Parma/IT

Purpose: The aim of this work was to evaluate the accuracy of clinical examina-tion in the diagnosis of temporomandibular joint (TMJ) disk position abnormali-ties compared with magnetic resonance imaging (MR) findings, assumed as thestandard of reference.Methods and Materials: Participants in this study were 51 consecutive patientswith signs and symptoms of temporomandibular disorders (TMD). All 102 TMJswere evaluated to detect disk position abnormalities by means of a standardizedclinical assessment according to Research Diagnostic Criteria for temporoman-dibular disorders (RDC/TMD) and MR performed by a blinded radiologist. Theaccuracy of clinical assessment was evaluated with respect to MR.Results: Clinical assessment demonstrated a good accuracy in the diagnosis ofnormal disk position (predictive value 86.2%) and disk displacement with reduc-tion (PV 70.3%), while it seemed less accurate in predicting MR diagnosis of diskdisplacement without reduction. The overall agreement between clinical RDC/TMD examination and MR for the assessment of disk position was 77.3%.Conclusions: Clinical RDC/TMD examination proved to be accurate in detectingnormal disk position and disk displacement with reduction in the temporoman-dibular joint but not reliable in predicting MR diagnosis of disk displacement with-out reduction.

C-505Is an increased capsular width a reliable indirect indicator oftemporomandibular joint effusion?F. Tognini1, D. Manfredini1, V. Zampa1, G. Tognini2, M. Bosco1; 1Pisa/IT,2Parma/IT

Purpose: To establish the most accurate cut-off value of ultrasonographic (US)capsular width which consents to discriminate between temporomandibular joints(TMJ) with and without magnetic resonance (MR) effusion.Methods and Materials: The study group consisted of 69 patients who soughttreatment for temporomandibular disorders (TMD). All the TMJs (n = 138) wereevaluated in order to detect the presence of effusion by means of US and MR.Ultrasonographic examination allowed measurement of the capsular width, in thesagittal-oblique scans, as the distance between the hyperechoic lines represent-ing condylar surface and the glenoid fossa. After capsular width was measured,ROC curve analysis was performed to establish the most accurate cut-off valueto discriminate between joints with and without MR effusion.Results: Diagnostic accuracy of US to predict MR evidence of TMJ effusion wasgood (area under the ROC curve = 0.817). US sensitivity was high for valueslower than the cut-off value of 1.95 mm (true positive rate (TPR) = 83.9%; falsepositive rate (FPR) = 26.3%), while specificity was high for values higher than thecut-off value of 2.15 mm (TPR = 71.0%; FPR = 11.8%).Conclusion: Ultrasonography proved to be accurate in detecting the presence ofeffusion in the temporomandibular joint. Analysis of receiver operating character-istic curve seems to reveal that the critical area of capsular width indicating effu-sion is that around the value of 2 mm.

C-506Spectrum of various pathologic conditions involving the lacrimal gland andlacrimal fossaW. Jung, K. Ahn, S. Hahn; Seoul/KR

Purpose: To illustrate a variety of pathologic conditions involving the lacrimalgland and lacrimal fossa.Materials and Methods: MR and CT imaging features of various pathologic con-ditions are described. Tumorous conditions include pleomorphic adenoma, lipo-ma, dermoid cyst, neurofibroma, hemangiopericytoma, adenoid cystic carcinoma,squamous cell carcinoma, myoepithlial carcinoma, malignant lymphoma and sec-ondary squamous cell carcinoma developed from pleomorphic adenoma. Inflam-matory conditions include dacryoadenitis, pseudotumor and xanthogranuloma.Other disease includes lymphoid hyperplasia involving the lacrimal gland.Results: Lacrimal gland and lacrimal fossa lesions include a wide spectrum ofpathologic categories of inflammatory and tumorous conditions.Conclusion: Various pathologic conditions affecting the lacrimal gland and lac-rimal fossa have characteristic findings and allows informed radiologists to makespecific diagnoses based on radiographic findings.

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C-507Neck imaging with MR to determine needle angles and safe depths for localanaesthesia in interscalene brachial plexus nerve blocksR.N. Patel, A.M. Sardesai, M.J. Herrick, A.K. Dixon; Cambridge/UK

Learning Objectives: To improve understanding of relationships of surface ana-tomical markings and cervical spine neural foramina using magnetic resonance(MR) imaging. To determine angles and safe depths of brachial plexus nerveblocks, for both a conventional and adapted anaesthetic technique.Background: For shoulder surgery, anaesthesia and analgesia can be providedwith local anaesthesia to the brachial plexus. There are reports of spinal cordanaesthetic administration and damage due to intra-thecal delivery. Newer bra-chial plexus catheters have been introduced, causing the technique to be adapt-ed, with a higher skin position. Needles available locally are 25 mm and 50 mm.Procedure Details: Volunteers were studied with the head turned as per anaes-thetic practice. Marker capsules were placed on the skin at the established land-marks. Three dimensional MR image data was acquired. Co-ordinates of themarkers and neural foramina, especially of the 6th cervical vertebra, were meas-ured and angles and depths calculated.Conclusion: Initial results show skin to C6 neural foramina distances were be-tween 25 mm and 50 mm, for both conventional (mean 44.8 mm, range 43.5 to47 mm) and adapted anaesthetic technique (mean 37.8 mm, range 35.3 to42 mm), suggesting the long needle as potentially unsafe. Angles from markersto C6 neural foramina measured in the axial plane (off sagittal) for the conven-tional verses newer technique were similar (mean 67.5 verses 68 degrees). An-gles in the coronal plane were different, with previous technique (mean 1.5degrees) being near perpendicular but newer technique requiring angulation to-wards the feet (mean 40.3 degrees off axial plane). Further data will be available.

C-508Carotid body tumors: A teaching fileR. Iannaccone, C. Catalano, A. Laghi, M. Danti, F. Mangiapane, D. Marin,M. Celestre, R. Passariello; Rome/IT

Learning Objectives: 1. Review the pathophysiology of carotid body tumors. 2.Become familiar with the appearance of carotid body tumors on US, CT, MR,angiography and somatostatin scintigraphy.Background: Between January 2002 and March 2003, 200 patients were re-ferred for CT angiography of carotid arteries in our institution. Of these patients,10 were found to have carotid body tumors and were included in the study. Alltumors were confirmed with several imaging modalities (US, MSCT, MR, digitalsubtraction angiography and somatostatin scintigraphy) and with histologic ex-amination performed on the resected surgical specimen.Imaging Findings: The US (including power- and color-Doppler scanning), MSCTangiography, MR angiography, digital subtraction angiography and somatostatinscintigraphy findings of 12 carotid body tumors were reviewed. Tumors were uni-lateral in eight cases and bilateral in the remaining two patients. All lesions werewell-defined (ranging in size from 1.0 to 6.5 cm) and located within the carotidbifurcation, causing splaying of the carotid branches. All tumors were highly vas-cularized (mainly by branches of the external carotid artery) and no sign of malig-nancy was identified. After pre-operative embolization, all lesions were surgicallyremoved with no complications and were confirmed to be carotid body tumors athistology.Conclusion: The diagnostic possibility of a carotid body tumor has to be consid-ered when a solid mass is detected within the carotid bifurcation. Imaging studiesare essential to differentiate carotid body tumors from other masses of the neck(lymphadenopathy, tumors, cysts, etc).

C-509Imaging of cervical spaces: Correlation of anatomy, ultrasound, computedtomography and MRIM. Peralta, V. Garriga, M. Cuadrado, X. Pruna, S. Medrano, M. Zarcero,S. Vizcaya; Barcelona/ES

Learning Objectives: To illustrate the anatomy of the cervical spaces and corre-late it with the three techniques to provide a baseline for examination of cervicalregions.Background: Evaluation of cervical spaces is an important procedure for pa-tients with cervical pathology because it assesses the prognosis of the patients

and helps to select adequate treatment. Ultrasound, computed tomography andmagnetic resonance play an important role in the imaging diagnosis of this area.However, before examination of pathology, a clear understanding of the anatomyof cervical spaces is essential. The neck is divided into eight regions, enablingthe radiologist to examine all areas of the neck in a systematic way in order not tomiss a lesion.Procedure Details: We have reviewed all the normal studies of the neck thatwere performed during the last year using at least one of the three techniques.We selected the most illustrated cases to describe the anatomy of the cervicalspaces.Conclusion: The neck is a complex anatomic area. This education exhibit helpsthe radiologist to have a better knowledge of imaging of the cervical spaces.

C-5103D ultrasound angiography in preoperative evaluation of thyroid nodulesH. Markova, V. Bashilov, V. Gazhonova, A. Zubarev; Moscow/RU

Purpose: To evaluate the role of 3D US-angiography (3D USA) in preoperativeassessment of thyroid nodules and to correlate US findings with postoperativeresults.Materials and Methods: Eighty patients with thyroid nodules were examined.Preoperatively, the thyroid nodules were assesed in terms of number, compressi-bility, texture, complexity, margins, volume, vascularity, interactions with greatvessels and the presence of thyroid, parathyroid and cervical lymph nodes. 3DUSA multiplanar reconstructions (MPR) reslicing thyroid nodules for virtual sur-gery were created. US results were compared with intra-operative findings andfinal pathomorphology.Results: Fifty-three patients had operations (39 lobectomies, 7 thyreoidectomiesincluding 2 with lympadenectomies and 7 thyroid resections). Six cancers, 26adenomas, 15 colloid nodules, 14 goiters and 9 with thyroiditis were found. Dem-onstration of the nodules in three orthogonal planes by 3D USA and assessmentof the nodule's character and vascularity helped to change surgical managementin 8 cases; in 2 cases post puncture morphological diagnosis and in 9 casesoperation was rejected. 3D USA was superior to conventional 2D in differentialdiagnosis of thyroid nodules. The preliminary decision to perform a lobectomy ora total thyroidectomy was based on variety of factors, many of which were delin-eated by detailed ultrasound examination. Preoperative evaluation of thyroid vas-cular anatomy and MPR of the nodules were of value for changing surgicalmanagement for thyroid resections and in rejecting the necessity of operation.Conclusions: 3D USA is a useful complement to conventional ultrasound thatallows precise preoperative evaluation of thyroid nodules which influences surgi-cal management.

C-511The value of MR imaging and MR angiography in the differential diagnosisof carotid space tumorsP.-f. Liu, R.-X. Bao; Tianjin/CN

Purpose: To determine the features of MR imaging and 2D TOF MR angiography(MRA) and to study the value in the differential diagnosis and surgical planningfor carotid space tumors.Methods and Materials: Twenty-six patients with carotid space tumor suspectedclinically were imaged by MRI and 2D TOF MRA from 1996 to 2003. The charac-teristic appearances of MRI and MRA in 26 cases were analyzed, including le-sion shape, margin, signal intensity, carotid artery bifurcation and the relationshipbetween the great vessel and carotid space mass, which is most important in thedifferential diagnosis.Results: Of the 26 patients in the study, 22 were verified histopathologically,including 15 carotid body tumors (1 patient had bilateral carotid body tumors), 4carotid artery aneurysms, 3 schwannomas and 1 metastatic carcinoma. Fourhad clinical pseudomasses proved by MRI and MRA as considerable dilated orcircular carotid artery compared with the contralateral one. Combined MRI andMRA assessment of carotid body tumors and carotid artery aneurysms yieldedaccuracy of 100%. In addition, the study reveals that the anatomy shown on theMRI and axial MRA source images was consistent with that found at surgery.Conclusion: MRI in combination with MRA is presently considered as a non-invasive imaging technique for the evaluation of carotid space tumors as it allowsa multiplanar approach and direct visualization of the tumor and adjacent ves-sels. Instead of DSA, MRI and MRA are superior to other modalities in evaluatingthe differential diagnosis regarding vascular vs non-vascular tumors.

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C-512Thyroid nodules: Prevalence, grey-scale and color Doppler pattern in arandom adult population screened by high-resolution UST.V. Bartolotta, M. Midiri, M. Galia, G. Runza, F. Barbiera, R. Lagalla;Palermo/IT

Purpose: To assess the prevalence, gray-scale and color-Doppler patterns ofthyroid nodules in a random population at ultrasound examination.Material and Methods: Three hundred and fifty-two consecutive patients (200female and 152 male; age range 18-93 years; mean: 38 years) with no history,symptoms or clinical signs of thyroid disease underwent gray-scale, color andpower Doppler US examination of the thyroid. US abnormalities were classifiedas diffuse (inhomogeneous) and nodular. Number, size, location, echotexture(presence of calcifications, peripheral halo, margins of the nodule) and color-Doppler pattern were assessed. Fine-needle biopsy was performed only in thenodules with US and/or color Doppler findings suspicious for malignancy.Results: Seven hundred and eleven thyroid nodules were detected in 112 sub-jects (31.8%). Prevalence was higher in females (295 nodules in 67 women,59.8%), than in males (416 nodules in 45 men, 40.2%). In both sexes, nodulenumber increased with age (with the highest prevalence in the 36-57 year agegroup). The majority of nodules was sized less than 1 cm (509 vs 202), weresolitary (64 patients) rather than multiple (48 patients), almost equally located inboth lobes, hypoechoic (461, 64.9%) and had peripheral vascularization only(449, 63.1%). Fine-needle biopsy was performed in 163 nodules and no malig-nancies were found.Conclusion: In our series the prevalence of small, hypoechoic thyroid noduleswith peripheral vascularization was high. This suggests a conservative approachto these type of findings unless clear signs of malignancy are detected at B-mode and/or color Doppler US examination.

C-513Virtual laryngoscopy: Comparison with fiberoptic laryngoscopical findingsZ. Celej1, A. Wygoda1, C. Przeorek1, W. Przeorek1, J. Baron2, A. Siemianowicz2;1Gliwice/PL, 2Katowice/PL

Purpose: To evaluate the concordance between virtual and direct laryngoscopyin the estimation of laryngeal carcinoma staging.Material and Methods: Multislice CT and direct laryngoscopy were used to ex-amine 10 patients with laryngeal carcinoma. CT data were obtained on a sixteenrow detector (0.75 mm slice thickness, pitch factor 1) during free breathing and"e" phonation both before and after contrast enhancement. The patients wereexamined before radiotherapy and surgical treatment. Postprocessing was per-formed using multiplanar rendering (MPR) and virtual laryngoscopy (VL) as asurface rendering algorithm with boundary density of -600,- 400 and -200 HU. AllCT examination results (MPR and VL) were compared with fiberoscopy.Results and Conclusions: Virtual images created at boundary density of -200 HUrevealed better concordance to direct laryngoscopy. Every case of laryngeal car-cinoma, even plain infiltration at T1 stage, was correctly diagnosed by virtualendoscopy. The disorder of vocal cord function was better demonstrated in fiberos-copy. Virtual laryngoscopy is complementary to fiberoptic endoscopy and shouldbe combined with axial slices and MPR images for the estimation of laryngealcarcinoma staging.

C-514Ultrasound characteristics and histopathologic correlation in primarythyroid carcinomasC. Lin, T.C. Soong, Y. Huang, A.-C. Feng, M.-Y. Lee, J.K.Y. Chan, A.T. Huang;Taipei/TW

Purpose: To examine the ultrasound characteristics of primary thyroid carcino-mas and correlate the data with histopathologic types to determine if these ultra-sound features help to differentiate papillary from follicular carcinoma.Methods and Materials: Ultrasonographies of 123 surgically-proven thyroid car-cinomas in 114 patients (30 men and 84 women; age 16-77 years) were retro-spectively evaluated. Imaging analysis without prior knowledge of histopathologictypes was made with respect to four ultrasound features: microcalcifications, ir-regular margins, the halo sign and hypoechogenicity.Results: Of the 123 thyroid nodules, there were 74 classic papillary, 28 follicularvariant of papillary, 17 follicular, 2 medullary and 2 insular carcinomas. Microcal-cifications were seen in 71.5% of the nodules without showing any significantdiscriminating power across all histologic types of thyroid carcinoma (p = 0.07).Statistical significance (p < 0.001), however, was noted in the other three ultra-sound features: irregular margins, the halo sign and hypoechogenicity. One dis-

tinct histologic subtype, follicular variant of papillary carcinoma, demonstratedmore halo sign than classic papillary carcinoma (p = 0.002). Hypoechogenicitywas a more powerful sign than microcalcifications in distinguishing classic papil-lary from follicular carcinoma. The overall accuracy for ultrasound diagnosis ofclassic papillary and follicular carcinoma was 82.4%.Conclusion: Ultrasound characteristics are helpful in differentiating classic pap-illary from follicular carcinoma. Hypoechogenicity is a highly valuable sign forclassic papillary carcinoma of the thyroid.

C-515The use of MRI in the differential diagnosis of different forms ofHashimoto's thyroiditisG.R. Vagapova, I.M. Mikhaylov; Kazan/RU

Purpose: To describe the MRI signs of different forms of Hashimoto's thyroiditis.Material and Methods: Thirty euthyroid patients with different forms of Hashim-oto's thyroiditis living in a region of iodine deficiency were examined by MRI inFSE T1 and T2 pulse sequences. Diagnosis was confirmed by sonography withcolour Doppler, fine needle aspiration biopsy and presence of antithyroid autoan-tibodies.Results: The atrophic form of Hashimoto's thyroiditis (2 cases) showed reduc-tion of thyroid volume with denominated lobularity of its structure and prevalenceof low signal intensity on T1- and T2-weighted images. The focal form of thedisease (2 cases) demonstrated blurring sidebars and structure of smitten lobewith slight hyperintensity on T2- and insignificant hypointensity on T1-mode. Thehypertrophic form of the disease (26 cases), as well as diffuse (20 cases) anddiffuse-nodular (6 cases) variants noted 2 types of change. The first type showedincreased thyroid volume, blurring and inhomogenity of its structure with hyperin-tensity on T2 mode (5 cases). The second type was distinguished by presence ofmultiple hyperintense spots in T1 and T2 pulse sequences with signs of the firsttype (11 cases). Obtained diversity of MRI appearances may be explained byexistence of several histological forms of Hashimoto's thyroiditis. Presence ofhyperintense spots on T1- and T2-weighted images can be explained by colloidaccumulation in patients with autoimmune thyroiditis, developed on the back-ground of endemic goiter.Conclusion: MRI of the thyroid gland is useful in the diagnosis of different formsof Hashimoto's thyroiditis.

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Miscellaneous

C-516Multimodality imaging in the neck and ENT regionP. Kovacs, R.C. Moncayo, R. Prommegger, C. Profanter, M. Rieger,W.R. Jaschke, R.J. Bale; Innsbruck/AT

Learning Objectives: To describe the technique and problems related to SPECT/PET/CT/US image fusion in the neck region and to demonstrate the clinical rele-vance of the information gained by multimodality imaging on a series of 58 pa-tients with neck tumors, lymph node metastasis, Graves disease and chronicENT inflammations.Background: Small tumors or subtle changes in inflammatory diseases cannotbe detected in only one imaging series. Multimodality imaging allows for a combi-nation of functional and anatomical information in one dataset and therefore givesmore detailed informations on distinct changes.Procedure Details: For reproducible immobilization of the patient, an individualmold of the patient's head, neck and shoulder was produced using the BodyFixvacuum device (Medical Intelligence, Schwabmünchen, Germany). Up to 8 mo-dality-specific markers were reproducibly attached to the skin and to the mold.The data-sets were transferred to the TREON StealthStation navigation system(Medtronic Inc.) and image fusion was performed based on the markers and an-atomical landmarks. Image fusion allowed precise correlation of suspicious trac-er-enhancements to tumorous contrast-enhanced nodules on the CT images. Inpatients with Graves disease and ENT inflammations focal disease in homoge-neous tissues was uncovered due to increased tracer uptake. US images wereused for screening and to depict vascularisation.Conclusion: The presented method aids in the detection of tumors and lymphnode metastasis in the neck area, influencing the surgical strategy in most pa-tients. In patients with Graves disease and chronic inflammations the real amountof inflammation can be determined.

C-517Lemierre's syndrome (Necrobacillosis): The imaging findingsS. Powell, M. Powell, D. Bakshi, J. Evans; Liverpool/UK

Learning Objectives: The purpose of our poster is to demonstrate the imagingfindings in the rare and interesting Lemierre's syndrome (necrobacillosis), toheighten clinincal suspicion and therefore allow more rapid diagnosis.Background: Lemierre's syndrome is the triad of pharyngitis, internal jugularvein thrombosis and pulmonary infection. The causative organism is Fusobacte-rium necrophorum. This is a commonly fatal disease requiring both the radiolo-gist and clinician to keep an index of suspicion. The diagnostic findings includepharyngitis with direct local invasion into the lateral pharyngeal space and throm-bophlebitis of the internal jugular vein. Metastatic infection is common and theusual site is pulmonary (80%).Imaging Findings: The imaging findings include pharyngitis with direct spreadof infection into the lateral pharyngeal spaces. Internal jugular vein thrombosisand pulmonary infiltration leading to cavitation are the next most commonfindings.Other findings include pleural effusions, spinal and brain abscesses, septicarthritis and IVC thrombosis. A variety of imaging modalities are employed toassess the patient with disseminated Fusobacterial infection.Conclusion: Our poster aims to provide a comprehensive collection of imagingfindings in Lemierre's syndrome.

C-518Lymph node staging in head and neck cancer: A pictorial reviewS. Connolly, H. Lewis-Jones, R. Hanlon; Liverpool/UK

Learning Objective: The purpose of this poster is to describe and show theanatomical location of the lymph node levels as described by the American JointCommittee on Cancer. It will also cover some of the difficult diagnostic areasinvolved in reporting head and neck staging images.Background: As a radiological department attached to a large head and neckunit, we have wide experience of head and neck cancer. The extent and level ofcervical node involvement is probably the most important prognostic factor forpatients with a primary squamous cell carcinoma. Node level has also been shownto be a highly significant predictor of survival.Procedure Details: Using anatomical drawings and cross sectional images ofpathology that we have encountered in our department, we will show examplesof nodes in the described levels. The pictorial review will include examples of

normal reactive nodes as well as typical examples of extracapsular spread, sq-uamous cell cancer metastatic nodes and lymphoma. We will also depict some ofthe more unusual cases we have experienced, such as histologically proven re-current metastatic nodes, which on imaging grounds appeared benign and cyst-ic, along with some examples of intraparotid nodal disease.Conclusion: The pictorial review will allow greater understanding of the stagingprocess of head and neck cancer and its implication on patient prognosis andsurvival.

C-519CT findings of Kikuchi's disease: Analysis of 96 casesT.-K. Kim, N. Lee, H. Seol, J. Kim; Seoul/KR

Purpose: Although CT findings of Kikuchi's disease (KD) or histiocytic necrotiz-ing lymphadenitis have been reported in several case reports, a large-scale anal-ysis of disease has not been made.Materials and Methods: From 1990 to 2002, a series of 96 patients who under-went a biopsy of a cervical lymph node and proven histologically to have KDwere enrolled in this study. We reviewed the clinical records and CT. We recordedtotal number of affected nodes, location of lymph nodes, size and the presence ofcharacteristic findings including necrosis, perinodal infiltration and contrast-en-hancement.Results: There were 68 women and 28 men (2.43:1 ratio; mean age 24.4 years).A total 1196 lymph nodes were affected in 96 patients (12.5 nodes per case). Thedimensions of affected lymph nodes were in the range of 0.5 to 3.5 cm (mean1.62 cm). Perinodal infiltration was found in 68 patients (70.8%). Eighty cases(83.3%) showed homogeneous nodal contrast-enhancement. Nine cases (9.4%)had lymph nodes with focal low density and 7 cases (7.3%) had ring-shape lymphnodes. Unilateral and bilateral cervical lymph nodes were affected in 76 and 20patients. Lymph nodes were mainly located level II (IIA 174 nodes, IIB 254 nodes),III (222 nodes), IV (160 nodes) and V (VA 126 nodes, VB 130 nodes).Conclusion: The CT appearance of KD can be variable, but cases with commonfindings can be diagnosed with little difficulty.

C-520Oxygenation/viability in metastic lymph nodes: Comparison of methods fordepicting the blood supplyM.R. Mühler, T. Fischer, D. Geismar, D. Beyersdorff, A. Dubbke, B. Hamm,S. Filimonow; Berlin/DE

Purpose: Determining the value of contrast enhanced (CE) power Doppler (PD)and advanced dynamic flow (ADF) technique either 2D and 3D in depicting theblood supply in metastastic lymph nodes.Methods and Materials: Ten patients with squamous cell carcinoma of the neck(T2-4, N2-3) planned for primary radiochemotherapy were examined at severaltime points in the course of the 6 weeks therapy (before, after beginning, and at3 and 6 weeks). The examinations were performed with Aplio US-System (Toshiba)with 7.5 MHz broadband transducer. PD and ADF (either 2D and 3D) were ap-plied pre and post application of ultrasound contrast agent (intravenous bolus of2.4 mL SonoVue). The methods were compared by visual assessment.Results: Both CE ADF and PD are sufficient to depict blood supply. While PDdelivers better B-Mode information, ADF allows continuous examination due tothe lower MI thus giving more time to acquire 3D data set and determining signalintensity time curve after one bolus application of contrast. ADF showed lessartifacts concerning blooming and cluttering in number and extent in almost allcases. In 5 cases, we were able to demonstrate a perfusion after 6 weeks oftherapy but in 3 it was only possible using CE techniques.Conclusion: Although PD delivers more B-Mode information ADF is the methodof choice since it has the same sensitivity for detecting blood vessels but allowscontinuous examination and is less susceptible for artifacts.

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Interventional Radiology

Non-vascular

C-521Percutaneous islet cell transplantation for type I diabetes: Technique andindicationsR.D. Garcia-Monaco, R. Lambertini, S. Hyon, C. Ceballos, P. Argibay;Buenos Aires/AR

Learning Objectives: To illustrate the clinical and interventional aspects of per-cutaneous islet cell transplantation, outlining the indications and technical ap-proach of this new interventional procedure.Backround: Pancreas transplantation is recommended in patients with long termtype 1 diabetes. Recently, percutaneous transportal islet cell transplantation wasintroduced as a safe and mini-invasive alternative to surgical transplant. In thiscommunication we shall discuss the current techniques and indications of thisinterventional procedure.Procedure Details: The intervention is performed by percutaneous transhepaticportal approach under ultrasonographic and fluoroscopic guidance. Following tran-shepatic access into a portal branch with a 25 G needle, a 4F cathether is intro-duced using the Sedinger technique. A suspension of approximately 200 mL ofpurified pancreatic human islet cells is then injected either in the main portal veinor a branch of the left lobe. Portal pressure, monitored during the procedure,usually shows a slight increase. At the end of the intervention the catheter iswithdrawn, with tract embolization with a gelfoam strip. Liver functional tests andimmunosuppression are performed in all patients.Conclusion: Percutaneous islet cell transplantation appears to be a simple andclinical promising radiological intervention and an alternative to surgical pancre-as transplantation in patients with type 1 diabetes refractory to insulin therapy.

C-522Intervertebral disk diseases: Diagnosis and interventional percutaneoustechniquesA. Gangi1, S. Guth2, J. Imbert1, J. Dietemann1; 1Strasbourg/FR, 2Haguenau/FR

Learning Objectives: Description and illustrations of imaging and minimally in-vasive procedures of intervertebral disk diseases.Background: The long term outcome, complications and sub optimal results whichmay accompany open disk surgery have led to the early development of othertreatment techniques to avoid a surgical approach through the spinal canal andan extensive disk ablation. These techniques are minimally invasive procedures.Imaging Findings and Procedure Details: Diagnostic imaging and interven-tional minimally invasive percutaneous procedures in disk diseases are reviewedthrough an interactive hypertext-based teaching file with images and movie dem-onstrations. CT, MR Imaging and discogram findings in disk pathology will bedescribed including degenerative disk diseases, spondylosis, disk herniations,traumatic disk diseases, septic diskitis, and postoperative disk diseases. Tech-niques, indications, contraindications, complications and results of percutane-ous minimally invasive procedures of intervertebral disk diseases will be describedand illustrated. These procedures include percutaneous periradicular and epi-dural steroids injection, percutaneous diskogram, diskal biopsy and drainage,percutaneous radiofrequency and laser nucleotomy.Conclusion: For disk disease with appropriate indications, minimally invasiveinterventional radiologic procedures are able to relieve pain and to minimize therisk of disability.

C-523Colonic stents in acute malignant colorectal obstruction: 78 casesP. Bermudez Bencerrey, J. Falco Fages, J. Perendreu Sans, J. Fortuño Andrés,M. Alcantara Moral, D. Gil Bello; Sabadell/ES

Learning Objectives: To illustrate our experience with colonic stents in the treat-ment of acute obstruction from colorectal cancer. To describe the results andcomplications of the procedure based on a series of 78 patients.Background: Colorectal cancer is an important health problem with a high mor-bidity and mortality rate. Between 10-30% of patients with colon cancer presentwith acute obstruction. 70% of acute obstructions are in the left colon and rec-tum, and only 40% of left sided carcinoma colonic obstructions can be treatedwith intraoperative lavage and subtotal colectomy. The rest of the patients need atemporary or, more probably, permanent colostomy with an important impact onquality of life. In this exhibit we will describe the use of colonic stents as a tempo-rary treatment prior to elective surgery of left sided colon and rectal cancer and

as a palliative treatment in the unresectable colon cancer. Between July 1997and August 2003, 78 patients with acute colonic obstruction were treated withcolonic stents in our department. The procedure, indications, contraindications,and the results are described and illustrated.Procedure Details: Plain abdominal radiography and abdominal CT was per-formed to all patients prior to the procedure. Two different types of colon stentswere used: enteral Wallstent (Boston Scientific) and Hanarostent (MITech Co.,Ltd.)Conclusion: Clinical resolution of the obstruction was achieved in 84%. Anasto-mosis was successfully performed in 95% of the patients undergoing surgery.Major complications developed in 13% (5 perforations, 5 obstructions and 3 mi-grations). Palliative treatment was effective in all cases.

C-524Saline injection of solid tumours prior to radiofrequency ablation:Our experienceA.M. Camenzuli, A. Attard, J.C. Evans; Liverpool/UK

Learning Objectives: 1. To outline the procedure we have adopted to instil sa-line into the tumour. 2. To describe the appearances of complete necrosis on theinital, early and late follow-up scans. 3. To describe the complications and pat-terns of recurrence of tumours after radiofrequency ablation.Background: The injection of saline to potentiate the effects of radiofrequencyablation in solid organ tumours in experimental models is well described in theliterature. We have injected saline prior to ablation into primary hepatocellularcarcinomas, colorectal metastases to the liver and primary renal cell carcinomas.Procedure and iImaging Details: Using either ultrasound guidance or CT andunder general anaesthesia, we lace the tumour with 5 mL of 30% saline via a co-axial needle. A radioablation probe is then placed along the needle - the latter isthen removed prior to applying the RF pulse. We routinely ablate the track alongwhich the probe has travelled to avoid seeding. Routine follow-up with a dualphase abdominal CT scan is done at 1 month and 3 months. The appearances ofablated tumours, recurrences and complications are reviewed in this presentation.Conclusion: Saline infiltration is a safe and effective way of potentiating radiofre-quency ablation of solid tumours in the liver and kidneys.

C-525Percutaneous renal abscess drainage under CT guidance: Indications,technique and possible complications presented in an interactive CD-ROMin HTML formatL. Thanos, S. Mylona, S. Tandeles, M. Pomoni, P. Ellinas, N. Mbatakis;Athens/GR

Learning Objectives: To demonstrate the technique and discuss the indicationsand complications of renal abscesses drainage based on a series of 13 patients.Background: Renal abscess is a collection of purulent material confined to therenal parenchyma. It is often life threatening leading to septicemia and is difficultto manage only with the use of antibiotics especially in immuno-compromisedpatients. CT is currently the most accurate modality in detecting and followingrenal abscesses. Treatment with CT-guided percutaneous drainage and appro-priate antibiotics can be very useful. In a period of two years we treated 13 pa-tients with renal abscesses. We demonstrate the technique and discuss theindications and complications of CT-guided percutaneous drainage of renal ab-scesses.Procedure Details: The procedure is performed with the patient in prone posi-tion under local anesthesia supplemented with minimal sedation. Initially a 22-gauge Chiba needle is passed into the renal abscess under CT guidance. Onconfirmation of an abscess we use a pigtail trocar catheter of 8 to 10F for thedrainage.Conclusion: CT-guided percutaneous drainage is an effective and well-toleratedmethod for the therapeutic management of renal abscesses.

C-526The imaging features and percutaneous drainage of mediastinal abscessessecondary to oropharyngeal infectionS. Sadiq, S. Owen, R. Evans; Swansea/UK

Learning Objectives: Oropharyngeal infection, such as dental abscess and acutepharyngitis, are recognised but rare causes of mediastinal abscess formation.We highlight the use of multimodality imaging and percutaneous image guideddrainage.Background: The hospital records of four such patients, including casenotes,microbiology data and imaging were reviewed. The clinical courses were followed

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in order to identify the causative pathogen and illustrate the imaging features andsubsequent radiological interventional management.The patients presented over a two-year period. The age range of these patientswas sixteen to forty seven. The primary aetiology in three patients was a dentalabscess. The fourth patient had an acute pharyngitis.Image Findings: A combination of ultrasound (US), computed tomography (CT)and magnetic resonance imaging (MRI) of the neck and thorax was used to de-fine the anatomical compartments involved. Radiological placement of an 8F-pigtail catheter using US or CT avoided a major surgical procedure in all patients.The common pathogen isolated was Streptococcus viridens. Patients were treat-ed with the appropriate antibiotics and all made an uneventful recovery.Conclusion: An understanding of the anatomical spaces of the neck and theircommunication with the mediastinum is demonstrated and we recommend thatin this condition, which has a high mortality when managed surgically, interven-tional radiology is an effective treatment option with a low complication rate.

C-527Management of complications following percutaneous biliary drainage andstentingM.S. Gulati, S.B. Paul, B. Guglani, N.D.L.V. Rao, P. Sahni, P. Garg, G.K. Pande,T.K. Chattopadhyay; New Delhi/IN

Learning objectives: 1. To display and discuss the spectrum of complicationsoccurring following percutaneous transhepatic biliary drainage (PTBD) and stent-ing in patients with malignant biliary obstruction. 2. To discuss the managementof these complications.Background: PTBD and stenting of malignant biliary obstructions are a com-monly performed procedure in our set up for palliation in inoperable patients.Complications occurring after drainage are not uncommon and add to the mor-bidity of the procedure. The authors display their experience in handling compli-cations (remedial procedures with appropriate images) that occurred in 100patients with malignant biliary obstruction, in whom PTBD and/or stenting wasperformed over a 2-year-period. The authors will also list precautions to be ob-served to prevent such complications.Procedure Details: Severe hemorrhage was treated by catheter repositioning,angiographic embolization of pseudoaneurysm and coil embolization of a portalvein branch rent via a PTBD tract. Cholangitis and bilomas required placement ofadditional drainage catheters. A migrated plastic stent was repositioned with vas-cular snare. A ring biliary catheter that broke during procedure, the proximal partlying in peritoneal cavity, was removed by image guided forceps, followed byreplacement. Blocked plastic stents were removed endoscopically or via the per-cutaneous route by canulation with a guidewire followed by replacement. Ringbiliary catheter and additional stents plastic/metallic stents were used for blockedmetallic stents. Pericatheter leaks responded to flushing, wire passage or largercatheter exchange.Conclusion: It is important to be aware of complications that occur during PTBDand stenting, and how to deal with them before embarking on a full time biliarydecompression program.

C-528Intellectual property: Development and protectionC. Cook1, M. Rees2; 1Weston-super-Mare/UK, 2Bristol/UK

Learning Objective: To discuss the different methods of Intellectual Property(IP) protection. To review the methods of interventional radiology device productdevelopment.Background: There are many ways of protecting intellectual property. We dis-cuss each of these in turn. We discuss the differences between the methodsused in the United States and the European Union. We also discuss the methodsof product development.Details: Trademark, copyright, patents are all reviewed. We discuss the need forpatent attorneys and specialist IP management units. We describe the differenttypes and levels of protection available. We also discuss specific means by whichan idea can be developed, then protected. We look at the methods available tolink with development companies, leading to manufacture. All the principles arespecifically discussed with respect to the development of a interventional radio-logical device.Conclusion: There are numerous ways of protecting IP, and we describe each ofthese in turn. In addition we look at the means of developing and ultimately man-ufacturing a radiological interventional device.

C-529MR imaging-guided focused ultrasound surgery in the management ofsymptomatic uterine fibroids: Initial experience and clinical evaluationK. Mikami, A. Okada, T. Marukawa, T. Murakami, H. Nakamura; Osaka/JP

Purpose: To evaluate the clinical effectiveness of MR imaging-guided focusedultrasound surgery (FUS) in the management of symptomatic uterine fibroids.Methods and Materials: From April to July 2003, FUS was performed in the 20patients (age range, 34-55 years) with symptomatic uterine fibroids in Japan. Theselection of the patients was performed according to our therapy-requirementsfor FUS. Written informed consent was obtained form all patients. The treatmentwas performed with a 1.5-T MR imaging system (Signa; GE medicals systems,Milwaukee Wis) and a MR imaging-compatible focused ultrasound system (Exa-blte 2000; Insightic-TxSonics, Haifa, Israel). Eight patients complained of hyper-menorrhea. Seventeen patients complained of the bulk-related symptoms, suchas frequency of urination, sensation of pressure, or sensation of mass. The im-provement of clinical symptoms was assessed by questionnaire and follow-upMR imaging was performed a month after the FUS.Results: Nineteen of the 20 patients had technically successful procedures andwere interviewed a month after FUS. 6 (75%) of 8 patients reported improvementin hypermenorrhea. 12 (71%) of the 17 patients with bulk-related symptoms re-ported improvement in these symptoms. Follow-up MR imaging showed a mean10% reduction in uterine fibroids volume. A patient experienced a second-degreeskin burn as a complication.Conclusion: The uterine fibroids to be treated by FUS are limited, but FUS is aneffective and safe therapy in the management of symptomatic uterine fibroids.Further investigation and long-term evaluation are warranted.

C-530Percutaneous treatment in liver tumors: 16 years experience in a singlecentreL. Bianchi, R. Vilana, M. Squarcia, M. Sala, C. Nicolau, C. Ayuso, T. De Caralt,J. Ayuso, M. Pages, M. Sanchez, A. Castells, J. Fuster, J. Llovet, J. Bruix,C. Bru; Barcelona/ES

Purpose: Ethanol injection (PEI) and radiofrequency (RF) are the percutaneousradical therapies most frequently employed in Europe to treat liver tumors in nonsurgical patients. We present our experience in these techniques over the last 16years at the Hospital Clinic in Barcelona.Methods and Materials: Since 1987 multisession PEI was applied in 328 pa-tients with hepatocellular carcinoma (HCC) (uninodular ≤ 5 cm or multinodular3 ≤ 3 cm). RF was performed in 114 patients since 1998: 73 HCC, 39 Metastasisand 2 others. CT and US (with contrast agents in the later years) were used forefficacy assessment.Results: PEI: Initial complete response (CR) = 70.4%. Extra and intratumoralrecurrence = 20 and 22%. One, 3 and 5 year survival rates in Child A patients= 90, 58 and 38% and in Child B patients = 79, 35 and 12% (mean follow-up = 48months). RF: CR in HCC patients = 67%. Extra and intratumoral recurrence = 19and 17%. One, 2 and 3 years survival rates = 83, 68 and 52% (mean follow-up =30 months). In patients with metastasis CR = 61%, with a recurrence rate = 41%(mean follow-up = 12 months). Major complications, that includes hemoperitone-um, liver abscess, needle-tract seeding and cardiovascular death are 1.5% inPEI and 6.1% in RF.Conclusion: PEI and RF are effective local curative methods in liver tumors, withmore frequent major complications in the RF group.

C-531Percutaneous vertebroplasty immediately relieves pain of osteoporoticvertebral compression fractures and prevents prolonged immobilization ofpatientsK. Shimoyama, K. Nakamura, K. Kobayashi, Y. Shigaki, M. Fujiwara,N. Kawaraya, S. Sasaki, O. Shiroeda, A. Nishiyama; Fukuchiyama/JP

Purpose: To assess the immediate efficacy of percutaneous vertebroplasty (PVP)in treating patients with poor mobility from painful vertebral compression frac-tures secondary to osteoporosis.Materials and Methods: Two hundred and six patients (55 men, 151 women;age range, 52-99 years; mean age, 77.9 years) underwent 251 percutaneousinjections of polymethylmethacrylate into a vertebra (102 thoracic and 149 lum-ber) under CT and fluoroscopic guidance during 34 months. Patients were askedto quantify their pain on a visual analog scale (VAS) before and 24 hours after theprocedure. The degrees of improvement of pain were expressed with the differ-ences of pre and post procedural VAS scores, and were classified into four groups

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according to the differences; ineffective (zero or less), poor (1-2), effective (3-6)and excellent (7-10). The efficacy was also evaluated with the days until the pa-tients unable to move started to walk again after PVP.Results: PVP was technically successful in all patients with three cases of min-imal complications. The mean VAS score for 198 patients was 7.16 before PVPcompared with 2.05 after the procedure. On the degree of improvement, the groupsof ineffective, poor, effective and excellent consisted of 4.0, 9.6, 56.1 and 30.3%of patients, respectively. 166 patients (86.5%) could walk the next day after PVPand the mean value until ambulation was 1.56 days.Conclusion: PVP is a safe and effective treatment for relieving severe pain ofosteoporotic vertebral compression fractures, leading to avoid various complica-tions associated with prolonged immobilization in aged patients.

C-532Effect of vessel size on creation of pulmonary radiofrequency lesions insheep: Assessment of the "heat sink" effectK. Steinke1, K.S. Haghighi2, K.K. Hazratwala2, D.L. Morris2; 1Basle/CH,2Sydney/AU

Purpose: To evaluate the effect of vessel size on radiofrequency lesion creationin the lung with respect to potential for perfusion-mediated heat sink effect andfor vascular and bronchial injury.Methodology: Radiofrequency lesions targeted to tissue encompassing a varie-ty of vessels were created in vivo in the lung of 10 cross-bred sheep. The accesswas either open after thoracotomy along the 5th intercostal space, or percutane-ous. Acute, subacute and chronic changes have been investigated, with immedi-ate, 96 hours and 28 days sacrifice of the sheep post ablation. Macroscopic andhistopathologic analysis of the vessels and bronchi was performed. The degreeof vascular and bronchial injury and viability of perivascular pneumocytes wererecorded.Results: Heat sink effect, macroscopically indicated by invagination of the lungtissue between the vessel and the radiofrequency lesion, was not observed invessels with a diameter less than 3 mm. Half of the vessels 3 mm or smaller werethrombosed, while the arteries of the same size looked to be patent. Macroscop-ically no vessel wall injury could be detected. All vessels 5 mm and above showeda certain extent of invagination, no clots were visible. Occasionally within thebronchial lumen small amounts of dark solid material was seen, macroscopicallybelieved to be consolidated blood-tinged sputum. The histopathological resultsare expected soon.Conclusion: As already shown for liver vessels, lung vessels seem to also havea perfusion-related heat sink effect, consistently seen in vessels above 5 mm indiameter.

C-533Peritoneal seeding of hepatocellular carcinoma after radiofrequencyablation: Rate and risk factorsJ.-Y. Oh, K.-J. Nam, J.-C. Choi, J.-H. Cho, B.-H. Park, T.-B. Shin, J.-H. Lee;Pusan/KR

Purpose: We retrospectively reviewed a series of patients with HCC treated withRF ablation, in order to analyze the rate and risk factors of post-RF peritonealtumor seeding.Methods and Materials: From May 1999 to May 2003, a total of 306 patientswith HCC were treated by RF ablation. From them 43 patients who dropped outwere excluded. Seven cases of peritoneal tumor seeding were detected. We an-alyzed AFP, tumor size, site, capsular attatchment, bulging, ascites, post-RF bleed-ing and the pattern of peritoneal seeding.Results: Capsular attachment and bulging were noted in all cases (7 patients).Post-RF bleeding was detected in 4 cases. Two of these patients had hepaticarterial embolization performed due to severe bleeding. In terms of seeding pat-tern, massive perihepatic and ometal masses were seen in 2 cases and multiplesmall peritoneal nodules were noted in a further 2 cases. Other cases showed 1small single mesenteric mass and 1 gastrohepatic ligament thickening.Conclusion: The rate of peritoneal tumor seeding after RF ablation of HCC was2.7%. The capsular attachment, tumor bulging and post-RF bleeding seems tobe risk factor of peritoneal seeding after RF ablation of HCC.

C-534SPIO-enhanced magnetic resonance imaging: Patterns of focal hepaticlesions treated with percutaneous radiofrequency thermoablation(Preliminary experience)R. Marcello, L. Broglia, M. Castellana, G. Gasparini, M. Castrucci; Rome/IT

Purpose: The aim of our study was the evaluation of the SPIO contrast-enhancedMR pattern of malignant focal liver lesions treated with percutaneous radiofre-quency ablation.Methods and Materials: 23 focal liver lesions were evaluated with MagneticResonance (1.5 Tesla Philips, The Netherlands), with SPIO (Resovist Schering,Germany) contrast media after RF percutaneous ablation. Lesions ranged in sizefrom 1.6 cm. to 5.0 cm. MR examination sequences protocol was as follows: TFET1W and FFE dynamic study before contrast media injection and after 15 and40 sec SPIO IV administration; TSE T2W and SPIR TSE T2W before contrastmedia injection and after 10-13 min after SPIO injection. All patients underwentMR imaging evaluation after 10 days, 30 days and 3 months the procedure wascarried out.The signal intensity appearance was examined in order to identify size, signs ofabsence, residual or recurrence of neoplastic tissue. The gold-standard was clin-ical and CT imaging follow-up.Results: SPIO enhanced sequences were superior in conspicuity, presence orabsence and residual or recurrence of tumoral tissue. In 60% of lesions a homo-geneous pattern was observed within the lesion with a hyperintense peripheralrim; in 20% of cases inhomogeneity of lesions was observed in examinationsperformed at 10 days. Residual tumor was depicted at 30 days examination aspresence of hyperintense foci localized within the treated area.Conclusion: In this preliminary study SPIO appeared to be an efficacious con-trast agent for detection and follow-up of percutaneous RF ablated focal hepaticlesions, especially on T2W and the 40 sec T1W dynamic MR study.

C-535Radiofrequency ablation of hepatic dome lesionsG. Papaioannou, L. Thanos, A. Nikita, E. Alexopoulou, D. Loggitsi,D.A. Kelekis; Athens/GR

Purpose: To present the additional difficulties and technical peculiarities of radi-ofrequency ablation (RF) for hepatic dome lesions.Materials and Methods: 19 patients with focal subphrenic hepatic lesions (8HCCs, 11 metastases) underwent percutaneous CT-guided RF ablation. Elec-trodes with 7 or 9 active tips were advanced under CT-guidance. Although tech-nically difficult due to the great needle angulation and penetration of a long hepaticportion, transhepatic route was followed in all cases. Transpulmonary penetra-tion was considered high-risk due to the large diameter of the electrode.Results: All patients experienced mild discomfort during the procedure. Threecomplications were noted: 2 small subcapsular hematomas and 1 pleural effu-sion, which were treated conservatively. 75% of the HCCs and 81.2% of the met-astatic lesions showed signs of complete necrosis immediately post procedure.Residual non-necrotic tumour was present in 4 cases and repetition of the proce-dure was required. Tumour recurrence was demonstrated in 2 patients (10.52%)on 1-year follow-up control and was treated with a new session of RF ablation.Overall, 25 RF sessions were performed.Conclusion: Hepatic dome lesions can be treated successfully with RF ablation.Careful planning and technical skill are required due to their location.

C-536Transoral fluoroscopic approach of C1-C2 for endosteal corticoid infusionin two children with Langerhans cell histiocytosis (LCH)A.D. Kelekis1, J.-B. Martin2, E. Alexopoulou1, M. Kampanarou1,G. Papaioannou1, Y. Sayegh2, D.A. Kelekis1; 1Athens/GR, 2Geneva/CH

Purpose: Lytic bone lesions of LCH, not reacting to IV treatment, have beenreported to improve post endosteal infusion of corticoids. A transoral fluoroscop-ic approach for lytic lesions in C1 and C2 was performed in order to achieveendosteal injection of steroids.Materials and Methods: Two cases of 4 years old children with LCH are pre-sented. Both children had multiple bone lesions, including the cervical spine (C2),requiring cervical braces. Neither showed improvement of the cervical osteolyticlesions in CT post standard IV treatment (chemotherapy and steroids). In order tospeed up the healing process and achieve brace removal, an endosteal injectionof steroid, under fluoroscopy was considered. Under general anaesthesia, in theangiography suite, transoral access of the C2 body and axis was achieved with a20 G needle. Intraosseous needle positioning was controlled by DSA after con-

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trast media injection, and completed by endosteal steroid infusion (methylpred-nisolone, 125 mg).Results: No treatment complications were noted. The patients recovered wellpost injection. CT performed in both children after three months showed ossifica-tion of the lytic lesions, allowing the cervical braces to be removed.Conclusions: To our knowledge no prior experience in endosteal cervical ster-oid injection has been reported. These two cases confirm the improvement ofosteolytic lesions in children with LCH after treatment with endosteal infusion ofsteroids. Stabilisation of the cervical spine was particularly beneficial, as the chil-dren were no longer in pain and removed the need for cervical braces three monthsafter the treatment.

C-537The influence of radiofrequency ablation on hepatic vessels in porcine liverK. Satoh, K. Nakamura, M. Hamuro, Y. Sakai, N. Nishida, Y. Inoue, R. Yamada;Osaka/JP

Purpose: The objective of this study was to clarify the influence of radiofrequen-cy ablation on hepatic blood vessels.Methods and Materials: Hepatic RFA was performed on 18 swine (mean bodyweight: 22 kg). The livers were removed either immediately following ablation, 1week or 3 weeks after ablation. The patency of vessel was determined by CT, andthe extent of endothelial disorder with diameter less than 1.0 mm was determinedhistopathologicaly.Results: The portal vein patency rate of immediately, or 3 weeks after RFA were:43.5 ± 6.9%, 11.7 ± 20.3% (less than 1.0 mm), 76.5 ± 20.9%, 75.5 ± 25.1%(3.0 mm and more). Hepatic vein patency rate were: 42.5 ± 21.0%, 5.6 ± 9.7%(less than 1.0 mm), 76.9 ± 14.1%, 75.6 ± 30.8% (3.0 mm and more). The paten-cy rate was higher for larger vessel diameters. The patency rate of the portal andhepatic veins with diameters less than 3.0 mm was found to decrease with time.At 3 weeks after ablation, the patency rate for vessels with diameters of 3.0 mmand over were significantly higher (P < 0.05) compared to those of diametersless than 2.0 mm. Endothelialization were found in patent vessels from 1 week to3 weeks after ablation.Conclusion: Endothelization was confirmed from 1 week to 3 weeks after RFA inpatent vessels. Blood vessels with diameters of 3.0 mm and over maintain highpatency even after RFA. It is therefore possible to maintain blood flow in the distalarea of hepatic parenchyma following ablation for hepatic tumors, thus RFA has alimited impact on hepatic function.

C-538Percutaneous cholecystostomy: Evaluation of complication with regard tothe access route and techniqueK.S. Shin, J.S. Cho, B.S. Shin; Daejon/KR

Purpose: To evaluate the safety and feasibility of percutaneous cholecystostomywith regard to access route (transperitoneal vs transhepatic) and technique inpatients of acute cholecystitis.Materials and Methods: In 139 consecutive patients (80 male, 59 female meanage; 67 years) with acute cholecystits, medical records about percutaneous chole-cystostomy (approach route, technique, used device and complications) wereretrospectively reviewed. In all patients, the procedure was performed under ul-trasound guidance for GB puncture and fluoroscopy control for catheter manipu-lation.Results: In 136 of 139 patients, percutaneous cholecystostomy was technicallysuccessful (98%). In three cases, a successful second trial after an initial failurewas performed. The procedure was performed by means of a transhepatic (n = 63)or a transperitonea l (n = 76) access route. During procedure, the Seldinger tech-nique was used (transhepatic approach, n = 63, transperitoneal approach, n = 62)in 125 patients, while in the remaining 14 patients the procedure were performedusing a trocar technique with a transperitoneal approach. Chiba needles (20G,Mdtech, Denmark, n = 22), JELCO needles (16G, Johnson & Johnson, USA,n = 67) and Secalon catheters (16G, Ohmeda, UK, n = 36) were used for initialpuncture of GB. Only minor complications such as abdominal pain (n = 16), hem-orrhage (n = 2), referred pain (n = 4) occurred in 21 cases (15%). Abdominalpain is more frequent in transhepatic approach (18%) than in transperitonealapproach (7%), but not statistically significant (p = 0.061). Overall complicationrate is lower in transperitoneal approach (8%) than in transhepatic approach(24%)(p = 0.016). According to puncture needle, there is no significant differencein complication rate between the Chiba needle (18%) and the 16 G needle (Jelconeedle and Secalon catheter, 16%).Conclusion: Percutaneous cholecystostomy has proved to be safe and effectivetreatment for patients with acute cholecystitis.

C-539Lumbosacral disc herniation: Spinal interventional chemonucleolysis withoxygen-ozone (O2-O3) mixture with periradicular and periganglionictechnique (Role of CT)T.V. Bartolotta, T. Angileri, M. Midiri, F. Sorrentino, G. Sparacia, A. Carcione;Palermo/IT

Purpose: To evaluate the CT role in treatment of lumbosciatalgia through chem-onucleolysis with oxygen-ozone (O2-O3) mixture with periradicular and perigan-glionic technique.Materials and Methods: From January 2000 to June 2002, 145 patients (85women, 60 men; age range: 30-75 years) with lumbosciatalgia, underwent in-tradiscal, periradicular and periganglionic treatment with O2-O3 mixture, corti-costeroids and anaesthetics. The analysis of the results was made by VisualAnalogue Scale (VAS) 1 day before treatment (T0) and, respectively, 4 weeks(T1), 3 months (T2), 6 months (T3) later. All the procedure was performed in astep-wise fashion and controlled by CT scans: from positioning the needle in thecentre of the nucleus polposus to mixture administration within the nucleus andin periradicular and periganglionic sites.Results: In 125/145 (86.2%) patients a partial remission of the complaints justafter the first treatment (VAS 6 at T1) was observed; VAS was 4 at T2 and at thelast evaluation, six months later (T3), it was 2. In 20/145 (13.8%) patients VASwas 8 at T1 and another treatment was performed, with an improvement of VASat T2 and T3 respectively of 6 and 3 in 15/20 cases. The remaining 5/20 patientsdid not show any improvement even after the second treatment and VAS rangedfrom 8 to 10 at T3.Conclusions: Chemonucleolysis with O2-O3 mixture with periradicular and per-iganglionic technique under CT guidance is a reliable and competitive method intreatment of lumbosciatalgia.

C-540Multiple cross-stent-positioning operated through one percutaneousaccess in patient with malignant biliary obstruction of hepatic hilumT. Ciarpallini, A. Casullo, E. Mazza, D. Beccani, I. Orlandi, M. Falchini,V. Cartei; Florence/IT

Purpose: To assess the feasibility of multiple cross-stent-positioning operatedthrough one percutaneous access in patents with malignant biliary obstruction ofhepatic hilum.Methods and Materials: From January 1998 to March 2003, 320 patients withmalignant biliary obstruction underwent percutaneous biliary drainage with one-step positioning of the 507wallstent.In 22 patients with malignant biliary obstruction of the hilum and unavailable bi-lateral access, drainage of biliary tree was obtained with one percutaneous ac-cess through which multiple stent deployment was performed with across-positioning technique. The first self-expandable endoprosthesis was posi-tioned in the common bile duct. Thereafter a balloon catheter was inserted alonga previously introduced guide wire to dilate the mesh of the stent. After havingremoved the catheter, a second stent was implanted through the dilated wall ofthe first stent, across the hilum.Overall 47 stents have been cross-implanted. In 20 patients 2 stents have beeninserted, in 1 patient 3 stents, in another patient cross-positioning of 4 stents wasrequired.Results: No relevant complications have occurred. Patient survival and stentpatency rates were comparable with those of multiple-access stenting technique.The procedure is generally more protracted implying an increased radiation ex-posure for both the patient and the operator.Conclusion: Biliary stenting with one percutaneous access and cross-position-ing technique is a useful procedure in all cases in which bilateral access in notpossible. It reduces the risks connected to multiple passages of liver parenchy-ma though at the expense of a longer time of exposure for both the patient andthe radiologist.

C-541Combined treatment of rectal tumors and their liver metastasesZ. Vigvary, B. Forgacs, Z. Tarjan, G. Toth, E.K. Mako; Budapest/HU

Purpose: To asses the alternative interventional treatment results for rectal tu-mors and liver metastases.Material and Methods: Sixty-five patients with inoperable lumen restricting rec-tal tumors were treated with the combination of selective chemoembolisation (ADMand/or MMC+gelaspon), intraluminal cryotherapy and low-dose rate Cs-137 irra-diation. The catheter was placed into the superior rectal artery or into the hy-

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pogastric (internal iliac) arteries. In 29 pts with liver metastases additional selec-tive hepatic artery chemoembolisation and hyperthermy was performed, alto-gether accounting for 55 cycles. for response assesment, rectal and abdominalUS and CT examinations were carried out. Survival times and quality of life wereassesed.Results: i. Rectal tumors acute bleeding was stopped and tumor volume wasreduced in all cases: CR 1, PR 38, MR 23, P 3. ii. Multiple liver metastases (n = 29),CR 0, PR 13, MR 12, P 4.Conclusions: Combined chemoembolisation, intraluminal cryotherapy, low-doserate radiotherapy after-loading, radiological treatment proved to be as effectiveas palliative treatment in non-operable rectal tumors and their hepatic metastases.

C-542Percutaneous vertebroplasty in vertebral hemangiomas: Our experiencesM. Osiecki, P. Zukowski, K. Brzozowski, B. Jaron; Warsaw/PL

Introduction: Vertebral hemangiomas are very rare vertebral malformations butthey also represent important clinical problems. The aim of this study was todetermine the efficacy of percutaneous vertebroplasty in treating painful verte-bral hemangiomas.Material and Method: From January 2003 to September 2003 the techniquewas used in 11 patients with painful lumbar level vertebral body hemangiomas (9woman and 2 man, average age 52, range 24-76). In one case we had a three-level hemangioma with one compression fracture. We used a unilateral trans-pedicular percutaneous puncture after premedication and under local anesthesia.Before PMMA (polymethylmethacrylate) injection, a vertebral angiogram wasobtained to evaluate the filling pattern and identify sites of potential PMMA leak-age. Injection of opacified PMMA was performed under continous visual controlwith fluoroscopy.Results: In 10 (91%) patients pain relief was complete within one to two daysafter injection. One (9%) patient with multilevel hemangioma failed to respond.We did not observe any complications.Conclusion: Percutaneous vertebroplasty is a promising therapy for patients withpainful vertebral hemangiomas. This method is effective, with low risk of compli-cations, and may be appliciable to asymptomatic cases as a preventive treat-ment.

C-543Percutaneous nephrostomy in pediatric populationD. Akinci, B. Peynircioglu, M. Karcaaltincaba, B. Cil, M. Ozmen, O. Akhan;Ankara/TR

Purpose: To evaluate the safety and efficacy of percutaneous nephrostomy inpediatric population in a single center.Materials and Methods: A retrospective analysis was performed of 127 percuta-neous nephrostomies in 107 patients (74 male, 33 female; age range: 6 days-16years). Twenty patients had bilateral nephrostomies and 5 patients were recath-eterized. The procedures were performed with sonographic and fluoroscopic guid-ance under sedation or general anesthesia. The catheters (5.7-10 Fr) were placedeither with a Seldinger technique or an Accustick Introduction System.Results: Percutaneous nephrostmy catheters were placed due to UP junctionobstruction in 37 patients, UV junction obstruction in 10 patients, posterior ure-thral valve in 7 patients, neurogenic bladder in 10 patients, congenital anomaliesin 9 patients, trauma in 3 patients, stones in 14 patients, tumor in 1 patient andrenal insufficiency in 6 patients. Pyonephrosis was detected in 17 patients. Ninedislodged catheters were replaced percutaneously. All procedures were carriedout successfully. No procedure related mortality was seen. One patient arrestedright after the procedure because of methemoglobinemia due to local anestheticand treated with methylene blue. No other major complications were detected.Catheter dislodgement and infection were detected in 9 and 1 patients, respec-tively. Duration of catheterization was between 1 and 150 days. All the catheterswere removed after medical, surgical or percutaneous treatments.Conclusion: Image guided percutaneous nephrostomy in pediatric population isa safe and effective procedure with low mortality, morbidity and high successrates.

C-544Percutaneous CT-guided facet screw fixation in lumbar spines: TechnicalaspectH.Y. Kang, S.H. Lee; Seoul Korea/KR

Purpose: To report our experience of the technique of percutaneous CT-guidedfacet screw fixation of 18 cases in lumbar spines.

Materials and Methods: The CT gantry has an angle tilt limitation of approxi-mately 28.5 degrees, but the Z-axis (coronal) angle of facet joints is about 40-50degrees. Thus under local anesthesia, positioning was head first, prone with ce-phalad elevation of upper body to compensate for the facet angle. After selectingthe route of the procedure, the guide wire and fixed screws were inserted, aftermeasurement of the size of fitting screw. This procedure was performed in 18patients, with combination of anterior lumbar interbody fusion (ALIF, 16 patients)and cases of discitis (2 patients).Results: All procedures of facet screw fixation with ALIF were performed suc-cessfully, there were no definite malpositioning of screw or segmental instabilityon postoperative images at one month follow-up. In cases of discitis, the proce-dure were performed also successfully, but with more slightly decreased discheight on image at one month follow-up. The controlateral translaminar facet screwfixations were performed at the levels of L3-4 and L4-5, and ipsilateral transfacetscrew fixations were done at L5-S1 level.Conclusion: Percutaneous CT-guided facet screw fixation in lumbar spines wasa safe and reliable procedure for a method of spinal fusion.

C-545Minimally invasive management of benign biliary diseasesA. Doros, V. Weszelits, A. Peter, A. Nemeth; Budapest/HU

Purpose: Report our experience in treating percutaneously benign biliary stric-tures, fistulas, post-operative leakages, residual stones/sludge, bilomas and ab-scesses.Material and Methods: In the last five years, 27 patients (20 women, 7 men, 18-68 years) with benign biliary diseases were referred to our interventional radiolo-gy unit. Twenty patients underwent laparoscopic or open cholecystectomy, sixhad residual stones, three had biliary fistulas. Twenty patients had hepatico- orduodeno-jejunostomy stenoses, four had cholangitis-induced liver abscesses,and three had chronic pancreatitis.Results: Forty percutaneous biliary interventions were performed with good long-term results. Strictures were dilated 22 times. Six metallic stents were placed intothree patients. Two plastic stents were placed in one patient with a rendez-vousmaneuver. Two fistulas were treated with drainage and glue. Five stones wereremoved percutaneously with balloons or Dormia baskets. One patient with chronicpancreatitis was treated with a metallic stent. Another patient underwent inser-tion of three metallic stents for intrahepatic stenosis. Of the four abscesses, twowere surgically and one was percutaneously drained. One patient had two smallabscesses treated with IV antibiotics.Conclusions: Percutaneous management is useful in selected benign biliary dis-eases. Dilatation, stone extraction, and abscess drainage can be performed suc-cessfully. In difficult cases combined surgical, endoscopic and percutaneousapproach must be chosen.

C-546Role of aspiration-lavage in the treatment of abscesses in the gallbladderbed after laparoscopic cholecystectomyA.B. Stoian, Z.A. Sparchez, R. Badea; Cluj Napoca/RO

Purpose: The evaluation of the efficacy of ultrasound guided aspiration followedby lavage with antibiotics in the treatment of gallbladder bed abscesses afterlaparoscopic cholecystectomy.Materials and Method: 20 patients with gallbladder bed abscesses were treatedpercutaneously between 2000-2002. The abscesses were located in gallbladderbed with extension into subhepatic area 35% (7/20). The volume of aspirated puswas 5- 20 mL (average 15 mL). The first step of the treatment was the abscesspuncture by a transhepatic 65% (13/20) or another approach 35% (7/20) usingan 18 G needle (1.2 mm). After pus aspiration, the cavity was washed 2-3 timeswith a Metronidazol + Ampicillin solution, the amount of antibiotics once injectedbeing half the amount of the aspirated pus. Oral or IV antibiotics (correspondingto antibiogram) were administrated for 7-10 days. In the case of fluid reaccumula-tion the treatment was repeated.Results: The immediate results were very good with resolution of fever and sep-tic state in 100% of cases. The recovery index was 85% (17/20). Therapeuticsessions were performed uniquely in 30% (6/20) of cases and multiplely in 70%(14/20): two sessions 50% (10/14), three sessions 20% (4/14). The failures (15%)were caused by the existence of bile leakages in the cavity in 10% (2/20) orbecause of a haemorrhage from abscess wall in its cavity in 5% (1/20). No othercomplications were found.Conclusion: The percutaneous ultrasound guided approach by aspiration-lav-age is an efficient method of treatment of abscesses after laparoscopic chole-cystectomy.

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Interventional Radiology

Vascular

C-547Results and complications of 500 radiologically implanted ports in 486consecutive oncology patientsM. Rodríguez-Castilla, J. Táboas, M. Fernández-Carrera, F. Romero,E. Guerra, F. Tardáguila; Vigo/ES

Learning Objectives: To illustrate image-guided subcutaneous port insertion. Toreport our results of 500 radiologically implanted subcutaneous ports. To exam-ine factors that may bring about infection and venous thrombosis in a series of486 patients.Background: Radiologically placed subcutaneous ports are long-term venousaccess devices commonly used for administrating chemotherapy in oncologypatients. From January 1998 to July 2003, 500 subcutaneous ports were implant-ed in 486 oncology patients in our interventional radiological department. Thetechnique, results and complications are reported.Procedure Details: Three models of ports were used (76 Titanium Port withPASV System® Boston, 304 Districath Elies® Districlass Medical, and 121 Life-port® Pfizer). All procedures were done in the interventional radiology suite, withultrasound and fluoroscopy guidance, under local anaesthesia. Follow-up wasperformed by the oncology clinic. The indication for placement, vein accessed,success of placement and model were noted. Complications were classified asthey appeared into: immediate, short-(less than 4 weeks), and long-term (morethan 4 weeks) groups.Conclusion: Technical success was 100%. The only immediate complication wasan accidental arterial punction. A total of 83 catheters (16.5%) were removed,which included the end of treatment in 28 patients (5.6%), catheter tip migrationin 5 (0.9%), skin erosion in 6 (1.4%), thrombosis in 11 (2.2%), and infection in 30(6%).

C-548Percutaneous portal vein embolization (PTPE) before extended right liverresection: Why and how to embolize segment IVG. Krupski, D.C. Broering, G. Adam; Hamburg/DE

Learning Objectives: To demonstrate the importance of segment IV emboliza-tion in order to 1. reach the maximum regenerative answer and 2. to preventregenerative failure. To illustrate segment IV portal venous anatomy. To describethe technique of segment IV embolization.Background: PTPE is a reliable tool to induce liver regeneration of the non-embolized lobe. This facilitates extended right resection in e.g. Klatskin tumor,HCC or liver metasases. Between 1998 and 2000 we performed 80 PTPE. Inthree cases we noted a failure in regeneration of segment II + III but a growth ofsegment IV after right lobe embolization. In 10 portal vein ligations which regular-ly spare segment IV the regenerative outcome was significantly reduced com-pared to PTPE including segment IV.Procedure Details: In 9/10 patients we use a subxiphoidal access to puncturethe left portal vein under US-guidance, otherwise a transhepatic right intercostalaccess. Via 5F guiding catheters a 2.5F microcatheter is placed in each segmen-tal branch in order to apply 5-8 mL histoacryl-lipiodol solution in total. SegmentIV branches are difficult to reach because of the configuration of the Rex reces-sus anatomy. Since the left lateral segments lie adjacent, the emolization of seg-ment IV is critical and has to be performed with the utmost care to prevent spillover of embolzation material.Conclusion: Segment IV turnes out to be the key for optimal portal vein embol-ization results. Although bearing the risk of embolization material displacementto segment II and III the better results clearly suggest application of this tech-nique.

C-549Chronic mesenteric ischemia: PTA and stenting of visceral arteriesM. Ruffino, M. Natrella, P. Muratore, C. Suriani, D. Savio, D. Rossato,C. Rabbia; Turin/IT

Learning Objectives: To assess the value of endovascular treatment in chronicmesenteric ischemia. To illustrate the advantages and the limits of this approachin our experience in 37 patients (41 vessels). A review of the literature.Background: Chronic mesenteric ischemia (CMI) is a rare clinical condition thatcauses weight of loss and abdominal pain. Its diagnosis occurs usually late, afterseveral gastrointestinal investigations. The indications for treatment are classic

symptoms of chronic ischemia with obstructive pathology of one or more visceralarteries. Surgical treatment (aorto-celiac and aorto-mesenteric bypass, endoar-terectomy, reimplantation) has a high technical success, recurrence of 4-15%,mortality ranging from 0% to 17% and a morbidity of 15 to 33%. Indications forendovascular treatment are symptomatic stenosis or short occlusion (except forDunbar syndrome).Procedure Details: Between September 1996 and May 2003, 37 patients (41vessels: 24 SMA, 14 CA, 3 IMA) underwent endovascular treatment for CMI. 35/37 were symptomatic. The favorite access was the brachial one (22/37). Utilisinglong sheaths or guiding catheters, we performed only PTA or PTA/stent of thevessels (with balloon-expandible or self-expandible stent). We obtained technicalsuccess in 38/41 vessels and clinical success in 31/37. There was no periopera-tive mortality. In 2 cases we had access site lesions. The follow-up (2-51 months)shows 25% (7/30) of restenosis or reocclusion.Conclusion: Most patients have a multilevel visceral disease, but treating onlyone vessel is often effective; even if the rate of the restenosis is high, endovascu-lar stenting gives excellent immediate result and is probably the procedure ofchoice.

C-550Radiological placement of gastroduodenal uncovered metal stents forpalliation of malignant upper GI obstruction: A pictorial reviewC. Tam, R. Catlow, R. Stockwell; Chorley/UK

Learning Objective: A step by step guide to how to perform upper GI stentingwithout endoscopic assistance.Background: We describe our experience with placement of uncovered self ex-pandable metal stents under fluoroscopic control for 18 patients in the followingcategories: 1. Post-operative upper GI cancer patients with recurrent obstruction(n = 5). 2. Palliation of gastric cancers with obstruction via trans-oral route (n = 4).3. Palliation of duodenal obstruction via trans-oral route (n = 5) and trans-gastricroute (n = 4).Procedural Details and Results: For group 1 and 2, and the trans-oral route ingroup 3, the technique is essentially an extension to the well established tech-nique of oesophageal stenting of malignancy (except longer wires and cathetersare used when more distal stenting is required). As more distal lesions are tack-led, the intrinsic difficulty of manipulating long wires and catheters increases andgives way to the more direct transgastric route approach of group 3. This is alsoan extension to the well established technique of radiological insertion of gas-trostomy using T-bar fixation.Failure of insertion occurred in 2 patients in the duodenal obstruction group viathe trans-oral route. There were no immediate or delayed complications and nore-interventions were required. Five patients (30%) returned to normal diet, 6patients managed semi-solid diet (40%) and 5 patients (30%) had no significantimprovement post stent insertion respectively. The mean survival for groups (2)and (3) (i.e. primary carcinoma) was 58 days (range 10 to 224 days).Conclusion: Radiological placement of gastroduodenal stents is effective forpalliation of upper GI malignancies.

C-551Impact of multi-detector-row-CT (16x) prior to angiographic interventionM.S. Juchems, S. Pauls, H.J. Brambs, A.J. Aschoff; Ulm/DE

Learning Objectives: To demonstrate the additional impact of contrast enhancedmulti-detector-row-CT angiography (MDR-CTA) compared to digital subtractionangiography (DSA) for planning of angiographic intervention.Backround: In selected cases a pre-interventional CTA can be useful to facilitateangiographic intervention. We selected four patients with different disease enti-ties (pulmonary AV malformation; bleeding caused by hepatic aneurysmosis andfrom renal pseudoaneurysm after partial renal resection; hepatocellular carcino-ma (HCC) prior to transarterial chemoembolization (TACE) with aberrant arter-ies) from our collective who underwent CTA prior to angiographic intervention.Procedure Details: All CT scans were performed using a 16 channel Multi-De-tector-Row-CT (Philips Mx8000 IDT). Both multiplanar reconstructions (MPR) andslab maximum intensity projections (slab MIP) were performed. After CTA, pa-tients underwent angiographic intervention (coil embolisation in the first three,TACE in the last case).MDR-CTA can demonstrate the exact extent and localize multiple vascular mal-formations, as demonstrated in the first case. In addition, MDR-CTA can not onlyfind the cause of hemorrhage but also demonstrate the exact localization of thespecific vascular pathology (2nd and 3rd case). These findings facilitate the inter-vention, resulting in decreased table time in the angio suite and a reduction inradiation exposure. The fourth case illustrates the anatomic detail achievable with

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MDR-CTA. Even very small aberrant arteries (crucial to the success of TACE) arerevealed. These arteries did not show in overview DSA and required superselec-tive catheterization (only performed after MDR-CTA).Conclusion: MDR-CTA can provide important information in planning of inter-ventional procedures.

C-552Percutaneous transluminal renal angioplasty (PTRA) for renovascularhypertension in childrenB. Radanovic, B. Marinovic, I. Cikara, Z. Cacic, K. Ilakovac, M. Pervan,M. Batinica; Zagreb/HR

Learning Objectives: To present the role and value of PTRA in the treatment ofrenovascular hypertension.Background: During a recent one-year period, DSA was performed in four chil-dren aged 9, 12, 15 and 16 with clinically suspicious renovascular hypertension.In three children, a renal artery stenosis between 80 and 90% due to fibromuscu-lar dysplasia was discovered. In two of these three, the stenosis was unilateraland in one bilateral. In the remaining child, a long stenosis of unknown etiologywas discovered.Procedure Details: In all patients, PTRA was performed after having exactlydefined the morphology and the hemodynamics of the renal artery stenoses. Inthree children we have achieved very good.Results: PTRA was successful resulting in an increased diameter of the arteriallumen. PTRA was repeated and unsuccessful in one child with a severe stenosisand an emphasised "recoil" phenomenon. Autotransplantation was therefore per-formed.Conclusion: PTRA is the method of choice and the first step in the treatment ofrenovascular arterial hypertension.

C-553AAA stents: Selection criteria for accurate fixation and sealingM. Pomoni, K. Papadopoulos, A. Tsanis, D. Tsavoulis, L. Thanos, S. Mylona,F. Takis, P. Galani, N. Batakis; Athens/GR

Learning Objectives: To present the selection criteria for fixation placement andsealing in relation to the renal arteries concerning AAA stents. Reference is madeto current controversies on this issue.Background: Endoluminal repair is an acceptable treatment modality for abdom-inal aneurysms. Implant selection is based on the aneurysm's neck anatomy,resulting in two main implant groups; those fixed above the level of the renalarteries, and those fixed below this level. Each group presents advantages anddisadvantages that should be considered in the selection process. Type I en-doleaks are the most common complications derived from implant selection.Procedure Details: In order to select the implant, the patient should undergo acontrast-enhanced abdominal CT scan with coronal reconstructions to image indetail the abdominal aorta, and measure the size of the aneurysm, the distancefrom the renal arteries to the upper border of the aneurysm, and several othermeasurements needed. Alternatives are abdominal aortic DSA and MRA. Thetwo main features that will determine the fixation site are the neck's shape anddistance. Sealing is always infrarenal. Suprarenal devices provide better fixation,although some series report small renal parenchyma infarcts, due to emboli. In-frarenal devices are easier to handle, provide for small corrections one placed,but cannot be placed in tortuous necks.Conclusions: Two main implant groups are used in endoluminal abdominal an-eurysm repair, the suprarenal and infrarenal fixation devices. Proper patient se-lection is needed to decide which device is to be used, in order to minimizepost-procedural complications.

C-554Complications of central venous accessE. Lonjedo, J. Martinez-Rodrigo, A. Ruiz, S. Isarria, C. Soto, E. Blanc;Valencia/ES

Learning Objective: To illustrate the complications related with central venouscatheters (CVC) and analyze the treatments.Background: The increasing involvement of interventional radiologists in plac-ing long-term CVC has resulted in increased activity in the development of alter-native access sites. Image assisted puncture has decreased complications.In our institution more than 300 port-a-caths, and 100 dialysis and Hickman cath-eters are put in place per year.We summarized our experience in complications and follow-up of CVC.Imaging Findings: Complications associated with puncture site can be avoided

or dramatically reduced with image guidance. With ultrasound guidance we haveno pneumothoraces, carotid punctures or hematomas.We illustrate the most often complications that you can find working in CVC:thrombosis, infection, malposition or migration of the tip, pinch-off syndrome,perforation or extravasation at the puncture site.Conclusion: Interventional radiologists play an important role on the manage-ment of CVC. Knowledge of complications are necessary for their early detection.

C-555In-vivo transcatheter implantation of a new aortic stent-valve for thetemporary relief of acute aortic insufficiencyM. Hashimoto1, T. Kaminou1, P. Haage2, Y. Ohuchi1, K. Nakamura1, K. Sugiura1,Y. Noishiki3, R.W. Günther2, T. Ogawa1; 1Yonago/JP, 2Aachen/DE,3Yokohama/JP

Purpose: Acute aortic regurgitation is a life-threatening condition, particularlywhen associated with Type A aortic dissection or aortic ectasia. The aim of thisanimal study was the evaluation of a novel temporary stent-valve as a potentialtemporizing measure to prevent progression to sudden death until conventionalsurgical repair can be performed.Materials and Methods: An umbrella-shaped highly porous polyester mesh valvewas placed in the subcoronary portion with the attached metallic stent fixed inthe ascending aorta. The prosthesis (stent-valve) was implanted in 6 pigs via theright carotid artery through an 8Fr introducer. The efficacy of the valve was as-sessed by aortography, pressure measurement and electrocardiography. 1 hourafter the implantation, the animals were killed and the stent-valve was subjectedto macroscopic examination.Results: A severe peri-prosthetic leak and cardiac arrest due to the deep im-plantation of the stent-valve were seen in 1 case. Although, a few prematureventricular complexes were seen in 1 and slight blood stagnation in the Valsalvasinus was seen in two, excellent performance of the mesh valve was demonstrat-ed in 5 of 6 cases. There was no significant thrombus formation inside the um-brella valve.Conclusion: The presented new temporary stent-valve shows promise for possi-ble future clinical application. Further studies are necessary to assess valve throm-bogenicity and coronary flow.

C-556Percutaneous treatment of biliary complications in liver transplant patientsV. Muñoz, V. Pineda, A. Segarra, M. Moreiras, M. Pérez, M. Fité Grau;Barcelona/ES

Aim: To assess the usefulness of interventional procedures for resolving postop-erative biliary complications in liver transplantation.Material and Method: We reviewed 24 patients (1996-2003) with hepatic post-transplantation biliary complications who required treatment with interventionalradiology techniques. 12 were pediatric patients and 12 were adults.Diagnostic percutaneous transhepatic cholangiography (PTC) was performed inall patients, followed by placement of an internal-external biliary drain in the sameprocedure. In 10 patients presenting with stenosis in the area of the anastomo-sis, dilatation with balloon angioplasty was also carried out. In 2 patients withbiliary calculi, lithotomy was performed followed by expulsion of the calculi to thedigestive tract. One patient presented with a massive biliary leak that did notrespond to percutaneous drainage and required implantation of a metal prosthesis.Results: The transhepatic approach was used for the diagnostic study, for locat-ing the cause of the complication and to carry out the therapeutic maneuversrequired for its resolution. In the 24 patients studied, the initial outcome of percu-taneous treatment was satisfactory (100% technical success) and in 16 of them(66%) it was the definitive therapeutic measure. Among the remaining 8 patients,4 underwent surgical re-anastomosis and 4 re-transplantation. Drainage place-ment was beneficial in all patients, allowing elective surgical treatment once theinfectious-obstructive complication was resolved.Conclusion: Interventional radiology plays an important role in the therapeuticmanagement of hepatic post-transplantation biliary complications. PTC allowsprecise early diagnosis of the complication. The interventional technique reduc-es the need for reoperation, thereby reducing associated morbidity and mortality.

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C-557A comparative study of transjugular intrahepatic portosystemic shunt andtranscatheter sclerotherapy for gastric varicesT. Ninoi1, K. Nakamura1, N. Nishida1, Y. Sakai1, T. Kitayama1, M. Hamuro1,R. Yamada1, Y. Inoue1, T. Kaminou2; 1Osaka/JP, 2Yonago/JP

Purpose: The rupture of gastric varices (GV) is a serious complication in pa-tients with portal hypertension. Transjugular intrahepatic portosystemic shunt(TIPS) and transcatheter sclerotherapy (TS) are effective treatments of GV. Theeffects on the portal pressure completely differ in TIPS and TS. However, to ourknowledge, no comparative study of the two treatments for GV has been report-ed. The purpose of this study was to compare TIPS with TS on GV bleeding andsurvival.Materials and Methods: A total of 139 cirrhotic patients with GV underwent en-dovascular treatment. Of the 139 patients, 104 without hepatocellular caricinomawere enrolled in this study; 27 patients were treated by TIPS, and 77 patients byTS. GV bleeding and survival rates were compared between the TIPS and TSgroups. Multivariate analysis was used to identify the prognostic factors for GVbleeding and survival.Results: The cumulative GV bleeding rate at 1 year was 20% in the TIPS group,and 2% in the TS group (p < 0.01). The prognostic factor associated with GVbleeding was the treatment method. The cumulative survival rates at 1, 3, and 5years, were 81%, 64%, and 40%, in the TIPS group, and 96%, 83%, and 76%, inthe TS group, respectively (p < 0.01). The prognostic factors for survival were thetreatment method and the Child-Pugh classification.Conclusion: TS may be more useful for GV than TIPS in consideration of GVbleeding and survival.

C-558Interest of portal vein embolization combined with two-stage hepatectomyin treatment of colorectal liver metastasesM. Greget, N. Pfleger, P. Briggs, E. Blonde, F. Veillon, D. Jaeck; Strasbourg/FR

Purpose: To evaluate the results of portal vein embolization (PVE) when com-bined with two-stage hepatectomy in order to treat initially nonresectable bilobarcolorectal liver metastases (CLM).Methods and Materials: 47 patients underwent right portal vein embolizationbefore major right hepatectomy for CLM. Among them 20 patients (group A) withbilobar metastases were treated in a two-stage hepatectomy fashion: first hepa-tectomy to clear the left lobe followed by percutaneous PVE. After hypertrophy ofthe healthy left liver, right hepatectomy was attempted. The other 27 patients(group B) were classically treated with first PVE followed by single right hepate-ctomy.Results: In group A, the mean volume of the future remnant liver (FRL) was383 cc before PVE and 622 cc after. Mean hypertrophy was 46%. In group B, themean volume of FRL was 488 cc before and 774 cc after PVE. Mean hypertrophywas 40%. Ratio between FLR and the volume of total liver increased respectivelyfrom 21% to 33% in group A and from 26% to 35% in group B. After PVE 14patients (70%) underwent right hepatectomy in group A and 21 (77%) in group B.The 3 years survival rate of resected patients was 61.4% in A and 61% in B.Conclusion: Right portal vein embolization combined with two-stage hepatecto-my has nearly same results as conventional technique using PVE and singleheapectomy. This procedure allows to treat patients with multiple bilobar CLMinitially considered nonresectable.

C-559Non-surgical management of high grade splenic injuries: Role oftranscatheter proximal splenic artery embolizationB. Bessoud1, F. Doenz2, S.D. Qanadli2, J.-M. Calmes2, P. Schnyder2, A. Denys2;1Le Kremlin-Bicêtre/FR, 2Lausanne/CH

Purpose: To evaluate transcatheter proximal splenic artery embolization (TP-SAE) in the management of grade III, IV and V splenic injuries (AAST OrganInjury Scale).Materials and Methods: Retrospective study of 79 consecutive adult patients(63 men, 16 women) treated for splenic trauma over a 52-month period. Elevenpatients underwent immediate hemostasis surgery and one patient died beforeany treatment. We compared the outcome of 37 patients (mean age 40 ± 17 years)treated by TPSAE and 30 patients (mean age 37 ± 15 years) treated by bed restalone.Results: TPSAE was technically feasible in all patients without procedure-relat-ed complications. Despite significant higher injury grade (3.7 vs 2), higher rate ofactive contrast extravasation (38% vs 3%) and higher amount of hemoperitone-

um on CT, secondary bleeding rate requiring splenectomy was lower in the TP-SAE group (2.7% vs 10%).Conclusion: TPSAE is a feasible and safe procedure in the treatment of splenicinjury. TPSAE allows a non-operative management despite a selection of severesplenic injuries with one of the lowest reported secondary splenectomy rates.

C-560Recanalization of acute vertebro-basilar occlusion by a coronary waterjetthrombectomy deviceT.E. Mayer, G.F. Hamann, H. Brueckmann; Munich/DE

Purpose: With a death rate of more than 50%, vertebrobasilar thromboembolismstill remains a dangerous disease. This high rate can be mainly attributed to theoverall failure of recanalization of 30%, depending on the extensiveness of theclot. This is especially in multisegmental occlusions, where the recanalizationrate is very low and mortality is about 90%. We investigated the feasibility ofusing a coronary mechanical device based on the Bernoulli effect (Angiojet) forrapid recanalization.Methods: Ten patients with acute vertebrobasilar occlusion were included in thepilot study. Inclusion depended on the presence of multisegmental intracranial (8patients) or any extracranial occlusions and coma lasting no more than 8 hours.Local intra-arterial fibrinolysis had failed in two patients before the Angiojet wasused, and thrombolysis was administered to two patients afterwards (rt-PA). Fivepatients underwent additional intracranial balloon or stent angioplasty, and fivereceived platelet inhibition by tirofiban.Results: Treament was primarily done with the Angiojet and succeeded in com-plete recanalization in 90% of the patients (97% of the vessel segments). Addi-tion of fibrinolysis resulted in success in 100% of patients and segments. Threehemorrhages were associated with additional thrombolysis, tirofiban, or both.Seventy percent of the patients survived, and 60% had moderate to excellentoutcome.Conclusion: The use of the coronary Angiojet in the vertebrobasilar system isfeasible. A success rate of 100% recanalization was achieved in a pilot study.Compared to historical data of multisegmental thrombosis, the death rate wascut in half and good neurological outcomes increased.

C-561Experience of transradial and transulnar abdominal angiography andinterventionT. Sato, M. Kajikawa; Hiroshima/JP

Purpose: In coronary angiography and angioplasty, transradial and transulnarapproach has currently been accepted as an alternative catheterization methodto transfemoral or transbrachial approach. The purpose of this study was to re-port practical and clinical applicability of these methods in abdominal angiogra-phy and intervention.Methods and Materials: Between February 1999 and August 2003, 263 abdom-inal examinations were tried transradially or transulnarly in 167 cases. 111 caseswere for liver or gall bladder tumor, 35 cases were for other abdominal tumors, 17cases were due to gastrointestinal bleeding, 3 cases were for renal or superiormesenteric arterial thrombosis and 1 case was for ulcerative colitis. 193 exami-nations were with further intervention. 27 cases were examined twice, 14 caseswere examined 4 times, 1 case was examined 4 times, 4 cases were examined 5times, 1 case were examined 6 times and 2 cases were examined 7 times duringthis period, transradially.Results: Radial puncture was failed in 8 examinations (3.1%) and changed tobrachial puncture. In 5 cases with weak radial pulsation, ulnar puncture was tried.In cases of hepatocellurar carcinoma, superselective catheterization was alsoavailable and transarterial chemoembolization was done. In cases of abdominalbranch aneurysm, successful coil embolization was done in 3 cases and a femo-ral approach was needed on another occasion for complete embolization in onecase. No puncture site hematoma was seen. Radial arterial stenosis was foundin 2 cases at the next examination. No cerebrovascular problems were noted.Conclusion: Transradial and transulnar approach are alternative catheterizationmethods even in abdominal angiography and intervention.

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C-562Frequency and significance of lumbar and inferior mesenteric arteryperfusion after endovascular repair (EVR) of abdominal aortic aneurysms(AAA)G.A. Fritz1, H. Schoellnast1, H. Deutschmann1, U. Stessel1, E. Sorantin1,C. Maier1, K. Tiesenhausen1, K. Hausegger2; 1Graz/AT, 2Klagenfurt/AT

Purpose: To evaluate frequency and influence of perfused lumbar arteries (pLA)and inferior mesenteric arteries (pIMA) on development and incidence of type-2endoleaks (EL-II) and volume changes of AAA after EVR.Methods and Materials: From 10/1996 to 3/2003 114 patients (mean age, 71.94years) underwent transfemoral insertion of endoluminal stent-grafts for treatmentof AAA. Patients with < 6-months follow-up or type-I endoleaks were excluded.Pre- and post-operative CT scans before discharge, at 1, 3, 6 months and bian-nually thereafter were performed; pLA and pIMA were evaluated in each follow-up scan and the number of pLA was counted.These data were correlated withthe frequency of EL-II. Pre- and postoperative volumes of the aneurysmal sacswere measured from CT data.Results: Median follow-up was 24 months (range 6-36 months).In total 706 CTscans were performed and analyzed. Six months after stent-graft implantationpIMA and/or at least 2 pLA were seen in 45 patients (50.5%); 11 patients (12.4%of the study cohort) had an EL-II. No EL-II was seen in patients without pLA/pIMA. Three groups were identified and compared: patients without pLA/pIMA/EL-II and patients with pLA/pIMA with/without EL-II. A tendency to minor meanvolume loss in patients with pLA/pIMA and a significant trend to volume increasein patients with EL-II in later follow-ups was seen.Conclusion: There is a high incidence of pLA/pIMA in patients after EVR. Per-sistent lumbar and inferior mesenteric artery perfusion is associated with signif-icantly higher EL-II rates after EVR of AAA. Significant differences in volumechanges in later follow-ups were seen between patients with or without EL-II.

C-563Chemoembolization of hepatocellular carcinoma in candidates fororthotopic liver transplantation: Histopathologic findingsS. Terraz, P. Majno, L. Rubbia, P.-A. Schneider, C.D. Becker; Geneva/CH

Purpose: To evaluate the effects of selective transarterial chemoembolization(S-TACE) in patients with suspected hepatocellular carcinoma (HCC) before or-thotopic liver transplantation (OLT).Materials and Methods: 36 candidates for OLT, with viral or alcoholic cirrhosisand a total of 64 nodules suspected to be HCC (1-5 nodules of 0.7-5.7 cm), un-derwent S-TACE with doxorubicine/lipiodol in 1-3 sessions. Catheter position wassegmental or subsegmental in 71% and unilobar in 29%. Particles were addedunless complete stasis was observed. The delay between S-TACE and OLT was129 (5-500) days. Histologic findings of the explanted livers was correlated withall clinical, biologic and radiologic parameters.Results: Based on the final diagnosis, 58 nodules were HCC, five were regener-ative nodules and one was focal nodular hyperplasia. We observed total or near-total necrosis (> 90%) in 35 (60.4%) HCC nodules and no dissemination waspresent. Twenty-three HCC (39.6%) nodules were partially necrotic; in 13 of these,capsular and/or vascular invasion were present. One patient developed a pseu-doaneurysm at the puncture site; no other complication was observed.Conclusion: S-TACE leads to complete necrosis in the majority of HCC nodules.OLT candidates with a long waiting period should be followed by repeated imag-ing studies, in order to be able to prevent tumor regrowth or spread by repeatingS-TACE when necessary.

C-564Kasabach Merritt syndrome: Treatment with transarterial embolizationK.S. Malagari, D. Antonopoulos, D. Loggitsi, D. Danassi, A. Rigopoulou,A. Sissopoulos, A. Nikita, G. Papaioannou, D. Kelekis; Athens/GR

Aim: Kasabach Merritt Syndrome is a rare life threatening condition character-ized by consumption coagulopathy, most often associated with liver hemangi-omas. We report on the value of transarterial embolization in the treatment of thiscondition.Material and Methods: Two patients are included in the study (mean age 63 yrs,range 52-74). Both were women. Kasabach Merrit was the first manifestation ofthe liver lesion in one patient and a complication of a known cavernous liverhemangioma in the second. Hct values were 33% and 28%, PLT 4,000 and 5,400/mm3, fibrinogen 98 and 77 mg/dl respectively. Spiral CT of the liver showed typi-cal hemangiomas with a lace-like enhancing pattern (mean diameters 5 and 14 cmrespectively).

Results: Patients were infused with platelets, fresh plasma, cryoprecipitates,aprotinin and antithrombin prior to embolization. One patient required also 6 unitsof packed red blood cells. Selective hepatic angiography was performed prior toembolization, followed by superselective injection of the feeding vessel(s). Micro-spheres of 300-500 microns were injected under fluoroscopic guidance until ces-sation of flow. The procedure was uneventful in both patients. Partial restorationof PLT cell count was observed from the following day and within a week fibrino-gen levels and PLT levels were completely restored in one patient and partially tothe other.Conclusions: Transarterial embolization may be life saving in Kasabach Merrittsince it can safely control coagulation abnormalities and allows planning for moredefinitive treatment including surgical resection or liver transplantation for nonoperable hemangiomas.

C-565In vivo characteristics of microspheres injected into the hepatic arteries ofrabbits: Angiographic and microscopic comparison of embosphere andbeadblockM. Takahashi, Y. Saida; Tsukuba/JP

Purpose: The authors presently utilize non-resorbable microspheres (MS) forthe transarterial embolization (TAE) of hepatocellular carcinoma (HCC). To cor-relate their clinical features and in vivo characteristics, two different types of in-dustrially-produced MS, injected into the hepatic arteries of rabbits, weremicroscopically compared.Materials and Methods: Eight Japanese-white rabbits were divided into fourgroups. Hepatic arteries were selectively catheterized by the femoral approach.In each group, Lipiodol, Embosphere (40-120 and 100-300µ) or BeadBlock (100-300µ) were injected. MS were prepared as a 10 mL suspension with contrastmaterial, in which 2 mL MS were contained. Animals were sacrificed immediatelyafter the injection. The liver was excised with ligation of all major vessels. Sec-tions were made in the radiate plane along with hepatic arteries.Results: Lipiodol spread into the hepatic sinusoid and reached the central veins.They were found also in the peribiliary plexus (PBP). MS reached maximallyGlisson's sheath but was not found around the PBP nor the sinusoids. Embosphereoccluded the artery after an injection of some milliliters. Microscopically they wereoften clustered and compressed but their spherical shape was maintained. SmallerEmbosphere penetrated deeper than larger one. BeadBlock once occluded theartery with a smaller amount of suspension than Embosphere. After a few min-utes, however, the arterial flow resumed and additional injections were possible.Microscopically they formed casts and tend to reach deeper tissue than Em-bosphere of the same size.Conclusion: Embosphere is elastic but robust, while BeadBlock is plastic, form-ing casts in the vessel. These characteristics explain much of their features at thetime of injection.

C-566The estimation of early complications in the group of 110 patients withabdominal aorta aneurysm after endovascular operationsM. Osiecki, B. Jaron, M. Nowicki, M. Maruszynski, K. Brzozowski, K. Staron,P. Zukowski, M. Zagrodzka, P. Twarkowski; Warsaw/PL

Aim of the study: The aim of this study is to estimate early complications in thegroup of 110 patients with AAA treated by the use of bifurcated aortic stent-grafts.Material and Methods: Between the year 2000 and the first half of 2003, 110patients were selected for endovascular operations. 84 were operated under epi-dural anesthesia and 26 under general intravenous anesthesia.Results: During the hospitalization, clotting in one of the crura of the stent-graftoccurred twice.At another patient 30 hours after the implantation the rupture of common femoralartery aneurysm was stated. There were also observed certain post-hospitaliza-tion complications which included: a) clotting of stent-graft leg in 2 cases b) leaktype I which demanded implantation of additional element of stent-graft in onecase c) small leaks type I in 3 cases and type II in 2 cases which did not demandany further intervention-the type II leaks were observed in 3 cases 6 months afterthe operation d) the increase of parietal circular thrombus inside the main part ofthe stent-graft in two cases e) complaints connected with the internal iliac arteryocclusion were declared by 4 patients.Conclusions: The early results of AAA treatment by the use of bifurcated stent-grafts are satisfactory and connected with low rate of complications. The propermeasurement of the stent-graft and the strategy of patients' treatment play a veryimportant role.

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Most early complications are connected with wrong patient selection, improperstent-graft choice and technical errors during the operation.

C-567Cutting balloon percutaneous transluminal angioplasty in lower limb:Preliminary reportL. Belli, S. Saccheri, M. Mentasti, F. Galli, M. Marcolli; Castellanza/IT

Introduction: Cutting balloons (Boston Scientific, Natik, Mass. USA) are rela-tively new devices, designed originally for the treatment of restenosis of coronaryartery stents. The catheter has four microsurgical blades that cut directly into thestenotic plaque during inflation. Recently they were proposed for the use in pe-ripheral arterial system using a balloon diameter raging from 4 up to 5.5 mm.Material and Methods: Seven consecutive patients (mean age 58 years) weretreated with cutting balloon PTA (CB-PTA) from June until September 2003. All ofthem had severe multiple, calcified stenosis of the femoro-popliteal artery, maxi-mum 2 cm in length, never treated before. All patients had important associatedrisk factors such as insulin-dependent diabetes mellitus, hyperlipoproteinemiaand smoking.Results: CB-PTA was technically successful in all patients, with lumen diameterimprovement at least of 50% or residual stenosis less than 20%; moreover wenever observed major dissection of the intimal plaque and we never requiredstent placement.Conclusion: CB-PTA in lower limb calcified stenoses is a promising techniquethat seems to be superior to PTA alone, without requiring stenting in femoro-popliteal arteries.

C-568Management of superficial vascular malformationsH. Rajhi, S. Ayadi, N. Ezzine, S. Mhiri, K. Zitouni, R. Hamza; Tunis/TN

Purpose: Our objectives are to evaluate the place of sclerotherapy in the treate-ment of superficial vascular malformations (SVM).Methods and Materials: 289 patients with superficial venous malformation werein the care in our service. 3 of them presented with cavernomas, 1 with Maffuci'ssyndrome and 10 with Klippel-Trenaunay syndrome. The lesions were cervicaland cerebral in 76% of cases; thoracic and abdominal in 24% of cases. Lesionenvolvement was evaluated by CT scan (n = 20) and MRI (n = 10).The approaches were: abstention because of iatrogenic risk or small lesions(n = 61), elastic contention (n = 11), only surgery (n = 5), one to four sessions ofpercutaneous sclerotherapy only (n = 172) and followed by surgery (n = 40).Results: There was clear regression in 60% of patients treated exclusively bysclerotherapy. Among the 40 patients treated by both sclerotherapy and surgerygood results were obtained in 80% of cases.Conclusion: The management of superficial vascular malformations needs amultidsciplinary approach. Percutaneous sclerotherapy is the first choice treate-ment, which can be followed by surgery.

C-569Long nitinol stent-method of choice for bending area of peripheral vessels:Animal studyA. Nikanorov, J. Harrison, D. LaFlash; Santa Clara, CA/US

Purpose: To evaluate the performance of various length nitinol stents in the fem-oral artery and otbtain a risk determination of stent migration and/or stenosis inthe bending areas of the vessel.Methods and Materials: A retrospective review of a study in which 18 porcinefemoral arteries (n = 9 pigs) were implanted with nitinol self-expanding stents(n = 29) was carried out. Stent lengths were 28 to 100 mm. Stents were implant-ed separately and overlapped in the distal iliac and superficial femoral artery(SFA). Angiographies were performed during hip flexion/extension post-implantand at 3 and 28 days.Results: Angiography during hip flexion showed significant bending in commonfemoral/proximal SFA, mild bending along the length of the SFA, no bending iniliac and deep femoral arteries. Follow-up results were constant and dependedon stent length and location.Short stent 28 mm in iliac and deep femoral arteries showed no adverse effect; incommon femoral and SFA demonstrated stent migration, arterial kinking at thestent's edge, severe stenosis, and separation of overlapped stents.Medium stents 38 and 56 mm in iliac/proximal SFA migrated; moderate stenosisobserved. Long stent 100 mm covered the bending area of the SFA and bentalong with the artery. There was no migration or stenosis.Conclusion: Long stent may be a method of choice for SFA. Short stent can

cause arterial kinking and lumen obliteration. To prevent stenosis and stent mi-gration avoid implanting stent with the edge in the area of arterial bending. Por-cine femoral artery may represent worst-case model for stent evaluation inperipheral vasculature.

C-570Our experience with endovascular treatment of abdominal aortic aneurysmwith the Talent stent-graftJ. Maskovic, L. Cambj Sapunar; Split/HR

Purpose: To evaluate our experience with treatment of AAA with the Talent stent-graft placement.Methods and Materials: From October 1999 through September 2003, at theDepartment of Radiology in Split, 40 patients (38 man, 2 woman) were treatedwith endovascular repair of AAA with a Talent stent-graft. Mean age of the pa-tients were 72 years (65-77 years). Aneurysm diameter in all patients were > 5 cm(average diameter were 6.9 cm, range, 5.5-10.4 cm). The mean follow-up was 17months. Average hospital stay after the intervention was 7-9 days.Results: The stent-grafts were successfully deployed in all patients. Control spi-ral CT 24 hours after the procedure revealed endoleak in 5 patients (15.6%).Spiral CT follow-up on 7th day following the intervention showed that in 4 patientsendoleak spontaneously stopped and in one patient small endoleak was seen,but it also stopped within a month following the intervention. In two patients (6.3%)acute thrombosis of iliac graft extensions was diagnosed a month after the inter-vention. In both cases successful endovascular thrombolysis was performed withgood clinical outcome. In one patient (3%), progression of atherosclerotic dis-ease resulted in migration of the stent-graft two years after the placement of thegraft. Reintervention was done with successful deployment of additional aorticextension of the stent-graft. Average reduction of aneurysm diameter was 8.2 mm(range, 0-32 mm).Conclusion: Endovascular treatment of AAA with Talent stent- graft is a safe andeffective procedure. In patients with well defined indication it is safe alternative toopen surgery procedure.

C-571Direct thrombin injection for non-femoral pseudoaneurysmsR. Corso, M. Solcia, M. Castoldi, R. Vercelli, M. Intotero, A. Rampoldi; Milan/IT

Purpose: Percutaneous thrombin injection under sonographic guidance has beenshown to be an effective and well tolerated treatment for a iatrogenic femoralpseudoaneurysms. For these reasons some authors suggest thrombin injectionas alternative treatment also in other body districts. We illustrate our experience,techniques and results in the ablation of pseudoaneurysms of different etiologiesand locations whit direct thrombin injection.Materials and Methods: From June 2000 we treated six patients, age range 33-75 years, affected with pseudoaneurysms developed after iatrogenic trauma inthree patients (arising from radial, posterior tibial and thoraco-acromial arteries),post-pancreatitis (splenic and superior mesenteric arteries) in two patients andin one patient after spontaneous rupture of renal angiomyolipoma in tuberoussclerosis. Two patients were anticoagulated. The diameter of pseudoaneurysmsvaried between 2.4-11.5 cm. After disinfection of the entry site, we slowly inject-ed bovine thrombin (1000 U/mL of solution) percutaneously under ultrasoundguidance in four cases, while in two cases we injected directly the thrombin in thepseudoaneurysm cavity with a fluoroscopically guided endovascular angiographiccatheter.Results: All interventions were successful and showed no immediate or late com-plications. Doses of thrombin needed varied between 200-6000 units (0.2-6 mLof solution). A complete thrombosis of the pseudoaneurysm sac was accom-plished within minutes of thrombin injection. No recurrence was seen at the fol-low-up.Conclusion: In selected cases, direct thrombin injection may be useful in treat-ing non-femoral pseudoaneurysms resulting in rapid and persistent occlusion. Inour limited experience it represents a safe and effective minimally invasive tech-nique and an alternative to surgical repair.

C-572The importance of normal and anomalous internal spermatic veinconfluence in interventional treatment of varicoceleA. Zvezdin, G. Spanovic; Novi Sad/YU

Purpose: The clinical significance of varicocele lies in its causal association withmale infertility. The first aim of this study was to describe the phlebographic char-acteristics of varicocele patients. However, further aims emerged from the fact

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that there exists a connection between phlebographic findings of spermatic veinconfluence with treatment outcome.Methods and Materials: This study included 178 patients, between 10-19 yearsof age. 76 patients underwent interventional radiology methods due to left-side orbilateral varicoceles. 67% of examinees were older then 13 and younger than 17years of age.Results: Left-sided varicocele was diagnosed in 93% of patients and bilateral in7%. The spermatic vein is connected with renal vein in most cases (90%). Anom-alous confluence was registered in the ventral branch in 2% of patients and in therenocaval region in 6%. The number of confluences of the spermatic vein variedfrom 1-3, but mostly there was only one (67%). Obtuse anglulation was found in50% of spermatic veins. Whereas 20% were nonvalvular, in those with valvules,their function was preserved only in 11%. Collateral spermatic veins was identi-fied in almost 65% of patients. Type I confluence was established in 27%, andtype II in 13% of patients.Conclusion: Difficulties during interventional radiography are presented withcases of dual or multiple renal veins, broad spermatic vein confluence, presenceof valvules and spermatic vein anastomoses, as well as in type IV and type Vspermatic vein confluences.

C-573Coil embolization of intrapulmonary sequestration: An alternative methodto surgeryS.S.C.S. Lima, H.M.R. Marques, I.M.G.B. Nobre, G. Correia; Lisbon/PT

Purpose: Bronchopulmonary sequestration is a combined lung and vascularanomaly witch is usually surgically treated. In those cases witch the anomaly ismostly vascular, coil embolization is a safe alternative to surgery.Method and Materials: Coil embolization of intrapulmonary sequestration wasperformed in three adult patients, two of them admitted with hemoptysis and thethird one with low left thoracic pain and fever. The initial diagnosis was made byCT and confirmed with angiography. We embolised the feeding arteries usingcoils (from 3 to 6 mm, Cook). Angiography after embolization indicated almostcomplete occlusion and all patients were discharged the next day.Results: There were no immediate nor long term complications. Follow-up CTwas performed six months and one year later, at witch time there was completeocclusion of the anomalous artery. All patients are asymptomatic at present.Conclusion: Arterial embolization of intrapulmonary sequestration with a pre-dominant vascular component, is a less invasive method of occluding the anom-alous artery in selected patients and is a safe alternative method to surgery.

C-574Emergency endovascular repair of ruptured hepatic artery pseudo-aneurysm with coronary stent-graft: Two casesA. Park; Pusan/KR

Purpose: To report two cases of successful emergent endovascular treatment ofruptured pseudoaneurysm from the hepatic artery using balloon expandable cor-onary stent-grafts.Materials and Methods:Case 1. A 65-year-old male underwent Whipple's operation for a cholangiocarci-noma in the distal common bile duct, but his postoperative course was complicat-ed by serious blood loss from a ruptured pseudoaneurysm in the common hepaticartery. Using premounted coronary stent-grafts (Jostent, JoMed, Germany), theneck of the aneurysm was completely excluded.Case 2. A 66-year-old male underwent surgical treatment of a Klatskin's tumorand hepaticojejunostomy. Four weeks later, an episode of gastrointestinal bleed-ing prompted celiac angiography. Active bleeding from a small pseudoaneurysmin the right hepatic artery was controlled with endovascular deployment of a pre-mounted coronary stent-graft (Jostent, JoMed, Germany). The final angiogramdemostrated a total exclusion of the aneurysm with preservation of the arteriallumen.Results: Transcatheter embolization using a variety of embolizing materials hasbeen considered the treatment of choice for true or false hepatic artery aneu-rysms. However stent exclusion of the hepatic artery bleeding in an emergentsituation has been reported only in few cases. For patients with a compromisedblood supply due to portal vein occlusion or exclusion of important collateral path-ways by surgical operation, a stent-graft may become the procedure of choice.Conclusion: In emergent situations of hepatic artery bleeding, endovascularimplantation of a stent-graft may be an alternative procedure to transcatheterembolization or surgical repair.

Interventional Radiology

Miscellaneous

C-575Percutaneous treatment in patients presenting with malignant cardiactamponadeP.-Y.R. Marcy1, A. Martinoni2, P. Brunner3, B. Descamps1, C. Foa1; 1Nice/FR,2Milan/IT, 3Monaco/MC

Learning Objectives: To demonstrate the clinical, ECG and US findings in on-cology patients presenting with cardiac tamponade. To illustrate the percutane-ous approaches and techniques of pericardial drainage. To outline the advantagesand limits of the imaging-guided percutaneous pericardiocentesis and to com-pare them with the surgical treatment.Background: Pericardial involvement with metastatic tumor is a frequent compli-cation in cancer patients (up to 21% in some autopsy series). Although it canremain asymptomatic, malignant pericardial effusion can lead to life-threateningpericardial tamponade. Partial or complete surgical pericardiectomy is an estab-lished management technique for recurrent effusion. Percutaneous pericardioto-my is an alternative approach that avoids operative and anesthetic morbidity. Inthis exhibits, we will describe the results, advantages and limits of the percutane-ous techniques compared to the existing surgical procedures.Procedure Details: Blind procedure, percutaneous drainage under US/Fluoros-copy and CT guidance, pericardiotomy catheter placement, intra pericardial in-jection of sclerosing agents, percutaneous balloon pericardiotomy are described.Conclusion: Initial relief of pericardial effusion can be obtained with percutane-ous pericardiocentesis. Imaging procedures allow precise localization of an entrypoint into the pericardial space and the risk of myocardial puncture is minimized.Effusion recurrences (up to 40%) may be treated by percutaneous drainage cath-eter placement, pericardial sclerotherapy or balloon pericardiotomy.

C-576Materials and biomaterials for interventional radiologyT. Hasebe1, A. Shimada2, T. Suzuki3, Y. Matsuoka3, H. Yoshimura2,S. Kuribayashi1; 1Tokyo/JP, 2Sagamihara/JP, 3Hiyoshi/JP

Learning objectives: 1. To describe the most often used interventional devices(ID) benefiting from the recent intensive research activity to improve their func-tionality or their biocompatibility. 2. To provide an update on the current status ofnew materials and biomaterials available in the field of vascular and non-vascu-lar interventional radiology, including our original experimental data 3. To discussthe importance and the safety issues related to the use of biomaterials and coat-ing materials concerning ID.Background: In the past decade, interventional radiology has allowed percuta-neous access devices and therapeutic implants to be more reliable and effective-ly used due to the availabiliity of new materials. Currently, there are several passiveor active stent coatings commercially available with good results in preliminarystudies. These materials more often result from industrial research and less fre-quently from medical research.Procedure Details: In this paper, we discuss biomaterials currently available foruse, together with new biomaterials for the vascular or non-vascular ID, such as,for example, the drug-eluting stents, coils for embolization, and biliary/ureteralcatheters or stents. Finally, we discuss the future of biomaterial use in interven-tional radiology with the original data in our laboratory (e.g., antithrombogenicand biocompatible stent coating: diamond-like carbon).Conclusion: Biocompatible issues are very critical for ID in order to coexist withliving tissue without causing harm. Considering the recent advances in new ma-terials with biological effects, we believe the biomaterials will soon constitute anew core of interventional radiology. The radiologists should establish new re-search domains and complete new and effective products.

C-577Clinical usefulness of a unified multidetector-CT and angiography systemY. Iwasaki, Y. Hama, M. Fujii, T. Kaji, S. Kusano; Tokorozawa/JP

Learning Objectives: To understand a unified multidetector-CT and angiographysystem. To understand the clinical usefulness of angiography assisted multide-tetor-CT for the diagnosis. To understand the clinical usefulness of multidetector-CT assisted angiography and interventional procedures for the therapy.Background: We developed and started clinical use of a unified multidetector-CT and angiography system in May 2001. The system is a combination of a multi-detector-CT scanner on rails and an angiography unit. Both systems use the

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same angio table. We can always generate a control image during interventionwithout repositioning the patient. We have performed highly integrated imagingdiagnosis and interventional therapy with this system in more than 200 patients.Procedure Details: Angiography assisted multidetector-CT was performed forthe diagnosis and the target therapy of hepatic, pancreatic, adrenal and renaltumors and uterine myomas. In addition, multidetector-CT assisted angiographyand interventional therapy was performed for vascular recanalization, such asaortic and peripheral vascular stent therapy; for endovascular treatment of aneu-rysms and for percutaneous therapy of varices, with a variety of three-dimension-al reformatting techniques. We also performed several interventional procedures,such as percutaneous biopsy, biliary and abscess drainage, with this system.Conclusion: We introduce our highly integrated intervetional CT system withtechnical merits to clinical use.

C-578Transsjugular liver biopsy (TJB) using a 15 G modified Ross-needle:Comparison with the truecut techniqueG. Krupski, P. Buggisch, A. Koops, S. Petri, G. Adam; Hamburg/DE

Learning Objectives: To demonstrate the technique of aspiration transjugularliver biopsy. To compare cost and efficacy of the two competing techniques.Backround: TJB is a well established technique for (US)-guided and non-guidedliver biopsy particularly in patients with massive platelet dysfunction, bone mar-row suppression or impaired clotting in order to prevent fatal intraperitoneal he-morhage. The second goal is to achieve a sufficient biopsy that reveals adequateinformation e.g. histology and histochemistry as well as microbiology.Procedure Details: Between 1998 and 2003 we performed 75 consecutive TJBusing a modified Ross needle resulting in 100% sufficient biopsy specimens frommean 1.2 punctures per patient. No severe complications occured. We comparedour results with reports from the literature (truecut technique and aspiration). Twomajor differences can be pinpointed between aspiration and truecut technique:aspiration is cheaper and the biopsy specimens are larger resulting in a need forless punctures.Conclusion: TJB should be performed with an aspiration technique using 15 Gmodified Ross-needles. This technique shows better biopsy quality and is morecost efficient. Complications are equal.

C-579Arterial extravasation on contrast-enhanced CT after blunt abdominopelvictraumaW. Yoon, Y. Moon, J. Kim, Y. Jeong, J. Park, H. Kang; Gwangju/KR

Learning objectives: 1. To review the CT findings of active contrast extravasa-tion in patients with blunt trauma to the abdomen and pelvis. 2. To correlate thefindings of contrast-enhanced CT with those of conventional angiography. 3. Todiscuss the role of transarterial embolization in patients with active extravasationon contrast-enhanced CT.Background: CT is the imaging method of choice to evaluate hemodynamicallystable patients with significant blunt abdominopelvic trauma. Contrast enhance-ment is essential for the diagnosis of many visceral injuries in these patients. Ithas been demonstrated that contrast-enhanced CT is valuable in the detection ofactive extravasation of contrast material. The detection of contrast extravasationis critical because it indicates an ongoing, potentially life-threatening hemorrhage.Imaging Findings: The purpose of this exhibit is to review our experience withactive contrast extravasation in patients with blunt trauma to the abdomen andpelvis. Findings of contrast-enhanced CT are correlated with those of conven-tional angiography. The role of angiography and transarterial embolization in pa-tients with active extravasation on contrast-enhanced CT will be discussed.Conclusion: Contrast extravasation on CT can be used to localize anatomic sitesof hemorrhage and to guide immediate angiographic or surgical intervention inpatients with abdominopelvic trauma. State-of-the-art CT enables a more detec-tion of contrast extravasation than is possible with conventional and single detec-tor helical CT.

C-580Robot prototype for CT-guided interventions: First in vitro resultsG. Kronreif1, J. Kettenbach2, M. Figl2, M. Fürst1, W. Birkfellner2; 1Seibersdorf/AT,2Vienna/AT

Purpose: Development of a 7 degree-of-freedom robot prototype for CT-guidedpercutaneous interventions. Preliminary phantom tests shall validate feasibility.Material and Methods: For the presented in vitro study, peas (mean diameter9.4 mm) were embedded within a gel-phantom in order to simulate small target

lesions. Positional data of the patient and of the needle guide mounted to therobot arm were acquired via an optical tracking system (NDI Polaris). A prelimi-nary CT calibration procedure allowed assignation of 3D coordinates to each 2Dpixel of the particular CT scan for fast and accurate intervention planning. Thebest needle trajectory was defined graphically by simply selecting skin entry pointand target point - appropriate position and angulation of the robotic arm werecalculated and sent to the robot controller. After confirmation of the planning, therobot moved to the start position using different modes of motion. The coaxialbiopsy was performed manually using a 17-gauge puncture needle, combinedwith an 18-gauge biopsy needle and an automated biopsy device. The completeintervention could be monitored and documented by means of superimposedinformation on the actual CT scan. To prove efficacy of biopsy the length of theharvested specimen, as well as the distance between actual needle tract andcentre of the lesion was measured.Results: Biopsy specimens were successfully obtained from all 20 targets withonly one needle pass necessary. Radial distance between needle trajectory andcentre of the target was surpassing clinical requirements.Conclusions: Robotic assisted biopsies with high accuracy were feasible usingCT guidance.

C-581A new laser guidance device for ultrasound guided percutaneous biopsyA.E. Samir, J. Koukounaras, P. U, A. Moorhouse, M. Brooks; Melbourne/AU

Introduction: Ultrasound guided needle placement is usually performed by in-serting a needle along a path in the plane of the ultrasound beam. This permitsvisualisation of the needle in "real time", allowing accurate needle placement. Anovel laser guidance device that facilitates needle placement during ultrasoundguided biopsy is presented.Methods: A laser module was constructed by mounting a laser diode in a nylontube. A lens was used to transform the pencil laser beam into a linear alignmentbeam. The laser module was mounted on an ultrasound probe using a custom-designed clip that consisted of two polycarbonate half shells. The linear laserbeam was calibrated to be coplanar to the ultrasound beam. No probe modifica-tions were necessary. Fourteen biopsy operators performed eight free hand andeight laser guided biopsies each of capsicum-stuffed olives suspended in gela-tine phantoms. Endpoints measured were: (1) time to biopsy, (2) sample qualityand (3) perceived usefulness.Results: The laser beam was visible on the surface of needles ranging from 14 to22 gauge in size. When the needle was inserted colinear to the laser beam it wasvisible on the ultrasound image.A significant difference in procedure time or sample quality was not observed.However, 71% of operators stated that laser guidance had a positive effect on theprocedure, and 79% said that they would use it in the future.Conclusion: A probe-mounted laser guidance device is perceived to facilitateaccurate ultrasound guided needle insertion by the majority of operators in a pilotstudy.

C-582Modular automated targeting device for CT-guided biopsiesG. Kronreif1, M. Figl2, J. Kettenbach2, M. Fürst1, M. Vogele3; 1Seibersdorf/AT,2Vienna/AT, 3Schwabmünchen/DE

Purpose: Development of a modular automated targeting device for percutane-ous interventions under CT guidance.Materials and Methods: The developed targeting device consists of one or two2DOF (degree-of-freedom) positioning modules in different configurations. Theintegrated design allows high dexterity regardless of the small footprint of themodule. The module dimensions of 100 mm x 150 mm x 30 mm (WxLxH) ena-bles use of the system inside the CT gantry without major restrictions. Depend-ing on the chosen configuration the targeting device allows 2DOF needleangulation (± 20°), 2DOF positioning (± 20 mm) as well as maintaining a soft-ware-defined pivot point for angulation. Planning of the intervention is on basis ofCT-imaging data sets acquired immediately before an intervention. Spatial rela-tion between imaging space and targeting device is either established by using ofan optical tracker system or via robot registration based on a CT data set. Aftergraphically selection of the target point and manual pre-positioning of the device,correct needle angulation will be set automatically by the system. During theintervention, the robot kinematic holds the needle guide in a defined position/orientation to the patient's body - needle insertion will be performed manually bythe physician.Results: The developed system is easy-to-use and does not interfere to the clin-ical work-flow. System accuracy and clinical relevance currently is being testedin a series of in vitro tests.

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Conclusions: The designed and realized prototype of a modular automated nee-dle guide allows positioning of a biopsy needle based on an intra-operativelyplanning with good cost/benefit ratio.

C-583Effect of radiotherapy and ischemia on rat liverZ. Vigvary, P. Kupcsulik, A. Szijartó, O. Hahn; Budapest/HU

Aim: The aim is to create a model of a liver resection combined with intraopera-tive irradiation for micrometastases. This combined ischemic-reperfusion and ir-radiation injury of the liver has not yet been investigated.Methods: Normothermic segmental liver ischemia were created on 250-280 gmale Wistar rats. Rats were divided into four groups for 30, 45, 60 and 90 minutesof ischemia. Hepatic microcirculation was studied by laser Doppler Flowmeter.Histological alterations were followed. I, II, IV lobes were exposed to 0, 25 and50 Gy of Cs-137 ã-radiation. ALP, ALT, AST, LDH, bilirubin and TNF-á tests wereperformed.Results: Reperfusion was assesed by post-ischemic flux plato maximum (PM),by area under the curve (RT) and by the time to maximum flux level (RMI). Flow-metery showed a nonlinear fashion of reperfusion according to ischemic period.After 30 and 45 minutes ischemia the rate of the reperfusion is almost the same.60 minutes of ischemia represents an intermediate lesion in term of recovery.After 90 minutes, minirapid deterioration of flux (below 20% of control) was ob-served. Survival is rather determined by the length of the ischemic period, thanthe irradiation dose. Low dose irradiation (25 Gy) with short-term ischemia (30 min)did not result in increased liver enzymes and resulted only in minimal histologicalchanges. The group of 25 Gy irradiation with normotherm, short-term ischemiaseems to be tolerable for the tumor-free liver.Conclusion: Liver toleratse irradiation injury suprisingly well and precondition-ing promotes restitution of liver circulation after ischemic injury.

C-584Radiation protection devices for reduction of scatter radiation to theradiologist during CT fluoroscopy-guided interventionsB.M. Stoeckelhuber1, T. Leibecke1, E. Schulz1, J. Blobel2,C.U. Bergmann-Koester1, J. Gellissen1; 1Lübeck/DE, 2Neuss/DE

Purpose: The aim of the study was to assess radiation exposure to the radiolo-gist incurred with CT fluoroscopy.Methods and Materials: The spectrum of indications and radiation exposuresfor the radiologist were assessed for an 8-month period. Scatter exposures weremeasured with and without radiation protection devices: without and with place-ment of a lead drape on the patient, with and without use of thin rubber radiationprotection gloves. In addition, scatter radiation was determined for a combinationof lead drape and radiation protection gloves.Results: There is a wide variety for the use of CT fluoroscopy ranging from diag-nostic biopsy procedures to therapeutic interventions such as radiofrequencyablation of liver metastases and CT fluoroscopy-guided osteosynthesis of frac-tures. Scatter exposure rates to the hand of the radiologist ranged from 1 to 320micro Sv per case without use of a lead drape and radiation protection gloves.The lead drape reduced the scatter exposure to the hand of the radiologist by 65percent. Radiation protection gloves reduced scatter radiation by 36 percent. Thecombination of both radiation protection devices was most effective in decreas-ing the dose by 76 percent.Conclusion: CT fluoroscopy is a useful targeting method with a wide variety forinterventional procedures. However, significant radiation exposures may occur.Therefore, the radiologists should be aware of different techniques of CT fluoros-copy guidance and the methods to reduce scatter radiation.

C-585Control of tumor perfusion with contrast harmonic imaging (CHI) and codedharmonic angio (CHA) during thermal ablation of liver tumorsD.-A. Clevert1, E.-M. Jung2, N. Rupp2; 1Munich/DE, 2Passau/DE

Purpose: The aim was to find out if it is possible to control the tumor vasculariza-tion and defects that develop and lead to tissue necrosis during percutaneousthermal ablation by the use of ultrasound with contrast agent enhancement.Material and Method: 22 patients with non-resectable malignant liver tumorsand a total of 34 lesions underwent a percutaneous radiofrequency thermoabla-tion using a perfused probe (Elektrotom HF 106, Berchtold). While intermittentenergy was supplied during thermal ablation, controls were carried out using theMSCT and Ultrasound with a transducer (3-7 MHz, LOGIQ 700, GE). 0.5 to 1 mLof Optison were applied as ultrasound contract agent. The ultrasound evaluation

of perfusion was made by using Power Mode, Contrast-Harmonic-Imaging (CHI)and Coded-Harmonic-Angio (CHA).Results: Only 21/34 lesions showed an increased intra- tumoral perfusion usingthe B-Mode together with Power Mode. The tumor vascularization in the earlyarterial phase was – similar to Spiral-CT – only reliably visible after contrast agentapplication in the CHA-Mode. The best way to detect an increasingly reducedperfusion of the tumor was the CHI-Mode with Power Mode. In 28/34 tumorsperfusion could not be detected by ultrasound after a maximal energy supply of100,000 W. Control by Spiral-CT showed complete necrosis in those cases.Conclusion: With the help of contrast agent enhanced sonography it is possibleto demonstrate real-time defects that develop during tumor thermal-ablation andfinally lead to necrosis. Using this technique treatment of larger tumors may bepossible.

C-586Challenges in realising effective radiological interventional virtualenvironments: The CRaIVE (collaboration in radiological interventionalvirtual environments) approachA.E. Healey1, D.A. Gould1, N.W. John2, R. Phillips3, K.W. Brodlie4, F. Bello5,D. Kessel4, M. Murphy1, N. Chalmers6; 1Liverpool/UK, 2Bangor/UK, 3Hull/UK,4Leeds/UK, 5London/UK, 6Manchester/UK

Purpose: Workforce planning, deskilling scenarios and risk containment are gen-erating a need for interventional training processes remote from patients. Fixedmodels lack ultimate realism, and animal models lack pathology with politicalproblems in the UK. Virtual environments for interventional needle puncture trainingrequire accurate haptics, based on force relationships between tools and tis-sues, and visualization. To achieve this demands advancements in tissue seg-mentation, assignment of tissue properties and generation of synthetic imagesfrom abnormal patient anatomy and pathology. These challenges require wide-ranging expertise and will probably take over a decade to achieve fully. No exist-ing simulator model covers interventional radiological needle access procedures(eg: targeted biopsy, nephrostomy, biliary and abscess drainage). Thus a sub-stantive collaboration is essential to develop appropriate virtual training environ-ments.Materials and Method: Internet search highlighted key development areas and,together with conventional networking, relevant departments and individuals werelocated with major involvement in medical simulations.Results: The CRaIVE collaboration was established and comprised interven-tional radiologists, computer scientists, physicists, clinical engineers and psy-chologists. The key challenges of interventional procedures have driven specificproposals for accurate representation of haptics, from measured in vivo forces,within imaging-derived, immersive, simulated environments.Conclusion: Achieving effective simulator modeling for training and rehearsalrequires research advances and further development in the underlying technolo-gies. While currently beyond the scope of any research group or individual com-pany, a substantive new collaboration, CRaIVE, aims to develop interventionalradiological simulator models, initially based on a spectrum of interventional nee-dle access procedures.

C-587Preoperative selective portal vein embolization before major surgeryJ. Matela, S. Vadnjal; Maribor/SI

Introduction: Resection of large hepatocellular carcinoma (HCC) located in thecentral portion of the liver (segments IV, V, VIII) and of diffuse hepatic metastasesremains a surgical challenge due to high risk of postoperative liver failure. Preop-erative portal vein embolization (PVE) allow physicians to preoperatively stimu-late hypertrophy of the future liver remnant, that portion that remains after liverresection.Materials and Methods: In the period between the years 2000 and 2003, alto-gether 7 patients underwent PVE: 3 patients with colorectal metastases and 4HCC patients. PVE was performed under general anaesthesia. The indirect splenicportography was performed after catheter was introduced into superior mesentericartery via femoral artery approach. The portal vein was punctured under fluoros-copy. Selected portal vein segments were embolized by injecting PVA particlesuntil stasis of blood flow was achieved. Areas proximal to the tumor and the chan-nel in the liver parenchyma were occluded with Gelfoam particles.The increase of the remnant liver parenchyma was measured by MR - 1.5 TeslaToshiba; Fast T1 in transverse plane.Results: The procedure was technically successful in all patients. One patientexperienced the post-embolization syndrome and another one had a subcapsu-lar hematoma. The volume of the liver parenchyma increased minimally by 320 mL

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and maximally by 530 mL. Altogether, 6 patients underwent surgical resection.Conclusion: The results show that PVE trigger a strong regenerative responseresulting in hypertrophy of the normal liver parenchyma and expand possibilitiesof curative surgery for patients who would not otherwise have been candidatesfor extended resection.

C-588Large digital flat panel technology in interventional radiology: In vitro studyand first clinical experiencesV. Chabbert, H. Rousseau, P. Duthil, P. Otal, K. Benali, A. Lowe, L. Despond,P. Gobert, F. Joffre; Toulouse/FR

Objective: The intent of this work is both to provide an overview of the digital flatpanel technology, its advantages and potential limitations in angiography andinterventional radiology.Material and Methods: An Innova 4100 (GE Medical Systems), equipped with a41 x 41 cm digital detector, was evaluated in vitro for dose monitoring and imagequality. Entrance dose measurement was compared to a conventional image in-tensifier based system (LCA, GE). The dose was measured using an ionizationchamber for 10, 15, 20, 25 and 30 cm of Plexiglas for both fluoroscopy and digitalsubtraction angiography, and for each magnification mode.305 angiography or interventional procedures were performed in the last 6 months.Results: In fluoroscopy, the digital flat panel resulted in significantly up to 42%(on normal dose mode) lower entrance exposure dose (75% on low dose mode),compared to the LCA. In DSA mode, it resulted in a 42% (on normal dose mode)and 72% (on low dose mode) reduction. Image quality measurements were con-sistently superior (90% higher resolution in fluoroscopy and 41% in DSA) withsignificantly more low contrast iodine targets and moving wires detected and alarger dynamic range or working thickness range.The results of our first clinical investigations give further evidence for superiorimage quality.Conclusions: On all modes, dose monitoring and image quality of the digital flatpanel system compared favorably to the conventional image intensifier system.The results of our first clinical investigations on image quality based on our rou-tine daily practice will be presented.

Musculoskeletal

Bone

C-589Differential diagnosis of femoral head bone marrow edema patternI. Kalaitzoglou1, P. Papadopoulou2, A.S. Dimitriadis1; 1Thessaloniki/GR,2Kavala/GR

Learning Objectives: To present the imaging features which help in the differen-tial diagnosis of the femoral head "bone marrow edema pattern".Background: Bone marrow edema of the femoral head is a non-specific MRIfinding associated with various painful conditions of the hip like osteonecrosis,idiopathic transient osteoporosis, transient bone marrow edema syndrome, mi-gratory osteoporosis and stress fracture. A total number of approximately 400 hipMRI examinations were performed in three different diagnostic centers from Jan-uary 1997 to July 2003. Bone marrow edema was present in 80 cases.Procedure Details: MRI units used ranged from 0.5 to 1.0 Tesla and the exami-nation protocols included T1 SE and T2 FSE fat-sat or STIR axial and coronalimages, while sagittal images and contrast administration were reserved for spe-cific cases. Patients with typical findings leading to the diagnosis of osteonecro-sis or fracture were excluded. The remaining patients had non-specific bonemarrow edema of the femoral head which was demonstrated as diffuse, ill de-fined, low signal intensity on T1W images, high on T2W and STIR images, andextended to the femoral neck region. In half of the patients follow – up examina-tions were also available. We selected and present the imaging criteria, at pres-entation and follow – up, which can lead to an early specific diagnosis.Conclusion: Bone marrow edema of the hip has to be correctly interpreted inorder to avoid overtreatment in transient and self-limiting conditions. The pres-ence of subtle subchondral lesions and the temporal evolution are usually key todiagnosis.

C-590Periosteal reactions: The spectrum of radiological appearances withhistopathologic correlationI. Pinilla, D. Bernabéu, C. Martín-Hervás, A. Alvarez, A. Bravo, F. López-Barea;Madrid/ES

Learning Objectives: The aim of this exhibit is to illustrate the spectrum of imag-ing features of periosteal reactions with plain radiography, computed tomography(CT) and magnetic resonance imaging (MRI) with emphasis in pathologic corre-lation.Imaging Findings: 1284 patients with histologically proved diagnosis of benignand malignant lesions in our institution between January 1991 and December2002 were identified from the pathology data base. Imaging findings with plainradiography, CT and MRI were retrospectively reviewed and correlated with keypathologic features. The various patterns of periosteal reaction are arranged intothe following categories: continuous (smooth, lobulated, and ridged shells, solid,single lamella, laminated or "onion skin", and parallel spiculated or "hair on end"reactions), interrupted (buttres, Codman triangle, lamellated, and spiculated re-actions), and complex (divergent spiculated or "sunburst", and combined reac-tions). The most representative cases of each form of periosteal reaction aredisplayed. Specific topics addressed include benign and borderline bone tumors(osteoid osteoma, osteoblastoma, periosteal chondroma, aneurysmal bone cyst,giant cell tumor, Langerhans cell histiocytosis, and adamantinoma), primarymalignant bone tumors (osteosarcoma, chondrosarcoma, Ewing's sarcoma andnon-Hodgkin's lymphoma), skeletal metastases, and non-neoplastic conditionssuch as osteomyelitis and myositis ossificans.Conclusion: The changes in the periosteum are common and important imagingfeatures of bone diseases. Recognizing and understanding the different radio-logical patterns and underlying histopathologic changes help the radiologist tonarrow the differential diagnosis. This teaching exhibit gives an overview of thewide spectrum of radiological appearances of periosteal reactions together withhistopathologic correlation.

C-591Chondroblastoma: Radiographic and MR findingsK. Nakanishi1, S. Nakata2, H. Tanaka2, H. Yoshikawa2, H. Nakamura2;1Osaka/JP, 2Suita/JP

Learning Objectives: To illustrate the analysis of the image characteristics ofchondroblastoma.Background: 11 cases (male 5, female 6) of chondroblastoma were reviewed

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(femur 6, humerus 2, tibia 1, calcaneous 1, talus 1). The age ranged from 8 to 25years old (mean 16.3). In all cases, roentgenogram and MRI were obtained.In MR images, spin-echo (SE) T1-weighted images (T1-WI) and T2-WI were ob-tained and Gd-DTPA contrast enhanced images were obtained in 5 cases.In these cases, the location, the radiographic findings, signal and enhanced pat-tern on MRI were analyzed.Imaging Findings: In 5 cases, the tumor located in epiphysis (45.5%), in 2 cas-es in apophysis (18.2%), in 3 cases in apo-metaphysis (27.3%), in 1 cases in epi-metaphysis (9.0%). In all cases, the tumor was depicted as radiolucent area andin 5 cases, the sclerotic margin was recognized. In all cases, the tumor was re-vealed as iso-intensity comparing with surrounding muscle on T1-WI. On T2WI,in 7 cases, the tumor revealed as iso-intensity with bone marrow and in the other4 cases, it revealed as low intensity. On T2-WI, in 8 cases, high intensity areawas included which corresponds to the cystic degeneration. In all 5 cases, thetumor was moderately enhanced on contrast enhanced T1-WI.In 2 cases, T1-T2-prolonged lesion which is considered to be the reactive inflam-matory change were shown in the bone marrow around the tumor.Conclusion: To analyze the image characteristics of chondroblastoma is impor-tant to approach the exact diagnosis of bone tumor.

C-592Chondrosarcomas: Radio-clinical featuresL. Ollivier1, D. Vanel2, J. Leclère2, H. Brisse1, B. Tomeno1, G. de Pinieux1,C. El Khoury1, V. Servois1, S. Neuenschwander1; 1Paris/FR, 2Villejuif/FR

Learning Ojectives: To describe the various types of chondrosarcomas, theirdifferential diagnoses, the steps and pitfalls in radiological and histological diag-nosis, the principles of treatments.Background: The chondrosarcoma is the most common primary malignant bonetumor in adult. The radiological and histological diagnosis may be controversialand the treatment needs radical surgery. Then, it is of a great importance for theradiologists not obviously trained in oncolgy, to be aware of the different aspectsof these tumors and their differential diagnoses.Imaging Findings: Our cases coming from 10 years series of 2 cancer centersand 1 orthopaedic surgical center, reviewed and analyzed in the light of literaturedata, are presented in a didactic form. The role of conventional radiology, CT andMRI is discussed at diagnosis and during the follow-up after treatment. Radiolog-ical features are compared with histological data.Conclusion: The analysis of radio-clinical cases of chondrosarcomas comparedwith the data of the literature, completes the knowledge of the radiologists andimproves their diagnostic performances.

C-593MRI features of parosteal osteosarcoma: Is there a correlation between thegrade of the tumor and the MRI signal?F. Yildirim Donmez, U. Tuzun, E. Yekeler, M. Tunaci, H. Ozger, G. Acunas;Istanbul/TR

Learning Objectives: To describe the MRI findings of parosteal osteosarcomaand assess the relationship between the histological grade of the tumor and theMRI signal intensity.Background: Parosteal osteosarcomas represent only 3-4% of all osteosarco-mas, and have better prognosis than the classical osteosarcoma.They are fre-quently low-grade tumors, which may rarely dedifferentiate into high gradesarcomas.Imaging Findings: MR images performed on 1-1.5 T MR system of 10 histolog-ically proven cases of parosteal osteosarcoma were retrospectively analyzed forthe bones involved, location and the relationship between the signal intensityand the grade of the tumor.There were 8 females and 2 males. Ages ranged from17 to 50 (mean 32.9). Most commonly affected bone was femur, on its distal end,posterior aspect (7). Histological grading was described as follows:Grade I: hy-pocellular stroma with subtle atypia; Grade II: mild increase in stromal cellularityand more prominent cytologic atypia, Grade III: marked pleomorphism with highcytologic atypia and mitotic rate, also called dedifferentiated type. Regarding thedescribed grading above, 6 of our cases were Grade I (low), 2 were Grade II(intermediate) and 2 were Grade III (high). On MRI, all of the parosteal osteosa-rcoma cases were of hypointense signal intensity on T1-weighted images andwere hyperintense on T2- weighted images with no exception. On gadolinium-enhanced images, heterogeneous contrast enhancement was observed.Conclusion: In our study, MRI signal intensity was the same in all of the cases;hypointense on T1-weighted images and hyperintense on T2-weighted images;regardless of the grade of the tumor.

C-594Giant cell tumor of knee: Imaging findings of the most common siteV. Zampa, S. Giusti, C. Spinelli, S. Ortori, C. Bartolozzi; Pisa/IT

Learning Objectves: 1. To describe imaging findings useful for an effective diag-nosis 2. To discuss the main differential diagnosis with giant cell tumor (GCT) ofknee.Background: GCT is a relatively common skeletal tumor. It is a benign but locallyaggressive and destructive lesion composed of primitive histiocytes and large,multinucleated giant cells. The most frequent symptom is pain, local swelling,limited range of motion and pathologic fracture (10%). Location of GCT and ageof patients suggest the diagnosis. It usually affects long tubular bones and, inparticular around the knee, the most common site is distal femoral and proximaltibia (50 and 40% of all TGC).The main differential diagnoses include osteosarcoma (teleangectatic or fibro-genic), malignant fibrous istiocytoma, chondromyxoid fibroma and aneurysmalbone cysts. Treatment of choice is surgical resection but recurrence is frequent.Imaging Findings: On radiography GCT appears as an eccentric and geograph-ic bone lysis, associated with a narrow zone of transition and lacking surroundingsclerosis. CT is superior to conventional radiography in outlining the extent of thetumor and in demonstrating cortical invasion but MR is currently the best imagingmodality in determining extra-osseous extent, articular surface involvement andtumor recurrence with optimal definition of either osseous sclerosis or pseudo-capsule. The signal characteristics of the lesion on the different MR sequenceswill be described to find out if they can help in differential diagnosis.Conclusion: Radiologic appearances of GCT is important in allowing prospec-tive diagnosis, guiding therapy, and facilitating early detection of recurrence.

C-595Superscans: A pictorial reviewS.A. O'Keeffe, T. Geoghegan, W.C. Torreggiani; Dublin/IE

Learning Objectives: The objective of this poster presentation is to pictoriallydescribe the causes, findings and interpretative pathways of patients undergoingradionuclide bone scintigraphy resulting in a superscan.Background: A superscan is a radionuclide bone scan which demonstratesmarkedly increased, homogenous skeletal radioisotope uptake relative to softtissues and is usually associated with absent or faint renal images. A retrospec-tive analysis of all whole body radionuclide bone scans performed over a five-year period was performed to identify the presence of superscans. Analysis wasbased on review of reports identified on a computerised Radiology InformationSystem (RIS). Images were reviewed in association with other relevant imagingand in select cases, with laboratory data and clinical notes. A variety of caseswere then selected for this pictorial review.Imaging Findings: A total of 6222 whole body bone scans were performed inour institution in the last five years. 11 superscans were selected for inclusion inthis pictorial review. The vast majority of superscans identified were related tometastatic disease of which prostate cancer dominated. Superscans were alsoidentified secondary to hyperparathroidism, metabolic bone disease includingosteomalacia and Pagets disease.Conclusions: In this pictorial review, we describe the patho-physiological path-ways resulting in the appearances of a superscan. In addition, we pictorially dem-onstrate a variety of causes resulting in superscan. Finally, interpretative pathwaysof analysis and helpful signs are suggested.

C-596Usefulness of 3D reformations in the assesment of spondylolisthesis andspondylolisis of the lumbar spineE. Vilar Bonacasa, P. Sanchez Santos, J. Torres Nuez, G. Martinez Sanz;Teruel/ES

Learning Objectives: To obtain images that provide a full and direct view of thepars interarticularis in order to determine the isthmal affectation in lumbar spond-ylolisthesis.Background: Nine patients with spondylolisthesis of the lumbar spine among 46sent to our department for CT study during the last year were performed a volu-metric acquisition from L3 or L4 to S1 instead of the conventional axial scanning.Later, a 3D image was obtained and modified in the work station, to achieve aview of the pars interarticularis from the vertebral canal.Procedure Details: Using this method, we obtained images wich allowed us toasses the isthmal affectation in a direct way in all patients. Moreover, it permitsthe study of the repercussion of vertebral bodies slide over the vertebral canaland the intervertebral foramina.

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Conclusion: Convencional CT has some limitations to determine exactly the typeand degree of isthmal affectation in spondylolisthesis as well as its repercussionon intervertebral foramina.Helical CT, using volumetric acquisition with three-dimensional reformations canresolve those limitations.

C-597Morphology of the scaphoid nonunion in high resolution helical multislicecomputed tomographyG.P. Christopoulos, R. Schmitt, G. Coblenz, S. Froehner, M. Wagner,H. Brunner, K.-H. Kalb, H. Krimmer; Bad Neustadt a. d. Saale/DE

Purpose: Morphological assessment of the scaphoid nonunion (pseudarthrosis)by means of high resolution multidetector computed tomography (MDCT).Methods and Materials: 769 patients suffering from radial-sided wrist pain wereexamined with a multislice CT (SOMATON Plus 4, Volume Zoom, Siemens, Er-langen) in a specially for the scaphoid designed scan plane and protocol. A2 x 0.5 mm collimation with an increment of 0.3 mm along the scaphoid long axis(oblique sagittal) in spiral technique (FOV 60 mm) and a coronal reconstruction(MPR) is recommended.Results: Out of the 769 patients 217 presented a scaphoid nonunion. The re-maining cases showed either an acute fracture, were postoperative follow-ups orwere inconspicuous. The following anatomical and morphological changes weredepicted. They correspond to the staging of scaphoid pseudarthrosis: Stage I:resorption zone with widening of the fracture line, a) without b) with fragmentdislocation. Stage II: cystic transformation extending into both fragments, a) with-out b) with carpal instability. Stage III: sclerotic fracture surfaces, a) without b)with carpal instability. Stage IV: secondary osteoarthritis, a) without b) with car-pal collapse.Conclusion: High resolution MDCT provides a superior anatomical and morpho-logical assessment of scaphoid pseudarthrosis. The spatial resolution as well asthe z-axis coverage is excellent, the thin collimation and optimal overlap allowsan ideal data set for multiplanar imaging.Thus MDCT is the imaging modality of choice: • In detecting and staging ofscaphoid non-union. • In assessing early periscaphoidal osteoarthritis. • Andfinally, for the postoperative clinical management.

C-598Whole-body MRI for detection skeletal metastases in cancer patients and inbenign pathology of bonesJ. Barcelo1, J. Vilanova1, M. Villalon1, M. Figueres2, E. Riera1, A. Rubio1;1Girona/ES, 2Palamos/ES

Purpose: Present our preliminary experience with a WB-MRI technique with anautomatic moving table as a screening tool for metastases in patients with can-cer, and possible application also in benign pathology of bone with multiple orsystemic localization.Method and Materials: WB-MRI was performed in 24 patients with histologicallyknown malignant tumors and clinical suspicion of bone lesions. An automaticmoving table was used for fast T1-SE and STIR sequences covering nearly thewhole skeleton. The total time of acquisition was only 18 minutes. We comparedWB-MRI and bone scintigraphy findings. Metastatic lesions were confirmed byfollow-up over 6 months or biopsy. We accomplished the same protocol in 3 pa-tients with benign pathology of bones.Results: WB-MRI was superior to bone scintigraphy in predicting lesions dignitywith a sensitivity of 90% (bone scintigraphy: 80%), a specificity of 93% (scintigra-phy: 71%) and an accuracy of 91% (scintigraphy: 75%). WB-MRI showed addi-tional metastases in extra-skeletal regions of the body.Conclusion: WB-MRI with automatic moving table technique is an effective meth-od for evaluating the entire skeleton in patients with suspected bone metastases.WB-MRI has significant higher sensitivity and specificity to scintigraphy in thedetection of bones metastases, and also can detect extra-skeletal lesions. Thistechnique is also useful to evaluate benign pathology of bones with possiblemultiple locations.

C-599Dynamic contrast-enhanced perfusion MR imaging of diseased vertebra:Differentiation of benign from pathologic compression fracturesO. Tokuda, N. Matsunaga; Ube/JP

Purpose: The purpose of the present study was to investigate perfusion magnet-ic resonance (MR) imaging for differentiating osteoporotic and pathologic com-pression fractures.Methods and Materials: Dynamic MR imaging was performed for 34 patientswith 48 lesions. All lesions were assigned to four groups: osteoporotic compres-sion fracture (OCF); benign lesion without fracture (BWF); pathologic compres-sion fracture (PCF); metastatic lesion without fracture (MWF). Peak enhancement(%) (PE), steepest slope (%/sec) (SS), and slope (%/sec) (S) were calculatedfrom the time-intensity curve (TIC) of diseased vertebrae. TICs were classifiedinto five types. Comparisons were made between groups by analysis of the threeparameters and the distributions of the TICs pattern.Results: There were significant differences in PE (58.82 vs 110.68, p < 0.05),SS (8.34 vs 14.5, p < 0.05), and S (2.6 vs 6.51, p < 0.05) between the resultsobtained in OCF and PCF. There were significant differences in PE (62.36 vs110.68, p < 0.05), SS (7.13 vs 14.5, p < 0.05), and S (3.09 vs 6.51, p < 0.05)between the results obtained in BCF and PCF. There were significant differencein SS between the results obtained in BCF and MWF (7.13 vs 11.45, p < 0.05).No characteristic distribution of the TIC pattern helpful for the differentiation ofbenign and metastatic lesions was found.Conclusion: For distinguishing osteoporotic from pathologic compression frac-tures, semi-quantitative analysis of the perfusion MR imaging is very useful. How-ever, the analysis of the TIC patterns can not significantly contribute to thedifferential diagnosis.

C-600Application of diffusion-weighted MR imaging to the diagnosis of bonemetastasis: a fundamental study using rabbit bone tumor model.M. Mikami, T. Sone, S. Imai, T. Yamashita, M. Fukunaga; Kurashiki/JP

Purpose: To evaluate the usefulness of diffusion-weighted magnetic resonanceimaging (DW-MRI) for the diagnosis of bone metastasis in a rabbit bone tumormodel.Materials and Methods: Skeletal lesion of tumor or inflammation was inducedby the injection of VX-2 tumor cell suspension or croton oil, respectively, at thedistal femur of Japanese white rabbits. Ten to fourteen days after the injection,MRI was performed under intravenous anesthesia. Single shot echo planar DWimages were obtained. After MRI, the diseased side of femur was extirpated,analysed histologically, and compared with DW images. The apparent diffusioncoefficient (ADC) values were compared among the different tissue regions, andtheir relationship with histological measurements was examined.Results: In the necrotic regions of intraskeletal tumors, ADC values were higherthan those in the regions with abundant viable tumor cells (p < 0.0001). In theextraskeletal tumor, necrotic cells were numerous and ADC values were similarto those in the intraskeletal necrotic tumors. Intraskeletal nflammatory lesionsand normal bone marrow showed the highest and lowest ADC values, respec-tively, among the regions evaluated. (p < 0.0001). In the comparison as a whole,ADC values were negatively correlated with cell area density and nuclear/cyto-plasmic ratio.Conclusion: ADC values in various skeletal lesions were correlated with histo-logical features, suggesting the potential usefulness of ADC mapping in differen-tiating benign lesion from bone metastasis.

C-601Ultrasonic quantitative assessment of bone callus formation:First experienceD.V. Passynkov1, I.V. Kliouchkine2; 1Ioshkar-Ola/RU, 2Kazan/RU

Purpose: We tried to perform the method of ultrasonic quantitative assessmentof bone callus at different formation stages.Materials and Methods: 114 patients (12-78 years old) suffered from 163 differ-ent bone fractures (ribs, extremities) have been examined. Ultrasonography hasperformed using Acuson 128XP/10 (USA), Medison SA8800 (Korea), probes 7-10 MHz. For quantitative assessment of ultrasonic images we used original soft-ware "Histography 1.0" on the outer IBM-compatible personal computer. As anassessment criterium we have proposed the consolidation coefficient (CC).Results: CC values of normal bone have been measured in healthy volonteersand have been considered as 0.85-1.16 (mean 1,.01 ± 0.071). Similar valueshave been registered in undamaged contralateral side (if possible). At early stag-

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es of reparative process CC values of haematoma gradually transforming intofibrous callus were 4.85-5.15 (5.01 ± 0.084). During the reparation we observedthe CC decreasing to the normal values. While calculating CC values at differentconsolidation stages we used relative time criteria (e.g. ¼, ½, ¾ etc. of completereparation time). Thus mean CC values up to the ¼ time necessary for completereparation was 4.23 ± 0.066, up to the ½ time - 2.23 ± 0.073, up to the ¾ time -1.98 ± 0.053. According to these date the curve of CC values alteration duringthe reparation period was worked out. Delayed consolidation was revealed asdelayed CC decreasing irresponding the reparation time.Conclusion: The proposed CC can be useful criterium in noninvasive assess-ment of bone callus formation at different fracture reparation stages.

C-602Multiple myeloma: Predictive value of MRI of the spine and 99Tc MIBIscintigraphy in the diagnosis and therapyJ. Nekula, M. Myslivecek, J. Bacovský, V. Šcudla, D. Horák; Olomouc/CZ

Purpose: We have investigated the validity of MRI and 99Tc-MIBI in the diagnosisand prediction of therapy effect in 52 patients, in whom both examinations weremade within 14 days.Methods and Materials: Fifty two patients: 14 monoclonal gammapathies ofundetermined significance (MGUS), 38 multiple myeloma D-S I-III, 18 after ther-apy. Th and LS spine was examined on Siemens Maestro Symphony 1.5 T, usingT1, T2, STIR and GRE. Whole-body scintigraphy 99Tc-MIBI, camera with two de-tectors.Results: Pathological bone marrow changes were detected in 94% of MRI and95% of scintigraphy exams, epidural mass in 18% of MRIs, vertebral compres-sion in 44%. After therapy, normal scintigraphy was in 89% in agreement with theclinical picture but MRI only in 22%.The MGUS patients had negative findings in both methods. Six patients in theinitial MM stages not requiring therapy had positive T1-weighted findings, withnegative STIR and MIBI. Out of the 38 patients with active disease, 32 had focaland 4 focal+diffuse MRI findings. MIBI showed D type in 18, F + D in 8 and F in 5patients. In patients in remission (within 2 months), 10 MRIs showed focal chang-es, 5 partial conversion. In MIBI, 11 of these patients had N type, 4 had F + D.Conclusion: MRI and MIBI scintigraphy are methods of equal sensitivity in de-tecting MM and complement each other. The advantage of MIBI is whole-bodyscanning and faster response to therapy, conversely, MRI reliably detects epidur-al propagation and vertebral compression and thus influences the therapeuticalprocedure.

C-603Transarterial embolization of unresectable hypervascular bone tumor - using a new embolic material superabsorbent polymer microsphere (SAP-MS)K. Nakanishi1, K. Osuga2, H. Yoshikawa2, S. Hori3, K. Hamada2, H. Nakamura2;1Osaka/JP, 2Suita/JP, 3Izumisano/JP

Purpose: To evaluate the efficacy and safety of transarterial embolotherapy (TAE)for treatment of bone tumor using a newly developed embolic material superab-sorbent polymer microsphere (SAP-MS).Materials and Methods: Embolic material was SAP-MS (sodium acrylate andvinyl alcohol copolymer) which provides new advantages characterized by spher-ical shape in a uniform size, easy delivery without aggregation via microcatheterand no toxicity.Between December 1997 to December 2002, 21 cases (M:F = 12:10, mean age61.4yo) with unresectable hypervascular tumors (Giant cell tumor 3, osteosarco-ma 2, angiosarcoma 1, Ewing sarcoma 1, metastasis from HCC 5, RCC 4, thy-roid ca. 2, alveolar soft part sarcoma 1, colon cancer 1, uterine cancer 1) (ilium 7,sacrum 5, pubis 3, spine 2, humerus 2, femur 1, scapula 1) were underwent TAEwith use of SAP-MS.In these cases, the improvement of the skeletal pain were scored in five-levels bypatients' interview from 5 = marked improved to 1 = worse and the duration of thesymptom's improvement was monitored.Results: A total of 39 TAEs (mean 1.9 times) were performed. All procedureswere technically successful. Skeletal pain was relieved in 17 patients (81%) be-tween 3 = slightly and 5 = markedly improvement. In 15 of 18 patients with malig-nant lesions, the duration of pain relief ranged from one to 60 months (mean 8months). No serious complications were observed except for a case with tran-sient neurogenic bladder.Conclusion: TAE using SAP-MS was a safe and effective treatment for the paincontrol with long duration of unresectable bone tumor.

C-604Bone marrow edema at MRI: Diagnostic clue to the underlying cause ofknee painA. Blanco, M. Martinez, E. Parlorio, M.A. Corral, S. Torres; Murcia/ES

Purpose: Bone marrow edema (BME) is usually associated with traumatic inju-ries of the knee but there are other conditions, often unsuspected, that can causethis pattern. Our purpose was to evaluate the patterns of distribution of BME inpatients with knee pain and try to correlate them with their possible underlyingcause.Methods and Materials: We retrospectively reviewed MRI examinations of 723patients referred for knee pain, with or without history of trauma, during a 26-month period. The examinations were performed in a 1.5 T unit using our stand-ard protocol which included fluid-sensitive sequences. In some cases intravenousgadolinium was used.Results: 95 patients (13.1%) showed BME with variable distribution, resultingfrom: acute trauma (57), stress fracture (4), degenerative disease (19), sponta-neous osteonecrosis (8) and osteochondritis dissecans (6) of the femoral con-dyle, soft-tissue infection (1), excesive lateral pressure syndrome (1), iliotibial-bandfriction syndrome (1), transient BME (3), tumor (4), and nonspecific (9). In manycases associated with trauma, the distribution of edema allowed to explain themechanism of injury and predict with accuracy the soft-tissue abnormalities thatmay be present.Conclusion: BME patterns at MRI can help to establish the possible cause ofknee pain. When there is a history of acute trauma, edema shows typical fea-tures that can give the clue to a possible mechanism of injury. On the other hand,if clinical data is not clear, the distribution of edema can orientate to other unsus-pected pathologic conditions. Appropriate recognition is necessary for an accu-rate diagnostic and therapeutic orientation.

C-605Percutaneous radiofrequency treatment of osteoid osteomaE. Mazza, A. Casullo, T. Ciarpallini, D. Beccani, V. Cartei, M. Falchini;Florence/IT

Purpose: To evaluate the effectiveness of CT-guided percutaneous radiofrequencythermoablation in the treatment of osteoid osteoma.Methods and Materials: From the June 1998 to February 2003, 58 radiofre-quency thermoablation procedures have been performed on 57 patients (rangeof age 3-70 years, mean age 26) with osteoid osteoma located in the inferior orsuperior limbs, pelvic bones, vertebrae and, in one case, in a rib.Percutaneous thermoablations was performed with radionics cool tip RF genera-tor system by using probes with 1 or 2 cm unprotected tip applied for 4 minutes inthe center of the lesion.The procedure consisted of localizing the osteoid osteoma on CT imaging andpositioning within the lesion a Kirschner wire, rigged on a hand-drill device. Oncethe nidus was engaged we proceeded to exchange the thread of Kirschner for aRF probe and emit the radio waves.Results: At a mean follow-up of 21 months the treatment has been consideredeffective in 91% of the cases.In four patients pain has subsequently recurred; one of these cases has beentreated for a second time with success. In two cases procedural complications ofminor degree, represented by limited cutaneous burns have occurred.Conclusion: In our experience CT-guided percutaneous radiofrequency treat-ment of osteoid osteoma proved to be effective in 91% of the cases. Deprived ofsevere complications it may represent an uncomplicated, minimally invasive, rap-idly effective procedure, alternative to the surgical treatment.

C-606A novel ROI for femoral DXA: Prediction of the bio-mechanical competenceof the hip in vitro by measurement of bone mineral content and density inthe upper portion of the femoral neckH. Boehm, F. Eckstein, V. Kuhn, K. Schreiber, D. Mueller, E. Rummeny, T. Link;Munich/DE

Purpose: To compare Bone Mineral Density (BMD) and Bone Mineral Content(BMC) in hip specimens measured in the newly defined upper neck region ofinterest (ROI) with densitometric parameters in standard ROIs as well as femoralneck axis length (FNAL) in predicting fracture load in vitro.Method and Materials: Measurements of BMD and BMC were performed on122 human hip specimens using a clinical dual-energy X-ray absorptiometry (DXA)scanner. The analysis included a newly introduced ROI in the upper neck regionas well as the standard ROIs. From the scan images FNAL was determined. In

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order to obtain the load-to-fracture, the specimens were tested destructively atside impact.Results: In the standard regions of interest, correlations between fracture loadand BMD (BMC) ranged from R2 = 0.64 to R2 = 0.70, p < 0.001 (R2 = .65 to 0.75,p < 0.001). For the newly defined ROI in the upper neck of the proximal femur,significantly higher correlations between BMD, BMC and fracture load (R2 = 0.76and 0.81, respectively; p < 0.001) were obtained. Only a weak statistical relation-ship between fracture load and FNAL was found (R2 = .23, p < 0.001). Normali-zation of fracture load with respect to FNAL of the specimens did not significantlyimprove results.Conclusions: The mechanical competence of the hip highly depends on the BMDand BMC of the proximal femur. Of all the regions of interest analysed in thisstudy a newly defined ROI in the upper neck showed the strongest correlationwith fracture load. Under in-vitro conditions, only a weak association betweenmechanical strength and FNAL was observed.

C-607Chondromyxoid fibroma: About 6 casesH. Guerini, L. Sarazin, S. Malan, F. Bach, C. Duffaut-Andreux, D. Godefroy,E. Pessis, J.L. Drape, A. Chevrot; Paris/FR

Purpose: Chondromyxoid fibroma (CMF) is a rare bone tumor representing 1%of all osseous tumors. We present 6 radiological and pathological correlations ofthis tumor.Material and Method: Retrospective study of imaging and pathological findingsin 6 cases of CMF.Results: On plain-films, CMF appeared as a mildly aggressive lesion involvinglong bones, flat bones or short bones. No calcifications were noted. Eccentriclocation, thinning or cortical disruption on CT-scan as well as peripheral scleroticborders were constantly noted in cases of long bone involvement. The classicalmetaphyseal location was in fact most commonly diaphyseal in ours cases. MRIwas characteristic, displaying a myxoid matrix with high homogeneous signalintensity of the tumor on the T2-weighted images. Following Gadolinium injec-tion, strong central and homogeneous enhancement was present without involve-ment of the surrounding soft tissues.Conclusion: In this uncommon bone tumor, imaging is often evocative. It mayhelp for the final histological diagnosis which may be confusing with chondrosa-rcoma.

C-608FDG-PET in case of Ewing tumours with a comparison to bone scintigraphyT. Györke1, T. Zajic2, A. Lange2, I. Brink2, E. Moser2, E. Makó1; 1Budapest/HU,2Freiburg/DE

Purpose: The high-grade Ewing Sarcomas (ES) and Primitive Neuro Ectoder-mal Tumours (PNET) consist of Tumours of Ewing family (ET). Our purpose wasto evaluate the value of 18F-Fluoro-Deoxy-Glucose Positron Emission Tomogra-phy investigation (FDG-PET) in ET and to compare PET and Whole Body BoneScintigraphy (WBS) regarding bone lesions.Methods and Materials: 24 FDG-PET and 14 WBS of 24 patients (ages: 6-62,17 males, 7 females) with suspicious ET were included in this retrospective study.Whole body FDG-PET and WBS investigations performed in the primary (n = 14)or secondary (n = 10) diagnostics were analysed visually. The final diagnosisbased on histology, imaging and follow-up.Results: Histologically the primary lesions were ES (n = 10), PNET (n = 13) andosteomyelitis (n = 1). The sensitivity and specificity of FDG-PET for disease (pres-ence of ET, and/or its metastases) were 95 and 75% respectively. FDG-PET and/or other imaging modalities detected altogether 138 focal lesions. Sensitivity andspecificity regarding focal lesions were 78 and 75%. This lower sensitivity is dueto small lesions. WBS detected all 11 primary bone lesions present at WBS in-vestigation, but only 8 of 70 bone metastases in four patients, while FDG-PETdetected both the primaries and metastases.Conclusion: FDG-PET investigation is a valuable method in case of ET-s. Con-cerning the detection of bone metastases of ET-s FDG-PET is superior to WBS,while for the depiction of small lesions mainly represented by pulmonary metas-tases FDG-PET is less sensitive than helical CT. The determination of the role ofwhole body FDG-PET in the diagnostic algorithm needs further investigations.

C-609The role of an optimized MR protocol in the detection of osteomyelitisneighbouring metallic bone implantsG. Michailidis1, N. Economopoulos2, C. Kontopoulou2, S. Argentos1,N.L. Kelekis2; 1Piraeus/GR, 2Athens/GR

Purpose: Osteomyelitis presents as a complication in a percentage of patientsafter metallic bone-implant placement. Early and accurate detection is crucial forproper treatment. Conventional MR images are usually severely degraded fromintense artifacts, rendering interpretation often impossible. We report our resultsusing an optimized MR imaging protocol in detecting foci of osteomyelitis nearmetallic bone implants.Materials and Methods: During the last year we examined 17 patients (12 menand 5 women, age range 25-70) with metallic bone implants and clinical suspi-cion of osteomyelitis.The MR protocol consisted of T2-weighted STIR and single shot turbo spin echosequences. For T1 and T1 contrast-enhanced images we employed turbo spinecho sequences with slice thickness of 3 mm, echo train length > 10, minimumecho spacing and minimum TE.Diagnosis of osteomyelitis was based on the detection of one or more of thefollowing findings: subperiosteal fluid, bone sequestrum, fistula and abscess.Results: All MR examinations were of diagnostic quality with minimal artifactspresent. In 6 patients one or more of the above mentioned findings were presentand were diagnosed with osteomyelitis. In the remaining 11 patients no findingssuggestive of osteomyelitis were observed. Confirmation was obtained by follow-up and clinical outcome.Conclusion: With the use of an optimized scanning protocol MRI may overcomeits limitations caused by metallic artifacts and is able to detect foci of osteomyeli-tis in patients with metallic bone implants.

C-610Primary leiomyosarcoma of bone: About 9 casesS. Malan, H. Guerini, B. Fabienne, D. Godefroy, G. De Pinieux, B. Tomeno,J.L. Drape, A. Chevrot; Paris/FR

Purpose: Review of plain films, CT scan, and MRI features of primary leiomy-osarcoma of bone.Methods and Materials: 9 patients were included, aged 20 to 72 years old. Flatbones (pelvis = 2, sternum = 2) were involved as well as metaphysis of tibia (n = 3)and femur (n = 2). Pathologic diagnosis was obtained in all cases.Results: In long bones, tumor originated from the medulla, excentered and met-aphyseal in location. In all cases, agressive patterns were present such as oste-olysis, cortical break and tumoral extension in surrounding soft tissues, lack ofperitumoral reactional osteocondensation. Periosteal reaction was present in onecase. No calcification was noted. On MR imaging, tumors demonstrated interme-diate signal intensity on the T2-weighted images with heterogeneous enhance-ment following gadolinium injection. Pathological findings included smooth musclecells with interlacing fascicles of spindle cells, without osteoid production or car-tilagineous matrix. Despite adequate surgical resection, metatastatic diseasesappeared in 8 cases.Conclusion: Primary leiomyosarcoma of bone is a rare tumor which must beincluded in the diagnostic possibilities in case of agressive purely osteolytic lesion.

C-611Value of MRI in assessing Blount diseaseI. Boric, D. Anticevic, G. Roic; Zagreb/HR

Aim: To review the changes of the proximal tibial growth plate in patient withBlount disease by MRI.Materials and Method: MR findings were evaluated in 8 affected legs of 6 chil-dren with severe tibial bowing using 2T MR unit.Results: In all patients was founded delay in ossification of the medial tibial epi-physis. Changes of tibial growth plate and surrounding structures we foundedincluding: bone marrow edema of the medial tibial epiphysis and medial and lat-eral metaphysis, widening and depression of the medial growth plate, intrusionsof growth plate cartilage into the metaphysis, varus deformity of the lower leg,widening of the lateral growth plate, osteochondral injury to the medial femoralcondyle, hypertrophy and signal intensity changes of the medial meniscus andfocal bone bridging.Conclusion: MRI shows a spectrum of the growth plate abnormalities in patientswith Blount disease, including bone bridges and is very useful in surgical planning.

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C-612Radiological and pathological correlation of the primary bone tumorsF. Todua, S. Kakhadze, M. Baramia, K. Lashkhi; Tbilisi/GE

Purpose: To describe the radiological features of primary malignant bone tumorsand to correlate clinical presentation and radiographic findings.Method and Materials: 71 patients with pathologically proven bone tumors werereviewed. Imaging included conventional radiographs, MRI, bone scintigraphy.Imaging features were correlated with histopathological diagnosis.Results: Patients included 32 females and 39 males (aged from 9 to 61 years)with pain in extremities. Osteogenic sarcoma was diagnosed in 34 patients, Ew-ing sarcoma - 19, chondrosarcoma - 11, bone lymphoma - 7. In 7 cases on plainfilm bone damage wasn't detected. On bone scintigraphy, the majority of lesionsshowed greater than mild uptake, in 11 cases showed no uptake. At MR imagingisointense or low T1w signal and increased T2w signal was present in all cases.Specific cellular constituents (e.g. fibrous, chondroid, blastic or teleangiectaticcomponents), can modify signal characteristics. Lesions that are primarily blast-ic, and, therefore, sclerotic on plain film radiographs, demonstrate low signal in-tensity on both T1- and T2-weighted sequences. Edema characterized by indistinctmargins, is a poor indicator of malignancy.Conclusion: Study shows that there is overlap in the radiological appearancesof primary malignant bone tumors especially in the early stages. Magnetic reso-nance imaging is shown to be a useful and sensitive modality in the detectionand evaluation of bone tumors. MR imaging accurately assesses soft tissue andsynovial involvement, as well as marrow infiltration, which may be radiographi-cally silent. In patients with extremity pain MR imaging is necessary and MRIdata wasn't correlated with conventional radiology.

C-613MR features and interspinous mobility at flexion-extension radiography ofthe interspinous ligament in patients of isthmic spondylolisthesisS. Lee, S. Lee, B. Kang, S. Kim, M. Shin; Seoul/KR

Purpose: To investigate the correlation between the interspinous mobility at flex-ion-extension radiography and MR features of the interspinous ligament in pa-tients of isthmic spondylolisthesis.Method and Materials: A total of 105 patients with one level isthmic spondy-lolisthesis were selected in our institution from February 2001 until February 2003.All of them were underwent lateral flexion-extension radiography and lumbar MRimaging. Differences of interspinous distances at flexion-extension radiographywere analyzed at upper, lower, and spondylolisthetic segments. The MR featuresof the interspinous ligament were divided into 2 groups according to their signalintensities: Group 1, with inflammatory type presented as high signal intensity atT2-weighted image and low signal intensity at T1-weighted image, and Group 2,fibrotic or fatty type. The incidence of the interspinous ligament with the inflam-matory type was analyzed on the spondylolytic segment and the upper and lowersegment without spondylolysis, respectively.Results: Spondylolysis at L3, L4 and L5 levels were 3, 30 and 72, respectively.Of 105 patients, the inflammatory type of the interspinous ligament was 25 (24%)on the spondylolisthetic segment and 54 (51%) on the upper segment withoutspondylolysis (p < 0.05). The mean difference of interspinous distance on thespondylolisthetic segment and the upper segment were 8.4 mm and 10.0 mm,respectively (p < 0.05).Conclusion: In patients of isthmic spondylolisthesis, the upper segment withoutspondylolysis showed more inflammatory type of the interspinous ligament onMR imaging than spondylolisthetic segment probably due to interspinous hyper-mobility.

C-614Advantages of multislice CT in the diagnosis of traumatic osseous diseaseC. Capuñay1, P.M. Carrascosa1, M. Ulla1, E. Martín López1, S. Chandra2,J. Carrascosa1; 1Buenos Aires/AR, 2Ohio, OH/US

Purpose: To show the usefulness of multislice CT multiplanar reconstructions inthe study of traumatic osseous disease.Materials and Methods: Two hundred CT studies with the probable diagnosis ofbone fracture were analyzed between December 2001 and August 2003. The CTscans were performed using a multislice CT scanner (Mx8000; Philips MedicalSystems) with a slice collimation between 0.5 to 2.5 mm depending on the areaof evaluation. Only one acquisition on the axial plane was done. The images weresent to a workstation and isotropic MPR reconstructions were carried out.Results: One hundred and twenty five fractures were diagnosed. The axial imag-es made the diagnosis of 96. The MPR reconstructions were necessary in the 29

remaining cases, to assess the articular surface involvement and the real exten-sion of the fracture.Conclusion: The isotropic MPR reconstructions carried out with the multisliceCT scanners allow us to scan the patient in only one position, usually the axialplane, saving time and using less radiation dose. The MPR reformats takes animportant role in the final diagnosis of many cases.

C-615The usage of three-dimensional CT reconstructions in imaging of the spineafter operations of the scoliosis with the Cotrel's methodW. Krupski, P. Majcher, M. Paslawski, M. Fatyga, J. Zlomaniec; Lublin/PL

Purpose: The aim of the study was assessment of spatial CT reconstructionsvalue in imaging the spine after operations of the scoliosis with the Cotrel's method.Material and Methods: Material comprises 7 patients operated due to progres-sive scoliosis with the Cotrel's method, which consist in putting on the bone graftstaken from fibula and iliac crest on the vertebral arches and intervertebral joints,was used up to early 80 s and was replaced with the Harringthon's procedure.Examinations were performed 21 - 36 years after the procedure, in 2 mm thickaxial sections. 3D reconstructions were performed with the bone threshold(150 HU). The spatial images were assessed in real time in any desired externaland internal projections.Results: In all cases the bone grafts were well accreted with the vertebral arch-es, forming the single bone segment. The vertebral bodies show different degreeof mineralization. The parts of the vertebral bodies on the bulging side of thescoliosis show the presence of multiple and large pseudo-foramens, resultingfrom intense osteoporosis of those vertebral parts. The parts of vertebral bodieson the concave parts of the scoliosis show real, intense mineralization. The widthof the spinal canal and vertebral foramens remain unchanged.Conclusions: 3D CT is valuable in imaging the spine after operations of thescoliosis with the Cotrel's method. The altered force vectors in the operated spinecause the presence of the pseudo-foramens. This is a good model of the lateresults assessment of posterior spondylodesis.

C-616Consideration of positioning in radiography for the waist of the scaphoidbone fracturesS. Matsubara; Hiroshima/JP

Purpose: The most common type of scaphoid bone fracture is the transversefracture of the waist (central 1/3). However, traditional positioning in radiographyfrequently fails to visualize bone fracture line. This may be caused by the fact thatX-rays cannot be irradiated perpendicularly onto the scaphoid long axis. In thisstudy, we searched optimal limb position for visualizing the waist of the scaphoidbone.Method: In 30 volunteers, the scaphoid bone was taken in the ulnoradial direc-tion at 40°ulnar deviation (group A) and 40° ulnar deviation with the fist clenched(group B). Images measured the angle between the cassette plane and long axisof the scaphoid (C-S) and the angle between the cassette plane and the volar tilt(C-V).Result: The C-S angle in group A was 32.5 ± 9.9° and in group B was 15.8 ± 7.5°.The C-V angle was 12.1 ± 3.2°. We devised new positioning that lift distal side offorearm upward at about 30° in group A, at about 15° in group B. These position-ing make the long axis parallel to the cassette plane. Especially, the later viewwas able to visualize the ulna-scaphoid joint more clearly without overlap of radi-us and scaphoid bones as compared to traditional method.Conclusion: In fractures of the scaphoid, in which early diagnosis is critical,optimization of first-choice X-ray imaging is a key factor, and an additional imageinvolving a 15° scaphoid waist view will be useful.

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C-618MRI apearance of traumatic and non traumatic lesions of the anteriorcruciate ligamentP. Papadopoulou1, I. Kalaitzoglou2, A. Dimitriadis2; 1Kavala/GR,2Thessaloniki/GR

Learning Objectives: To illustrate the imaging criteria leading to diagnosis incommon and uncommon lesions of the Anterior Cruciate Ligament (ACL).Background: MRI imaging is a very powerful tool in the evaluation of the ACL,with higher sensitivity than the clinical examination of the knee. Some of its le-sions are well known and easily identifiable, but others require careful interpreta-tion and familiarity with the spectrum of ACL pathology. Over 3000 knee MRIexaminations performed in three different diagnostic centers from January 1997to July 2003 were reviewed retrospectively. ACL lesions were found in approxi-mately 200 knees.Procedure Details: MRI units ranged from 0.5 to 1.0 Tesla, and various imagingprotocols were used, with T1 and T2 coronal and sagittal images obtained in allcases. Traumatic tears were the most common lesions identified. Tears were clas-sified as acute or chronic, complete or partial. We illustrate and discuss the pri-mary and secondary findings of ACL tears, as well as the imaging criteria in theevaluation of the postoperative ACL. We also present fractures of the anteriortibial spine with ACL avulsion, ACL ganglion cysts and mucoid degeneration,which are less commonly seen.Conclusion: In the examination of the ACL pathology the radiologist should eval-uate multiple signs and be aware of some less common pathologies in order toeffectively contribute to the clinical management.

C-619MR imaging of temporo-mandibular joints versus arthroscopic findingsW. Chmielewski, M. Golebiowski, H. Wanyura; Warsaw/PL

Learning Objectives: To compare MR and arthroscopic findings in cases of tem-poro-mandibular joints disfunction on a series of 47 patients.Background: Painful temporo-mandibular joint dysfunction needs arthroscopictreatment if noninvasive treatment is not effective. For precise planning of arthro-scopic procedure MR imaging enables preoperative evaluation of temporo-man-dibular joints. Betwen January 2002 and December 2002, 47 patients were treatedarthroscopically. MR and arthroscopic findings were described, compared andillustrated.Procedure Details: The Wilkes Score was used for MR patterns evaluation. Thesame Wilkes Score was used for arthroscopic findings classification. The corre-lation between MR and arthroscopic findings occured very high - about 90%.Conclusion: MR imaging of temporo-mandibular joints enables exact preopera-tive evaluation of intraarticular pathology and allows to precise planning of ar-throscopic procedures.

C-620Ultrasound and X-ray findings in painful shoulder involvement inrheumatoid arthritisL. Rutkauskiene; Vilnius/LT

Learning Objectives: To illustrate and compare conventional X-ray and ultra-sonography diagnostical possibilities of painful shoulder in RA.Background: Up to 60 percent of rheumatoid patients have shoulder pain. Arational decision on the treatment of shoulder disease in rheumatoid arthritisdepends on an accurate assessment of its cause and the extent of rheumatoidinvolvement.Imaging Details: A group of 25 RA patients, who reported a pain in the arm and/or limitation of the active movement, were examined first with conventional ante-rioposterior and obligue - outlet - view with 12-15 angulation X-ray of both shoul-ders. The most common findings were: joint space narrowing, erosions,subchondral cysts, irregularities of greater tuberosity, deformity and flattening,superior migration of humeral head, erosions in acromioclavicular joint, some-times soft tissues swelling. Ultrasonography study was performed with a 8.2 -11 MHz linear transducer, following the technique described by M.T. van Holsbeecket al. US findings were: bursitis and synovitis, glenohumeral effusion, tenosyno-

vitis and tendons ruptures, erosions of the humeral head, acromioclavicular jointlesions.Conclusion: Ultrasonography and X-ray supplements each other in explainingreal causes of pain of shoulder.

C-621Diagnosis of SLAP injuries and the variability of superior labral-bicipitalcomplex of the shoulder: Correlation of MR arthrography with anatomiccryosectionT.R. Trieb, M.C. Freund, K. Hausberger, I. Sitte, H. Maurer, W. Jaschke;Innsbruck/AT

Learning Objectives: To differentiate the normal range of variability of the supe-rior labral complex from SLAP-lesions utilizing MR arthrography and cryosec-tional correlative slides of anatomical specimens.Background: After intraarticular injection of Gd-DTPA under fluoroscopic guid-ance, eight shoulder specimens were investigated with standard MR-sequenceswith 1.5 T (T1w, with and without fat-saturation). An axial, a paracoronal and aplane parallel to the intraarticular portion of the long biceps tendon ("parabicipi-tal") were chosen. The specimens were cryosectioned in the parabicipital planeand photodocumented.Imaging Findings: Identical correlative sections between MR-arthrography andcryosectional surface of intersection showed two cases of pathological superiorlabral-bicipital complex. Two specimens appeared normal and four as norm-var-iants.Conclusion: MR-arthrography provides detailed information about superior la-bral-bicipital complex. Especially the parabicipital plane facilitates exact differen-tiation between normal variability of the superior labral-bicipital complex andpathological findings (i.e. SLAP lesions).

C-622MR imaging features of foot involvement in ankylosing spondylitis patientsZ. Erdem, S. Sarikaya, O. Erdem, S. Ozdolap, S. Gundogdu; Zonguldak/TR

Objective: To determine alterations of the soft tissues, tendon, cartilage, jointspace, and bones of the foot using MR imaging in Ankylosing Spondylitis (AS)patients.Material and Method: Clinical and MR examination of the foot was performed in23 AS patients on two sides. MR imaging protocol included; T1-weighted spin-echo, T2-weighted fast-field echo (FFE) and fat-suppressed short tau inversionrecovery (STIR) sequences in sagittal, sagittal oblique, and coronal plane usinga head coil.Results: Clinical signs and symptoms (pain and swelling) due to foot involve-ment were present in 3 (13%) of the patients while frequency of involvement was21 (91%) with MR imaging assessment. The most common involved anatomicalregion was the hindfoot (83%) following by midfoot (69%) and ankle (22%). TheMR imaging findings were bone erosions, Achilles tendinitis, para-articular en-thesophyte, joint effusion, plantar fasciitis, joint space narrowing, subchondralsclerosis, soft tissue edema, bone marrow edema, enthesopathy of the Achillesattachment, plantar fascia attachment, and plantar ligament, subchondral ede-ma, retrocalcaneal bursitis, subchondral cysts, subchondral fissures, and boneankylosis.Conclusion: MR imaging may detect bone, soft tissue, cartilage, tendon, andjoint abnormalities in AS patients, even if AS patients did not have clinical signsand symptoms of foot involvement. This imaging modality may be of importanceespecially early diagnosis of inflammatory changes in the foot. Additionally, fa-miliarity of the typical MR appearances of foot involvement in AS patients may behelpful in narrowing the wide differential diagnosis of spondyloarthropathies.

C-623MR findings of infero-medial displacement: A rare location of a freefragment of the medial meniscus of the kneeT.V. Bartolotta, A. Iovane, M. Midiri, F. Sorrentino, M. Galia, M. De Maria;Palermo/IT

Purpose: to define accuracy of MR in diagnosis of infero-medial displacement ofa free fragment of the medial meniscus.Materials and Methods: from December 2001 to June 2003, we retrospectivelyevaluated 676 MR knee studies of patients with traumatic disease submitted toarthroscopy. MR imaging was performed with a 0.5 MR unit provided with a sur-face coil. SE T1-w and GRE T2*-w images were acquired on sagittal, axial andcoronal plane with a slice thickness of 3 mm and intersection gap of 1 mm. Theknee was held in flexion of 10°. The images were evaluated to exclude bucket-

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handle meniscal tear using the following criteria: a) bow tie sign; b) double poste-rior cruciate ligament sign; c) coronal truncation sign; and d) displacement of thefree meniscal fragment.Results: in 54/676 cases a bucket-handle meniscal tear was identified. In 6 ofthese latter an infero-medial displacement of a free fragment of the medial me-niscus was identified. In all 6 cases a lesion of the posterior horn involving theinferior articular surface was observed on axial plane. On coronal plane was ob-served the truncated triangle aspect of the peripheral, not displaced, meniscalportion. On all planes the displaced free meniscal fragment was identifiable as alittle hypointense formation, medially to proximal tibial extremity, inferiorly to me-niscal plane and deep to tibial collateral ligament. In all cases diagnosis wasconfirmed by arthroscopy.Conclusions: MRI allowed the detection of the infero-medial displacement of afree meniscal fragment thus helping the arthroscopic approach.

C-624High-resolution MRI of ulnotriquetral ligament injury and its anatomicalvariations with a microscopy coilT. Ueno1, H. Yoshioka2, T. Tanaka1, Y. Kujiraoka1, M. Shindou1, K. Ooyama1,Y. Saida1; 1Tsukuba-Shi, Ibaraki/JP, 2Boston, MA/US

Purpose: To demonstrate ulnotriquetral ligament (UTL) injury and its anatomicalvariations using a microscopy coil.Materials and Methods: 50 patients (26 males and 24 females with age ranging14-67 year-old), who suffered ulnar side wrist pain and suspected triangular fi-brocartilage complex injuries, were investigated in 1.5 T MRI system with a mi-croscopic coil (47-mm in diameter). Axial and coronal T2*-weighted images, sagittaland coronal proton density-weighted images, coronal STIR images were obtainedwith a 50-mm FOV and a 1-1.5 mm of slice thickness for all patients.Result: UTL was identified in 49 patients and its injuries were found in 32 pa-tients. Regarding anatomical variations, in proximal side, UTL always connectedto volar radiocarpal ligament and disc proper. However, there were many varia-tions of the attachment to triquetrum bone. In 26 patients, 2 bands attached totriquetrum at different site: one attached to the distal aspect of triquetrum, andanother attached to a notch which was found at volar aspect of triquetrum.In 12 patients, one attached to proximal side of the notch. 3 patients showedseparate 3 UTL bands.Conclusion: High-resolution MRI with a microscopy coil is a promising methodto demonstrate UTL injury. It would be useful to know normal anatomical varia-tions for understanding the mechanism of UTL injury.

C-625Pictorial review of diagnostic imaging techniques in hip arthroplastyfollow-upJ. Rimola, P. Melloni, R. Valls, P. Bermúdez, D. Gil, A. Massuet; Sabadell/ES

Objective: To evaluate the spectrum of findings for plain-film radiography andother imaging techniques in patients with early or late complications of hip pros-theses. We describe the usefulness of each imaging technique in follow-up.Background: Over the last 14 years more than 200 hip replacements have beenperformed in our hospital annually. All patients are followed up immediately aftersurgery, at 6 months and then yearly or when necessary, using plain films andsometimes sonography (US) and/or computerized tomography (CT). US and CTare used to confirm or rule out osteointegration of the prosthesis and complica-tions such as periprosthetic abscess and/or hematoma.Imaging Findings: We analyzed radiological features of the normal and patho-logical evolution of hip prostheses. We describe early complications (affecting5.2% of patients), such as infection, cement extrusion, and periprosthetic frac-ture, as well as late complications (affecting 9.2% of patients), including asepticloosening, osteolytic lesions, heterotopic calcifications, migration of the acetabu-lar component, femoral diaphysis fracture, and dislocation of the prosthesis.Conclusion: Plain films are essential for evaluation and detection of hip arthro-plasties. US is usually used to guide percutaneous aspiration of soft tissue. CTenables correct assessment of osteointegration of hip prostheses.

C-626Evaluation of triangular fibrocartilage complex tears in the wrist:Comparison MRI and arthroscopyM. Bozan1, M. Acar1, L. Altinel1, B. Degirmenci1, H. Durmaz2; 1Afyon/TR,2Istanbul/TR

Purpose: Magnetic resonance imaging (MRI) has contributed to the develop-ment of evaluation techniques made for the accurate diagnosis; by detecting the

injuries of triangular fibrocartilage complex (TFCC) and ligaments in addition tothe bone structures. We evaluated MRI findings in wrist and compared them tothe arthroscopy findings.Methods and Materials: To evaluate the accuracy of MRI in detecting the tearsof the TFCC, 70 consecutive patients with posttraumatic chronic wrist pain wereexamined with MRI, and after arthroscopy the results were compared.Results: With wrist arthroscopy as the standard of reference, average sensitivityand specificity of non-enhanced MRI, for tears of the TFCC were 0.82 and 0.77respectively and 0.98/0.97/ for arthroscopy.Conclusion: MR imaging-plays a major role in evaluation and management oftraumatic wrist injuries, improves clinicians diagnostic accuracy and reduces theneed for arthroscopy.These preliminary results illustrate the ability of MRI to assess the integrity of theTFCC and suggests its use as the first imaging method following plain radiogra-phy in the evaluation of patients with chronic posttraumatic pain on the ulnar sideof the wrist. Wrist arthroscopy is a more valuable technique in determining thelocation, size, and extent of ligament injuries within the wrist.

C-627High-resolution US versus X-ray study in the early assessment of acutetraumatic lesion of the acromioclavicular jointT.V. Bartolotta, A. Iovane, M. Midiri, F. Sorrentino, F. Candela, M. De Maria;Palermo/IT

Purpose: To compare high-resolution ultrasound (HRUS) with conventional X-rayin the assessment of early anatomical-structural changes in acute traumatic le-sion of the acromioclavicular (A-C) joint.Materials and Methods: From September 2001 to September 2002, we studied18 patients (2 women, 16 men; mean age: 32 years) referred from E.R. for asuspect traumatic dislocation of the A-C joint. All patients underwent plain X-rayexamination (conventional projections integrated by "outlet" view and stress pro-jections) and HRUS scan (longitudinal and axial scan planes of interested liga-ments) of both the interested and contralateral A-C joint. Ultrasonographic criteriaof lesion were considered the absent recognition of the ligament and strongechostructural inhomogeneity A-C joint. Measures of A-C and coraco-clavicular(C-C) distances were drawn by means of both methods. Dislocation's degreewas defined according with Rockwood's classification.Results: In 6/18 cases of indirect trauma, diastasis of the A-C joint (2-5 mm),was observed, whereas C-C joint was not involved and C-C ligaments were nor-mal. In 12/18 patients with direct trauma, distracting lesion of the A-C ligamentwas observed in 4 cases, and involvement of both A-C and C-C ligaments withdiastase of both joints was observed in the remaining 8 cases. A complete corre-spondence of the two methods was observed.Conclusion: HRUS enables early anatomical-structural changes detection andlesion's degrees assessment in acute traumatic lesions of the A-C joint, and couldbe considered more than complementary to X-ray exam in the emergency clini-cal setting, mantainig its role in the follow-up.

C-628Upper limb joint involvement and peripheral nerve appearance detected bysonography in patients with arthropathic psoriasis and systemic sclerosisJ.B. Cwikla, E. Szymanska, A. Rakowska, E. Gorczyca-Wisniewska,J.M. Walecki, L. Rudnicka; Warsaw/PL

Purpose: A comparison ultrasonography (US) to clinical and radiological exam-inations in the detection of the upper limb joints abnormality including peripheralnerve appearance in patients with arthropathic psoriasis and systemic sclerosis(SSc).Methods and Material: 30 patients, 18 with psoriasis and 12 with SSc (with orwithout clinical and radiological signs of joint involvement). Mean time of diseasefor patients with psoriasis was 14 years and 12 for patients with SSC. All patientshad independent clinical and radiological examinations of shoulder, elbow andwrist. US was performed to detect bursitis, structure thickness, bone erosion,enthesitis and other degenerative changes (mostly osteophytosis). Additionallyulnar and median nerves within elbow and wrist were analysed to investigatenerve pathology. A score of abnormalities was formulated from no detected chang-es, to severe involvement of affected structure.Results: Patients with psoriasis most frequently had shoulder enthesitis 79%,ulnar entesitis 86% and wrist degenerative changes 70%, other changes in up-per limb joints were detected from 25% to 86%. Compare to clinical and/or radi-ological signs: shoulder 19%, ulnar joint 31%, wrist 44%.Most patients with SSc had shoulder degenerative changes 78%, ulnar joint de-generative changes 38%, wrist structure thickening 67%. Other abnormality in

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upper limb joints were detected from 25% to 67%. Compare to clinical and/orradiological signs shoulder was affected in 42%, ulnar joint 25% and wrist 58%.Conclusion: US seems to be more effective than clinical and/or radiological ex-amination in the detection of upper limb joints abnormality in patients with arthro-pathic psoriasis and SSc.

C-629MRI, MR arthrography and histopathologic correlations of knee cartilageG. Valeri, C. Ferrara, M. Marinelli, A. Gigante, A. Giovagnoni; Ancona/IT

Purpose: To correlate MR and MR-arthrography of knee cartilage in vivo an MRimages in vitro with histopathologic (biochemical, histochemical and immunohis-tochemical) data.Materials and Methods: Eight patients with primary arthritis scheduled for kneeprosthesis underwent MR and MR arthrography at maximum 1 week before sur-gery. The medial tibial plates of all patients underwent MRI in vitro.On MR images we measured maximum, median and minimum thickness of thecartilage. The same tibial plates underwent histochemical evaluation with ema-toxilin-eosin, van Gieson, safranin O and alcian blu; immunohistochemical evalu-ations with anti S-100, anti-collagen type I and II, anti-condroitin sulphateantibodies were performed. The maximum, median and minimum thickness ofthe cartilage were measured with histomorphometric analysis (Leika Quantimet500+ system). The cartilage morphology in vitro was scored with O' Driscoll scale.The MR, MR-arthrography and histomorphometric measures were compared anda statistical analysis was performed (Pearson and Spearmann correlation index).Results: MR arthrography based measures of chondral thickness were moreprecise than in vivo 3D T2w unenhanced images but less than in vitro evaluation;the in vivo and in vitro 3D images correlated better than MR arthrography withmorphologic evaluation based on O' Driscoll scale. The areas of chondral defectsdetected with MRI showed a depletion of sulphate proteoglycans in the immuno-histochemical evaluation.Conclusions: Our preliminary data show that MR-arthrography is the best tech-nique for cartilage thickness measurements but 3D T2w sequences are better inchondral structure evaluation.

C-630MR imaging of sports related injuries of the elbowE.M. Dieguez Costa, I. Cogollos, M. Ramos, A. Hernando, P. Borrego;Madrid/ES

Purpose: Magnetic Resonance Imaging (MRI) provides clinically useful informa-tion in assessing sports related injuries of the elbow joint. Such injuries of theelbow are important because they are frequent lesions of nonprofessional recre-ational athletes.The purpose of this poster is to present the MRI features of sportsrelated injuries of the elbow and the efficacy of the MRI study for the diagnosisand initiation of therapy.Materials and Methods: 210 studies were retrospectively reviewed.Results: The following diagnoses were established by MRI: 1. Sprains(20): Medi-al collateral ligament injury(7), Lateral collateral ligament injury(13). 2. Tendoninjuries(110): Lateral tendinitis(50), Medial tendinitis(26), Biceps tendon inju-ries(29) Triceps tendon injuries(5). 3. Muscle tears(9): Biceps tears(5), Tricepstears(1), Brachialis tears(3). 4. Olecranon bursitis(6). 5. Ulnar neuropathy(13). 6.Fractures(27): Fractures of the radial head(18), Fractures of the coronoid proc-ess(5), Fractures of the capitelum(4). 7. Osteochondritis dessicans(13): Capite-lum(10), Radial head(3). 8. Loose bodies(12).Conclusion: MRI can disclose most soft tissue and bony injuries of the elbowassociated with sports. The MRI results are sufficiently conclusive for treatment.

C-631Acute traumatic acromioclavicular joint lesions: Usefulness of sonographyversus conventional radiographyA. Iovane, M. Galia, T. Bartolotta, A. Carcione, M. Midiri; Palermo/IT

Purpose: To assess the feasibility of ultrasonography, in comparison with con-ventional radiography, to quantificate and classify the grade of acute traumaticacromioclavicular (AC) joint lesion.Materials and Methods: From September 2001 to September 2002, 18 patients(16 men, 2 women; age range: 17-78 years) submitted to our Emergency Servicewith clinically suspected acute traumatic AC joint lesion, were sonographicallystudied by a 7.5-Mhz transducer. Ligaments and AC joint soft-tissue morphology,acromioclavicular distance and coracoclavicular distance were evaluated. Sono-graphic findings were correlated with the results of conventional radiographicexamination, which was performed in all cases with anteroposterior projections,taken with and without weights, and with "outlet" projection.

Results: Sonographically, all patients presented lesion of AC ligament with highamount of sero-hemorrhagic fluid inside and outside the joint. In 6/18 patients,which had indirect trauma, we observed AC joint dislocation with AC ligamentlesion that was not associated to involvement of CC joint and ligament. In 12/18patients, which had direct trauma, we observed lesions of AC and CC legamentswith associated joints dislocations.Conclusions: Ultrasonography, if performed with appropriate technique and ad-equate transducer, is accurate in the evaluation of acute traumatic AC joint lesionand dislocation, integrating and correlating well with the informations offered byconventional radiography.

C-632Study of the MR imaging of the posterolateral structures of the normal kneeC. Yu, K. Li; Beijing/CN

Puropse: Through the study of the MRI appearance and localization of the pos-terolateral structures (PLS), to provide a practicable method for intactly display-ing them.Methods: Thirty tibial bone specimens were observed to establish the bony land-mark for localizing the knee. In 50 cadaver knees, the angles between lateraltibial plateau and the long axis of the individual structure of PLS were measured.Then we can determine the scan methods of the oblique MR images based onabove results. The routine and oblique scans of T1WI were performed in 40 nor-mal knees. The display effect and appearance of the PLS were observed in MRI.Results: The lateral tibial plateau is a stable bony landmark for measuring andlocalizing of the knee. In the PLS, The fibular collateral ligament can be intactlydisplayed on 70° posterior coronal oblique images in 34 cases (85%). The popli-teus can be better seen on either 60° posterior coronal oblique in 34 cases (85%)or 45° medial sagittal oblique planes in 36 cases (90%). The popliteofibular liga-ment can be intactly appreciated on both 60° posterior coronal oblique in 32cases (80%) and 70° lateral sagittal oblique images in 34 cases (85%). Althoughthe arcuate ligament and the fabellofibular ligament can occasionally be seen onroutine and oblique images, their presence rate is low.Conclusion: The oblique MR imaging can intactly display the main structures ofPLS, and can be an useful tool in diagnosing these structures' injuries.

C-633Technical procedure and examination protocol for MR arthrography of thehip: Findings in patients with negative or doubtful conventional MRexaminationsA. Rolon, A. Rasumoff; Buenos Aires/AR

Purpose: To describe our technical procedure, examination protocol and find-ings in MR artrography in patients with negative or uncertain conventional MRexaminations.Method and Materials: From November 2002 to August 2003 we performed 15arthrographies in 14 patients. Hip puncture was done under CT guidance in allcases. We instilled 5-12 cc of a saline solution with iodine contrast (for CT guid-ance) and gadolinium. All cases were studied with a 1.5 T system with body ar-ray coil for both hips comparison and dedicated surface coil. Examinations includedcomparative coronal 4 mm slice thickness STIR (4000/60/135) and 380-410 FOV,localized 1-1.5 mm slice thickness axial FFE T1W 3D (23/5), and 3 mm slicethickness axial, coronal and sagittal T1W (600/12) with fat suppression and 170-200 FOV.Results: In all cases the technical procedure and examination protocol weresuccessful. Two patients had normal exams. Findings included 10 anterosuperiorlabral tear, 1 posterior labral tear, 4 loose bodies, 5 cartilage defects and 2subchondral lesions, 1 capsulitis, and 2 rectus femoris reflected head lesions.Conclusion: MR hip arthrography is a simple procedure with this technique andprotocol and revealed several lesions not seen with conventional MR examina-tion helping arthroscophy planning.

C-634Correlation between patellar variances and iliotibial band friction syndrome:MRI evaluationM. Bankaoglu, A. Üçgül, E. Çiçek, M. Basak; Istanbul/TR

Purpose: To show the correlation between variances of patella and iliotibial bandfriction syndrome.Materials and Methods: 12 knees of twelve patients (4 F, 8 M) suffering fromiliotibial band friction were detected with MRI. Patellar shapes were noted ac-cording to the Wiberg's classification whereas patellar positions were measuredas ratio of patellar tendon length to patellar height in the mid saggital images.

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Patients are also asked for the presence of their prolonged physical activity intheir life.Results: 5 patients had type II, 4 patients had type I and 3 of them showed TypeIII patellar shapes, out of 12. 2 patients had patella alta whereas all others stayedin normal range as patellar position. In 4 patients' case no other abnormalitieswere seen apart from the signs of iliotibial band friction syndrome and three ofthem had shown type III patellar shape.Conclusions: No apparent correlation was found between iliotibial band frictionsyndrome and patellar position. As it is much more rare in the normal populationWiberg type III patella showed considerably high prevalance in our study.

C-635Shoulder arthritis: The spectrum of sonographic and colour Dopplerfindings of dialysis related amyloidosisK. Chatzimichail, K. Tsakouridi, M. Sonikian, I. Bechrakis, D. Schizas,O. Hiotellis, I. Katsaounos, P.S. Zoumpoulis; Athens/GR

Purpose: To demonstrate the echo-anatomy and vascularity of the shoulder joint(SI) with ultrasound and color Doppler study (CDU). To evaluate the spectrum ofabnormalities found in shoulder arthritis of dialysis patients in correlation withclinical and diagnostic parameters of dialysis related amyloidosis (DRA). To de-termine the diagnostic role of the method in these patients.Materials and Methods: Shoulder examination with CDU was performed in eleven(11) dialysis painful shoulder patients (A) and was compared to eleven randomlyselected asymptomatic dialysis patients (B). CDU results were graded accordingto the changes of extra- and intra articular structure and vascularity. All patientswere clinically and radiologically evaluated for DRA.Results: Patients in A showed bilaterally thickened tendons, synovial prolifera-tion, hypervascularization, synovial and fluid collections in biceps and subacro-mial bursae. CDU severity score was much more in A compared to B and correlatedwith clinical and other diagnostic parameters of DRA.The spectrum of abnormalities found in shoulder arthritis of dialysis patients arediscussed. Characteristic changes in rotator cuff tendons, subacromial and bi-ceps bursae, synovial fluid and microvascularization are illustrated with typicalexamples.Conclusion: Painful shoulder is a frequent joint complication in dialysis patients.CDU in these cases is of diagnostic importance and suggestive of secondaryamyloidosis.

C-636MRI postoperative evaluation of the cystic lesion of the lateral meniscus ofthe kneeG. Cerone, F. Iannessi, G. Bonanni, V. Calvisi, A. Barile, C. Masciocchi;L'Aquila/IT

Purpose: To assess by MRI the potential benefit and efficacy of selective menis-cectomy combined with radiofrequency ablation in cystic degeneration of the lat-eral meniscus treatment.Materials and Methods: Sixty-one patients entered this study. 28 patients un-derwent arthroscopic selective meniscectomy and 33 patients underwent arthro-scopic selective meniscectomy and radiofrequency treatment (Arthocare,Sunnyvale, CA) of the meniscal remnant. All of them were submitted three monthslater to MRI and clinical evaluation. In 15 case MRI examination was performedbefore and after the surgical treatment. MRI examination was performed using adedicated 0.2 T (Artoscan Esaote Italy) and a 1.5 T superconductive unit (GESigna Horizon USA) employing SE T1-w, SE T2-w and GE T2-w sequences onaxial and longitudinal scan planes. In 7 case Arthro-RM was also performed.Clinical evaluation included physical examination and questionnaire.Results: Clinical evaluation did not show statistically significant discordancebetween the two groups. MRI follow-up after 3 months demonstrated a very cleardecrease of the degenerative spots inside the meniscal remnant in the groupwith combined treatment respect to the group treated only with selective menis-cectomy.Conclusion: In conclusion our experience considers MRI the method of choicein the evaluation of post surgical treatment of degenerative cystic diseases of thelateral meniscus of the knee.

C-637High-resolution ultrasonography of the extrinsic carpal ligaments:Examination technique and performanceD.V. Guntern, N. Favarger, P. Schnyder, N.H. Theumann; Lausanne/CH

Purpose: To develop an examination technique to visualize the extrinsic carpalligaments by ultrasonography and to assess the performance of high resolutionultrasonography in the visualization of different parts of these ligaments.Materials and Methods: The extrinsic carpal ligaments of 9 wrists of 9 healthyvolunteers were examined with a 15 MHz linear array transducer by two musku-loskeletal radiologists in consensus. An examination technique was developedfor each extrinsic carpal ligament (radioscaphocapitate, radiolunotriquetral, pal-mar scaphotriquetral, dorsal scaphotriquetral, palmar ulnotriquetral, dorsal ul-notriquetral, dorsal radiotriquetral and radial collateral ligaments). Delineation ofthe proximal attachment, the body and the distal attachment of each ligamentwas evaluated as good, poor or absent.Results: With a profound knowledge of the anatomy, especially of the osseouslandmarks, an easy and fast examination of the extrinsic carpal ligaments byhigh resolution ultrasound is possible. The more superficial ligaments such asthe dorsal scaphotriquetral and the dorsal radiotriquetral ligaments are well visu-alized by high resolution ultrasound whereas ligaments in a deeper position, suchas the proximal and distal insertion of the palmar scaphotriquetral and the distalinsertion of the radioscaphocapitate are less well visualized.Conclusions: High resolution ultrasonography is an accurate method to visual-ize the extrinsic ligaments of the wrist.

C-638Direct MR arthrography of the glenohumeral joint with capsular distensionusing a posterior approachR. Drescher, J. Ludwig, F. Rubenthaler, O. Köster, G. Schmid; Bochum/DE

Purpose: Evaluation of the clinical use of direct MR arthrography of the gleno-humeral joint with maximum distension of the joint capsule in patients with gleno-humeral instability using a posterior approach.Patients and Methods: Direct MR arthrography of the shoulder joint was per-formed on a 1.5 T system in 30 patients (12 women, 18 men, mean age 36 years).17 right and 13 left shoulders were evaluated. All patients had anterior or bidirec-tional instability (18 posttraumatic, 12 constitutional). Using a fluoroscopicallyguided posterior approach, 10 mL iopamidol 250 M and 5 mL 0.2% mepivacainewere injected, followed by a 1% dilution of dimeglumine gadopentetate in 0.9%sodium chloride until full capsular stretching was achieved. MR sequences wereT1-weighted spin-echo axial and oblique-coronal, fat-saturated T1 3D axial andoblique-coronal, and axial T2 Flash-2D.Results: Arthrography was possible in all patients. The total amount of intraartic-ularly injected fluid was 30-60 mL (mean 38 mL). No complications occurred. MRimaging showed significant capsule distention in 11 patients (37%) and ventralcapsule defects in 5 patients (17%). 14 labral lesions (11 anterior, 3 posterior), 3bicipital tendon lesions (1 complete, 2 partial ruptures) and 2 partial ruptures ofthe rotator cuff were noted. 13 patients underwent surgery. Regarding labral le-sions, sensitivity of MRI was 88.9%, specificity was 75%, and diagnostic accura-cy was 84.6% compared with surgical results.Conclusions: Glenohumeral direct MR arthrography allows accurate detectionof labral and tendinous lesions. Maximum capsular distension allowed preopera-tive evaluation of capsular laxity as a source of shoulder instability.

C-639Anterior talofibular ligament injury: Evaluation with MR imagingJ. Ishida1, J. Yoshigi1, H. Okizuka2, K. Ooae1, M. Takao1, T. Yoshizako1,K. Izaki1, N. Uchida1, H. Kitagaki1; 1Izumo/JP, 2Himeji/JP

Purpose: Inversion stress is most frequent injury of all ankles. ATFL is the weak-est of lateral collateral ligaments and first to rapture. The purpose of this study isto evaluate the usefulness of high-resolution MRI for diagnosis of ATFL disrup-tion divided into acute and chronic phase.Method and Materials: 32 patients suspected ATFL disruption underwent MRI(1.5 T). 18 cases were in acute phase (< 10 days) and 14 cases were in chronicphase (> 1 month). Axial spin-echo (SE) T1-WI (TR/TE = 720/20, FOV 18 cm, 2 mm/0.2 mm, 512 x 512, 2 NEX,) and axial fast SE T2-WI (TR/TE = 3500/96, ETL7,FOV 18 cm, 2 mm/0.2 mm, 512 x 512, 2 NEX,) were obtained with an extremitycoil. ATFL disruption was diagnosed when either finding is positive:discontinuity,irregularity, non-visualization of AFTL, and high signal intensity lesion in ATFL onT2-WI.Results: Arthroscopy confirmed ATFL disruption in 14 cases in acute phase and

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12 cases in chronic cases. In acute phase, sensitivity was 93%, specificity was100%, and accuracy was 94%. Only 1 false negative was seen.In chronic phase, sensitivity was 67%, specificity was 50%, and accuracy was66%. 4/12 was false negative.Conclusion: In acute phase, MRI was accurate for evaluation of AFTL disrup-tion. However, in chronic phase, MRI was less accurate because granulomatoustissue after disruption cannot be detected with MRI.

C-640CT arthrography of the shoulderA. Gligorievski, Z. Temelkovski; Skopje/MK

Purpose: To present CT arthrography (CTA) as a new method in our practice inorder to point out its advantages and to compare the results with conventionalarthrography and MR arthrography.Methods and Materials: We describe the technique of the examination in detail,performed at the Institute of Radiology in cooperation with an orthopaedic sur-geon and radiologist that form the diagnostic-therapy team. CTA performed with18 patients, aged 25 to 62, 12 men and 6 women. Conventional arthrography wasperformed in 7 and MRA in 11 patients.Results: 7 patients presented with lesion of the glenoid labrum, 5 with rotatorcuff lesion, 2 with a frozen shoulder, 2 with a Hill-Sachs lesion, 1 with bicepsbrachi tendon subluxation and 1 case with SLAP lesion. We report our first expe-riences and the results gained are compared to similar recent studies as well asto the conventional radiologic techniques. CTA is a method of choice in case offrozen shoulder and glenohumeral instability, but MRA is better in case of rotatorcuff lesion.Conclusion: We can conclude that CTA is a sophisticated method of extremediagnostic value in the evaluation of the humeral joint especially in case of gleno-humeral instability. The invasiveness of the method is small, no complicationshave been noticed and compared to MR it is significantly cheaper and more avail-able for the Medical Centers equipped with a CT scanner.

C-641MR imaging of the metatarsophalangeal joint with standard MR imaging:Evaluation of six patients with clinical suspicion of plantar plate disruptionP. Hauser; Lausanne/CH

Purpose: to report the MR Imaging findings of painful injured metatarsophalan-geal joints (MTPJ) in case of clinical suspicion of plantar plate (PP) tear.Materials and Methods: A series of 13 patients with clinical suspicion of PPrupture of first (MTPJ 1) or second (MTPJ 2) ray underwent MR studies with1.5 Tesla units with use of an extremity coil. The patients lay on their back withthe ankle in plantar flexion and the toes in extended position. The standard MRImaging protocol performed in all specimens consisted of T1 weighted spin echosequences in sagittal and coronal plan and T2 fse fat satured sequences in sag-ittal, coronal and transverse plan. The examinations were interpreted separatelyby two musculoskeletal radiologists assessing whether or not a PP rupture andassociated lesions were present. After the imaging study all the patients under-went surgical revision in a mean delay of one month.Results: Tears of the PP were visualized in 9 cases, degenerative lesions of thePP were visualized in two cases and two other cases showed no lesion. The MRImaging results concerning PP rupture although allowed depiction of several as-sociated lesions including injuries of the extensor hood, the collateral ligamentcomplex, ostechondral lesions and joint deformities.Conclusion: Although surgical treatment is generally the rule for hallux valgusdeformities, surgical repair is also often required in cases of traumatic injuries ofthe MTP joints. The force of accord between radiologists and surgical observa-tion of PP ruptures is good.

C-642MRT monitoring of autologous hyaline cartilage graftsC. Müller, E. Grönewäller, C.D. Claussen, F. Schick; Tübingen/DE

Purpose: Seven different MR sequences were compared to localize cartilagedefects in knee and to evaluate the stage of maturation of the hyaline cartilagegraft.Methods: MRT was performed in 19 patients aged 17-48 years with autologoustransplantation of a hyaline cartilage tissue graft after a knee trauma. Examina-tion dates were: before transplantation to localize the defect, and 6 weeks, 3, 6and 12 months after transplantation to control the morphology and the matura-tion of the autologous graft. Standard T2- and proton-density weighted turbo spinecho (TSE) sequences, T1-weighted spin echo (SE) sequences, gradient echo

(GRE) sequences with and without magnetization transfer (MT) pulses as well asexperimental diffusion weighted GRE sequences (PSIF) were used.Results: For depiction of the graft short time after surgery T2-weighted TSE-sequences showed the best results, to identify potential secondary damagesbefore transplantation PD weighted sequences were superior. 6 and 12 monthsafter transplantation spoiled 3D-GRE-sequences displayed the graft in high spa-tial resolution. From the diffusion measurements no statistically significant dis-crimination between cartilage and graft was obtained at any time, whereas,different images from GRE-sequences with and without MT pulse provided highcontrast between cartilage and surrounding tissue. The quantification of the MTeffect showed an assimilation of the graft to the original cartilage within 12 months.Conclusion: MRT should be performed before every transplantation becausecartilage defects and secondary damages can be detected clearly. After trans-plantation MRT can easily identify the graft and detect hypertrophy or debondingin early stage.

C-643Quantitative macroradiographic study with fractal signature analysismeasures bone loss in the rheumatoid arthritis handL. Disini1, M. Foster2, J. Buckland-Wright1; 1London/UK, 2Loughborough/UK

Purpose: Fractal Signature Analysis (FSA), a computerised method of texturalanalysis, permits the separate measurement of changes in vertical and horizon-tal trabeculae based on the fractal dimension over a range of trabecular widths(fractal signature). We determined whether the FSA of high definition macroradi-ographs (X5 magnification) quantified differences in trabecular organisation atsites of osteopenia and erosion formation in the rheumatoid arthritis (RA) hand.Methods: Sixty-seven RA patients had macroradiographs of the left hand. Thedistal radius was scored and grouped from very mild (RA1) to moderate (RA4)disease. Macroradiographs were digitised and FSA of horizontal and verticaltrabecular organisation were measured in the radius at sites of osteopenia, ero-sion formation and a mid-shaft site. The fractal signatures were compared to 11healthy non-arthritic subjects using the t-test.Results: Compared to the non-arthritics, FSA at the distal radius in groups RA1to RA4 measured a significant reduction (p < 0.05) in fractal signature at theosteopenic and mid-shaft sites, affecting small to large sized vertical trabeculae,and at the erosion site, involving small and medium sized horizontal and verticaltrabeculae. The reduction was smallest in RA1 and greatest in RA4.Conclusion: FSA quantified the trabecular bone loss in the distal radius of RApatients of increasing radiographic severity based on a proportional reduction infractal signature. Disease related bone loss involved varying trabecular widthswith vertical trabeculae at the osteopenic site and both vertical and horizontaltrabeculae at the erosion site. Potentially, FSA can distinguish changes conse-quent to bone-mediated RA drug treatment.

C-644The usage of the spatial 3D CT reconstructions in revealing of theosteophytes and degenerative narrowing of the intervertebral foramens inthe cervical spine in the patients with neck painW. Krupski, M. Paslawski, P. Majcher, M. Fatyga, M. Krupski, K. Krzyzanowski,J. Zlomaniec; Lublin/PL

Purpose: The aim of the study is assessment of the usage of 3D CT reconstruc-tions in revealing of the osteophytes and degenerative narrowing of the interver-tebral foramens in the cervical spine in the patients with neck pain.Material and Methods: Material comprises a group of 40 patients with neck pain.In all patients CT examination was performed in sequential technique with 2 mmthick axial sections. The value of axial sections, MPR, internal and external 3DCT reconstruction in revealing of the osteophytes of anterior and posterior verte-bral margins and narrowing of the intervertebral foramens was compared. Thestatistical analysis of the results with McNemar's and Q Cochran's statistics wasperformed.Results: The value of 3D CT reconstructions in external projections was thehighest in revealing of the osteophytes of anterior margins of vertebral bodies;the anterior osteophytes were found in 33 (82.5%) patients on 3D CT images.The 3D CT reconstructions cut off in sagittal plane along the spinous processwere the best imaging modality in evaluation of the osteophytes of the posteriormargin of the vertebral body, which were seen in 34 cases (85%) and in evalua-tion of narrowing of the intervertebral foramens (14 cases - 35%).Conclusions: 3D CT reconstructions are valuable in determining the localizationand the extent of the cervical spine osteophytes. They are the imaging modalityof choice in assessment of the degenerative narrowing of the intervertebral fora-mens. 3D CT reconstructions should be the integral part of CT examination ofpatients with the neck pain.

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C-645Epidemiology of juvenile spondyloarthropathies in Croatia: A retrospectivestudy over the last 6 yearsK. Potocki, M. Jelusic, L. Tambic Bukovac, R. Stern-Padovan, M. Hrabak;Zagreb/HR

Purpose: The aim of our study was to determine the incidence of JSpA in Croatianpopulation in the last 6 years in relation to other rheumatic diseases and thepresence of HLA - B 27 in children with JSpA.As the cause of JSpA is still unknown, the strong association with HLA - B 27suggests genetically determined mechanism.Methods and Materials: The patients from 1 to 18 years of age diagnosed dur-ing the period 1997-2003 at Department of Paediatric Rheumatology, UniversityHospital Zagreb following strict criteria of European Spondyloarthropathy StudyGroup. We identified 681 newly diagnosed patients with rheumatic disease usinghospital and outpatient records.Results: 69 were identified as having JSpA (9.8%) amongst 8,358 patients withrheumatic disorders. Sex ratio was 22 females against 47 males, mean age of13.6 years. 55 patients had undifferentiated spondyloarthropathy (79.7%), 4 pa-tients had Reiter's syndrome (5.8%), 6 had arthritis of inflammatory bowel dis-ease, i.e. Crohn's (8.7%), two patients had psoriatic arthritis (2.9%), and two hadankylosing spondylitis (2.9%). Ocular complications were present in 24 patients(34.8%), enthesitis in 51 (73.9%), sacroileitis in 60 (86.9%) and peripheral arthri-tis in all 69 patients (100%), diagnosed radiologicaly. HLA - B 27 was present in49 patients (71.1%).Conclusion: Our epidemiological study showed similar incidence of JSpA amongother rheumatic diseases in childhood and adolescents (9.8%) compared to re-sults of American, Canadian and British studies in which this incidence is 7.9 -9.8%. However, the presence of HLA - B 27 antigen is lower (71.1%).

C-646Postprocessing optimization of computed tomography data of acetabularfracturesV. Moschenko, T. Shamova, A. Sklyarenko, I. Bobkova; Kharkov/UA

Purpose: To study diagnostic opportunities of postprocessing programs - multi-planar (MPR) and 3D shaded surface display (SSD) reconstruction of CT data onacetabular fractures.Methods and Materials: 21 patients aged 15 - 57 with acetabular fractures invarious terms since the moment of trauma (from 2 days to 15 months) were ex-amined. Plain radiographs and CT with the subsequent application of programsMPR and SSD were conducted. The acetabular fractures classification by Judet- Letournel was used.Results: Use of postprocessing programs allowed in 3 (14.3%) cases to specifya type of fracture and character of deformation of acetabulum, therefore in 2(9.5%) - the originally prospective conservative treatment was replaced by oper-ative.Considering complexity of choice certain reformations MPR and SSD for analy-sis and documenting of views, we used standard projections: for MPR - 1) alonganterior column, 2) along posterior column, 3) along both columns; for SSD - 1)anteroposterior view of the pelvis; 2) direct projection (lateral view) of the acetab-ulum; 3) obturator oblique view of the pelvis; 4) iliac oblique view of the pelvis. In18 (85.7%) cases use of only these projections was enough to establish the typeof acetabular fracture.Conclusion: Use of MPR and SSD in CT data postprocessing allows establish-ing the type of acetabular fractures that defines a choice of treatment tactics. Ourstandard protocol of MPR and SSD reduces analysis time of research resultsand creates conditions for uniform perception of injuries by all participants ofdiagnostic process.

C-647CT view of Garden III and IV femoral neck fracturesR.V. Kastelov, C. Deliverski; Sofia/BG

Purpose: The objective of this study is to present CT criteria for distinguishingdisplaced femoral neck fractures of stage III and IV according to Garden.Methods and Materials: 29 displaced femoral neck fractures were studied. Allwith women between 59 and 85 (average age 73.8). All fractures result from lowenergy traumas. Conventional A-P and lateral X-rays and CT were made. CTimages are interpreted on fovea capitis level.Results: According to conventional X-rays 26 are of stage III and 3 are of stageIV. CT images show 20 fractures of stage III and 9 of stage IV, i.e. in 6 cases(20.7%) A-P and lateral projections fractures of stage III are judged as stage IV.

In all fractures femoral head is internally rotated, and neck – externally. The twofragments form an angle open backward. With fractures of stage III the two frag-ments remain in contact with each other. With fractures of stage IV we establish:1. Lack of contact between fracture surfaces. 2. Total displacement of trabecularsystems of head and neck. 3. Alignment of head's trabeculae and trabeculae ofacetabulum. 4. A small bone fragment from the posterior of neck or head.Conclusion: Routine X-ray projections prove insufficient to establish a diagnosisin 1/5th of the cases. Confusion is caused by overlaying of fracture edges andpelvic bone in the direction of X-ray beams. The latter makes hardly visible thesmall posterior fragment, too. Therefore, CT scanning is required for the diagnos-tic protocol of displaced femoral head fractures.

C-648Is Gadolinium enhanced MR imaging useful in the therapeutic strategy ofcarpal scaphoid undisplaced fractures? (work-in-progress)L. Grazioli, P. Borelli, P. Caccia, C. Vielmi, R. Taranto, L. Romanini,M. Bondioni; Brescia/IT

Purpose: To investigate the role of unenhanced and enhanced MR imaging (MRI)in acute undisplaced fractures of the scaphoid and to correlate MRI with the radi-ological features in order to predict union/nonunion and recovery time.Materials and Methods: 27 consecutive patients with acute scaphoid fractures(1-10 days) were prospectively examined with conventional plane film and unen-hanced/enhanced Gd-DTPA MRI. MR examination considered: a. Site and typeof fractures (according to Herbert and Fisher 1996 classification). b. Signal inten-sity and vascular status at the level of the fracture and proximal fragment. c.Qualitative evaluation of enhancement.Results: On plain films all fractures were detected and well described. On unen-hanced MRI in only 9/24 patients the fracture line was detected, hypointense onT1w images and hyperintense on T2w images. In 15/24 patients the line fracturewas not recognized, due to ill defined hypointensity on T1w and hyperintensity onT2w images astride the fractures site. In one patient diffuse hypointensity in-volved the proximal fragment. After Gd-DTPA administration, performed in 18/24cases, the bone marrow showed significant and homogeneous enhancement in13/18, weak and heterogeneous in 5/18. 4/5 patients with weak heterogeneousenhancement and 5/13 patients with intense and homogeneous enhancementshowed delayed radiological and clinical recovery.Conclusion: In our preliminary experience, unenhanced MRI could be consid-ered valid tool to select patients for immediate surgical treatment (internal screwfixation). Gadolinium enhanced MR imaging is not considered useful method inthe choice of treatment.

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Musculoskeletal

Soft tissue

C-649Soft-tissue masses that infiltrate nerves: US and MR imaging findingsR. Podestà1, G. Succio1, A. Picotti2, L.E. Bacigalupo1, S. Bianchi3, L.E. Derchi1,C. Martinoli1; 1Genoa/IT, 2Siena/IT, 3Geneva/CH

Learning Objectives: To describe US and MR imaging findings of nerve infiltra-tion by extrinsic masses, including lipomas, hemangiomas, non-Hodgkin lym-phomas and ganglion cysts. To learn to differentiate between these pathologicconditions. To emphasize the role of US and MR imaging in the management ofthese lesions to further delineate the nature and extent of the process.Background: In addition to peripheral nerve sheath tumors (e.g. neurofibromas,schwannomas and malignant peripheral nerve sheath tumors), there are soft-tissue masses, such as hemangiomas, lymphomas and ganglion cysts, which donot originate from the nerve itself but may occasionally infold among the nervefascicles and expand into the neural tissue. The intraneural growth of these massesis rare, may cause nerve dysfunction and local symptoms and should not beconfused as the more common nerve sheath tumors.Imaging Findings: 12-5 MHz US and 1.5 T MR imaging findings for a series ofeight retrospectively collected cases of masses infiltrating nerves are illustratedwith emphasis about the different pathogenetic mechanisms of intraneural infil-tration. Hemangiomas involved the median and ulnar nerves, ganglion cysts theperoneal nerve, non-Hodgkin lymphomas the sciatic and median nerves. Corre-lation of imaging findings with gross surgical views is provided in 6/8 cases.Conclusion: High-resolution US and MR imaging can detect nerve infiltration byextrinsic masses. Knowledge and recognition of the characteristic imaging fea-tures can aid in the proper diagnosis and treatment of these lesions.

C-650MRI of lipomatous soft tissue tumors: Radiologic pathologic correlationM. Pilavaki, D. Chourmouzi, G. Boulogianni, A. Drevelegas; Thessaloniki/GR

Purpose: To study the MR imaging findings for each type of lipomatous soft tis-sue tumors and to correlate them with the pathological findings.Material and Methods: We studied retrospectively the MR examinations of 36patients with histological proven lipomatous soft tissue tumors. The histologicaltypes of the tumors were: 21 lipomas, 1 fibrolipoma, 1 lipoblastoma, 3 lipomato-sis and 10 liposarcomas (4 well-differentiated, 5 myxoid, and 1 mixed type)T1-, T2-, and fat-suppressed and T1-weighted images after administration of gado-pentetate dimeglumine were obtained. The signal intensity on different sequenc-es, the internal characteristics, the presence of septa and other nonadiposecomponent, revealed on the MR images and the degree of contrast enhance-ment of septa and nonadipose component were evaluated.Results: From the group of 26 benign lipomatous lesions 11 lesions were with-out a recognizable nonadipose component. 14 lesions had thin septa withoutcontrast enhancement. In case of fibrolipoma areas of nonadipose componentcorrelated with fibrous tissue.In the group of well-differentiated liposarcomas 1 had thin septa and 3 thick septawith mild contrast enhancement. The 6 remaining liposarcomas had thick septawith 5 of them having a nodular and globular non-fatty component with enhance-ment after the administration of paramagnetic agent.Conclusion: Statistically significant imaging features favoring a diagnosis of li-posarcoma included the presence of thick septa, enhancement of septa and thepresence of nodular or patchy nonadipose components. Imaging features sug-gesting benignancy included thin septa with no enhancement relative to muscleand no recognizable nonadipose component.

C-651Guidelines for diagnosis of soft tissue lipomatous masses (STLM)G. Chave, D. Ranchere-Vince, P. Meeus, P. Thiesse; Lyon/FR

Learning Objectives: To clarify the steps of pretreatment diagnostic proceduresin case of soft tissue lipomatous masses (STLM). To describe the MRI findingsfor lipomas and liposarcomas. To develop the principles of percutaneous biopsy.Background: Differential diagnosis between lipomas and liposarcomas, espe-cially atypical lipomas is not always easy. Despite similarities, differential diagno-sis can be reliably established employing image parameters. Nevertheless, thestaging process of STLM culminates in biopsies, allowing to manage the propertreatment. Biopsies can be performed percutaneously using imaging guidance.An open biopsy with the resection of the entire mass is disputed when the STLM

is composed essentially of fat on MRI imaging to avoid the misdiagnosis of be-nign lipoma. Each procedure must be carefully planned: an inadequate biopsymay fail to allow proper diagnosis, have a negative impact on survival, and ulti-mately necessitate an amputation to accomplish adequate margins of resection.Procedure Details: After the description of characteristics and different histo-logical subtypes of lipomas and liposarcomas, we will describe the MRI findingsfor each diagnosis, according to a review of the litterature by illustrating with MRIimaging of patients followed in our center.We will develop the principles of percutaneous biopsies according to litteratureand our experience.Conclusion: Accurate diagnosis of STLM is based on three factors: clinical pres-entation, radiological features and pathologic evaluation. The importance of carefulplanning and performance of biopsies cannot be overemphasized because er-rors may have a negative impact on survival and impede proper diagnosis.

C-652High-resolution US of traumatic injures of the extensor tendon complex inthe fingersG. Succio1, A. Picotti2, L.E. Bacigalupo1, R. Podestà1, S. Bianchi3, L.E. Derchi1,C. Martinoli1; 1Genoa/IT, 2Siena/IT, 3Geneva/CH

Learning Objectives: To provide an overview of the spectrum of abnormalitiesof the extensor tendon complex in the fingers by means of high-resolution US. Toshow the value of static and dynamic US in the evaluation of finger pathology.Background: Clinical assessment of extensor tendon injuries is not straightfor-ward because of the peculiar anatomy of these tendons made of several inter-connecting layers and different attachment sites in the fingers. The developmentof very high-frequency "footprint" transducers has improved the ability of US toscan the extensor tendon complex in the fingers, allowing accurate depiction ofthe central and lateral slips of the extensor tendon, and the sagittal and lateralbands of the extensor hood.Imaging Findings: Paradigmatic 12-5 MHz and 15-7 MHz US images from aseries of retrospectively collected cases with a variety of extensor tendon injuriesin the fingers are illustrated, including partial and complete rupture of the centralslip (boutonnière deformity), tears of the lateral slip, avulsion injury of the termi-nal tendon (mallet finger), injury of the sagittal band over the metacarpophalan-geal joint with tendon instability (boxer knuckle). Dynamic US is essential todiagnose injuries of the extensor hood mechanism. Correlations of US findingswith schematic drawings and the results from 1.5 T MR imaging are also provided.Conclusion: High-resolution US is promising for evaluating the extensor ten-dons complex in the fingers. It can identify and characterize a variety of abnor-malities. By providing unique information on these tendons, US has potential formajor impact on treatment planning.

C-653High-resolution US of tenosynovitis in the wrist and handA. Picotti1, L.E. Bacigalupo2, R. Podestà2, G. Succio2, F. Pugliese2, S. Bianchi3,C. Martinoli2; 1Siena/IT, 2Genoa/IT, 3Geneva/CH

Learning Objectives: To describe the spectrum of tenosynovitis of flexor andextensor tendons in the wrist and hand by means of high-resolution US. To corre-late US findings with clinical features and MR imaging. To emphasize the role ofUS in the management of these lesions to further delineate the nature and extentof the process.Background: Tenosynovitis of wrist and hand tendons are common and accountfor a high percentage of orthopaedic consultations. They can be related to localcauses, particularly overuse due to sport or occupational activities or may be theresult of systemic musculoskeletal disorders.Imaging Findings: Paradigmatic 12-5 MHz and 15-7 MHz US images from aseries of retrospectively collected cases with a variety of tenosynovitis in thewrist and hand are illustrated with emphasis on the pathogenetic mechanism oftendon disease, including de Quervain disease, intersection syndrome, extensorpollicis longus, extensor carpi ulnaris, flexor carpi radialis and flexor digitorumtenosynovitis. The main findings in infectious and hypertrophic tenosynovitis arealso described and a spectrum of unusual causes producing them is reported,including foreign bodies and conflict with fracture residuals and osteosynthesismaterial.Conclusion: Due to its widespread availability, low cost and high spatial resolu-tion, high-resolution US is an excellent tool for investigating a variety of tenosyn-ovitis of the wrist and hand.

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C-654MR muscle screening method and imaging findings in idiopathicinflammatory myositisÖ. Özsarlak, J.W.G. Van Goethem, P. De Jonghe, A.M.A. De Schepper,P.M. Parizel; Antwerp/BE

Learning Objectives: To present MR imaging findings of the skeletal muscles inidiopathic inflammatory myositis (IIM).Background: The patients with inflammatory myopathies (inclusion-body myosi-tis (IBM) = 4, polymyositis (PM) = 3 and dermatomyositis (DM) = 1) underwentwhole-body MR muscle screening examination. MR examination is performed atsix different levels: neck, shoulder, abdomen, pelvic girdle, and upper and lowerleg. T1- and T2-weighted images with and without fat suppression were performedfor each level. Signal intensity of muscles, volume and the symmetry of involve-ment were quantified in 54 individual muscles on each side.Imaging Findings: IBM, DM and PM are rare diseases with clinical and his-topathological similarities. IBM usually does not respond to immunosuppressivetherapy. Therefore, it is necessary to distinguish these entities correctly. IBM ischaracterized by more frequent fatty infiltration, atrophy, inflammation, a distalpredominance, and anterior group involvement. The finding of selective involve-ment of the medial gastrocnemius and of the vasti with sparing of rectus femorisis typical for sporadic IBM. The selective involvement of flexor digitorum profun-dus is also highly suggestive for IBM. T1, T2 and fat-sat images contain differentbut complimentary information. PM and DM predominantly affect muscle groupsof the shoulder girdle and the thighs.Conclusion: A newly introduced MR technique provides an excellent overviewof all diseased muscles in the body. Moreover, it helps us to distinguish IBM fromother IIMs. MRI may help establish the diagnosis, suggest appropriate sites forbiopsy, and enable assessment of disease progress or regression over time.

C-655Is diagnosis of elastofibroma dorsi possible with US examination only?Retrospective analysis in 5 patients: Radiological findings and literaturereviewA. Sarno, T. Cammarota, D. Robotti, G. Bonenti, G. Olivieri, B. Ciancia,P. Debani, F. Marzano, C. Berrino; Turin/IT

Learning Objectives: To demonstrate that US, performed with 7.5-10 MHz line-ar probe, are valuable in elastofibroma dorsi diagnosis. Description of 5 caseswith histological confirmation.Background: Elastofibroma dorsi is a rare, typically slow-growing, often bilater-al, para-neoplastic formation. It's composed by fibro-elastic and adipose tissueand is selectively localized along the postero-lateral side of thoracic wall, underthe scapula. The certain diagnosis is cyto-histological. MRI was the hitherto elec-tive diagnosis. All cases of elastofibroma in our series were studied with US;some of them also with CT and MRI; in a retrospective analysis US allowed tosuspect presence of elastofibroma in all patients: 3 of them underwent surgerythat confirmed the diagnosis.Procedure Details: In our series the US examination, performed with 7.5-10 MHzlinear probe, showed solid masses, sometimes in both sides, with badly visiblemargins, hypoechoic with inside hyperechoic stripes, obliquous from the trans-ducer plan.Conclusions: In all cases US and clinical findings allowed the diagnosis of elastofi-broma dorsi. The MRI, performed in 3 patients that underwent surgery, confirmedthe US findings. The remaining 2 patients are undergoing follow-up with US. So,US findings, within site, slow growth and possible presence of bilateral masses,allow the diagnosis of elastofibroma dorsi, avoiding costly MRI.

C-656A comparison between ultrasound, echo-color-Doppler, and MRI in theevaluation of achilles enthesopathy in psoriasis: Preliminary resultsF. Maggi, F. Di Gregorio, C. De Simone, C. Pagliarello, M. Politi; Rome/IT

Purpose: Psoriasis is often associated with Achilles enthesopathy. This studycompares the efficacy of Ultrasound, Echo-Color-Doppler and MRI in the evalu-ation of early signs of Achilles enthesopathy in psoriatic patients.Methods and Materials: 22 consecutive psoriatic patients, 17 men, 5 women,mean age 48 years (age range 19-72), mean PASI score 14, entered the study.All patients underwent sonography of the Achilles tendon and peritendinous struc-tures with Aplio (Toshiba) equipped with a linear multifrequence (8-13 Mhz) trans-ducer; the study was completed with Color-Doppler analysis. An MRI study, beforeand after gadolinium, was then performed using E-Scan XQ (Esaote), 0.2 Teslasuperconducting magnet. Axial and sagittal T1 and T2 weighted, sagittal GE and

STIR sequences were obtained. After gadolinium, axial and sagittal T1 weightedsequences were obtained.Results: The more frequent US findings were microcalcifications inside the Achil-les tendon (27% of cases) and signs of bursitis (27%), while uncommon therewere degenerative lesions and signs of peritendinitis. Completion with Echo-Color-Doppler did not add significant data to US study. MRI imaging showed degener-ative lesions and peritendinitis as well as US, but was not able to identify anymicrocalcification. All the alterations were identified in the basal study; adminis-tration of gadolinium did not allow any additional pathological finding.Conclusion: Our preliminary results show that MRI, especially with low magnet-ic field, is not sensitive compared to US in detecting early changes of Achillesenthesopathy in psoriatic patients, while Echo-Color-Doppler and enhanced MRIsequences had limited utility in diagnostic imaging of early stages of this pathology.

C-657Characterization of musculoskeletal soft tissue tumors by their relationshipwith the superficial fascia on MRIM. Pilavaki, D. Chourmouzi, G. Boulogianni, A. Drevelegas; Thessaloniki/GR

Purpose: To identify the diagnostic value of the relationship between soft tissuetumors and the superficial fascia in the distinction of benign and malignant lesions.Material and Methods: From a group of 124 soft tissue tumors lesions locatedeither subcutaneously or deeply and having contact with the fascia were select-ed. The study group was composed of 70 tumors (31 benign and 39 malignant).MR studies were performed with 0.5 and 1.5 units. MR images were obtainedwith T1-weghted and T2-weighted spin-echo sequences in at least two planes.STIR sequences and post -gadolinium T1-weighted images were also obtained.The relationship between tumor and the superficial fascia (minimal or widely fas-cial contact, acute or obtuse angles, crossing the fascia) were examined by mask-ing the pathologic confirmation. The linear extension of the tumor along the fasciaalso known as fascial tail sign was also examined.Results: Of the 70 tumors, 20 (16 benign and 4 malignant) showed minimal fas-cial contact with acute angle with the fascia. 14 (9 benign and 5 malignant) showedwider fascial contact with acute angles. 36 tumors (6 benign and 30 malignant)had wider contact with obtuse angles with the fascia. 2O of them (all malignant)crossed the fascia from either side. Of the 36 lesions 21 lesions (3 benign and 18malignant) had positive fascial tail sign.Conclusion: Obtuse angles between superficial fascia and soft tissue tumor, atumor crossing the fascia and the presence of fascial tail sign strongly suggestmalignancy.

C-658High resolution US and MRI in the evaluation of plantar fibromatosisI. Gallesio, S. Parodi, R. Pastorino, D. Schettini, M. Falchi, E. Silvestri,G. Garlaschi; Genoa/IT

Purpose: Plantar fibromatosis is a benign fibroproliferative disorder of the plantarfascia clinically presenting subcutaneous nodules in the foot sole. This study aimedto evaluate the application potential of US and MRI performance in detection ofthese lesions.Material and Method: 7 patient with palpable nodules suspected plantar fibroma-tosis were evaluated. The US examination was performed by means of a highresolution transducer through tranverse and longitudinal scans along with evalu-ation of intra-nodular vascularization by power-Doppler. MRI was performed bymeans of a 1.5 T unit with axial and sagittal planes.T1 weighted MRI images after administration of iv contrast medium were ac-quired from two patients.Results: 11 nodules were, overall, detected, most of them located in the medialplantar fascia. All nodules were oval-shaped, hypoechoic at US and hypointenseat MRI. Considering number and size of nodules, US and MRI overlapped (werestrikingly similar). Moreover, nodules showed hypervascularization at power-Dop-pler, confirmed at MRI with paramagnetic contrast medium. This pattern mightsuggest a different pathoanatomical condition of these lesions, as hypervascu-larization is a sign of an early stage lesion, featuring a large fibrovascular prolif-eration. No correlation was found between vascularization degree and symptomsthe latter resulting from the neurovascular structures disorder.Conclusions: US associated with power-Doppler is the first choice method inthe evaluation of plantar fibromatosis, able to detect number, size and activitypattern of nodules, leading to a pre-surgery diagnosis. In severe plantar fibroma-tosis MR is to be considered a complementary method in evaluation of the extent.

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C-659Dynamic contrast enhanced MRI in the differential diagnosis of soft tissuetumorsN. Tuncbilek1, H.M. Karakas2, O.O. Okten1; 1Edirne/TR, 2Malatya/TR

Purpose: Conventional MRI is a well-accepted technique in evaluating soft tis-sue tumors. However it is not specific in differentiating benign and malignant le-sions. In this study the differential value of the dynamic contrast enhanced MRI(DCE-MRI) was investigated.Methods and Materials: Turbo FLASH DCE-MRI was performed on 27 subjects(2-74 yrs) with soft tissue tumors. Enhancement in the 1st min (E1), 2nd min (E2),maximum enhancement (Emax), and time-signal intensity curve (TIC) slopes werecalculated. Discriminant analyses were performed to reveal parametric differenc-es of the benign and malignant lesions.Results: Histopathological diagnosis of benign (N = 9) tumors were hemangi-oma (n = 3), neurogenic tumor (n = 3) lipoma (n = 2) and desmoid (n = 1), whereasmalignant lesions (N = 18) were classified as liposarcoma (n = 5), osteosarcomawith soft tissue component (n = 5), malignant fibrous histiocytoma (n = 5), syno-vial sarcoma (n = 2) and giant cell tumor (n = 1). For malignant lesions meanvalues for E1, E2 and Emax were 98%, 102%, and 119%, respectively. Mean TICslope was 2.75. For benign lesions the above mentioned values were 43%, 66%,76%, and 1.43, respectively. ANOVA based discriminant analysis was correctlyclassified 74% of the lesions to benign and malignant groups using E1, 78% ofthe lesions using E2 or Emax, and 82% of the lesions using TIC slope. The com-bination of the above mentioned parameters had resulted a 93% accuracy(p < 0.001).Conclusion: DCE-MRI parameters are the surrogate markers of tumoral micro-circulation and tissue perfusion. These parameters may be used as key factorswhen deciding proper treatment alternatives and to reveal malignant transforma-tions.

C-660The relation of flexor retinaculum laxity with age, gender, and handdominanceT. Altinok, H.M. Karakas; Malatya/TR

Purpose: Carpal tunnel syndrome (CTS) is an entrapment neuropathy involvingthe median nerve within its fibroosseous tunnel at the wrist. One of the mainradiologic parameters in diagnosing CTS is the palmar displacement (PD) of theflexor retinaculum In this study, possible physiologic factors that may affect thepalmar displacement and decrease the sensitivity of this criterion were investi-gated.Materials and Methods: 160 normal wrists of 40 male and 40 female with agesbetween 20 and 58 (Mean: 39.6; SD: 11.2) were ultrasonographically investigat-ed with 4-7 MHz linear transducer. PD values obtained were correlated with withage, gender, and hand dominance was analyzed.Results: There was no significant difference between different genders and be-tween dominant and non-dominant hands regarding palmar displacement. Whenconsidering all subjects this parameter was varied between 0.50 and 3.70 mm(mean: 2.00; SD: 0.64). Palmar displacement exhibited a very strong correlationwith age (p < 0.0001; r = .635 and r = .544, for dominant and non-dominant hand,respectively). When considering all subjects, linear regression between both fac-tors was found to be 0.589 (p < 0.0001).Conclusion: The sensitivity of PD in diagnosing carpal tunnel syndrome wasvariously reported to be lower than other radiologic criteria. We have found thisrelative insensitivity to be originated from the age dependent laxity. The cut-offvalue of 2.5 mm given in the relevant literature must therefore be considerednormal for the paients older than 55 years of age. The use of the normalizationdata presented may help to improve the sensitivity of the palmar displacement.

C-661Vascular soft tissue tumor discrimination with MR image findings bypattern recognition techniquesC. Vidal, J. García-Gómez, L. Marti-Bonmati, M. Robles; Valencia/ES

Purpose: To discriminate within soft tissue tumors (STT) those with a vascularorigin from other histological groups by using pattern recognition techniques withMR image findings.Methods and Materials: A total of 346 consecutive patient with confirmed mus-culoskeletal STT from different European centres were examined with MR. T1-and T2-weighted fat-suppression or STIR images were obtained in all subjects.The recorded variables were: age, clinical presentation, localization, size, shape,MR signal intensity, margins, homogeneity, edema, T1-hyperintense tracts, mul-

tiplicity, target appearance, muscular atrophy, intratumoral hemorrhage, calcifi-cation, intratumoral fat, fibrosis, fascial relationship, bone alterations, vessels.The k-nearest neighbour (KNN), support vector machine (SVM) and decisiontrees (DT) were used to classify vascular from cystic, fatty, nervous, synovial andfibrous origin. The sample was splitted with 30% of cases used as test.Results: Efficacy of vascular in front of each histological group using KNN washigh (nervous 0.95, cystic 0.93, fibrous 0.85, fatty 0.84 and synovial). Vascularvs. all other STT gave an efficiency of 0.97 with DT, 0.95 with SVM and 0.93 withKNN.Conclusion: Discrimination of vascular from nervous and cystic origin was eas-ier than from fatty, synovial and fibrous STT. However, the overall values werevery high. The computer assisted diagnosis in the discrimination of the vascularhistological group from the others in STT diagnosis is possible by using patternrecognition techniques.

C-662Spring ligament chronic injury on MR imagingA. Iovane, M. Midiri, M. Galia, T. Bartolotta, R. Lagalla; Palermo/IT

Purpose: To evaluate the usefulness of MR to depict spring ligament (SL) and tovisualize its chronic abnormalities even when associated to injury of the posteri-or tibial tendon (PTT).Materials and Methods: MR images from 185 patients (102 female and 83 male;age range 35-62 years), with clinical suspect of injury of the PTT, were retrospec-tively examined for SL normal appearance and abnormalities. All exams wereperformed by a 0.5 T MR using T1 weighted spin-echo and T2 weighted fast spin-echo sequences on the axial plane.10 asymptomatic control patients (7 femaleand 3 male; age range 33 - 63 years), were examined in the same interval timeusing T1 weighted spin-echo and T2 weighted fast spin-echo sequences on anoblique plane (45°), parallel to SL. We evaluated if SL was totally or partiallyvisualized, SL thickness and signal intensity.Results: In all control patients SL was completely visualized, 4-5 mm thick andhomogenously hypointense. 120/185 patients had injury of PTT. Among these120 patients SL was visualized in its medial portion in 78 patients of which 56had chronic abnormalities of LS. At standard MR examination was not possible tovisualize the inferior portion of SL in almost all 185 patients.Conclusions: MR seems to be an important diagnostic technique to evaluate SLabnormalities. The high association of SL lesions with PTT injury has to be knownand considered when studying patients with proved advanced PTT injury in orderto plan correctly the MR study to SL whole examination.

C-663Primitive muscular hydatidosis: A pictural review of 11 casesA. Konan, H. Rajhi, N. Mnif, M. Karray, M. Zlitni, R. Hamza; Tunis/TN

Purpose: Soft tissue involvement by hydatid disease remains unusual even inendemic areas. In this report our aims are to review the imaging findings of mus-cular hydatidosis and underline possible peculiarity.Methods and Materials: We review retrospectively 11 patients (4 men, 7 wom-en) who underwent surgery for primitive muscular hydatid disease. Imaging tech-nique used included ultrasonography (n = 11), CT scan (n = 7) and magneticresonance imaging (n = 4).Results: Ultrasonography found multiple anechoic and hypoechoic cystic lesions(n = 10), necrozing tumor-like lesion (n = 1). CT scan showed evidence of multi-vesicular cysts in all cases. MRI showed typical liquid lesions (n = 3), heteroge-nous signal due to scraps (n = 1) and evaluate accurately the extent of involvement.Conclusion: In our experience multivesicular cysts is the main lesion showed inprimitive hydatidosis soft tissue. Ultrasound is still in routine relevant to detectmuscular hydatidosis; CT scan and MRI confirme the diagnosis and are helpfulto demonstrate the relation between cysts and adjacent structures and evaluateextent of involvement before surgical management.

C-664Lumbar disc enhancement value: A contrast-enhanced fat suppressed MRimaging studyA.M. Dupont-Thierry, L. Meziti, J.L. Drape, D. Godefroy, A. Chevrot; Paris/FR

Purpose: To determine value of disk enhancement as degenerative or inflamma-tory sign.Methods and Materials: 150 patients with non-inflammatory and inflammatorypainful back syndrome were investigated by contrast-enhanced MRI. Disk en-hancement was classified in peripheral, or central. Disc degeneration was classi-fied in stages II, IIIA, IIIB and IV on T2 weighted images. End plate signal was

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classified in fatty, inflammatory, normal or sclerotic. Presence of paravertebralabscesses was noted.Results: 115 MRI showed degenerative signs. In 30% disc enhancement wasperipheral, parallel to the end plates.The disk enhancement was at L4-L5 in 35%and L5-S1 in 47%. It was found in 86% of end plates inflammation and in 88% offatty changes. It was found in 6% of stage II and IIIA normal or earlier degenera-tive stages, 21% of stage IIIB and 57% of IV stage latter degenerative stages. 10biopsies were performed avoiding disc infection. 5 of the 15 MRI of patients withankylosing spondylitis showed large contrast enhancement parallel to the endplates without end plates inflammation. 10 MRI of operated patients showed lin-ear uptake parallel to end plates associated with enhancement in the posteriorpart of operated disc. 10 MRI of patient with infectious spondylitis showed centraldisk enhancement with end plates inflammation in 100% and vertebral abscessin 50%.Conclusion: Disc enhancement parallel to end plate is a disc degenerative signin operated and non-operated disc. It may be present in inflammatory conditionsas ankylosing spondylitis. Central disk enhancement appears to be an infectionsign.

C-665Effectiveness of US-guided core needle biopsy in the diagnosis ofmusculoskeletal lesionsI. Lecumberri, J.L. del Cura, O. Gorriño, I. López, A. Legorburu, D. Grande;Bilbao/ES

Purpose: To evaluate effectiveness and accuracy of ultrasound (US) guided coreneedle biopsy in musculoskeletal lesions.Material and Methods: US guided core needle biopsies were performed in 111patients with musculoskeletal lesions imaged by US. All lesions were tumors onUS exam, except two that appeared as ill-defined alterations in soft tissues. Twelvewere arising from or involving bone. Location of the lesions was axial in 54 and inextremities in 57. Results of core biopsy were correlated with the final diagnosis,that was based on the exam of surgical specimen in 53 patients who were oper-ated on, and in clinical course in the rest.Results: No complications occurred. Core biopsy was considered diagnostic in108 cases. Fifty-two lesions were finally diagnosed as malignant and 59 werebenign. In 11 cases final diagnosis was different from that of core biopsy. Twolesions with non-diagnostic result were finally diagnosed as malignant and an-other one as benign. Five lesions, benign in core biopsy, were diagnosed as adifferent benign entity after surgery. Three lesions, considered benign after corebiopsy, were finally diagnosed as malignant. US-guided core needle biopsyachieved 90% sensibility, 100% specificity, 100% positive predictive value and95% negative predictive value to detect malignancy in musculoskeletal lesions.Conclusions: In US-visible musculoskeletal lesions, US-guided core biopsy canestablish a diagnosis with great accuracy and frequently can avoid other explora-tions. Thus, it should be considered a stable technique in the management ofmusculoskeletal pathology.

C-666Extra-abdominal desmoid tumours in the post-partum period: Diagnosisand staging with ultrasonography and MRIL. Dogliotti1, M. Bazzocchi1, N. Gandolfo1, F. Pugliese2, F. Prefumo2,G. Serafini1; 1Pietra Ligure/IT, 2Genoa/IT

Purpose: The extra-abdominal desmoid tumour (EADT) is a rare disease morecommon in young females. This study describes the ultrasonographic features ofEADTs, and compares them with MRI in the diagnosis and staging of the dis-ease.Materials and Method: A total of 12 lesions of the anterior abdominal wall andperineum have been assessed with ultrasonography and MRI. Six of them weresubsequently diagnosed as EADTs at histology. Of these, 5 were located in theanterior abdominal wall and one, the largest, was embedded within the perinealmuscles. All patients were female and reported being pregnant in the year pre-ceding the diagnosis. Three had delivered by caesarean section. The ultrasoundexamination were performed with a 12-5 MHz multifrequency transducer. MRIimaging employed TSE–T1w sequences with and without gadolinium, and TSE-T2w sequences with and without fat suppression.Results: In the cases of EADT ultrasonography showed solid homogeneousmasses, slightly hypoechogenic compared to the adjacent fibromuscular struc-tures. In the 5 anterior abdominal wall cases, the margins were clearly identifiedon a transversal plane but spiculated and irregular along the longitudinal plane in3 out 5 cases. The large perineal lesion (diameter 6 cm) appeared dyshomoge-nous, but margins were regular and clearly identifiable. At Color Doppler exami-

nation, all lesions showed a rich vascularisation. MRI confirmed the fibrous na-ture of the lesions and helped in the differential diagnosis with endometriosis.Conclusion: EADTs appear as solid, homogeneous, clearly delimited lesion atultrasonography. MRI is useful for excluding endometriosis in case of dyshomo-geneous lesions.

C-667Retrospective analysis of ultrasound guided core biopsy in the diagnosis ofsoft tissue massesF.J. Perks, I. Beggs; Edinburgh/UK

Purpose: to assess the accuracy of ultrasound guided core biopsy of soft tissuemasses.Patients and Methods: We reviewed 65 soft tissue biopsies in 62 consecutivepatients. Diagnoses were compared to the post excision diagnosis in 28 patients.All core biopsies were performed by the same radiologist using ultrasound guid-ance. Biopsies were performed as outpatient procedures.Results: 3 biopsies repeated. 56 (85%) biopsies diagnostic of a wide range ofbenign and malignant disease. 24 of 28 (86%) biopsies accurately representativeof post excision histology. 28 biopsies diagnosed disease that did not warrantexcision. 4 false negative biopsies when sampling liposarcoma, lymphoma, chon-drosarcoma and metastasis. Overall sensitivity and specificity was 87.8% and100% respectively. There were no complications.Conclusions: Ultrasound guided core biopsy of soft tissue masses yields a rep-resentative tissue sample permitting accurate tissue diagnosis. The technique istime and cost effective and carries a negligible complication rate. Cartilagenousand lipomatous tumours are most likely to yield false negative histology due tosampling error.

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Miscellaneous

C-668SAPHO syndrome: Imaging of musculoskeletal manifestations. A study of24 casesJ.-L. Michel, T.-T. Pham, S. Nasser, C. Reynier, M. Soubrier, J.-J. Dubost,J.-M. Ristori; Clermont Ferrand/FR

Learning Objectives: The purpose of this exhibit is to describe the imaging fea-tures of SAPHO in adults. This retrospective study included 24 patients (13 wom-en, 11 men). All imaging procedures, radiographs, CT, MRI and scintigraphy, werereviewed.Background: SAPHO (acronym for synovitis, acne, pustulosis, hyperostosis andosteitis) is a syndrome of obscure cause, commonly considered to represent aseronegative spondylarthropathy, affecting especially young adults and childrenand leading to osteoarticular and skin manifestations. Osteosclerosis, corticalthickening, enlargement of bone, arthritis are the predominent radiologic pattern,but periostitis and soft tissue swelling also may be seen and these findings cansimulate osteomyelitis, sarcoma, lymphoma.Imaging Findings: Of the 24 patients, topographic localizations were the upperanterior chest wall (82%), spine (50%), periphral bones and joints (46%), pelvis(30%), mandible (12.5%). The main radiologic findings correlated with hyperos-tosis, osteitis and synovitis.Conclusion: The radiologist plays a major role in the diagnosis: this exibit re-views the radiologic appearance of this syndrome and illustrates difficulties indifferential diagnosis.

C-669Erdheim-Chester disease: Detection and staging with multimodalityimagingA. Miquel1, E. Dion2, C. Graef2, Y. Menu1, P. Grenier2, J.-D. Laredo2;1Le Kremlin-Bicêtre/FR, 2Paris/FR

Learning Objectives: To illustrate the clinical, radiological and histological spec-trum of findings in Erdheim-Chester disease. To be able to recognise the diseasein a patient with elementary symptoms. To describe the imaging modalities thatare necessary for a precise staging of the disease.Background: Erdheim-Chester disease is a multisystemic histiocytosis associ-ated with characteristic skeletal abnormalities. Bone (bone pain), skin (xantho-mas), orbits (exophthalmos), pituitary gland (diabetes insipitus), retroperitoneum(hydronephrosis) and lungs may be affected by the disease. The relashionship ofthe disease with Langerhans cell histiocytosis is still unclear. Seventeen patientswith Erdheim-Chester disease were evaluated between 1990 and 2001, usingconventional X-rays, US, CT, bone scintigraphy and MRI. Radiological-patholog-ical correlations were available in 15 cases.Imaging Findings: Osteosclerosis of long bones in lower limbs is the most com-mon feature (15/17 cases) and should be a trigger for the diagnosis. MRI demon-strates replacement of the high signal of the bone marrow by a decreased signalon T1 and T2-weighted images. Atypical osseous manifestations include involve-ment of ribs, skull and pelvis; focal lytic lesions are seldom encountered (3/17).Visceral involvement may affect pituitary gland, orbits, pericardium, lungs, kid-neys and retroperitoneum. Pathologic study shows accumulation of lipid-ladenhistiocytes and fibrosis.Conclusion: Bone lesions are rather specific and should suggest the diagnosisof Erdheim-Chester disease. Detection of visceral involvement, sometimes asymp-tomatic, requires imaging of brain, lung and retroperitoneum. Histological analy-sis is necessary to assess the diagnosis and differentiate the disease from othercases of histiocytosis, especially Langerhans cell histiocytosis.

C-670The many faces of multiple myelomaD.A. Mc Kenna, A. Iqbal, D. Lohan, C.J. Roche, P. Mc Carthy; Galway/IE

Learning Objective: We aim to highlight the manifestations of myeloma usingreferrals from such specialities as haematology, orthopaedics and general med-icine. The classical appearances of myeloma are presented with aids to enablethe radiologist confirm the diagnosis and differentiate from other pathologies ofsimilar appearance.Background: Multiple myeloma is the commonest primary malignant neoplasmand therefore as pathology the radiologist should be mindful of its many appear-ances.

Imaging Findings: Through a pictorial review we show not only the classicalappearances of myelomatosis on plain film and bone scans but we also presentits' appearance on CT scan and MRI. The limitations and benefits of each modal-ity are discussed. Furthermore we highlight the recent findings which show thatnot only is MRI better at staging multiple myeloma but compared to the dated"Durie and Salmon" criteria it negates the need for repeat blood and urine samples.Conclusion: Multiple myeloma may not always present with classical appear-ances and therefore it is paramount that a radiologist be aware of some of theunusual forms. Through an assortment of imaging modalities we present not onlythe characteristic appearance but also atypical varieties.

C-671Vertebral development: Normal and abnormal aspects-interactiveA. Marinescu, A. Pavel, H.C. Ionescu, G. Iana; Bucharest/RO

Learning Objectives: The program is conceived as an interactive lesson for thosewho wants to easy understand the vertebral development and also the pathologyof an inadequate development. It is addressed to any radiologist in training.Background: The vertebral development consists in three stages: mesenchy-mal, cartilaginous and bony. During this development appear many centers of thefuture vertebrae (mesenchymal, chondrifications and ossifications centers).o:p>Procedure Details: Using a graphic presentation (originally and schematically)of the vertebrae for any stage and a color convention (the mesenchimal stage isrepresented in orange, the cartilaginous stage in blue and the third - the bonystage in pink); you can follow all the steps of the vertebral development.The program is interactive, meaning that you can follow the graphic presentationof the steps of the vertebral development, but also: • If you want to know moreabout the elements on the graphics, you can use the left button of the mouseclicking on the red sign. • Before "details" and you will get the information andexplanations. Then, you can come back to the slide with the marks ü "details".• You can see, for each type of pathology which can occur in different steps ofvertebral development, a graphic presentation and radiography (you press theleft button of the mouse on the red sign before "pathology".Conclusion: All the radiology trainees in our department have been satisfiedwith the program, instead of reading some arid pages for this topic.

C-672Nevoid basal cell carcinoma syndrome: A pictorial reviewA. Grgic, M. Heinrich, S. Aliani, D. Dill-Mueller, M. Uder, B. Kramann;Homburg a.d. Saar/DE

Learning Objectives: The aim of this exhibit is to describe typical clinical fea-tures in nevoid basal cell carcinoma syndrome as well as to present characteris-tic imaging features of the most common pathologies.Background: Nevoid basal cell carcinoma syndrome (NBCCS) is a rare auto-somal dominant inherited disorder with complete penetrance but variable expres-sivity. Although many radiologists are familiar with typical findings (e.g. majorcriteria) of this disease there are also findings that are only rarely demonstrable(e.g. minor criteria).Imaging Findings: We present NBCCS-findings of 5 patients. They include nu-merous pathologies such as multiple cutaneous basal cell carcinomas, odon-togenic jaw cysts, ectopic calcifications of the falx cerebri as well as palmar orplantar pits. Characteristic images of the patients faces as well as bifid or fusedribs, vertebral anomalies, bridging of the sella turcica, flame shaped pseudo-cysts of the hands, lymphomesenteric cysts as well as increased frequency oftumors particularly medulloblastomas and ovarian fibromas that are also veryimportant to recognise will be shown.Conclusion: The radiological findings are specific for this disease and may con-firm the diagnosis in combination with the clinical presentation. Furthermore ear-ly diagnosis as well as periodical follow-up examinations is very important sincethe nevi after puberty turn out to be aggressive.

C-673Imaging with pathological correlation of sacral and presacral lesionsS.A. O'Keeffe, T. Geoghegan, W.C. Torreggiani; Dublin/IE

Learning Objectives: The objective of this poster presentation is to pictoriallyreview the imaging of a series of patients with sacral and presacral lesions and tocorrelate these with pathology.Background: Presacral tumours are extremely rare accounting for less than 1 in40,000 hospital admissions. There are many pathological causes as this is ananatomical area of embryologic fusion. A review of reports on the Radiology In-formation System (RIS) was undertaken to identify those patients who had pre-

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sented with sacral and presacral tumours. The imaging of 8 patients of selectedfor review. Imaging included MRI, CT, ultrasonography and angiography. Histo-logical correlation was obtained for all patients.Imaging Findings: Of the cases identified, 8 patients with varying pathologywere chosen for review. The imaging findings of each case were correlated withpathological findings. Characteristic features of benign, malignant, osseous andneurogenic lesions are highlighted.These cases included: • Chondroma • Plasmacytoma • Plexiform neurofibroma• Cystic hamartoma • Haemophilic pseudotumour • Hodgkins lymphoma • Giantcell tumour • Metastatic diseaseConclusions: In this pictorial review, we describe the anatomical contents of thepresacral space and correlate this with the possible pathological causes of alesion in this area. In addition, the imaging and pathology of a selection of sacraland presacral tumours is presented and methods of analysis of imaging are sug-gested.

C-674Diagnosis and management of pelvic fractures: Contribution of CTC. Torrents, L. Casas, A. Rivas, M. Perez-Lafuente, R. Dominguez Oronoz,O. Persiva; Barcelona/ES

Learning Objectives: 1. Familiarization with the Tile and Young Burgess classi-fications of pelvic fractures and their correlation with CT. 2. Describe the techni-cal procedure of CT guided percutaneous fixation of pelvic fractures. 3. To evaluatethe usefulness of CT imaging in the diagnosis of occult and stress pelvic frac-tures.Background: Pelvic fractures are a common and often life threatening result ofmajor trauma. The importance of pelvic fractures lie in potential osseous andligamentous instability and the vascular pelvic injury associated. Fracture classi-fications are useful to the surgeon as a means to determine pelvic stability. TheTile and Young Burgess classifications are the most widely accepted by ortho-pedic surgeons. CT scan has become an essential element in the orthopedicmanagement of pelvic fractures. Also it can be useful to diagnose and locateactive pelvic hemorrhage. In addition CT guided fixation of reducible sacral frac-tures and sacroiliac joint disruptions is a safe alternative to open reduction andinternal fixation. Finally CT is helpful for confirming the presence of occult pelvicfractures with emphasis on insufficiency fractures.Procedure: Six years retrospective study of 279 patients who underwent CT fora pelvic injury at a level 1 trauma center. The more characteristics CT findings ofpelvic fractures were described. Also we show the CT guided percutaneous fixa-tion of pelvic fractures.

C-675Molecular targeted therapies: MRI patterns of tumor response.The paradigma of chordomasA. Messina, P. Casali, D. Vergnaghi, S. Stacchiotti, F. Bianchi, R. Musumeci;Milan/IT

Learning Objectives: To understand MRI patterns of tumor response to Imatinibmesylate in advanced chordomas.Background: Chordomas are very rare tumors, for which standard medical ther-apies are lacking. Following detection of PDGF-R expression in tumor samples, itwas decided to treat some patients with advanced chordoma with Imatinib me-sylate on an individual basis. These patients were treated at the Istituto Nazion-ale Tumori, Milano, Italy, as from August 2002.Imaging Findings: Five pts with advanced disease (4 with sacral, one with cli-vus chordomas) undergoing Imatinib mesylate were evaluated with MRI at base-line, and then every 2 months. Four pts showed hints of tumor response. Thesewere: i) minor and slow decrease in size in the pt with the longest follow-up,following a transient initial increase in size, which was seen in all pts; ii) hypoden-sity of lesions on T1w images and hyperintensity on T2w images; iii) hypovascu-lature of lesions on contrast-enhanced T1w images in comparison to baselineassessment.Conclusion: Actual responsiveness of chordomas to molecular-targeted thera-py with Imatinib mesylate is left to be determined. However, preliminary observa-tions suggest that MRI may be useful to assess tumor response. Signs of responsemay be subtle, likely depending on changes in tumor tissue rather than (or be-fore) decrease in size.

C-676Groin pain in athletes: MRI findingsF. Idoate Saralegui; Pamplona/ES

Learning objectives: This exhibit reviews the RMI findings in athletes with groinpain.Background: Groin pain is a common complaint in athletes, particularly preva-lent among soccer players. This condition is frequently multifactorial, and thedifferential diagnosis can cover a rather broad area of entities, mainly involvingadductor muscle and tendinous group, pubic bone even inguinal hernia. BetweenJanuary 1998 and August 2003, 90 athletes with groin pain were examined at ourinstitution. The MRI findings of the possible causes of groin pain in athletes aredescribed and illustrated.Imaging Findings: The examinations were performed in a 1 Tesla imaging sys-tem (Magnetom Impact Expert, SIEMENS) with a surface coil. T1-weighted spinecho and T2-weighted fat suppressed turbo spin echo images were obtained inaxial plane; STIR a T2-weighted turbo spin echo sequences were performed incoronal plane.The pathological findings observed were: osteitis pubis, stress fracture of pubicbone, muscle tears (adductor, obturator, rectus abdominis, pectineus, iliopsoas,gracilis and rectus femoris groups), abdomino fascial abnormalities, inguinal her-nia, bursitis and inflammation conditions of the spermatic cord.Conclusion: MRI depicts adequately the numerous pathologic entities related togroin pain in athletes.

C-677Infection in the prosthetic era: A pictorial guideS. Walsh, D.G. Lohan, D. McKenna, D. O'Keeffe; Galway/IE

Learning Objectives: To highlight numerous forms of prosthetic infection, withparticular reference to the limitations and benefits of various imaging modalities.Background: Prosthetic, graft or catheter infection, irrespective of location, in-variably equates with a poor outcome. Modern aseptic technique, in addition tothe use of antibiotic-coated prostheses, have dramatically reduced the incidenceof such infection. Aggressive antibiotic suppression is effective in fewer than 30%of cases, the remainder requiring removal of the infected prosthesis, with associ-ated morbidity, and occasionally, mortality. Clinical signs and symptoms are fre-quently non-specific, including lethargy, pyrexia and anorexia. It is for this reasonthat quite often the task of locating a causative factor relies upon the expertise ofthe radiologist.Imaging: Using a pictorial review we depict the numerous pitfalls in the radiolog-ical diagnosis of prosthetic and endovascular graft infections. In addition, a guideto radiological imaging of less frequently encountered infections, such as thoseof breast and penile prostheses, ventriculo-peritoneal shunts, intra-ocular lens,cardiac pacemakers and valves, will be provided. The limitations and benefits ofConventional Radiography, Digital Subtraction Angiography, Computed Tomog-raphy, Ultrasound, Magnetic Resonance Imaging and Radio-isotope Scintigra-phy with respect to the site of infection will be explored in turn.Conclusion: The radiological diagnosis of infection of synthetic materials is no-toriously difficult. The use of these materials for therapeutic, cosmetic and pallia-tive purposes is ever-increasing. It is therefore of vital importance that theradiologist be aware of the advantages and disadvantages of available imagingmodalities in arriving at a confident, swift diagnosis.

C-678A new method for radio frequency of lumbar disc in treatment of chroniclow back painN. Azulay1, M. Forgerit2, A. Moumouh1, E. Alava3, P. Vandermarq1, J.-P. Tasu1;1Poitiers/FR, 2Niort/FR, 3Barcelona/ES

Purpose: Treatment of chronic low back pains remains a challenge for physi-cians. Recently, radio-frequency heating of inter vertebral disc has been pro-posed, as an alternative to surgery. We propose here a new method of discalradiofrequency in which heated water is used to spread the thermal energy.Materials and Methods: Seventeen patients were included prospectively ac-cording to the criteria used in previous intra discal radiofrequency studies. Thecatheter is placed in the nucleus and heated water is used as thermal conductorto burn the annulus nociceptors. Intra discal pressure and impedance measure-ments were used to control the energy delivered during the procedure. Clinicalresults were evaluated by the Oswestry score. The treatment was scored as asuccess with at least a 50% pain reduction on global perceived effect on Os-westry score.Results: The global Oswestry before treatment was 50.6 points and 25 points

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after corresponding to a 50.6% improvement. On the 17 patients, 12 were suc-cessfully treated (71%).Conclusion: We have shown that injection of heated water is sufficient to spreadthermal energy to the anular nociceptor. This method is technically more simplethan previous techniques using anular needle, avoiding navigation of the cathe-ter through the anulus.

C-679Ultra low dose CT in navigated closed reduction and percutaneous screwfixation of pelvic ring fracturesH.G. Staedele, R. Huegli, S. Meckel, A.L. Jacob, H. Roser, P. Messmer,J. Roth; Basle/CH

Purpose: To reduce radiation doses in image-guided pelvic closed reduction andpercutaneous fixation CRPF without compromising guidance quality and proce-dural outcome.Methods and Materials: Prospective study including patients with pelvic ringfractures treated with CT-guided CRPF. Patients received 2 screws which werenavigated over guide pins. Imaging modality used was a single slice scanner(General Electric, USA). Tube current was reduced by 50% with every step start-ing with routinely used scan parameters for diagnostic and interventional proce-dures (200 mA). If the image quality was good the next control scan was performedwith 50% reduction of mA again.Results: 13 patients with 16 fractures underwent CRPF. 9 were males, 4 females,with a mean age of 39 years (range 23.3-88.9). Dose reduction was possible inall patients in 2 to 4 steps ending up in 50 mA (n = 3), 25 mA (n = 4) and 10 mA(n = 9) respectively. 10 mA is the lowest current provided by the CT. Number ofmisplaced screws was 0. Number of additional correction of guide pin was 0.Number of fallbacks to the next dose level was 0.Conclusion: By lowering scan doses no relevant morphological information need-ed for safe guidance of instruments and implants was lost. Scan protocols can bechanged to lower mA values without compromising the safety of CRPF. Immedi-ate procedural outcome was not affected.

C-680withdrawn by authors

C-681Pelvic painful syndrome in athletes: Diagnostic imaging evaluationL. Zugaro, F. Iannessi, A. Catalucci, A. Barile, C. Masciocchi; L'Aquila/IT

Purpose: To describe the imaging features of the anterior and posterior painfulsyndrome in athletes.Materials and Methods: 28 athletes (23 males, 5 female) suffering from pelvicpain (groin pain = 13 and hamstring syndrome = 15) underwent MRI after plainfilm and ultrasound preliminary evaluation. In 5 patients CT evaluation was alsoperformed. MR examination was performed using a 1.5 T unit (GE Medical Sys-tem). Proton density, T1 weighted and T2 weighted sequences on axial and coro-nal planes were employed. In one case MRI was also obtained after surgicaltreatment.Results: In all cases MRI demonstrated pathological findings: anterior painfulsyndromes were related to osteitis pubis, bursitis, inguinal hernia, post-traumaticmuscular lesions and stress fractures. Hamstring syndrome was related to inser-tional pathology of hamstring tendons, inflammation disease of regional bursaeand fibrotic changes of fatty tissue surrounding the ischial tuberosity.Conclusion: Anterior and posterior pubic painful syndromes are painful condi-tions often affecting athletes. MRI provides a correct evaluation of these syn-dromes enabling an adequate therapy.

C-682The value of qualitative and semiquantitative ultrasonographic findings inthe differential diagnosis of superficial lymph node enlargementsO.O. Okten1, N. Tuncbilek1, H.M. Karakas2; 1Edirne/TR, 2Malatya/TR

Purpose: The value of the gray-scale (GSUSG), color Doppler (DUSG), and powerDoppler (PDUSG) ultrasonography in the differential diagnosis of superficial lymphnode enlargements were evaluated.Methods and Materials: The study group was consisted of 36 males and 17females (2-74 yrs old, mean age 36.1 yrs) in whom physical examination hadrevealed superficial lymph node enlargement(s). All patients were investigatedwith power Doppler USG (Sonoline Elegra Advanced, Siemens, Germany) using7.5 MHz linear transducer. Longitudinal/transverse dimensions (L/T), edge char-acteristics and hilar echogenecity of lymph nodes were evaluated with GSUSG.

Pulsatility (PI) and resistivity (RI) indexes were calculated using CDUSG. Vascu-lar pattern described as hilar or non-hilar were determined by PDUSG. Aboveparameters were analyzed to determine their differential diagnostic values usingANOVA based discriminant analysis.Results: When clinical data and histopathological findings were combined, 31subjects were diagnosed as lymphoma, and 22 cases were classified as lym-phadenitis. Multiple comparison analysis of qualitative GSUSG and PDUSG fea-tures consisting of edge characteristics, hilar echogenecity and vascular patternwas able to differentiate lypmhomatous lymph nodes and lymphadenitis with 87%accuracy (p < 0.001). In contrary, semiquantitative features (RI, PI and L/T) werenot able to classify lymph nodes (58% accuracy, p < 0.05).Conclusion: Semiquantitative RDUS parameters are not valuable in the differ-ential diagnosis of superficial lymph node pathologies. Qualitative USG andPDUSG features, on the other hand, may be used as an alternative work-up tocytological studies in patients in whom diagnostic surgical procedures cannot beperformed.

C-683Modern imaging in Langerhans cell histiocytosisA. Geoffray, K. Oudjhane, L. Lau, S. Weitzmann; Toronto, ON/CA

Purpose: To review imaging features of pediatric Langerhans cell histiocytosis(LCH) with particular attention to cross-sectional imaging and aggressive cases.Material and Methods: We reviewed retrospectively the imaging database of allthe cases treated in our institution for LCH during a 5 years period (January 1998to December 2002). There were 45 patients, 30 boys, 18 girls, with an age rangeof 3 weeks to 13 years.Results: 2 patients had no imaging anomalies and were excluded. Among the 43with anomalies, 16 had a solitary bone lesion (skull 3, orbit 3, spine 4, iliac 1, longbones 5), 19 had multiple bone lesions associated with other organ involvementin 6 (lung 4, liver and spleen 2, thymus 1), 7 patients had no bone lesions (1cervical adenopathy, 2 abdominal involvement, 2 abdominal and lung, 1 pituitarygland, 1 middle ears), 1 patient had LCH associated with neuroblastoma, andpresented with lymphadenopathy, mediastinal and sacrococcygeal masses. Im-aging modalities were conventional radiography in 100%, nuclear scans 95%,CT 93%, MR 76%, US 62%.Conclusion: LCH in children is characterized by a wide spectrum of organ in-volvement. Cross sectional imaging is useful in assessing the diagnosis andmanaging the most aggressive cases.

C-684Can calcaneal spur help in the evaluation of a painful heel?N. Sabir, S. Demirlenk, B. Yagci, N. Karabulut; Denizli/TR

Purpose: To determine the value of presence of calcaneal spur in evaluatingpainful heels.Materials and Methods: 145 heels of 66 female and 11 male patients with amean age of 45.7 ± 9.8 years and mean body mass index (BMI) of 35.0 ± 10.5complaining of bilateral (n = 68) and unilateral (n = 9) heel pain were studied.Lateral radiographs of the 145 symptomatic and 163 asymptomatic heels wereobtained to assess presence of calcaneal spur. MR imaging of the symptomaticheels was performed using 1.5 T superconductive system. The images were tak-en and reviewed for presence of plantar fasciitis (PF). Heel pad thickness wasalso measured.Results: Calcaneal spur was seen in 72 of 145 (49%) symptomatic and in 13 of163 (7.9%) of asymptomatic heels. MR has revealed PF in 68 of 145 (46.9%)painful heels and calcaneal spur was present in 53 of the cases with PF. Calca-neal spur was significantly correlated with weight (P < 0.001), BMI (P < 0.001),age (P = 0.029), heel pain duration (P = 0.003) and PF (P < 0.0001). No correla-tion was seen between calcaneal spur and both height and heel fat pad.Conclusion: Although calcaneal spur is not the cause of pain, it may provide anobjective assessment of the changes due to chronic repeatitive trauma to plantarfascia secondary to obesity or age. On the other hand foot radiography should bepart of the initial diagnostic methods as it helps in excluding different causes ofheel pain.

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C-685Assessment of dynamic FDG-microPET scanning in a rabbit VX2 tumormodelK. Koyama, T. Okamura, Y. Hamasawa, Y. Wada, K. Ishii, T. Ookuma, S. Kondo,Y. Watanabe, Y. Inoue; Osaka/JP

Purpose: The MicroPET P4 scanner is one of the first commercially availablesmall animal PET imaging systems with a high spatial resolution (1.85 mm). Weevaluated FDG-microPET dynamic scans with the microPET P4 scanner in ananimal tumor model.Materials and Methods: VX2 cells were implanted into muscles of bilateral limbsof Japanese white rabbits and tumors were produced with necrotic lesions (n = 6;diameters, 25-50 mm). Helical CT scans were done before the PET studies. Inthe PET study, after four hours fasting, and following transmission scans, dynam-ic emission data acquisitions were performed for two hours after intravenous FDGinjection. Images, reconstructed every ten minutes using a filtered-back projec-tion method, were analyzed visually. Time activity curves (TACs) and tumor-to-muscle ratios (T/M ratios) were also calculated after regions of interest were setin tumors and muscles referring to CT images.Results: In visual analysis, FDG accumulations in all tumors gradually increasedover time but FDG accumulations in muscles showed no change. In quantitativeanalysis, T/M ratios of viable lesions in tumors showed continuously increasingand those TAC curves showed upward, whereas T/M ratios of necrotic lesions intumors showed equivalent and those TAC curves showed flat. T/M ratios of viablelesions in tumors acquired in 110–120 minutes (9.67 ± 2.91) were significantlyhigher than those acquired in 50–60 minutes (7.08 ± 2.86) (p < 0.05).Conclusions: Continuously increasing FDG accumulations were observed in alltumor lesions in FDG-microPET dynamic scans and images acquired in 110-120minutes showed excellent visualization of tumors.

C-686Radiographic interpretation by the emergency department staff: An audit of2198 X-ray filmsZ. Husamaldin; Colchester/UK

Purpose: The purpose of this study is to 1) Assess the ability of EmergencyDepartment (ED) staff which includes Staff Grades (SGs), Senior House Officers(SHOs) and Emergency Nurse Practitioner (ENPs) to interpret X-rays. 2) Com-pare between ED doctors and ENPs in X-ray interpretation. 3) Compare errorrate between day and night or weekends. 4) Assess the improvement over thestudy period. 5) Show the most common error sites.Methods: The study covered a three-months period. All patients with a history oftrauma who had an X-ray were included. the assessment of X-rays by emergen-cy department staff were recorded then compared with the radiologist reports.Results: The interpretation of 2198 trauma X-ray films was examined. There were703 (32%) films with abnormal findings. 141 (6.4%) films were misinterpreted byED staff, of these, 38 (1.7%) were significant errors. Locum SGs had the highesttotal error rate, but these errors were the least significant. ENPs total error rate issimilar to SGs and SHOs. their error during night and weekends was twice that ofthe day. no improvement in SHOs interpretation accuracy was noted over thethree months period of the study. The most common error site was the ankle, footand wrist.Conclusion: The overall error rate was within the national average. although SGs,SHOs and had ENPs a similar overall error rate, ENPs had the highest error rateduring the night and weekends. Therefore staff training, guidance and formal re-porting by radiologist is still essential.

C-687Evaluation of lymphoscintigraphy used together with bone scintigraphyK. Kato1, T. Nihashi1, S. Ito1, S. Iwano1, M. Ikeda1, M. Tadokoro2, H. Kobayashi3,T. Ishigaki1; 1Nagoya/JP, 2Toyota/JP, 3Toyoake/JP

Purpose: The positive areas in scintigraphy of sentinel lymph nodes are some-times difficult to be anatomically identified. We have examined the usefulness ofbone scintigraphy performed together with lymphoscintigraphy for identificationof the anatomical positions of the positive area in lymphoscintigraphy.Materials and Methods: Sixteen patients, 12 cases of malignant melanoma and4 cases of squamous cell carcinoma were examined by lymphoscintigraphy. Ninepatients, 7 cases of malignant melanoma and 2 cases of squamous cell carcino-ma, were examined by bone scintigraphy together with lymphoscintigraphy. Thepatients were divided into three groups. In the first group, lymphoscintigraphywas performed alone. In the second group, the patients were first injected intra-venously with Tc-99mHMDP or Tc-99mMDP and then lymphoscintigraphy was

performed after intradermal administration of Tc-99m sulphur colloid. Three hoursafter injection of Tc-99mHMDP or Tc-99mMDP, Bone scintigraphy were taken. Inthe third group, lymphoscintigraphy was performed 30 minutes after bone scin-tigraphy.Result: Anatomical identification of the positive areas in lymphoscintigraphy wasdifficult when used alone, whereas their identification became easier when usedtogether with bone scintigraphy. When bone scintigraphy was performed afterlymphoscintigraphy, evaluation of lesions in the bones near the original focuswas sometimes not easy. However, evaluation of lymphoscintigraphy was notaffected by prior performance of bone scintigraphy.Conclusion: Identification of the anatomical positions of the positive areas inlymphoscintigraphy was easier when used together with bone scintigraphy thanin lymphoscintigraphy alone. In cases of the joint use, lymphoscintigraphy shouldbe operated after bone scintigraphy.

C-688Ultrasonographic detection of iatrogenic foreign bodies in an in vitro studyI.K. Rozylo-Kalinowska, L. Barczewski, E. Szczepanik, R. Lenard; Lublin/PL

Purpose: Sometimes foreign bodies being parts of surgical appliances remain insoft tissues as a result of iatrogenic faults. Their presence is dectected clinicallyor radiologically, when the objects are radiopaque. Nevertheless, radiolucent orfaintly radiopaque objects often are a diagnostic challenge as their presence isdifficult to diagnose on the basis of conventional radiograms.The purpose of the study was application of ultrasonography for detection ofradiolucent and faintly radiopaque foreign bodies in an in vitro model.Methods and Materials: Examples of radiolucent and poorly radiopaque foreignbodies such as plastic fragments of syringes, intravenous catheter, different cot-ton and gauze swabs, were embedded in containers filled with gelatine, whichserved as a model of soft tissues as well as played the role of a stand-off pad.The ultrasound scanning was performed by means of ATL HDI 3500 machinewith a high-frequency broadband linear transducer.Results. There was determined the possibility of detection of various types offoreign bodies. There were described ultrasonographic image patterns of differ-ent objects.Image Findings: All types of used materials were well visible and hyperechoic inultrasound image. Plastic objects caused appearance of reverberation artifacts.The swabs produced characteristic patterns of internal structure. Variations inultrasonographic image patterns of foreign bodies studied in vitro allowed differ-entiation of various types of the examined materials.Conclusion: Ultrasonography may become a useful, widely available and cost-effective tool in detection and localisation of foreign bodies of iatrogenic originthat otherwise remain undetected.

C-689Spectrum of MR findings of herniation pit of the femoral neckM. Ferrer, R. Dominguez, M. Romera, E. Castella, X. Merino, L. Casas;Barcelona/ES

Background and Purpose: Herniation pit of the femoral neck has been consid-ered a normal variant. This lesion is located in the superior aspect of the femoralneck, below the anterior cortex of the femur. The aim of this study was to describethe spectrum of magnetic resonance imaging (MRI) findings associated with her-niation pit of the femoral neck.Material and Methods: We retrospectively reviewed the MR studies in patientswith hip pain performed in our hospital over the last 10 years. A total of 12 pa-tients presented herniation pit. The features analyzed included: type of herniationpit (unilateral/bilateral), iliofemoral ligament thickening and asymmetry, iliopsoasmuscle/femoral head relationship, acetabular coverage angle, cervicodiaphisaryangle, femoral anteversion angle, and associated imaging findings (synovitis).Results: In patients with hip pain and herniation pit, the following data were found:no other apparent cause of the pain (25%), iliofemoral ligament thickening (100%),decreased acetabular coverage angle (80%), altered cervicodiaphisary angle(90%).Conclusion: The elevated incidence of alterations in acetabular coverage andcervicodiaphisary angle in herniation pit, together with other alterations in stabi-lizing elements, lead us to suggest that, rather than a separate entity, herniationpit can be considered a component of the spectrum of adult hip dysplasia.

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C-690High resolution ultrasound of the peripheral nerves of the lower limb:Technique of examination and normal US appearanceX. Montet1, S. Bianchi1, C. Martinoli2, J. Fasel1; 1Geneva/CH, 2Genoa/IT

Objective: To present the basic normal US appearance of peripheral nerves eval-uated in vitro and in vivo. To describe the examination technique, the normal USfindings and the main anatomic variations of the nerves of the lower limb.Materials and Methods: US images were obtained with commercially availableequipment utilizing two linear probes (5-12, 7-15 MHz). The normal US appear-ance of a peripheral nerve was evaluated by in vitro examination a human sciaticnerve. Sonograms were then obtained in normal volunteers and correlated withMRI and images from anatomic textbook.Results: The in vitro US appearance of the a normal peripheral nerve correlateswell with the internal nerve structure. Fascicles appear as hypoechoic bundlesembedded within the hyperechoic connective tissue.The normal anatomy of the sciatic, peroneal, tibial nerve is first briefly described.Then for each nerve the scanning technique is presented with emphasis on pa-tient position, probe orientation and dynamic maneuvers. To improve the under-standing of US images, correlative drawings showing the adjacent anatomicstructures and diagrams showing the position of the probe are presented.Conclusions: High frequency transducers allow a detailed analysis of even small-er peripheral nerves. We present a practical manner to realize a US examinationof the nerves of the upper extremity as well as US images of normal nerves andof their main anatomic variants.

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C-692Radiologic and sonographic examinations in patients with heterotopicossificationsJ. Nagy; Budapest/HU

Purpose: To evaluate the diagnostic capability of radiologic and ultrasonograph-ic examinations in patients (pts) with heterotopic ossifications (HO).Materials and Methods: During the last four years we have examined 107 pts(23 women, 83 men; age: 51 /20-90/ years) in case of the clinical suspicion of HO.Dynamic conventional radiologic and ultrasonographic (7.5 MHz linear transduc-er) examinations were performed.Results: In the background of HO, spinal cord injury (43 pts, 40%), brain injury(37 pts, 34%), limb damage (19 pts, 18%), orthopedic surgery (5 pts, 5%) or limbamputation (3 pts, 3%) were found. The most frequent localizations of HO wereas follows: one side (53 pts) or on either of the sides of the hip (40 pts), elbow(13 pts), knee (8 pts), hip + knee (4 pts) or rare localizations (around the femoralstump) (7 pts). More than one localization was found in half of the pts. When theclinical suspicion of HO was not proved by radiology, dynamic ultrasonographicexaminations were positive in each cases (17 pts, 16%).Conclusions: (1) HO can occur in more than one localization after CNS or limbinjuries, (2) The most frequent localization was around one or both hip joints, (3)Sonographic examinations showed earlier positivity compared to conventionalradiology, (4) Rare localizations of the HO can induce differential diagnostic prob-lems in clinical practice.

C-693Ultrasonographic experiences of spine-related lesions in patients with backpain: Correlation with MRIW. Jin; Incheon/KR

Purpose: Multiple paraspinal lesions or spine-related lesions have been over-looked on transabdominal ultrasonograhic examination. Therefore, we correlatedtransabdominal ultrasonographic findings with MRI findings in spine-related le-sions.Materials and Methods: 50 patients were underwent transabdominal ultrasono-graphic examinations for routine check prior to surgery. They were 28 men and22 women aged 17 to 70 (average, 45) years. All patients also were checked withMRI. In transabdominal ultrasonographic examination, compression of abdomi-nal wall and inner contents were done. After this, we observed closely the con-tour of body, the height of body, disc height, and paraspinal lesion.Results: In 50 patients, there were 1) compression fractures or burst fractures;23 patients, 2) spondylitis; 7 patients, 3) bone tumorous condition; 2 patients, 4)abscess formations in paraspinal muscle; 3 patients, 5) ankylosing spondylitis; 1patient, and 6) disc herniation; 14 patients. In these patients, transabdominal

ultrasonographic findings were relatively correlated with MR findings, but lesionsin posterior and middle elements of spine could not be evaluated with transab-dominal ultrasonographic approach.Conclusion: Despite of many limitations of transabdominal ultrasonographicexamination for detection of spine and paraspinal lesion, when spine and par-aspinal structures or lesion are visible on transabdominal ultrasonography, ultra-sonography suggested to be a screening method in patients with back pain. Inparticular, ultrasonography was superior to MRI in detecting the minimal changeof anterior disc, prediscal space, or anterior longitudinal ligament of spine.

C-694Creation of a radiological musculoskeletal database (DB) for statisticreferrement, differential-diagnosis and didactic use (STUART project)S. Trupiani, E. Baldan, R. Stramare, C. Saccavini, L. Bacarini, G. Feltrin;Padua/IT

Purpose: To create a radiological DB, with normal and pathologic cases, to beused for statistic endings, differential-diagnosis and for consultation.Methods and Materials: The DB is available to everyone who as investigation orconsultation needs or else for cases submission; for this reason is necessary tofollow some fixed criteria unless the case is not accepted. The submission mo-dalities have a starting schedule that contains: patient's anagraphic data, docu-mentation source, sequence of technical-methodological procedures used, adescription of every semeiological aspect contained in every single image, Gam-uts criteria-based diagnosis and final diagnosis. The cases are resumed by ACRcode. The definitive diagnosis, that contain a synthesis of anatomical-clinical anddiagnostic aspects about the pathology observed, is open to critical observationsby everyone that is consulting the DB. Every DB consulter is able to introduce hisopinion in a special window. The case report ends with a bibliographic correlationthat contains the latest literature articles about the argument.Conclusions: The DB contents can be utilized as a cases archive for clinicalresearch (for this aspect, very important is the ACR code), or as a support in thediagnostic report making, or as a didactical archive. Moreover the DB users canexchange their opinions, modify or add informations for every case by the web.

C-695Radiograph interpretation by A&E junior staffT.A. Szyszko, A.W. Mitchell, H.T. Millington; London/UK

Purpose: To look at the accuracy of interpretation of A&E radiographs by A&Ejunior staff, to identify common misses and overcalls.Material and Methods: 300 A&E radiographs were audited. Interpretation of eachradiograph was indicated with a chinagraph mark. An "N indicated a normal film.An arrow indicated an abnormality. An arrow + ? Indicated a possible abnormal-ity. The median time for radiological reporting was recorded in terms of workingdays.Results: 59% of all radiographs were marked with a chinagraph. Of those markednormal, 15% had missed an abnormality, mainly chest pathology. Of those markedwith an arrow, 45% were in fact normal. These were most commonly normal var-iants on lower limb films especially bipartite patellae as well as vessels and car-diac fat pads on chest films. Upper limb films were most accurately interpreted inA&E. A&E radiographs were reported within a median of one working day. Re-ports at variance with the initial interpretation were communicated back to A&Eimmediately by fax.Conclusion: Radiological reporting of A&E films is meeting the standard recom-mended by the RCR. The chinagraph system informs the radiologist of the initialinterpretation of the film; hence if the radiological report is at variance with this,the A&E department can be immediately notified. A&E junior staff are confidentwith upper limb films but have difficulty with chest films and normal variants. Thisinformation can be used to target teaching.

C-696MRI findings of brucellar spondylodiscitisH. Ozdemir, K. Demirdag, M. Cihangiroglu, Z. Bozgeyik, P. Yuce; Elazig/TR

Purpose: To present MRI findings of brucellar spondylodiscitis.Materials and Methods: Brucellosis was diagnosed with clinical findings, =1/160 titers of brucella agglutination tests and positive blood cultures. MRI wasperformed to patients with cervical and lumbar pain and spondylodiscitis wasdetected in16 of them. Signal changes and enhancement patterns of interverte-bral discs, vertebral bodies, paravertebral soft tissues, vertebral endplates andepidural spaces were assessed.Results: 7 patients were female and 9 patients were male. Only 1 discal involve-

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ment was present in 15 cases (93.7%) and 4 discal involvement was present in 1case (6.3%). 15 patients had soft tissue involvement and abscess was present in2 patients. All cases showed vertebral and discal enhancement. 9 patients showeddiffuse involvement of vertebral corpus and 5 patients showed endplate involve-ment. 2 cases showed both vertebral corpus and endplate involvement. Interver-tebral space narrowing was present in 13 cases, height loss in vertebral bodywas observed in 2 cases and 16 cases showed end plate deformities. We detect-ed epidural extension in 6 cases, posterior longitudinal ligament (PLL) elevationin 12, spinal cord compression in 9 and root compression in 2 cases.Conclusion: Spondylodiscitis is a rare complication of brucellosis and it can causepermanent neurologic deficits and spinal deformities. MRI is a very sensitive andnon invasive imaging technique which must be firstly preferred for the early diag-nosis of spondylodiscitis.

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C-697Preoperative evaluation of intracranial aneurysms: Comparison of three-dimensional multi-detector CT angiography (3D CTA) with volume rendering(VR) and surface shaded display (SSD) techniques and conventionalangiographyJ. Oh, W. Yoon, J. Seo, J. Kim, J. Park, H. Kang; Gwangju/KR

Learning Objectives: 1. To recognize the unique usefulness of 3D-CTA-VRT inthe preoperative evaluation of intracranial aneurysms. 2. To know the differencebetween DSA and 3D-CTA-VRT and SSD in the evaluation of the anatomy ofintracranial aneurysms. 3. To learn the strengths and limitations of 3D-CTA-VRTand SSD in the assessment of intracranial aneurysms.Background: To compare three dimensional (3D) multi-detector CT angiography(CTA) with volume rendering technique (VRT) with 3D CTA with surface shadeddisplay (SSD), and two dimensional (2D) digital subtraction angiography (DSA)in the detection and evaluation of intracranial aneurysms.Imaging Findings: A total of 31 aneurysms in 26 patients were evaluated. Allwere proved at surgery. Five small aneurysms were not depicted at 3D-CTA-SSD(three were less than 3 mm, two were less than 5 mm). But only three smallaneurysms were missed in 3D-CTA-VRT (two were less than 3 mm, one wasless than 5 mm). In 21 (81%) of the 26 patients, 3D-CTA-VRT gave additionalinformations: orientation (n = 11), defining exact neck anatomy (n = 16), incorpo-ration of vessels into aneurysm (n = 10), lobulation (n = 10), and blebs of aneu-rysms (n = 8).Conclusion: 3D-CTA-VRT is superior to 3D-CTA-SSD in the detection of verysmall aneurysms and evaluation of complex anatomy of intracranial aneurysms.

C-698Gadolinium enhanced ultra-fast MRA: A primary diagnostic tool in therecognition and follow-up of dural sinus thrombosisS. Gaudino, T. Tartaglione, F. Molinari, V. Valentini, C. Colosimo; Rome/IT

Dural sinus thromboses (DST) are not extremely rare, they still account for 5% ofictus in young adults. They need an accurate diagnosis at the onset of symptoms,and during the follow-up, to reduce the risks related to prolonged thrombolytictherapy. Digital subtraction angiography (DSA) and, in the last years, phase con-trast MR angiography (PC MRA) with conventional MR sequences have becomethe methods of choice for DST diagnosis. Our purpose was to evaluate the use-fulness of gadolinium-enhanced ultrafast MRA (GE-UF MRA), routinely employedin supra-aortic vessel evaluation, in the diagnosis and follow-up of DST.Materials and Methods: We retrospectively evaluated 12 patients with diagno-sis of DST, studied using 1.5 T magnet, conventional SE, TSE and GE-UF MRAsequences. We could compare GE-UF MRA images with DSA in 3 patients andPC MRA in 5 patients.Results: In all 3 DSA controlled patients, we found a complete agreement be-tween GE-UF MRA and DSA concerning location and extent of DST. In all 5patients with both GE-UF and PC MRA, the overall DST diagnosis was identical,even if the diagnosis of minimal dural sinus involvement was easily and defini-tively assessed with UF-GE MRA, which allows a superior diagnosis confidence.Conclusions: Our preliminary experience suggests that GE-UF MRA is a veryfast modality, is easily obtained and analyzed and has a superior diagnostic con-fidence compared to PC MRA. In our opinion GE-UF MRA should be proposedas the primary diagnostic tool in the recognition and follow-up of DST.

C-699Imaging appearances of fat-containing intracranial lesionsD.R. Warakaulle, P. Anslow; Oxford/UK

Learning Objectives: 1. A brief review of the signal characterstics of fat on MRI.2. Demonstrating the CT and MRI appearances of fat or cholesterol containingintracranial lesions: lipoma, dermoid, epidermoid, craniopharyngioma and cho-lesterol granuloma, along with a brief review of the pathology and clinical presen-tation of these lesions. 3. Examples of chemical shift artefact and fat suppressionsequences used to confirm the presence of fat, which can be useful in narrowingthe differential diagnosis.Background: A small number of uncommon intracranial lesions contain suffi-cient fat and/or cholesterol to have characteristic appearances on CT and MRI,the imaging modalities most often used to investigate intracranial pathology. Fatcontaining lesions have low attenuation on CT. Fat and cholesterol containing

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lesions return high signal on T1 and intermediate signal on T2 weighted MRI. Thepresence of chemical shift artefact and the use of fat suppression sequencesallow a confident diagnosis of a fat containing lesion on MRI.Imaging Appearances: The images were obtained using unenhanced CT androutine MRI sequences for brain imaging (ie sagittal T1, axial T2 and coronalproton density weighted sequences). Fat suppression sequences were some-times used for further clarification.Conclusion: The characteristic CT and MRI appearances of intracranial fat andthe anatomical location of the lesion allow the provision of a narrow differentialdiagnosis using routine imaging protocols. This facilitates decisions on the needfor further imaging modalities.

C-700CT and MRI findings in vascular dementiaA. Guermazi1, Y. Miaux1, S. Salloway2, M. Sieffert1, H. Altman3, R. Pratt3;1San Francisco, CA/US, 2Providence, RI/US, 3Teaneck, NJ/US

Learning Objectives: To review the National Institute of Neurological Disordersand Stroke and "Association Internationale pour la Recherche et l'Enseignementen Neurosciences" (NINDS-AIREN) criteria for the diagnosis of vascular demen-tia (VaD). To present the CT and MR imaging findings consistent with VaD.Background: Vascular dementia represents a very heterogeneous diagnosticcategory. Utilizing the NINDS-AIREN criteria and a centralized imaging rater todetermine eligibility for enrollment in recent large-scale clinical trials testing newtreatments for vascular dementia has provided increased consistency in the di-agnosis of VaD. The diagnostic criteria for probable vascular dementia includethe development of dementia temporally related to stroke with neuroimaging con-firmation. The criteria include a table listing brain imaging lesions associated withvascular dementia. In this study, 520 patients have been screened for the pres-ence of cerebro-vascular disease using brain CT or MRI.Imaging Findings: The wide spectrum of neuroradiological features that areassociated with VaD may result from cerebral small-vessel disease with exten-sive leukoencephalopathy or lacunes (basal ganglia or frontal white matter), ormay be the consequence of single strategically located infarcts or multiple inf-arcts in large-vessel territories. It may also be the consequence of global cere-bral hypoperfusion, intracerebral hemorrhage or other mechanisms such asgenetically determined arteriopathies.Conclusion: Neuroimaging is required for confirmation of cerebrovascular dis-ease in VaD and provides information about the topography and severity of vas-cular lesions. Neuroimaging may also assist with the differential diagnosis ofdementia associated with normal pressure hydrocephalus, chronic subdural he-matoma, arteriovenous malformation or tumoral diseases.

C-701Imaging spectrum of cerebral complications after cardiac surgeryE. Testempassi, G. Katsou, V. Vantali, M. Kolios, D. Exarchos, D. Chondros;Athens/GR

Learning Objectives: To present a systematic approach to imaging findings ofcerebral complications caused by cardiac surgery. To review and understand themechanisms and pathophysiology of cerebral involvement after cardiac surgery.Background: A wide spectrum of neurologic complications may occur after car-diac surgery, such as motor, sensory or visual disturbances, stupor or depres-sion of consciousness. The role of imaging in differentiating a variety of conditionsthat may cause the above neurologic symptoms is very important. Morphologyand patterns of cerebral lesions also enables an assessment of the pathophysi-ology and hemodynamics of brain complications after cardiac surgery. We retro-spectively reviewed the brain CT images of 94 symptomatic patients, who pre-viously had cardiac surgery performed.Imaging Findings: A variety of common and uncommon findings on CT and MRimages of neurologic complications after cardiac surgery are illustrated. Acuteinfarctions involving a vascular territory, hemorrhagic infarctions, multiple infarc-tions, watershed infarctions, bilateral infarctions, braistem and cerebellar infarc-tions, uncal herniation, brain edema and inflammatory processes are depicted.Preoperative cerebral CT or MR images are helpful in diagnosing new lesions inpatients with old infarctions, lacuna or ischemic leucoencephalopathy.Conclusion: The radiologist must be familiar with the imaging appearance ofcomplications that affect the brain after cardiac surgery.

C-702Imaging findings of an ethmoidal dural arteriovenous fistula with venousdrainage in the vein of GalenV.T. Skiadas, A. Prasouli, P. Mitseas, G. Kottas, S. Laxanis; Athens/GR

Learning Objectives: To illustrate the MRI, MRA and angiographic findings of anethmoidal dural arteriovenous fistula (AVF) in the anterior cranial fossa.Background: Ethmoidal AVFs are rare vascular anomalies. Only 129 cases havebeen presented since 1963, when they were first described by Lepoire. They canbe either congenital or acquired lesions. Ethmoidal arteries are the main feedingvessels. The vast majority drain to the superior sagittal sinus and to the cavern-ous sinus. The presenting symptom is intracranial hemorrhage, mostly subarach-noid or intracerebral. Their propensity for hemorrhage justifies immediate surgicalremoval of the lesion.Imaging Findings: An MRI scan was performed demonstrating an abnormal re-gion of signal void, suggesting a vascular anomaly involving the base of the leftfrontal lobe. For further evaluation, the patient underwent an MRA examination. Avascular linear lesion, probably a vein, at the base of the left frontal lobe andenlargement mainly of the left, as well as of the right ocular artery was discov-ered. A digital subtraction angiography (DSA) was performed and an EDAF onthe left ciribriform plate supplied by bilateral ethmoidal arteries was revealed. Itdrained via a dilated abnormal vein to the left vein of Galen. So far, only one othercase has ever been reported with venous drainage to the vein of Galen.Conclusion: Specific MRI and MRA imaging findings should arouse the suspi-cion of an EDAF and DSA can effectively demonstrate the nidus of the lesion, aswell as the feeding and draining vessels and confirm the diagnosis.

C-703Functional MRI: A new diagnostic tool for therapeutic monitoring oftranscranial magnetic stimulation (TMS)F.L. Giesel, A. Hempel, E. Hempel, T. Wuestenberg, U. Seidl, J. Schroeder,H.-U. Kauczor, M. Essig; Heidelberg/DE

Introduction: Recent studies demonstrated acoustic hallucinations in patientswith schizophrenia to be associated with activations in the superior temporal lobes.Based on the hypothesis of focal cortical inhibition, low-frequency transcranialmagnetic stimulation (TMS) was used, resulting in a slight reduction of hallucina-tions in some patients. In this case study, functional magnetic resonance imagingwas employed to image blood oxygenation level dependent (BOLD) effect changesin the temporal lobes under TMS-therapy.Methods: In a curative attempt, a 30-year old schizophrenic patient (DSM-IV)with medication resistent acoustic hallucinations was treated with low-frequencyTMS (fstim = 1 Hz) over a four week period. fMRI was performed in a 1.5 T clin-ical scanner using the standard head coil and a GE-EPI sequence. The TMS-effects were detected based on the event related BOLD-fMRI of auditoryhallucination and auditory hallucinations rating scale. FMRI was performed priorto and after the TMS series to visualize possible cortical activation changes inthe stimulated area. Data analyses were performed with SPM99 (http://fil.ion.ucl.ac.uk.spm).Results: After the third week, the patient presented a reduced frequency of acous-tic hallucinations of approx. 50%, while the loudness of the hallucinations re-mained unchanged over the 4 weeks of stimulation. fMRI demonstrated a BOLDeffect activation reduction after TMS in speech related areas, which exceededthe local stimulation area.Discussion: fMRI data revealed an activation reduction in temporal and tempo-ro-parietal areas after TMS corresponding to the clinical recovery. The combina-tion of TMS and functional imaging is promising, allowing an insight intoneuro-biological mechanisms during TMS intervention, which may help to im-prove treatment success.

C-704Diffusion MR imaging findings of acute encephalopathy from liquid naturalgas (LNG) poisoningW. Cho, S. Kim, J. Kim, S.-J. Bae, J. Kim, J.-Y. Kim, M. Jeong; Seoul/KR

Learning Objectives: To describe the diffusion MR imaging findings of acuteencephalopathy from liquid natural gas (LNG) poisoning.Background: The reported clinical features of acute encephalopathy from LNGare identical to CO poisoning by hard coal but imaging findings are not reported.Recently we experienced a case of acute encephalopathy from LNG poisoning.A 49-year-old male and a 78-year-old female were admitted through the emer-gency room for unconsciousness. Their families smelled fumes in the patient'shouses. Initial levels of COHb were 16 and 6%, respectively. The first man under-

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went immediate hyperbaric oxygen (HBO) therapy and the initial result was ex-cellent. He was discharged with subtle weakness in the right lower extremity. Thesecond woman didn't undergo HBO therapy and was discharged with left hemi-paresis.Imaging Findings: MR imaging with diffusion-weighted images (DWIs) and ADCmaps were performed at admission. The first man showed high signal intensitiesbilaterally of the perirolandic cortex and occipital cortex on T2-weighted images(T2WIs) and DWIs. These areas showed dark signal intensities on ADC maps,suggesting cytotoxic edema. The second woman showed high signal intensitiesbilaterally of the perirolandic cortex, bilateral globus pallidus and left occipitalperiventricular white matter on T2WIs and DWIs. These areas also showed darksignal intensities on ADC maps.Conclusion: MR imaging findings are similar to CO poisoning in that cytotoxicedema involves the globus pallidus bilaterally. But we experienced some differentMR imaging finding to CO poisoning in that cytotoxic edema involves the periro-landic area bilaterally, which can be seen in profound perinatal asphyxia in terminfants.

C-705Computed tomography angiography (CTA) imaging of non traumaticintracranial hemorrhage in adultsM. Rodallec, A. Feydy, J.-M. Colombani, A. Helias, V. Vilgrain; Clichy/FR

Learning Objectives: 1. To understand the advantages and limitations of CTangiography in non traumatic intracranial hemorrhage. 2. To understand the clin-ical use of CTA for the detection and therapy planning of intracranial aneurysmsand arteriovenous malformations. 3. To recognize cerebral venous thrombosis.Background: Most intracranial hemorrhages in young and midddle-aged adultsare caused by aneurysms. In our institution, all patients with a non enhanced CTscan showing an intracranial hemorrhage are first explored by CTA for five years.Volumic acquisition of the brain with multislice detector CT at arterial phase isanalyzed systematically with 2D maximum intensity projection (MIP). In mostcases, volume rendering reconstructions are also performed. All patients withnegative CTA have a conventional cerebral angiography to visualize entire intrac-ranial circulation. CTA and conventional cerebral angiography are performed by4 senior neuroradiologists.Imaging Findings: Multislice detector CTA explores all the locations of intrac-ranial aneurysms. CTA is a quick and reliable technique for the detection andtherapy planning of intracranial aneurysms. Rarely, CTA depicts arteriovenousmalformations. In some cases, hemorrhage suggests cerebral venous thrombo-sis that is also diagnosed on CTA. We present selected cases emphasizing theutility and the limits of the technique.Conclusion: CTA is a non invasive, reliable tool to explore patients with nontraumatic intracranial hemorrhage. The use of cerebral CTA by expert neuroradi-ologists allows a significant reduction of the number of emergency diagnosticangiography required.

C-706Brain activations during bi-script reading in Chinese: A direct comparisonof alphabetic and non-alphabetic reading using functional magneticresonance imaging (fMRI)Y. Li1, X. Feng1, Y. Chen2, W. Tang1; 1Shanghai/CN, 2Oxford/UK

Learning Objectives: A direct comparison between reading alphabetic and non-alphabetic scripts was done using fMRI during bi-scripts reading of Chinese char-acters and its alphabetic sound symbols known as Pin Yin.Background: Six Mandarin speakers and skilled readers of Chinese participat-ed in this study. All the subjects were right handed. Experiments were performedon GE MRI scanner at the Huashang Hospital. Sixteen slices covering the wholebrain were collected with blood oxygenation level dependent (BOLD) sequence.The anatomical images were obtained in the transverse plane during the samescan session with 3D FSPGR sequence after the functional measurements. Thefour types of stimuli were distributed equally in two main conditions i.e. Chineseand Pinyin. In each condition, half stimuli were words and half were non-words.Data analysis was carried out using FEAT, the FMRIB Easy Analysis Tool, anextension of MEDX.Imaging Findings: The activations in the right inferior frontal gyrus, the left fusi-form gyrus, the bilateral cuneus and the bilateral superior frontal gyrus were strong-er for Chinese character reading than for pinyin reading. The activations in thebilateral supramarginal gyus, the bilateral superior parietal gyrus and the bilater-al middle frontal gyrus, however, were stronger for pinyin reading than for Chi-nese character reading. Different parts of the middle temporal gyrus were alsoactivated for reading these two scripts. The low hemispheric lateralisation for

both Chinese character and pinyin reading indicate an important role for bothhemispheres in reading.Conclusion: fMRI is one of the best methods of illustrating difference of brainactivations during alphabetic and non-alphabetic reading.

C-707MRI of the brain in inherited neurometabolic disorders: A pictorial reviewS.P. Prabhu, S.A. Barnard, N. Stoodley, S.A. Renowden; Bristol/UK

Learning Objectives: To illustrate typical MRI appearances of the brain of pa-tients with inborn errors of metabolism and toxic inherited white matter disease.A simple algorithm to unravel the possible cause of imaging findings is incorpo-rated as part of this presentation.Background: The diagnosis of a neurometabolic disease is usually suggestedby clinical history and physical findings and is confirmed by appropriate specialstudies, which may include neuroradiological investigations. When the patient isreferred with a nonspecific diagnosis, such as delayed development, the aim is tosuggest the possibility of a neurometabolic disorder and initiate further evalua-tion including possible therapy and genetic counselling. On occasion, routineneuroradiological studies may incidentally produce results suggestive of a neu-rometabolic disorder.Imaging Findings: Disorders including glutaric aciduria, pyruvate dehydroge-nase deficiency, Leigh's encephalopathy, maple syrup urine disease, methylmalon-ic aciduria, adrenoleukodystrophy, metachromatic leukodystrophy, Krabbe'sleukodystrophy and Pelizaeus-Merzbacher disease are illustrated. A pattern ap-proach based on which part of the brain is affected is used to provide an aid tothe diagnosis.Conclusion: Magnetic resonance imaging plays an important role in the identifi-cation, localisation and characterisation of underlying white matter abnormalitiesin affected patients and is also extensively used to monitor the natural progres-sion of such disorders and the response to therapy.

C-7083D digital subtraction angiography (3D DSA) of intracranial aneurysms:Comparison with conventional 2D digital subtraction angiography and threedimensional multi-detector CT angiography with volume renderingtechnique (VRT) and surgical findingsJ. Han, J. Seo, W. Yoon, J. Kim, J. Park, H. Kang; Gwangju/KR

Learning Objectives: 1. To recognize the unique usefulness of 3D-DSA in thepreoperative evaluation of intracranial aneurysms. 2. To know the difference be-tween 3D-DSA and 3D-CT angiography with VR in the evaluation of the anatomyof intracranial aneurysms. 3. To learn the strengths and limitations of 3D-DSAand 3D-CT angiography with VRT in the assessment of intracranial aneurysms.Background: To compare 3D-DSA with 2D-DSA and 3D multi-detector CT ang-iography (CTA) with VRT in the detection and evaluation of intracranial aneurysms.Imaging Findings: A total of 101 aneurysms were evaluated. Seven very smallaneurysms (diameter less than 3 mm) and two small aneurysms (less than 5 mm)that were not depicted at conventional 2D-DSA and 3D-CTA-VRT were depictedat 3D-DSA and all were proved at surgery. In 72 (90%) of the 80 patients, 3D-DSA gave additional informations: orientation (n = 26), defining exact neck anat-omy (n = 60), incorporation of vessels into aneurysm (n = 30), lobulation (n = 32)and blebs of aneurysms (n = 35).Conclusion: 3D-DSA is superior to 2D-DSA and 3D CTA-VRT in the detection ofvery small aneurysms and evaluation of complex anatomy of intracranial aneu-rysms.

C-709Low and high b-value brain diffusion weighted imaging: From the basics toapplicationsA. García Gerónimo, J.M. García Santos, J.I. Gil Izquierdo, S. Torres del Río,M.F. Cegarra Navarro, F. Lloret Estañ; Murcia/ES

Learning Objectives: To present a pictorial on the basics of diffusion weightedimaging (DWI), low and high b-value performance on imaging and clinical appli-cations.Background: DWI is a useful diagnostic tool that improves our background un-derstanding to pathology. The b-value choice has a significant repercussion onsignal-to-noise ratio, DWI contrast and T2 shine-through phenomenon. We havecreated a straightforward animated microsoft power point presentation showingdiffusion physical principles and its imaging consequences. The DWI studies from50 normal subjects and 50 patients (including brain tumours, encephalitis, demy-elinating and cerebrovascular diseases) were further analyzed. All studies were

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carried out with three different b-value (1000, 2000, 3000 s/m2). Exponential im-ages and apparent diffusion coefficient (ADC) maps were subsequently comput-ed. In normal individuals, the signal and ADC in the hemispheric white matter,basal ganglia and brain cortex were measured. Lesions' signal with different b-values, and their contrast rate on computed maps, were subjectively compared.Imaging Findings: When we visualised some acute lesions, higher b-valuesimproved contrast compared with lower b-values. Other lesions, like tumours,showed mixed DWI intensities and their contrast also improved with high b-valueimages. Exponential and ADC maps were useful for discarding T2 shine-througheffects, moreover with low b-values, but contrast rate was significantly dismissed.Conclusion: High b-value DWI provides a better contrast and a reduced T2 shine-through phenomenon but it does not display more lesions than low b-value DWI.As computed maps add useful information to that provided by DWI, it seems thatthe b-value choice depends on each group preferences.

C-710Utility of MR spectroscopy, diffusion and perfusion MR imaging in theevaluation of brain lesions in AIDS patientsL.C.H. da Cruz Jr, R.C. Domingues, J.F.R. de Souza, R.C. Domingues;Rio de Janeiro/BR

Purpose: To review the MR appearance of brain diseases in AIDS patients. Torecognize the utility of new MR techniques in the correct diagnosis of the differ-ent causes of neurologic involvement in AIDS patients. To demonstrate the im-portance of correlative imaging in the treatment and prognosis of those patients.Methods and Materials: We retrospectively reviewed 43 patients (27 men, 16women, average age 33.4 years) with neurologic symptoms in which all examswere performed on a 1.5 T clinical scanner (GE, USA). Diffusion weighted imag-ing were performed using a diffusion gradient of 1000 sec/mm2 applied in threeaxis planes. MR perfusion was performed using TR 1500 ms and TE 90 ms, fol-lowing bolus infusion of intravenous contrast material, obtaining relative cerebralblood volume maps (rCBV). To determine metabolites a MR spectroscopy (MRS)was performed with single-voxel PRESS-30 sequence.Results: We classified the brain lesions in two majors groups: one with brainlesions that cause mass effect (n = 26) and the other with infiltrating white matterlesions (n = 14). Three patients did not have any lesion. Mass effect lesions couldbe inflammatory/infectious diseases: toxoplasmosis (n = 9), tuberculosis (n = 5),cryptococcosis (n = 2) and neoplasic lesions: lymphoma (n = 10). As infiltratingwhite matter lesions, we included progressive multifocal leukoencephalopathy(n = 4), HIV encephalopathy (n = 6), CMV infection (n = 1) and HSV infection(n = 1). Brain infarct (n = 2) is an important condition in AIDS patients and ismore prevalent than in the general population.Conclusion: The MRS, diffusion and perfusion MRI have been shown to be ex-tremely useful in characterizing and making the correct diagnosis of brain lesionsin AIDS patients.

C-711Brainstem stroke: Anatomical-clinico-radiological correlations of vascularterritoriesP. Bermudez Bencerrey, A. Carvajal, A. Rovira, M. Zauner, C. Martin,J. Branera; Sabadell/ES

Learning Objectives: Knowledge of the brainstem vascular territories. Basicanatomy, pathways and functions related to brainstem stroke (BSS). Differentialdiagnosis of lesions mimicking ischaemic BBS.Background: Vascular territories in the brainstem have characteristic distribu-tions. It is important for the prognosis and management of patients with BSS tounderstand clinical findings and exactly correlate topography of the lesions withits vascular territories of the brain stem.Procedure Details: We have retrospectively reviewed the MRI of patients withBSS in the last five years in our center.Conclusion: A careful analysis of MRI findings allows us to establish an accu-rate clinical-anatomic correlation in patients with brainstem infarction. MRI is thegold standard technique to study the BSS allowing an understanding of lesionsrelated to vascular territory.

C-712"String-knot shape" enhancement: A presenting feature of cerebralsparganosis in MRIC. Shuguang; Shanghai/CN

Learning Objectives: To describe the MRI character of cerebral sparganosis.Background: The cases of cerebral sparganosis have shown a trend of increased

frequency with the change of eating habits, especially eating under- cooked prod-ucts of snake or frog. There is sparse literature available which illustrates non-specific findings of cerebral sparganosis in MRI including nodular lesions, whitematter degenerations or haemorrhages. MR imaging of six patients with cerebralsparganosis were reviewed retrospectively in our exhibit.Imaging Findings: All six cases of cerebral sparganosis showed a single lesion.The location of lesions were superficial with three in the parietal lobe, one in thefrontal lobe, one in the temporal lobe and one in the posterior part of brain stem.Five lesions were irregular in shape and about 3 cm diameter with moderatehypointensity on T1WI and hyperintensity on T2WI. A presenting feature of theparasitic granuloma was a "string-knot shape" enhancement, which was demon-strated in 5 cases. One case showed a cystic lesion with peripheral enhance-ment. There was slight hyperintensity surrounding the nodular lesions whichcorresponded to edema. No white matter degenerations or hemorrhages wererevealed which had been described by previous studies. Diagnosis of spargano-sis was made on the basis of characteristic enhancement in MRI for 5 cases andone was diagnosed as parasitic infectious disease. During surgery, live larvas ofsparganum were successfully removed in five cases with "string-knot shape"enhancement lesions. In the case with a cystic lesion, only fragments of wormbody were obtained.Conclusion: "String-knot shape" enhancement is a characteristic MRI findingwhich has a high value in diagnosis of cerebral sparganosis.

C-713Cystic lesions of the brain: A pictorial essay with MR imagingS. Cakirer, M. Basak, E. Serin, I. Ince, M. Birinci; Istanbul/TR

Learning Objectives: To illustrate the spectrum of intracranial cystic lesions. Toclarify the underlying reasons for specific MR appearances. To define the role ofadditional MR sequences for differential diagnosis of cystic lesions with similarappearances.Background: Intracranial cystic lesions are common in radiological practice. Thedifferential diagnosis of intracranial cystic lesions includes a wide spectrum ofdiseases and is much easier with the use of standard and advanced MR imagingtechniques including diffusion and perfusion-weighted studies and MR spectros-copy. Between January 2002 and August 2003, 358 patients with intracranialcystic lesions were studied in our institute. MR imaging characteristics of thelesions, the underlying reasons for the specific MR appearances and the role ofadditional MR sequences for the differential diagnosis were defined following thecategorization of the lesions.Imaging Findings: Intracranial cystic lesions can be categorized into five groups.They include cystic components of primary and secondary neoplasms (glioblas-toma multiforme, pilocytic astrocytoma, pleomorphic xanthroastrocytoma, epend-ymoma, ganglioglioma, central neurocytoma, hemangioblastoma, macroadenoma,craniopharyngioma, metastases), benign developmental cysts (arachnoid cyst,colloid cyst, epidermoid cyst, dermoid cyst, pineal cyst, Rathke cleft cyst, choroidplexus cyst), post-infectious and inflammatory cysts (abscess, parasitic cysts in-cluding cystisercosis and hydatid cyst, multiple sclerosis, ADEM), post-traumaticor post-infarct cysts (porencephalic cyst, encephalomalacic cyst, leptomeningealcyst) and normal variant cysts (enlarged tumefactive perivascular spaces, ca-vum septum pellucidum, cavum vergae).Conclusion: The underlying reasons for MR appearances of cystic lesions, roleof additional sequences for their diagnosis and differential diagnoses betweenlesions with similar appearances have been evaluated.

C-714Imaging findings of cerebral involvement in end-stage renal failure patientson hemodialysisG. Sparacia, C. Sarno, E. Cracolici, M. Governale, F. Cannizzaro, R. Lagalla;Palermo/IT

Learning Objectives: To illustrate the imaging findings at CT and MRI of centralnervous system involvement in end-stage renal failure patients on hemodialysis.Background: Patients in end-stage renal failure who have been on long-termhemodialysis tend to develop central nervous system complications character-ised by white matter changes, osmotic demyelination syndrome, reversible pos-terior leukoencephalopathy, cerebral atrophy, intracranial hemorrhage and cerebralinfarct.Imaging Findings: A spectrum of central nervous system abnormalities depict-ed at CT and MRI are presented with follow-up imaging.Conclusion: Imaging findings in patients in end-stage renal failure who havebeen on long-term hemodialysis can demonstrate central nervous system com-plications in the form of white matter changes, osmotic demyelination syndrome,

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reversible posterior leukoencephalopathy, cerebral atrophy, intracranial hemor-rhage and cerebral infarct.

C-715CT angiography of the circle of Willis in diagnostic evaluation of SAHZ. Pavcec, D. Ozretic, A. Pal, H. Saghir, B. Latin, Z. Perhoc, I. Zokalj;Cakovec/HR

Learning Objectives: To define advantages and limits of computed tomographicangiography (CTA) as a imaging method of choice in evaluation of acute sub-arachnoid haemorrhage. To describe the technique and its results in 41 patients.Background: CTA is a most appreciated offspring of spiral CT technology. Volu-metric acquisition and scanning during peak contrast enhancement allows veryaccurate computer-generated 3D-reconstructions of vasculature.Intracranial aneurysms are responsible for 75% of all nontraumatic subarachnoidhaemorrhages (SAH). The majority of aneurysms are located on the Circle ofWillis. In this exhibit we will describe the use of CTA in diagnostic evaluation ofSAH and the advantages and the limits of the method compared to the othersavailable. Between April 2001 and August 2003, CTA was performed in 41 pa-tients with SAH. The technique and findings are described and illustrated.Procedure Details: CTA was performed on a single-slice spiral CT scanner (HiS-peed LXi, GE) with slice thickness 1 mm, reconstruction interval 0.5 mm andpitch 1. An area from base of the skull to above the clinoid processes was cov-ered. A non-ionic contrast medium was injected in cubital vein (370 mgI/ml, 4 mL/s, 100 mL) and scanning started after delay of 15-20 s. Corresponding 3D imagereconstructions (maximum intensity projection (MIP) and volume rendering (VR))were produced at accompanying workstation (AW 4.0, GE).Conclusion: Intracranial aneurysms were visualized in 35 of 41 patients, butonly 23 were further evaluated. Although intra-arterial DSA is still regarded as"gold standard" in diagnostic evaluation of the SAH, CTA can serve as guidancefor intervention.

C-716Proton MR spectroscopy of the brain: Patterns and pitfalls in diagnosis ofbrain tumorsC.C.T. Lim, H. Parmar, H. Yin, V.G.E. Chua; Singapore/SG

Learning Objectives: To review typical spectral patterns of brain tumours andnon-neoplastic lesions and to understand the potential mimics and pitfalls in us-ing proton magnetic resonance spectroscopy (MRS).Background: MRS provides metabolic information that is independent of con-ventional MR imaging. MRS has been applied to distinguish brain tumors fromother diseases and is available on many clinical scanners. Post-processing ofsingle-voxel and multi-voxel studies may be presented either as metabolic spec-tra or parametric maps in the latter.Imaging Findings: In brain tumours, there is elevation of choline (a marker ofcell membrane turnover) and decreased N-acetyl aspartate (a neuronal marker)and creatine (an energy substance). Lactate and mobile lipids are sometimespresent. Conversely, non-neoplastic lesions typically do not show increasedcholine. Lactate is sometimes detected in ischemia, abscess and demyelination.Toxoplasmosis and tuberculomas typically show a dominant lipid peak. Bacterialbreakdown products including acetate, alanine and succinate are detected inabscesses. Occasionally, increased cellular infiltrates and reactive astrogliosismay result in elevated choline levels, mimicking tumour.Conclusion: With increasing clinical application of MRS, radiologists should befamiliar with common spectral patterns of brain disease as well as the potentialpitfalls in interpretation.

C-717Decreased signal intensity on T2-weighted MRI in the basal ganglia inpatients with white matter disordersP. Arguis, S. Capurro, J. Berenguer, T. Pujol, M. Olondo, J.M. Mercader;Barcelona/ES

Learning Objectives: To describe some aspects of brain iron metabolism whichcan be studied by MRI. To learn how decreased signal intensity on T2-W imagesin the basal ganglia can be seen in several white matter disorders.Background: The iron is taken up by capillary endothelial cells in basal gangliaand then is transported axonally to projection sites where it is used in local me-tabolism, there the iron is stored in oligodendroglia cells. Interruption of normalaxonal transportation of iron caused by white matter abnormality might lead toincreased accumulation of iron at the basal ganglia since it could still be taken upbut not be transported. It is generally accepted that there is a correlation between

the accumulation of iron in the extrapyramidal system and the degree of hypoin-tensity observed at this site on T2-weighted images.Imaging Findings: Low signal intensity on T2-W images were observed in thebasal ganglia in 14 patients with different white matter disorders (congenital,multiple sclerosis, postradiation toxicity, ischemia, AIDS-related and tumoral). MRstudies were performed with a 1.5 T scanner.Conclusion: Decreased signal intensity on T2-W images in the basal gangliacan be seen in several white matter disorders.

C-718Typical and atypical MRI findings and clinical presentation of WernickeencephalopathyM. Saborido, L. Concepción, E. Feliu, S. López, E. Roa, M. Garcia, I. Al-Assir;Alicante/ES

Learning Objective: Review the different risk factors, MR findings, clinical pres-entation and evolution, both frequent and infrequent.Background: Wernicke Encephalopathy (WE) is a severe neurologic disordercaused by thiamine deficiency related to malnutrition or malabsorption of B1 vita-min that occurs mainly, but not exclusively, in alcoholic patients. We reviewed therisk factors as well as the usual and unusual clinico-radiological features includ-ing two cases in non-alcoholic patients (one with gastroesophageal reflux andother with pyloric stenosis secondary to biliogastric reflux). A third of patientswith acute WE present with the classic clinical triad: opthalmoplegia, ataxia andconfusion. Other initial manifestations are hypothermia, hypotension, coma, nu-tritional polyneuropathy, cardiovascular involvement. Early diagnosis is crucialbecause of non-specific clinical findings, a high mortality rate but a possible com-plete recovery with immediate thiamine replacement.Imaging Findings: Typical MR findings include symmetrical signal changes inmedial thalami, tectum and periaqueductal region. In the acute stage, enhance-ment after contrast injection may be visible in these regions as well as in themamillary bodies, but at chronic stages atrophy is the main finding. Atypical fea-tures described include signal changes in the cerebellum, dentate nuclei, pons,red nuclei, basal ganglia and central and precentral sulci. Massive haemorrhag-es are rare whereas microscopic foci are frequent. Differential diagnosis includesde/dysmyelinating disorders, infarctions and Creutzfeldt-Jakob Variant but sym-metrical distribution of findings rules out most of them.Conclusion: WE is a reversible, severe disorder and a high index of suspicion isrecommended to diagnose it, even in non-alcoholic patients.

C-719MRI in cranial trauma: Hemorrhagic intracranial complicationsA. Buzzi, P. Buzzi, M. Mancini, A. Mancini; Buenos Aires/AR

Learning Objectives: To summarize and picture the MRI appearance of the dif-ferent hemorrhagic complications of head trauma affecting the various intracrani-al compartments. To understand the variable MRI appearance of hemorrhage inthe various intracranial compartments.Background: Hemorrhagic lesions are a common finding in patients with headtrauma and are usually studied with CT. MRI can be performed in patients withcritical clinical status but normal CT studies to find subtle abnormalities, or toimprove definition and find other lesions in patients shown to have haemorrhagiclesions on CT, and even in patients without a previous CT scan. Because of thevariable and sometimes equivocal MRI appearance of hemorrhage, the knowl-edge of the oxidation process of hemoglobin and the characteristics of its oxida-tion products as well as the differences in the various intracranial compartmentsis important to avoid misdiagnosis.Image Findings: The studies were performed with two MRI scanners: a 1.5 T(Toshiba VISART) and a 0.5T (Toshiba MRT 50 SP). We show the characteristicsof epidural, subdural, subarachnoid, intraventricular and parenchymal hemorrhage,in various stages of hemoglobin oxidation. MRI of hemorrhage is complex be-cause there are innumerable factors that potentially influence the signal intensitypatterns of hemorrhage.Conclusion: The identification of intracranial hemorrhage is critical to appropri-ate patient management and, ultimately, to outcome. The radiologist should beaware of the complex MRI appearance of hemorrhage and of the technical fac-tors involved.

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C-720A detailed, comprehensive and quickly performed functional MRI approachto brain tumors in clinical praticeL.C.H. da Cruz Jr, J. Nogueira, R.C. Domingues, F.F. Brito, T. Tapioca,R.C. Domingues; Rio de Janeiro/BR

To determine whether functional MR imaging sequences (diffusion tensor, trac-tography, perfusion, spectroscopy, blood oxygenation level dependent- BOLD),can help add new information to the pre-surgery approach to brain tumors. Todetermine the efficiency and efficacy of these news tools in evaluating brain tumors.During the period of 6 months, MR exams of 25 patients with brain tumors (17men, 8 women; mean age 47.5years) were performed in a 1.5 T clinical scanner(Siemens, Germany), using MR clinical standard protocol and functional sequenc-es (diffusion tensor imaging, perfusion, spectroscopy and BOLD sequence). Allthe patients had their histopathology diagnosis confirmed by brain biopsy andsurgery; glioblastoma multiforme (n = 9), anaplastic astrocytoma (n = 6), low gradeglioma (n = 6), gliomatosis cerebri (n = 1) and metastases (n = 3).High grade glioma and metastases had hyperperfusion, high picks of choline andlow N-acetylaspartate (NAA). Low grade glioma and gliomatosis cerebri had lowrelative cerebral blood volume, low NAA, high choline and myoinositol. Diffusiontensor imaging showed alterations of the main tracts within and nearest the highgrade tumors. Low grade tumors had main tracts dislocated but not interrupted.The white mater tract were preserved in gliomatosis cerebri. BOLD sequenceidentified the sensory-motor and language activating areas.MR imaging has been used to evaluate brain tumors. With new neuroimagingadvanced tools, we can do this analysis in a more accurate and precise way andit takes less time than it was thought to. It is a huge contribution to the evaluationand management of patients, providing a type of diagnosis close to histopathol-ogy diagnosis.

C-721Individual approach to recanalization treatment of acute ischemic brainstroke according to the various MR findings in the hyperacute stageY. Jang, D. Lee, H. Kim, J. Lee, C.-G. Choi, H.-K. Lee, S. Kim, D. Suh;Seoul/KR

We will present various MR findings of hyperacute ischemic stroke with our ownexperiences in the management of patients according to the findings. A total of441 patients underwent an "acute stroke MR" imaging protocol between Mar.2001 and Jun. 2003. The protocol included initial T2-weighted image (WI), diffu-sion WI (DWI, b = 2000), time-of-flight (TOF) MR angiography (MRA) and per-fusion WI (PWI). Follow-up T2WI, DWI, TOF MRA and neck vesselcontrast-enhanced MRA were obtained three to five days after the insult. Weretrospectively reviewed the MR findings and clinical courses of 193 patientswith anterior circulation territorial infarction. Those with ICA and MCA lesionswere divided into six and five groups respectively, according to the level andmechanism of the occlusion. PWI findings can be another factor in the manage-ment planning. Here, we will present representative cases of each group anddiscuss the management with thorough consideration of various factors, such aspattern and type of arterial occlusion, the extent of DWI/PWI mismatch, the dura-tion of the ischemia, age of the patient, the severity of neurologic deficits, or useof other anticoagulants, etc. We believe that MR imaging is very helpful in theevaluation and management planning of patients with hyperacute stroke. Thetreatment should be individualized to enhance the effectiveness and safety of thevarious treatment modalities.

C-722Similarities and differences in functional connectivity of the prefrontalcortex: Task and item-related aspects of episodic memory processesM.O. Fluess1, M. Beu1, D. Schmidt1, H.-W. Müller1, B.J. Krause2;1Düsseldorf/DE, 2Ulm/DE

Purpose: In episodic memory (EM), task- and item-related processes have beenpostulated to contribute to asymmetries in cortical involvement with the prefrontalcortex (PFC) being of particular interest. This study demonstrates task- and item-related differences in functional connectivity of PFC in verbal vs non-verbal EM.Methods and Materials: Twelve healthy volunteers performed visual non-verbal(line drawings of known objects) and verbal (abstract words) EM tasks undergo-ing O-15-butanol-PET to measure regional cerebral blood flow. Using correlationanalyses, functional connectivity of item-related (verbal vs non-verbal) process-es during episodic encoding and retrieval was assessed.Results: Across all tasks/items we observed strong prefrontal interactions re-garding the dorsolateral (DL) and frontopolar (FP) PFC. During encoding we found

bilateral but left dominant PFC interactions with any material, right DLPFC showedno interactions during the abstract word condition. During retrieval of pictures wefound an increase of right FPPFC interactions and a symmetrical increase ofDLPFC interactions. During retrieval of abstract words we observed an increaseof left FPPFC interactions, while right DLPFC showed no interactions. Memoryperformance was higher for pictures vs words.Conclusion: Firstly, our results support the idea of a common bilateral PFC in-volvement across different stimuli and mnemonic operations. Secondly, item-re-lated processes point to a left lateralized PFC involvement for words and a bilateralPFC involvement for pictures. These data support the "dual coding" hypothesis,introduced by Paivio (Paivio, 1971; Paivio 1991), postulating a double (verbal andnon-verbal) processing pathway for pictoral stimuli, hence a supplementary mne-monic strategy to increase memory performance.

C-723Perfusion weighted dynamic susceptibility (DSC) MRI in unilateral severeinternal carotid artery stenosis before and after thrombo-endoarterectomy(TEA): Evaluation of middle cerebral artery and border territoriesF. Gaudiello, S. Marziali, A. Bozzao, E. Ferone, R. Floris, G. Simonetti;Rome/IT

Background and Purpose: To assess hemodynamic modifications in sympto-matic patients with unilateral stenosis of the internal carotid artery (ICA) by theuse of perfusion-weighted MRI (PW-MRI) and compare these data with thoseobtained after TEA.Method: Fifteen patients with unilateral 70-90% carotid artery stenosis were stud-ied with DSA and perfusion-weighted dynamic susceptibility (DSC) MRI and werecompared to 15 age/sex matched controls. Regional cerebral blood volume (rCBV)and mean transit time (MTT) values were calculated in the middle cerebral artery(MCA) and borderzone (BZ) territories. All patients underwent TEA within oneweek from MRI and were re-examined one month after surgery.Results: There was no significant difference in rCBV and MTT values betweenthe hemispheres in the symptomatic patients. There was a significant differencein MTT values in the borderzones between patients and controls. After TEA wefound a decrease of MTT of both hemispheres in BZ territories while the remain-ing hemodynamic parameters persisted unchanged. The decrease in MTT val-ues after TEA lead these values to be similar to those of normal subjects.Conclusion: The results of our study suggest that there is an adequate compen-sation of unilateral stenosis when it is less than 90%. A hemodynamic compen-sation mechanism between the two hemispheres, particularly for the distal borderzone territories that tend to have a slower MTT with respect to the control sub-jects before TEA, and the restoring of MTT values in the BZ after surgery, seemsto be demonstrated as well.

C-724Parkinson's disease: Pre- and post-apomorphine perfusion evaluation withdynamic susceptibility contrast (DSC) MRIF. Gaudiello, S. Marziali, A. Ludovici, E. Ferone, R. Floris, G. Simonetti;Rome/IT

Purpose: Our aim was to study whether DSC-MRI perfusion method may detectan altered pattern of regional cerebral blood flow (rCBF) in Parkinson's disease(PD) patients in comparison to normal subjects and whether this altered patternmay be normalised by apomorphine.Material and Methods: Twenty subjects affected by idiopathic PD according withthe Brain Bank Criteria were enrolled for this study. Nineteen normal subjectswere included as controls. Ten of them performed a retest procedure. PD pa-tients, after at least 20 days of therapy withdrawal, were submitted to perfusionDSC-MRI. Sixteen of them were retested after apomorphine injection at least 24hours. Relative regional blood flow was evaluated by using regions of interest(ROI) of 50 pixels manually placed in different region of basal ganglia.Results: PD patients showed a significant inter-hemispheric asymmetry due to ahigher perfusion in the more affected side (< 0.01), while normal subjects did not.PD exhibited an abnormal "asymmetry index" in the measured nuclei. DSC-MRIperformed after subcutaneous apomorphine injection did not show any signifi-cant asymmetry in PD patients. Retest in normal subjects did not show any sig-nificant variation.Conclusion: DSC-MRI of basal ganglia confirms the asymmetry observed inPET studies of PD, suggesting this method as a promising technique in neurode-generative diseases.

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C-725Spectroscopic imaging of radiation-induced effects in the brain afterbrachytherapyG. Bajzik1, J. Julow2, I. Repa1; 1Kaposvar/HU, 2Budapest/HU

Purpose: The effect of brachytherapy, characterized by rapid dose fall off fromthe radiation source, is different compared to external radiation. We used protonMR spectroscopic imaging to investigate brain tissue response to brachytherapy.Methods and Materials: Twenty glioma patients treated with surgery and/or brach-ytherapy were studied with MR imaging (T2 weighted images and post contrastT1 weighted images) and 2D proton MR spectroscopy (TR: 1500 ms, TE: 135 ms,voxel size 3.3 cm3). Brachytherapy resulted in central necrotic zone, surroundedby an enhancing rim (demarcation zone) and an outer edematous zone on MRimages. In each patient sample, spectra of the three zones and the normal ap-pearing white matter were analyzed.Results: In demarcation zone, choline/creatine (Cho/Crea) ratio (2.9 ± 1.33 vs.1.04 ± 0.23, p = 0.004, two-tailed unpaired Student's test) and choline/N-acety-laspartate (Cho/NAA) ratio (1.43 ± 0.53 vs. 0.74 ± 0.28, p = 0.003) was increasedcompared to normal white matter. In edematous zone Cho/Crea ratio was in-creased (1.31 ± 0.33 vs. 1.04 ± 0.23, p = 0.007), Cho/NAA ratio was not different(0.9 ± 0.39 vs. 0.74 ± 0.28, p = 0.21) compared to normal white matter. In de-marcation zone we found elevated Cho/Crea ratio (2.9 ± 1.33 vs 1.31 ± 0.33,p = 0.03) and Cho/NAA ratio (1.43 ± 0.53 vs 0.9 ± 0.39, p = 0.006) compared toedematous zone. In the central necrotic zone we could only detect lipid and/orlactate peaks.Conclusions: MR spectroscopy demonstrates significant spectral differences inthe brain following brachytherapy. Tumor recurrence can be suspected in caseswhere focal choline accumulation is detected.

C-726Does CT-perfusion imaging based on parametric deconvolution permitprediction of infarct volume in acute stroke?G. Bohner1, A. Förschler2, C. Zimmer2, R. Klingebiel1; 1Berlin/DE, 2Leipzig/DE

Objectives: Suitability of quantitative CT-perfusion (CTP) imaging for assessingthe early as well as final infarct volume in acute stroke patients.Material and Methods: Twenty-two patients with acute cerebral ischemia under-went CTP on admission. Parameter maps of cerebral blood perfusion (CBP),cerebral blood volume (CBV) and mean transit time (MTT) were generated usinga parametric deconvolution algorithm. Additional diffusion weighted imaging (DWI)was performed in seven cases. Volume of diffusion abnormality was comparedwith the infarct volumes as assessed by two blinded neuroradiologists for each ofthe perfusion maps. In addition, final infarct volumes were determined on thebasis of follow-up studies.Results: Mean volumes of ischemia as assessed by CBP, CBV and MTT were38.5, 15.9 and 41.3 mL respectively. Amongst the patients in whom DWI wasperformed, six showed perfusions deficits in all perfusion images. In one patient,who had no DWI abnormality, perfusion deficits only were found on CBP andMTT images. Mean volume of DWI changes was 25.1 mL. The most significantcorrelation was found between the extent of CBV reduction and DWI infarct vol-ume (r = 0.899, P < 0.01). Mean final infarct volume was 27.7 mL for all patients.CBV reduction showed the best correlation (r = 0.838, P < 0.01) with final infarctvolume.Conclusion: Our findings suggest that CBV maps based on the CTP techniqueapplied in this study permit prediction of infarct volume in early stroke, so CTPwould deliver information about the ischemic penumbra.

C-727Hepatic encephalopathy in alcoholic and non-alcoholic subjects:Correlation of magnetization transfer ratio, apparent diffusion coefficientand critical flicker frequencyM. Cohnen, G. Kircheis, H.-J. Wittsack, F. Miese, F. Wenserski, A. Saleh,D. Häussinger, U. Moedder; Düsseldorf/DE

Purpose: To correlate quantitative changes of water content in brain parenchy-ma using magnetization transfer imaging (MTI) with different stages of hepaticencephalopathy (HE).Materials and Methods: Forty-three patients with hepatic encephalopathy and15 age-matched control subjects underwent MR imaging (1.5 T Vision, Siemens)including MTI, MR-spectroscopy (MRS) and diffusion weighted imaging (DWI).Liver cirrhosis was due to alcohol in 26 patients whereas non-alcoholic diseasewas found in 17. Patients underwent assessment of critical flicker frequency (CFF)as test for HE with a frequency under 39 Hz considered pathologic. Magnetiza-

tion transfer ratios (MTR) and apparent diffusion coefficient (ADC) values weredetermined in basal ganglia, posterior white matter and pons using ROI-meas-urements. Single-voxel MRS was performed using a STEAM sequence(TE = 20 ms, TR = 1.5 s) assessing basal ganglia and posterior white matter.Results: MRS showed typical findings with decreased myo-Inositol combinedwith increased glutamine/glutamate with increasing degree of HE indicated by areduced CFF. Compared to controls, MTR showed a significant decrease both inthe basal ganglia as well as in the posterior white matter. In alcoholic subjects,this was independent from the degree of HE, whereas in posthepatitic cirrhosis acorrelation was found. A non-significant increase in ADC was noted with a de-crease of CFF in both groups.Conclusion: The results may indicate an increase of free protons in the brainparenchyma of patients with HE possibly supporting the hypothesis of a low-grade cerebral edema. The differences between alcoholic and non-alcoholic sub-jects may hint at a general brain damage due to alcohol independent of hepaticfailure.

C-728Assessment of cerebral blood flow values obtained from dynamic perfusioncomputed tomography: A comparison with positron emission tomographyH. Yokote, K. Nakayama, T. Okamura, N. Tsuyuguchi, K. Kitamura, N. Ozawa,S. Minamikawa, T. Tashiro, Y. Inoue; Osaka/JP

Purpose: Among imaging modalities measuring regional cerebral blood flow(CBF), dynamic perfusion computed tomography (CT) studies are easy to per-form and readily available without specialized equipment. However, quantitativestudies comparing perfusion CT with positron emission tomography (PET) havebeen few. We assessed the correlation of CBF values obtained from perfusionCT and PET.Methods and Materials: Eleven patients with various cerebrovascular diseasesunderwent perfusion CT and PET. The perfusion CT studies were performed witha four-channel multi-detector row CT scanner. Four contiguous 8-mm CT sec-tions were cine-scanned during a 36 mL bolus of intravenous contrast medium ata rate of 4 mL/s, with a total acquisition time of 50 s. CBF maps were obtainedfrom perfusion CT data by central volume principle and deconvolution method.On CBF maps of both perfusion CT and PET, multiple regions of interest (ROI)were drawn independently, including frontal, temporal, parieto-occipital territo-ries, caudate nucleus, thalamus and white matter in both hemispheres. ROIswere visually matched by agreement of three radiologists. Mean CBF values ofmultiple ROIs with both CT and PET were compared through linear regressionanalysis.Results: Correlation coefficients for individual analysis ranged from 0.657 to 0.833,overall 0.553. Linear regression analysis showed moderate correlation betweenperfusion CT and PET values (slope = 0.668, intercept = 21.958).Conclusions: Our study has shown moderate correlation of CBF values betweenperfusion CT and PET. Despite the various alterations of cerebral blood flow inour cases, perfusion CT studies were validated to be an easy-to-perform imagingtechnique to assess CBF values.

C-729Ageing of the cerebrum: Assesment with quantitative proton MRspectroscopyJ. Ostojic, R. Semnic, D. Kozic, D. Bogdanovic, M. Prvulovic;Sremska Kamenica/YU

Introduction: Aging is recognized to originate from a diversity of mechanismsthat blur the limits between normal and pathologic processes. The purpose ofthis study was to determine the early effect of normal aging on the regional distri-bution of brain metabolite concentrations, including N-acetylaspartate (NAA),choline (Cho) and creatine (Cr).Methods: Seventy nine volunteers, ages 16 to 75 years, were examined by local-ized single-voxel proton MR spectroscopy at 1.5 T using PRESS 135sequence.Voxels 2 x 2 x 2 cm were placed in the middle white matter (WM) ofthe centrum semiovale in the left hemisphere and in the occipital gray matter(GM) of posterior parietal lobes. The ratio of NAA/Cho were calculated, as wellas absolute concentrations of NAA, Cr and Cho.Quantification was performedusing method of external standard.Results: Absolute concentrations (mM/kg) of Cho increased with age both inWM (r = 0.42, P < 0.05) and in GM (r = 0.57, P < 0.05). Cr concentrations weremuch higher in GM than in WM and significantly higher in the old than youngsubjets (r = 0.41, P < 0.05). The change of WM Cr with age failed to meet P < 0.05criteria. NAA concentration was higher in GM than in WM and did not differ be-tween young and old subjects. The age dependency of GM NAA/Cho ratio was

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steeper (r = 0.68, P < 0.001) comparing to WM (r = 0.49, P < 0.05) and almostnegatively linear.Conclusion: Our study shows that ageing effects on metabolite concentrationsare more pronounced in the GM regions of the brain. Determination of absolutemetabolite concentrations, rather than use of ratios only, is essential for charac-terizing age-related changes in brain metabolites.

C-730Diagnosis of cerebral vascular malformations with CT angiography inpatients with subarachnoid hemorrhageS. Stathopoulou1, C. Kokkinis1, N. Makris1, A. Petinelli1, K. Vassiou2,M. Vlychou2, P.J. Papadaki1, G.M. Zavras1, J.B. Fezoulidis2; 1Athens/GR,2Larissa/GR

Purpose: To evaluate the diagnostic accuracy of spiral CT angiography in pa-tients with subarachnoid hemorrhage due to vascular malformations.Methods and Material: One hundred and fifty-eight patients suffering from sub-arachnoid hemorrhage (SAH) underwent CT angiography (CTA) as well as intra-arterial digital subtraction angiography (IA-DSA). CTA was performed using spiralCT with 150 mL of intravenous contrast at 4 mL/sec, after a delay of 20 sec. Slicethickness 0.8 mm and a reconstruction index of 0.5 was used. Axial slices andmulti-planar reformatting (MPR), maximum intensity projection (MIP) and 3D sur-face shaded display (SSD) reconstructions were reviewed. IA-DSA followed in allpatients. There was comparative study between two methods.Results: Twelve cases of vascular malformations were diagnosed by CTA andthese comprised 9 arteriovenous malformations and 3 venous angiomas. In 10cases, the cause of SAH was vascular malformation and in 2 cases was an inci-dental finding. In comparison with IA-DSA, CTA missed only a small dural arteri-ovenous malformation but diagnosed a small venous angioma missed by IA-DSA.These two malformations appeared without hemorrhage.Conclusion: CTA is a useful non-invasive method in detection of cerebral vascu-lar malformations causing SAH, with similar results to IA-DSA. Even though IA-DSA offers more anatomical detail in the evaluation of supplying and drainingvessels, CTA can be a useful diagnostic tool as the tridimensional aspect offersadditional information in the therapeutic planning of these vascular malformations.

C-731CT virtual angioscopy in cerebral aneurysmsC. Kokkinis1, S. Stathopoulou1, N. Makris1, A. Mica1, K. Vassiou2, M. Vlychou2,P.J. Papadaki1, G.M. Zavras1, J.B. Fezoulidis2; 1Athens/GR, 2Larissa/GR

Purpose: To evaluate the usefulness of virtual angioscopy (endoscopy) usingcontrast enhanced spiral CT and volume rendering techniques in the evaluationof cerebral aneurysms.Material and Methods: CT angiography (CTA) was performed using spiral CTwith 150 mL of intravenous contrast at 4 mL/sec, after a delay of 20 sec. A slicethickness of 0.8 mm and a reconstruction index of 0.5 were used. Axial slicesand multi-planar reformatting (MPR), maximum intensity projection (MIP) andsurface shaded display (SSD) reconstructions were studied to evaluate aneu-rysm characteristics. Then the image data was analyzed using volumetric 3Drendering technique to succeed endoscoping imaging. This technique extractsCT numbers in the boundary region between the vessel wall and contrast mediawithin the vascular lumen.Results: Forty cases of cerebral aneurysms were detected by CTA. With thetechnique of CT virtual angioscopy, we assured an excellent visualization of theinner contours of the vessels including the neck and the dome of the aneurysm(fly through). Also 3D morphology of the internal structure of the aneurysm wasdemonstrated (fly around). The size of the sac (true lumen) and the neck wereexactly estimated. Blood vessels flowing into and out of aneurysms were visual-ized. In 9 patients with ruptured aneurysms that were operated, virtual angiosco-py showed the site of rupture, wich was confirmated by operation.Conclusion: Virtual angioscopy following spiral CTA is a very useful techniquesupplementary to CTA in non-invasive evaluation of cerebral aneurysms and se-lection of the most appropriate therapeutic modality.

C-732Serial MRI in adult-onset Rasmussen's encephalitis reveals two mainradiographic and clinical variantsN. Danchaivijitr, R. Nicholas, T. Smith, I. Hart; Liverpool/UK

Purpose: Rasmussen's encephalitis (RE) is a rare autoimmune disorder thatclassically affects one cerebral hemisphere. It is characterized by intractable ep-ilepsy with progressive neurological deterioration and usually presents in child-hood. Adult onset RE was believed to have a more benign clinical course and

imaging features are less well described. Here, we characterize the MRI brainfindings of a series of adult onset RE patients and correlate with the clinical pro-gression.Materials and Methods: We retrospectively reviewed the serial MRI brain scansof 6 patients with pathologically confirmed adult onset RE (53 scans in total).Five patients had complete series of annual MRI studies from their onset. Clinicaldata including neurological signs, cognitive deficits and functional disability wererecorded prospectively.Results: We recognized 2 patterns of imaging findings; 4 patients had focal in-crease signal on T2W in subcortical white matter of the temporal lobe. Later,these were followed by ipsilateral hemispheric atrophy. These patients had a rap-idly progressive clinical course in which neurological deficits occurred within 12months after onset. The second group (2 patients) had initial focal cortical atro-phy followed later by diffuse atrophy of affected hemisphere without evidence ofhigh signal changes. In addition, bilateral involvement and caudate atrophy weremore frequent than childhood variant.Conclusion: Adult RE can be difficult to diagnose because the early MRI find-ings can be subtle and physicians may be unaware of the possible presentationof one hemisphere atrophy without inflammation. Pattern of initial MRI featuresmay help to predict clinical course of the disease.

C-733Radiofrequency neurotomy for the treatment of headache associated withthe third occipital nerveG.B. Marshall, C. Siwak, B. Frizzell; Calgary, AB/CA

Purpose: To assess the efficacy of a fluoroscopically-guided neurotomy tech-nique in patients with cervicogenic headache associated with the third occipitalnerve.Methods: Retrospective analysis of 15 patients (12 women and 3 men) who un-derwent third occipital neurotomy for cervicogenic headache. These patients hadfailed conservative treatment and were selected based on response to facet jointinjection and medial branch block. Neurotomy procedures were completed bytwo radiologists. A chart review of pre- and post-procedural pain levels was un-dertaken in addition to follow-up patient interview to determine whether they hadimprovement in their activities of daily living and recreation.Results: All 15 patients reported a reduction in the frequency of their headaches.Pain levels reported on a Visual Analog Scale dropped from a pre-proceduralmean of 8.6/10 to a post-procedural mean of 2.5/10. The mean duration of painrelief was 9.4 months, with 9 of the 15 patients describing ongoing relief of symp-toms. All 15 patients reported restoration of activities of daily living, albeit forvarying lengths of time. No significant complications were encountered.Conclusions: This radiofrequency neurotomy technique may be a useful meansof providing symptomatic relief from cervicogenic headache associated with thethird occipital nerve. The study justifies proceeding to prospective evaluation ofthe technique.

C-734Functional magnetic resonance imaging (fMRI) study of memory functionsin elderly and young healthy controls and Alzheimer's disease (AD) patientsA. Urbanik, M. Binder, B. Sobiecka, J. Kozub, M. Kuniecki; Krakow/PL

Purpose: The aim of the study was to assess differences in the neural correlatesof nonverbal memory functions in pathological and normal ageing.Methods: Thirty-six volunteers were examined in a 1.5 T MR scanner. Threegroups of twelve subjects were examined: young and elderly healthy controls,and patients with probable AD diagnosis. Subjects were required to memorizecomplex geometrical figures. After the scanning session, they were all asked toredraw these figures. Their performance was scored. Image data were analysedwith SPM99 statistical package.Results: Both control groups copied drawings more accurately than the AD group.In all groups, the most prominent differences were seen in frontal regions and theoccipital lobes, extending to the temporal. For each group this pattern was dis-similar. For the AD group moderate activation in the occipital lobe was observed,but no activation in frontal lobes. In turn, the elderly group revealed quite weakactivation in occipital lobes and strong bilateral activation in the frontal lobes.Finally, in the young adults group there was very prominent activation in occipitallobes, as well as in the frontal lobes, with apparent left-hemispheric dominance.Conclusions: We have succeeded in revealing differential patterns of brain acti-vation in the studied groups during nonverbal memory encoding. Our results sug-gest that a successful encoding requires an involvement of frontal lobes, that areprobably responsible for the strategic aspects of memory functions. As was shownin the elderly control group, frontal lobes can compensate for the deterioratedvisual memory which is known to decline over time.

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C-735State of cerebral hemodynamics in patients with Chiari 1 malformationF. Todua, D. Miminoshvili, D. Berulava; Tbilisi/GE

The special features of cerebral hemodynamics were studied in 52 patients withChiari 1 malformation (CM) with the help of magnetic resonance angiography(MRA) and transcranial dopplerography (TCD). MRA data analysis (58) revealedthe frequent presence of vertebrobasilar system (VBS) maldevelopment andembryonic type of circle of Willis. TCD data analysis (100) discovered vertebro-basilar insufficiency and bilateral blood flow increase in the intracranial part ofthe internal carotid arteries giving evidence of the compensated blood flow fromthe carotid system to the VBS. 21% of patients with CM and communicating hy-drocephalus had TCD signs of intracranial hypertension. The most significantchanges in cerebral hemodynamics were found in patients with marked patholo-gy and older than 30 years.Conclusions: 1. Changes of cerebral hemodynamics in patients with Chiari 1malformation are conditioned by a complex of various causes; vertebrobasilarsystem underdevelopment, extravasal compression of the VBS arteries, romben-cephalon hernia (CM) compensated blood flow from internal carotid system toVBS and the presence of intracranial hypertension. 2. The role of vascular factorsin pathogenesis of the clinical signs of Chiari 1 malformation is confirmed.Acute disorders of cerebral ischemic circulation in VBS and syncopal conditionswere mainly found in patients with the 2nd/3rd degree Chiari malformation above30 years of age, that correlates with the greatest changes of cerebral hemody-namics by transcranial dopplerography findings.

C-736Routine MR imaging in Parkinsonian syndromesM. Cosottini, R. Ceravolo, G. Lazzarotti, U. Bonuccelli, M. Michelassi,C. Bartolozzi; Pisa/IT

Purpose: To assess the usefulness of routine MRI in the differential diagnosis ofparkinsonian syndromes such as multiple system atrophy type p or c (MSA p andMSA c), supranuclear palsy (PSP), and corticobasal degeneration (CBD) fromidiopathic Parkinson disease (PD).Methods and Materials: We retrospectively evaluated 142 patients with extrapy-ramidal signs and symptoms that had been followed for five years until a defini-tive clinical diagnosis. Ninety five patients had PD, 25 MSA p, 3 MSA c, 15 PSP,4 CBD. MR examinations were obtained with 0.5 and 1.5 T equipment in 52 cas-es and 90 cases, respectively. Axial DP-T2 and sagittal T1-weighted images wereevaluated considering the most frequently abnormal findings reported in parkin-sonian syndromes. PD MR examination was supposed to be normal.Results: Using the reported radiological criteria, imaging by MRI revealed a sen-sitivity and specificity of 66% and 96% in PSP, 60% and 96% in MSA p, 100%and 100% in MSA c, 75% and 99% in CBD. A correct diagnosis of atypical par-kinsonian syndrome was made in 70% of patients with extrapyramidal signs andsymptoms.Conclusions: Several features on brain MR imaging may improve the diagnosisof atypical parkinsonian syndromes and PD in a substantial proportion of patients.

C-737Brain MR perfusion with dynamic susceptibility contrast (DSC) technique incarotid artery stenosisM. Cosottini1, M. Michelassi1, M. Puglioli1, A. Pingitore1, T. Callegari2,A. Bertoldo2, I. Trivelli1, G. Parenti1, C. Bartolozzi1; 1Pisa/IT, 2Padova/IT

Purpose: To assess the usefulness of dynamic susceptibility contrast perfusionweighted imaging (DSC-PWI) in patients with internal carotid artery (ICA) steno-sis and correlate hemodynamic parameters to the compensatory intracranial cir-cles studied with MR and digital subtraction angiography (DSA).Materials and Methods: MR examination was performed on 20 patients withunilateral critical stenosis of ICA to obtain the measurement of cerebral bloodvolume (CBV), cerebral blood flow (CBF) and mean transit time (MTT) with PWI.Quantification of blood flow (MBF) in ICA and middle cerebral arteries (MCA)with done by PC MRA and the intracranial circle was evaluated with 3D TOFMRA. DSA was then performed to confirm the grading of stenosis and to depictthe presence of collateral intracranial compensatory circles. Patients were divid-ed into two groups on the basis of the presence (group 1) or absence (group 2) ofa regional or hemispheric perfusion defect detectable at visual inspection of MTTmap.Results: In group 1 (six patients) there was a prolonged MTT, a reduced CBFand an increased CBV in two cases. A poor depiction of MCA with MRA and asignificant reduction of MBF in the MCA homolateral to ICA stenosis (103 mL/

min), as well as an angiographic impaired willisian compensation with a recruit-ment of vessels arising from the external carotid artery and from superficial col-lateral supply was detected in group1.Conclusions: PWI reveals oligemic abnormalities in only some patients with ICAstenosis. Increased MTT and reduced CBF are associated with an impaired willi-sian collateral supply. Probably, bolus dispersion may influence the PWI-detect-ed oligemia in ICA stenosis.

C-738Specificity and sensitivity of 1H magnetic resonance spectroscopy (MRS)for the differential diagnosis of Alzheimer disease, other commondementias and depressionM.C. Martinez-Bisbal, E. Arana, L. Marti-Bonmati, B. Celda; Valencia/ES

Purpose: The evaluation of the specificity and sensitivity of 1H MRS in the differ-ential diagnosis of Alzheimer disease (AD), other common dementias and de-pression by 1H MRS.Materials and Methods: We studied 64 patients with cognitive impairment (CI)(mean age 70 ± 9). Depression and AD were established according to DSM-IV.Vascular Dementia (VD) was established according to "National Institute of Neu-rological Disorders and Stroke". The criteria for Mild Cognitive Impairment (MCI)were memory complaint from the patient and close relatives, normal activities ofdaily living, normal general cognitive functions and memory performance abnor-mal for age, but no dementia or depression according to DSM-IV. Spectroscopicstudy included single voxel in posterior parietal grey matter (PPGM) and in righttemporal lobe (RTL) with TE of 31 and 136 ms.Results: Statistical differences were found between the dementias group (ADand VD) and the non-demented group (Depression and MCI). The ratio choline/creatine (Cho/Cr), myoinositol/creatine (mI/Cr) and N-acetylaspartate/creatine(NAA/Cr) showed differences between the studied pathologies, only in PPGM,without significant differences in RTL. NAA/mI and mI/Cr distinguished betweenAD and the other pathologies, in PPGM, with the best area under the ROC curvefor NAA/mI, showing the higher sensitivity (82%) and specificity (73%) for thediagnosis of the AD.Conclusion: 1H MRS is a non-invasive tool for the study of CI, showing biochem-ical information to differentiate AD, VD, Depression and MCI. The metabolicalalterations observed contribute to the differential diagnosis with a high sensitivityand specificity in pathologies with CI, in particular for the diagnosis of AD.

C-739Value of transcranial Doppler (TCD) measurements and "hyperdense middlecerebral artery" sign on CT for acute ischemic stroke prognosisY.T. Efendiev, L.B. Khalilova; Baku/AZ

Methods: CT examination was carried out on the first day of stroke for 100 pa-tients (age range 35 to 47), who had ischemic infarcts in the middle cerebralartery (MCA) territory and repeated on the 3rd, 7th and 40th days. "Hyperdensemiddle cerebral artery" sign reflecting active intraluminal thrombosis was foundin 52 patients. The same 52 patients had TCD on the 1st day.Results: Symmetric blood flow velocity (BFV) in both MCAs was revealed in41% of the patients. In this group, clinical course was rather auspicious in morethan 70% of patients. Infarcts area in these patents had limited, cortical (73%)and subcortical (27%) localization. No lethal outcome was noted.Asymmetric blood flow with decreased MCA BFV by more than 20% on the af-fected side was noted in 32% of the patients. In this group, the infarctions hadcortico-subcortical localization on final CT. The clinical course was more severeand complicated than in the first group.One lethal case occurred.In 27%, TCD demonstrated signs of hyperperfusion of hemodynamics with in-creased of MCA BFV by more than 20%, on the affected side, combined withhigh peripheral resistance index. Infarcts had mainly deep basal location, and 3lethal cases occurred. Later CT detected hemorrhagic transformation of necroticarea (5 cases, 33%).Conclusion: "Hyperdense middle cerebral artery" sign on CT is significant forearly diagnosis of stroke, whereas the TCD measurements in MCA is importantto predict the clinical course and possible impairment at the early stage of thedisease.

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C-740Imaging of brain parenchymal and leptomeningeal metastases from lungcancer: Significance of contrast enhancement MRIM.P.I.M. Jakimovska, T. Markoski, M. Grunevski, S. Jakimovska, S. Jovanoska;Skopje/MK

Purpose: To estimate significance of iv application of paramagnetic contrast inMR imaging in diagnosis of parenchymal brain metastases, especially leptome-ningeal carcinomatosis seeding from lung cancer. Next purpose is to comparesensitivity between CT and MR imaging.Material and Methods: Thirty-six patients with lung cancer were evaluated radi-ographicaly to determine the present of metastases in CNS. We used CT as ascreening tool and MR after i.v. application of GdDTPA.Results: Our series with 36 patients included 27 or 75% with non small-cell lungcancer and 9 patients or 25% with small-cell lung cancer. Three patients (33%) of9 with small-cell lung cancer had occult metastatic disease to the brain. Eightpatients (28%) of 27 with non small-cell lung cancer had metastatic disease tothe brain parenchyma. In this series, leptomeningeal metastases were not found.CT scans were performed in all 27 patients, MRI was performed in 15 cases,some with i.v. application of GdDTPA, and in 8 patients brain metastatic diseasewas found. Post contrast MR imaging presents leptomeningeal carcinomatosisas thin linear enhancement along the cortical surface, which follows the gyralpattern of the cortex.Conclusion: All patients with lung cancer have to be investigated for brain me-tastases because of a great percentage (about 30%) of occult metastatic dis-ease. Contrast enhanced MR of the brain is a superior method compared to CTbecause of excellent contrast resolution, is safer and has multiplaner abilities. Todemonstrate meningeal seeding, contrast enhanced MRI is the modality of choice.

C-741Evaluation of the uselfulness of high b-value diffusion-weighted MRimaging in patients with acute cerebral infarctionH. Hirota1, E. Shimosegawa2, K. Takahashi3, M. Mineta1, T. Yamada1,W. Yamamoto1, K. Nagasawa1, H. Sato1, T. Aburano1; 1Asahikawa/JP, 2Akita/JP,3Iowa, IA/US

Purpose: We occasionally encounter cases without distinct abnormal findingson conventional diffusion-weighted MR imaging despite there being obvious clin-ical findings of acute cerebral infarction. Our purpose was to evaluate positivepredictive value of high b-value diffusion-weighted MR imaging in subjects withacute cerebral infarction.Methods and Materials: We prospectively assessed 21 subjects with acute cer-ebral infarction within 12 hours from the onset. All examinations were performedwith 1.5 T unit using single-shot echo planar diffusion-weighed MR imaging atthree different b values of 1000, 2000 and 3000 s/mm2. Seven days later from theonset, we re-examined the subjects with T2 weighted image for confirming thefinal diagnosis. Four experienced neuroradiologists assessed each diffusion-weighted images for the presence of cerebral infarction and then compared thefindings of each images with those of T2 weighted images. We divided the find-ings of each diffusion-weighted images into five categories by location of abnor-mal signal intensities and calculated true positive rate in each categories.Results: The true positive rates were 76.8% (b = 1000), 88.7% (b = 2000), and90.6% (b = 3000) in "all lesions". Significant differences were found in true posi-tive value of b = 2000 DWI (p < 0.05) and b = 3000 DWI (p < 0.05) in contrast tothat of b = 1000 DWI in "all lesions"and in category of "small white matter le-sions". No significant difference was found in true positive rate in other catego-ries although there was an increase in true positive rate from b = 1000 to b = 2000or b = 3000.Conclusions: High b-value diffusion-weighted MR imaging can improve the de-tectability of acute cerebral infarction when abnormality could not be depicted onconventional diffusion-weighted MR imaging in patients with obvious clinical set-tings.

C-742Efficacy of volume subtraction in intracranial 3D-CTAM. Ishifuro, Y. Akiyama, T. Kushima, J. Horiguchi, K. Ito; Hiroshima/JP

Purpose: Arterial visualization of intracranial 3D-CTA is difficult in the area of theskull base. This is due to the close proximity of the internal carotid artery andskull base and the fact that they both have almost the same CT values. Accord-ingly, subtraction artifacts due to misregistration are unavoidable using the con-ventional subtraction method. Even a slight difference of the start position in databetween pre- and post- contrast CT may lead to the production of considerable

artifacts. Nowadays, subtraction of two sets of volume data has become possibleon a workstation. We assessed whether this technique was useful in intracranial3D-CTA.Methods and Materials: Subtraction was performed in both phantom and pa-tients and the accuracy was tested.Results: Precise measurement was shown to be possible in the phantom exper-iment. Following this, several clinical cases were applied.Conclusion: Subtraction is effective due to being almost free of misregistration.

C-743Does an interpolated high resolution matrix improve the detection of brainhyperintensities on FLAIR images in multiple sclerosis?F. Sardanelli, A. Fausto, G. Spadaccini, B. Cotticelli; Milan/IT

Purpose: To test whether an interpolated high resolution matrix improves thedetection of brain hyperintensities on FLAIR images in multiple sclerosis (MS).Materials and Methods: Seven MS patients (1 male, 6 females, 23-68 years old,median 36) underwent brain MR at 1.5 T using a fast-FLAIR para-axial sequence(TR/TE/TI = 8300/135/2500 ms; FoV 230 mm; 20 no-gap 5-mm slices; matrix256 x 256; pixel size = 0.9 x 0.9 mm; time 3'36"). The sequence was repeatedchanging only from the standard 2562 matrix to an interpolated 5122 matrix with apixel size of 0.45 x 0.45 mm. The two sequences were read on a remote consolein a random blinded fashion, using a one-in-one format and free windowing, gradingthem as certain (C) or probable (P); for confluent plaques, only the lesions withmore than half the contour detectable were counted. Wilcoxon test was used.Results: A total of 530 hyperintensities (C/P = 401/129) with 2562 and of 550(431/119) with 5122 were counted. They ranged in total 9-147 (median = 72) with2562 and 8-178 (79) with 5122; C hyperintensities 3-127 (60) and 3-160 (59); Phyperintensities 6-25 (20) and 5-29 (18), respectively. Data were similar in 6/7patients; in the remaining patient (female, 36 years old) total hyperintensitieswere 147 (2562) and 178 (5122), with a C/P of 127/20 and 160/18, respectively. Inspite of this outlier, no significant overall difference was found between 2562 and5122 for total, C, and P hyperintensities (p > 0.447).Conclusion: Interpolated matrices do not significantly improve the detection ofbrain hyperintensities on FLAIR images in MS.

C-744A method for reducing radiation exposure in cerebral perfusion study usingmulti-detector row CTT. Nanjo1, K. Murase1, Y. Sugawara2, M. Hirata2, T. Mochizuki2; 1Osaka/JP,2Onsen-gun/JP

Purpose: Radiation exposure during CT perfusion study is a serious problem.The purpose of this study was to devise a method for reducing radiation expo-sure in cerebral perfusion studies using multi-detector row CT.Methods and Materials: Nine patients (6 males and 3 females; mean age 68.4years) participated in this study. Following a standard protocol for CT perfusionstudy, continuous (cine) scans (0.8-1.0 sec/rotation x 60 sec) consisted of four5-mm-thick contiguous slices performed after an injection of iodinated contrastmaterial (30-40 mL) using a multi-detector row CT scanner (Light Speed QX/I,GE). New image data were generated by thinning out the original images thusacquired. The thinned-out images were interpolated by linear or cubic interpola-tion. The functional images of perfusion parameters such as cerebral blood flow(CBF), cerebral blood volume (CBV) and mean transit time (MTT) were generat-ed from these images by applying deconvolution analysis based on singular val-ue decomposition pixel by pixel. We calculated the correlation coefficients betweenthe perfusion parameters obtained from original and thinned-out images for 15regions of interest in the grey and white matter.Results: When using 10 continuous images with a scan time of 0.8-1.0 sec andthe thinned-out images with a scan interval of 1.6-2.0 sec, the radiation exposurecould be reduced to 56.0-58.3%, with the correlation coefficients of CBF, CBVand MTT being kept greater than 0.9.Conclusion: This method can reduce radiation exposure while keeping the ac-curacy of perfusion parameters equivalent to that obtained from original images.

C-745Dynamic CT perfusion: Age-specific analysis of cerebral blood flowT. Hirano, T. Shonai, S. Tanabe, T. Satoh, M. Hirano; Sapporo/JP

Purpose: To perform age-specific analysis of cerebral blood flow in dynamic CTperfusion studies.Methods: A multislice CT scanner (Aquilion, Toshiba Medical Systems Corpora-tion, Japan) with collimation of 8 mm x 4 slices was used to perform dynamic

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scanning. The data acquisition conditions (analysis algorithm, analysis matrix,contrast medium injection rate, image reconstruction algorithm and exposure dose)were optimized while maintaining high quantitative analysis capabilities. Cere-bral blood flow was then measured in 13 volunteers in their 20 s, 10 in their 30 s,12 in their 40 s, 14 in their 50 s, 11 in their 60 s, and 10 in their 70 s. None of thesubjects had cerebral blood flow disorders.Results: The use of optimized data acquisition conditions provided high repro-ducibility while permitting the exposure dose to be reduced by 50% or more. Adecrease in cerebral blood flow with advancing age was confirmed in CT dynam-ic perfusion studies.Conclusion: The use of optimal data acquisition conditions allows the exposuredose to be reduced and provides high reproducibility while permitting acceptablequantitative cerebral blood flow analysis. This has made it possible to determineage-specific normal values for cerebral blood flow in dynamic CT perfusion ex-aminations. It is expected that dynamic CT perfusion analysis will prove clinicallyuseful for the assessment of diffuse cerebrovascular diseases and chronic-stageblood flow disorders, as well as for the diagnosis of acute-stage cerebral infarction.

C-746Diffusion weighted imaging (DWI) EPI on low field MR system (0.2 T):Comparison with 1.5 T and preliminary report on clinical use in brainischemiaP. Pieniazek1, P. Wojtek2, M. Konopka1, A. Jasinski3, J. Walecki4, M. Hartel1,R. Rosenberger2, E. Kluczewska1; 1Katowice/PL, 2Kedzierzyn-Kozle/PL,3Krakow/PL, 4Warsaw/PL

Recent technological progress has enabled DWI to be performed on low fieldsystems.Purpose: This study assessed the diagnostic value of low field DWI in brainstroke. The secondary goal was to compare apparent diffusion coefficient (ADC)values obtained in high and low systems.Methods: DWI were performed in 2 groups of volunteers, on 0.2 T and 1.5 Tsystems. DW images at b = 0 and 900 mm2/s were recorded. ADC values from17 regions of interest (ROI) were compared. Forty patients with acute symptomsof CNS stroke were examined by CT and MR, 2-10 h after symptoms onset. DWI-EPI images were obtained. Follow-up MR 2 weeks later were set as a reference.Results: Statistical analysis showed significant differences of ADC values de-pendent on ROI location within the brain hemisphere. There was no differencebetween right and left hemisphere. ADC values for low and high field systemswere similar. In 30 patients, ischemic lesions were found in the first examination.Follow-up confirmed 24 infarcts. Four patients out of 10 with negative DWI re-vealed infarction in follow-up MR. Sensitivity, specificity, and diagnostic accuracywere 87.5%, 50%, and 78%, respectively.Conclusions: Low field systems are capable of diffusion weighted imaging. Forthe same b value, ADC values at 0.2 T and 1.5 T are similar.In clinical practice DWI on low field MR systems can be used as a fast and relia-ble tool for detection of acute ischemic lesions in the brain.

C-747Advantages of a 3D multislab T2 turbo spin echo magnetic resonance (TSEMR) sequence for high resolution brain imagingB. Schmitz, M. Koelle, G. Groen, A. Wunderlich, A.J. Aschoff; Ulm/DE

Purpose: There is a constantly growing need for high resolution brain scans forneuronavigation, voxel based morphometry or automatic tissue classification. Highresolution T1 weighted sequences are currently available while a T2 weightedequivalent is lacking. A multislab 3D turbo spin echo (TSE) T2 weighted sequencewhich provides 1 mm³ isotropic voxels within reasonable acquisition time is pre-sented.Methods and Materials: Six healthy volunteers, mean age 27.4 years werescanned on a 1.5 T MRI. A 3D T2 weighted sequence with the following sequenceparameters was used: TR 2420 ms, TE 125 ms, 1 mm³ isotropic voxel size, 18slabs with 180 sagittal slices, bandwidth 199 Hz/Px, FA 150°, acquisition time(TA) 8:06 min. In addition a 3D T1 weighted MPRAGE sequence (TR 1880 ms,TE 3.2 ms, TI 1100 ms, FA 8º, 1 mm³ isotropic voxel size, 176 sagittal slices,bandwidth 160 Hz/Px, TA 8:02 min) was scanned for comparison. Image qualitywas subjectively assessed by two experienced radiologists. Signal to noise (SNR)and contrast to noise ratios (CNR) of gray versus white matter were determined.Results: All measurements were free of artifacts and provided excellent imagequality. The 3D T2 weighted TSE sequence showed significantly (p < 0.05) high-er SNR (39.4 vs 26.4) and higher CNR for gray versus white matter (11.8 vs 9.0)compared with the 3D T1 gradient echo images.Conclusion: It is feasible to scan the whole brain with T2 contrast in 1 mm³ iso-tropic resolution with high SNR and CNR using a multislab 3D TSE sequence.

C-748Postoperative multidetector-row CT angiography (MDCTA) after aneurysmclipping: Comparison with digital subtraction angiography (DSA)J. Lee, S. Kim, J. Cha, H. Kim, D. Lee, C. Choi, H. Lee, D. Suh; Seoul/KR

Objectives: To evaluate the usefulness of MDCTA as an evaluation tool afterclipping of intracranial aneurysms.Materials and Methods: We compared the results of postoperative MDCTA andDSA in 38 patients. In 18 of all, MDCTA was performed with 16-channel MDCT, in20 with 4-channel MDCT, and in 2 with both of them. Two radiologists blinded tothe results of DSA evaluated the presence of residual sac of aneurysm. The abil-ity of MDCTA to discriminate between surgical clips and branching vessels, andthe presence of vasospasm were evaluated with 3- and 4-point scale, respectively.Results: Fifty-two surgically clipped aneurysms were evaluated in this study. Theseparability of MDCTA was graded as good in 25, fair in 16, and poor in 11 cases.But in the cases with 16-channel MDCTA, it was graded as good in 19, fair in 3,and poor in 2 cases. Among three residual aneurysms confirmed by DSA, twowere accurately diagnosed by 16-channel MDCTA, and one was missed by 4-channel MDCTA. In addition, 4-channel MDCTA showed one false positive resultof residual sac, which was confirmed to be a turning vessel on DSA. MDCTAdetected vasospasm in 22 patients, but MDCTA tended to overestimate the de-gree of vasospasm in 9 of 10 discordant cases.Conclusion: Sixteen-channel MDCTA showed good ability to discriminate be-tween surgical clips and branching vessels, and was able to accurately diagnosethe presence of residual sac. Because of the tendency of overestimation, vasos-pasm must be diagnosed carefully only by the results of MDCTA.

C-749Brain surface rendering image of cortical dysplasiaG.-H. Chung, Y.-M. Han, S.-Y. Lee; Jeonju/KR

Purpose: To describe the abnormal gyral patterns obtained by means of three-dimensional (3-D) surface-rendering MR imaging in patients with cerebral corti-cal dysplasia.Materials and Methods: Eighteen patients with cerebral cortical dysplasia[M:F = 11:6, aged 1-50 (median 26.6) years] underwent 3-D surface-renderingMR imaging. There werecases of schizencephaly(2), hemimegalencephaly(2),bilateral perisylvian syndrome(2), lissencephaly(2) and focal cortical dysplasia(9).All were the subject of conventional brain MR imaging studies using the MP-RAGE (magnetization-prepared rapid gradient-echo) sequence and the resulting3-D data sets were processed on a commercially available workstation. Abnor-mal gyral configurations were reviewed.Results: Abnormal gyral patterns were seen 15 of 18 patients. The configurationand orientation of affected gyri were clearly evaluated in the brain surface-ren-dering image. In two cases of the schizencephaly (involved the frontal lobe), therewere wheel shaped broad gyral pattern of the superior, middle, and inferior fron-tal lobes. In two cases of the hemimegalencephaly, there were thick gyral patternand enlarged ipsilateral brain. In two cases of the lissencephaly, the frontopari-etal cortex was not delineated and showed a markedly thick and smooth gyralpattern. In two cases of the bilateral perisylvian syndrome, there were openedinsular cortex and a thickened gyral pattern. In the focal cortical dysplasia, therewere irregular serrated or thick and enlarged gyri.Conclusion: In patients with cerebral cortical dysplasia, brain surface-renderingMR imaging detects a detail gyral pattern and involvement site of abnormal gyri.

C-750Diffusion tensor MRI of brain tractography: Early prediction of functionalmotor outcome in patients with deep intracerebral hemorrhageK. Ishigame1, H. Toyoshima1, S. Aoki2, Y. Masutani1, M. Ibaraki1,E. Shimosegawa1, M. Hori3, T. Okubo3, T. Araki3; 1Akita/JP, 2Tokyo/JP,3Yamanashi/JP

Purpose: Brain tractography using diffusion tensor MR analysis and fiber track-ing can be expected to demonstrate main white matter anatomy. Our goal is toassess usefulness of visualization of the corticospinal tract using brain tractogra-phy to predict functional motor outcome in patients with deep intracerebral hem-orrhage.Methods and Materials: Patients with acute deep intracerebral hemorrhage wereprospectively evaluated by using brain tractography. Within 72 hours after theonset, diffusion tensor imaging was performed with a 1.5 T MR scanner. To de-pict corticospinal tract, we used the software (dTV1.5) for the diffusion tensoranalysis and fiber tracking that can be downloaded free. We set regions of inter-est (ROI) at the level of internal capsule and corona radiata on the corticospinal

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tract and obtained the value of apparent diffusion coefficient (ADC) and fractionalanisotropy (FA). The degree of depiction of corticospinal tract and the values ofFA and ADC was correlated with functional motor outcome.Results: Twenty-six patients were examined. The corticospinal tract ipsilateral tothe hemorrhage was not depicted in nine patients with bad prognosis. The ADCand FA values in patients with bad prognosis were lower than those with goodprognosis. Assessment of the degree of depiction and ROI analysis of corticospi-nal tract predicted motor functional outcome with sensitivity 93.8% and specifici-ty 100%.Conclusion: Brain tractography using diffusion tensor analysis and fiber track-ing was useful to predict functional motor outcome in patients with deep intracer-ebral hemorrhage.

C-7511H magnetic resonance spectroscopy (MRS): Is it useful in thedifferentiation between Alzheimer's and Lewy body diseases?A. Rotkiewicz, R. Magierski, W. Gajewicz, I. Karlinska, I. Kloszewska, B. Goraj;Lodz/PL

Purpose: Patients with varied types of dementia can present with a very similarclinical picture. It can create difficulties in the differential diagnosis and can there-fore cause problems in choosing the appropriate therapy. This is especially truein cases with Alzheimer's versus Lewy-body disease ((DLB), which require dif-ferent therapeutical approach. We applied 1H-MRS to assist the diagnostic proc-ess and to look for specific differences in the metabolic content of the brain tissuein these two entities.Methods: 1H-MRSwas performed using 1.5 T scanner in T1-weighted images in3 orthogonal planes in 24 elderly subjects with consensus criteria DLB (n = 12),NINCDS–ADRDA AD (n = 12), and normal control subjects (n = 10). 1H-MRSwas performed with single-voxel (SVS) technique using STEAM sequence (TR2000 ms, TE 20 ms). Voxel was positioned in the temporal, occipital lobe andcentrum semiovale.Results: In both Alzheimer's and Lewy-body group, 1H-MRS showed changes inthe metabolite pattern in all voxel locations, with the most distinct expressionwithin temporal lobes. NAA and creatine peaks were lowered in both patientsgroups, comparing to the controls. In spectra of Lewy-body patients myoinosytolpeak remained unchanged as opposite to the Alzheimer's where it was increased.Conclusions: 1H-MRS can be an additional, very important tool in dementiastudies and differential diagnosis of this group of diseases. In DLB patients 1H-MRS is feasible but there are difficulties in scanning patients in the later stages ofthe illness due to tremor and the degree of brain atrophy.

C-752Cerebellar activation related to various tasks: A functional MRI studyS.-H. Jeong, G.-H. Chung, Y.-M. Han; Jeonju/KR

Purpose: To assess cerebellar activation during various tasks using fMRI.Materials and Methods: Sixteen healthy subjects were imaged on a 1.5 T scan-ner. Each paradigm consisted of five epochs of activation vs control condition.The activation tasks consisted of left finger movement, sensory stimulation, lis-tening to comprehension (for sensory language area), word generation (for mo-tor language area) and working memory. The reference function was boxcarwaveform. Activation maps were thresholded at uncorrected p = 0.0001. Thethresholded activation maps were placed into Talarach's space.Results: Cerebellar activation was observed in the motor, the word generationand the working memory tasks. In the hot sensory and listening comprehensiontasks, there was not any visible activation in the cerebellum. Left and right poste-rior cerebellar (Declive) activation was observed in the left motor task. Ipsilateralcerebellar activation was more prominent than contralateral cerebellar activationduring the left motor task. Left posterior cerebellar (Declive) activation was ob-served in the working memory task. Left posterior cerebellar (Declive) and bothanterior cerebellar (Culmen) activations were noted in the word generation task.Conclusion: Cerebellar activation was observed in the afferent actions of thebrain including motor, motor language and working memory tasks. There was noactivation of the cerebellum in the efferent action of the brain including sensoryand sensory language tasks. The cerebellum is involved in a variety of functionaltasks including motor, word generation and working memory.

C-753Diffusion tensor tractography in the cases with visual field defect aftertemporal lobectomyT. Taoka, H. Nakagawa, S. Iwasaki, S. Hirohashi, M. Sakamoto, K. Kichikawa;Kashihara, Nara/JP

Purpose: Our purpose is to evaluate the degree of impairment of optic tracts inthe cases with visual field defect after temporal lobectomy using diffusion tensortractography.Materials and Methods: We examined 7 cases after temporal lobectomy for tem-poral lobe epilepsy. Visual field defect in medial sector and lateral sector of upper1/4 visual field were evaluated. Diffusion tensor images (EPI TR = 180, TE = 96,b = 3000, 6 axis encoding) were acquired. Tractography of optic radiation wasmade using diffusion tensor imaging software (dTV ver1.5). We evaluated thecorrelation between the degree of visual field defect and visualization of Meyer'sloop on tractographies.Results: There were two cases with intermediate defect in medial sector and nodefect in lateral sector (group A), two cases with complete defect in medial sectorand intermediate defect in lateral sector (group B) and three cases with completedefect in both medial and lateral sector (group C). Visualization of Meyer's loopwas complete in two cases in group A. While, visualization was incomplete in onecase and impossible in one case in group B, and was impossible in all threecases in group C.Conclusion: Medial sector field tends to be impaired after temporal lobectomy.Diffusion tensor tractography showed incomplete to no visualization of Meyer'sloop in the cases with severe visual field defect.This result was obtained by using the free software dTV (http://www.ut-radiology.umin.jp/people/masutani/dTV.htm) for MR-DTI analysis developed byImage Computing and Analysis Laboratory, Department of Radiology, The Uni-versity of Tokyo Hospital, Japan.

C-754The brain smell centres: Comparison of localisation and activation in maleand female subjects using functional MR imaging (fMRI)M.D. Marchwicka-Wasiak, B. Goraj; Lodz/PL

Purpose: The study was conducted in order to determine and to compare thelocation and activation of smell brain centres in females and males brains usingolfactory nerve-mediated (geraniol) and combined olfactory and trigeminal nerve-mediated (patchouli) stimulants.Methods: Ten normal volunteers (five women and five men), right-handed, non-smokers, without any CNS diseases were examined to determine the activatedcortex areas during stimulation by geraniol and patchouli. MR brain scans wereobtained using a 1.5 T clinical scanner, with the head-neck coil. The imaging wasperformed in each subject using SE and EPI sequences with a blood-oxygen-level-dependent (BOLD) effect. The individual inhaled odorized air during the 30seconds period and alternating room air over the same period. The mean pixelintensity of activated images was substracted from the mean pixel intensity ofpreactivated images.Results: The olfactory system-mediated stimuli (geraniol) evoked bilateral acti-vation of female brain smell centres compared to right hemisphere centre activa-tion in male brains. The exposure to the olfactory and trigeminal nerve-mediatedstimuli (patchouli) showed more activated regions in both sexes than to the olfac-tory nerve-mediated stimuli.Conclusion: fMRI proved to be a useful method to compare the location andactivation of male and female brain smell centres.

C-755MRI evaluation of midbrain atrophy in patients with progressivesupranuclear palsy (PSP)M. Cosottini, R. Ceravolo, M. Tosetti, G. Lazzarotti, L. Faggioni, M. Michelassi,U. Bonuccelli, C. Bartolozzi; Pisa/IT

Purpose: To assess midbrain atrophy through morphological (diameter and vol-ume) and biochemical (N-acetylaspartate (NAA)/creatine (Cr) ratio) data in pa-tients with clinically diagnosed PSP.Methods and Materials: We studied 10 patients with diagnosis of probable PSPbased upon the NINDS-SPSP clinical criteria and 10 age-matched healthy vol-unteers. All subjects underwent a MR protocol performed on a 1.5 Tesla unit in-cluding an axial SE DP-T2 weighted sequence, a sagittal SE T1 weightedsequence for cross-sectional area and linear brainstem measurements, and athree-dimensional fast spoiled gradient echo (FSPGR) sequence for brainstemvolume measurements. A single voxel MR spectroscopy (1H-MRS) study of the

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midbrain was performed in the same session using a short TE stimulated echoacquisition mode (STEAM) technique.Results: We compared the group of PSP patients with that of control subjectsand found a highly significant difference in antero-posterior midbrain diameters(Mann-Whitney test: P < 0.005), absolute midbrain volumes (P < 0.005) and NAA/Cr ratios (P < 0.01), as well as a significant difference in total intracranial vol-ume-normalized midbrain volumes (P < 0.03). We also found out a significantcorrelation between NAA/Cr ratios and antero-posterior midbrain diameters inPSP patients (Spearman's rank correlation test: rs = 0.7619, P < 0.05).Conclusions: Both morphological and biochemical alterations correlate with dis-ease condition. Measurement of the antero-posterior midbrain diameter can beundertaken instead of NAA/Cr ratio determination in MRI evaluation of PSP pa-tients.

C-756MR imaging in hippocampal sclerosis: Comparison of different commonlyused dedicated MR sequences and determination of a cost-effectiveprotocolA. Lefkopoulos, A. Haritanti-Kouridou, A. Kalogera-Fountzila, N. Mihailidis,G. Spanos, G. Sevas, A.S. Dimitriadis; Thessaloniki/GR

Purpose: The aim of this study was to compare the diagnostic accuracy of T2fast spin echo (T2FSE), fluid attenuated inversion recovery (FLAIR) and inver-sion recovery (IR), in evaluating hippocampal sclerosis and to determine a cost-effective protocol for this disease process.Materials and Methods: In this prospective study, 48 patients (aged 6 months-55 years) with drug-resistant temporal lobe epilepsy (based on clinical symp-tomatology and electroencephalographic (EEG) registrations) were evaluated byMRI with a 1.5 Tesla unit. The protocol consists of axial T1 and PD/T2 SE, andFLAIR, T2FSE and IR in a coronal plain perpendicular to the long axis of thehippocampus. Whenever necessary, we applied T1 + Gd SE in axial and coronalplanes. Films were interpreted by two experienced neuroradiologists. Sequenceswere statistically analyzed in pairs using Wilcoxon Sign Ranks Test.Results: There were 33 patients (68.75%) with MR and EEG findings suggestiveof hippocampal sclerosis. Eight of them underwent therapeutic surgery and therewas histopathologic confirmation of the diagnosis. FLAIR detected hyperintensi-ty of the hippocampus in 31/33 (94%) and was much more sensitive than T2FSE(18/33 p = 0.002) and PD/T2 (11/33 p = 0.000). Reduced hippocampal size (28/33), atrophy of hippocampus (22/33) and enlarged temporal horn (24/33) werebetter detected with IR than T1 (9/33 p = 0.000).Conclusion: A MR protocol using thin coronal sections angled perpendicular tothe hippocampus with FLAIR and IR sequences is cost-effective for mesial tem-poral sclerosis because it is highly sensitive, inexpensive, quick and easily appli-cable in most units.

C-757Reversibility of the brain white matter changes in adults with late diagnosedand treated phenylketonuriaM. Gizewska, L. Cyrylowski, D. Koziarska, P. Nowacki, A. Walecka,M. Walczak; Szczecin/PL

Purpose: Phenylketonuria (PKU) is an autosomal recessive disorder related toabsent or reduced activity of phenylalanine hydroxylase what leads to increasedplasma phenylalanine (Phe) concentration. Because screening the whole new-born population for PKU in Poland began in the late 1980s, many PKU adultshave been diagnosed and treated very late. Patterns and extent of the brain whitematter changes in these patients is described.Methods and Materials: In this paper, 13 late diagnosed and treated adults withPKU, including 9 males and 4 females, is presented. The mean age at diagnosiswas 37.2 y (range 18 - 50). Microcephaly was present in 7, seizures in 4, aggres-sive behavior in 3; all but one had speech difficulties, including total mutism in 7.MRI of the head was performed on 1.5 T unit with FSE and FLAIR sequenceswithout contrast medium administration.Results: MRI of the head detected white matter changes, hyperintense on T2-weighted images, in all but one patients. All but one of them had changes inparietal and/or occipital regions. The treatment with low-Phe has been introducedin 3 with improvement in all of them. The follow-up MRI were performed aftermean 8.7 months, revealing decreased severity of the white matter changes inall, from mean 20 (according to Cleary's scale) on the initial MRI to 7.3 on thefollow-up.Conclusion: Our results indicate the possibility of white matter changes revers-ibility in late diagnosed and treated PKU adults.

C-758Intracranial infection: Appearance on diffusion weighted-echo planar MRimagingJ. Borrego Gómez, A. Saiz Ayala, F. Matute Teresa, M. Santamaria Peña;Madrid/ES

Purpose: This exhibit illustrates diffusion-weighted imaging (DWI) patterns ofvarious CNS infections and key points and pitfalls in differential diagnosis.Methods and Materials: We reviewed DWI in 40 patients with various CNS in-fections. DWI was performed on a Signa Horizon 1 T system. Diffusion-weightingwas applied in three orthogonal orientations with b-values of 1000 sec/mm2. Ap-parent diffusion coefficient (ADC) analysis was carried out using Functool.Results: DWI showed pyogenic cerebral abscess as very hyperintense signalassociated with decreased ADC. Empyema collections and encephalitis werealso hyperintense on DWI. Diffusion-weighted imaging with or without ADC val-ues may be helpful in differentiating extra-axial empyemas from reactive sterileeffusions in patients with CNS infection. We observed that high diffusion signalheralds infection, while low diffusion signal does not. Toxoplasmosis lesions werevariable and did not show a distinct pattern and were more difficult to interpret. Inone patient with invasive aspergillosis, both solid and cystic components showedhyperintensity on DWI with decreased ADC. DWI showed hyperintensity lesionsin bilateral basal ganglia in patients with HIV, which were probably due to HIVvasculitis. In patients with bacterial meningitis, DWI demonstrated hyperintenselesions in the basal ganglia, corpus callosum, or subpial frontal cortex. In onepatient with Creutzfeldt-Jakob disease (CJD), DWI revealed hyperintense lesionsin the cerebral cortex.Conclusion: DWI is thought to be useful in the diagnosis of CNS infections. Inour experience, DWI may allow the differentiation of brain abscess from necroticor cystic brain tumor. DWI is also a useful tool to differentiate subdural and epi-dural empyemas.

C-759Detection of olfactory tract lesions in cases of post traumatic anosmia:Comparison of fluid-attenuated inversion-recovery (FLAIR), proton density-weighted (PD), and T2- weighted MRIA. Moumouh, P. Vandermarcq, J.-P. Tasu; Poitiers/FR

Objective: To compare fluid-attenuated inversion-recovery (FLAIR), proton den-sity-weighted (PD) and T2-weighted magnetic resonance (MR) imaging for char-acterization of post-traumatic anosmia lesions.Material and Methods: Twenty-eight patients (10 females, 18 men, range from 4to 66 years old), were explored for post-traumatic anosmia by MR examination.Examinations were performed on 1.5 Tesla magnet (Signa, GEMS, Milwaukee)for 12 patients and on a 0.5 Tesla magnet for 16 patients (MR MAX, GEMS,Milwaukee). Coronal views were performed for FLAIR imaging, and coronal andaxial views for DP and T2-weighted imaging. Images were reviewed by two sen-iors radiologists in consensus for localisation of the signal abnormalities.Results: Lesions of the olfactory system were observed in 23 patients (82%).Signal abnormalities were localised in the temporal lobe in 15 cases (54% with10 cases of unilateral lesions and 5 cases of bilateral lesions) and in the orbitofrontal cortex in 19 cases (68% with 17 cases of bilateral lesions and 2 cases ofunilateral lesions). With FLAIR, DP, and T2 weighted imaging, lesions was de-tected respectively in 56%, 38% and 48%. Olfactory bulb signal abnormalitieswere diagnosed in 19 cases (68% with 3 cases of unilateral lesions and 16 casesof bilateral lesions). For this localization, the accuracy of FLAIR, DP and T2 se-quences was respectively 46%, 63%, 54%.Conclusion: In post-traumatic anosmia, coronal FLAIR and coronal PD imagingis required to detect respectively signal abnormalities in the parenchyma and inthe olfactory bulbs. T2 weighting imaging seems to be inferior.

C-760Cerebral hydatid disease: CT and MR imaging findingsY. Bükte, S. Kemaloglu, H. Nazaroglu, A. Uyar, C. Akgül, M. Simsek;Diyarbakir/TR

Purpose: Cerebral hydatid disease is very rare, representing only 2% of all cer-ebral space occupying lesions, even in the countries where the disease is en-demic. The aim of this study was to describe the discriminative computedtomography (CT) and magnetic resonance (MR) imaging features of cerebralhydatid disease.Methods and Materials: We retrospectively reviewed the imaging findings of 18patients with pathologically confirmed cerebral hydatid disease over a period of13 years (1990-2002). Among these patients, there were 17 cases of Echinococ-

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cus granulosis and 1 case of Echinococcus multilocularis (alveolaris). They were12 male (66.7%) and 6 female patients (33.3%), ages ranging from 7 to 50 yearswith an average age of 21.8 years.Results: Common CT and MR imaging findings of E. granulosis lesions werewell-defined, smooth thin-walled, round or spherical, homogeneous cystic lesionswith no contrast enhancement, no calcification and no surrounding edema. Thelesion seen in E. multilocularis showed a well-defined multiseptated mass con-sisting of solid and cystic components with calcifications of solid portions. Cysticlesions with surrounding hyperintense area of perifocal edema, complete andincomplete rim of contrast enhancement were seen in two patients and werelabeled as complicated and infected cysts.Conclusion: Although the cystic cerebral hydatid disease could be equally welldemonstrated on CT and MR examinations, CT is superior in detecting calcifica-tion of the cyst, when present. MR is better in demonstrating cyst capsule, de-tecting multiplicity and defining the anatomic relationship of the lesion with theadjacent structures and helps in surgical planning.

C-761CT evaluation of cerebral atrophy in murderersM. Wyrobek-Renczynska, R. Chrzan, T. Zyss, A. Urbanik; Krakow/PL

Purpose: The aim of the study is to evaluate the frequency of occurence andintensity of cerebral atrophy, taking the age into consideration, in murderers ex-amined with CT by order of the law court in course of criminal action.Methods and Materials: In 65 people (59 men, 6 women, 15-72 years old), or-dered by the law court in course of action for murder, CT of brain was performed.Measurements of ventricular system, skull vault and external CSF spaces wereperformed and values of indexes as: frontal horn index, Evans index, ventricularindex, sella media index and Huckman number were calculated. Average valuesof measurements and indexes were calculated separately for four groups of age(up to 20, 21-40, 41-60 and from 61). Results were compared to norms of phys-iological brain ageing according to Meese with Kusmiderski's modifications.Results: Cortical atrophy in examined murderers, exceeding physiological val-ues was observed only in the group up to 20 years old. Subcortical atrophy, ex-ceeding physiological values was observed in groups up to 20 and to a lesserextent 21-40 years old. Values of frontal horn index and Huckman number, corre-sponding to frontal lobes atrophy, exceeded physiological values in groups up to20 and to a lesser extent 21-40 years old.Conclusion: Cerebral atrophy, particularly subcortical frontal lobes atrophy, ex-ceeding physiological values, indicating characteropathy as one of potential rea-sons for aggressive behaviour, was statistically significant in people up to 40years old, however in people above 40 years old it did not differ from normalvalues.

C-762Diffusion-weighted MR imaging of acute cerebral infarctions in patientswith middle cerebral artery stenosisN. Mayolas, F. Ramírez, E. Grivé, J. Arenillas, E. Sánchez, C. Schorlemmer,A. Rovira; Barcelona/ES

Background and Purpose: Atherosclerotic stenosis of intracranial arteries isthe cause of about 10% of all brain infarcts. Advances in neuroimaging such astranscranial doppler ultrasound (TCD), magnetic resonance angiography (MRA)and diffusion-weighted imaging (DWI) have provided new insights into the rela-tionship between intracranial atherosclerotic disease and cerebral infarction. Theaim of this study was to investigate the probable stroke mechanism in patientswith symptomatic atherosclerotic stenosis of the middle cerebral artery (MCA).Patients and Methods: We prospectively studied 31 consecutive acute strokepatients with MCA stenosis detected by TCD and MRA. Characteristics of acuteinfarcts on DWI were categorised according to their anatomic distribution: 1)Cortical territorial infarcts; 2) Fragmented cortical territorial infarcts; 3) Subcorti-cal territorial infarcts; 4) Lacunar infarcts; and 5) Watershed infarcts.Results: On DWI study, 10 patients (32%) had fragmented cortical infarcts, 9patients (29%) had watershed infarcts, 8 patients (26%) had lacunar infarcts and4 patients (13%) had cortical infarcts. No patients showed a purely subcorticalinfarct. Two of the patients with cortical infarcts had complete occlusion of a distalMCA branch.Conclusion: The common stroke mechanisms in patients with atheroscleroticdisease of the MCA include artery-to-artery embolism leading to cortical or frag-mented territorial infarcts, embolism or atheroma plaque in the origin of a pene-trator artery leading to lacunar infarctions, and distal branch occlusion leading tolimited cortical infarction. Hemodynamic compromise leading to watershed inf-arction represents about one third of the cases.

C-763Cerebral blood volume measurement with CT: Comparison of dynamiccontrast enhanced methods to single scan estimation methodsS. Pohlman1, J. Rodriguez2, A. Cook3; 1Cleveland, OH/US, 2Toledo, OH/US,3Ravenna, OH/US

Purpose: Quantitative cerebral blood volume (CBV) measurements obtained bya dynamic series of contrast-enhanced CT scans of a single anatomical level arecompared to single scan CBV estimates that may allow full brain coverage.Methods and Materials: Dynamic scans of 63 patients were obtained (Mx8000,Philips). Quantitative CBV maps were calculated by normalizing the area under atissue region of interest (ROI) curve by the area under a venous ROI curve. Thesingle scan technique was simulated by taking a single enhanced scan (30 safter contrast injection) from the dynamic sequence and subtracting an unen-hanced scan. CBV was estimated as the HU enhancement of each voxel. CBVvalues for the right and left MCA territory were compared for each method fornormal and abnormal patients.Results: CBV estimates using the single scan technique had a low correlation toquantitative CBV values obtained with the dynamic technique (R2 = 0.22). How-ever, left/right hemisphere CBV ratios were correlated between the methods(R2 = 0.75). For patients with a clear abnormality, (> 20% CBV difference be-tween hemispheres), 83% showed at least a 10% difference with the single scantechnique. This indicates that while the single scan technique is not quantitative,it may be used to identify regional differences within a patient. Qualitatively, sin-gle scan CBV maps were noisier than maps using the dynamic method.Conclusion: CBV estimates from a single contrast-enhanced scan may identifyabnormal areas. However, differentiation between normal and abnormal regionsis not as pronounced as when using quantitative, dynamic methods.

C-764Virtual endoscopic imaging of cerebral CT angiography (VECCTA) inselecting patients for neurosurgical intervention or endovascular treatmentR. Prpic-Vuckovic, M. Rados, M. Batinica, J. Papa, M. Seronja-Kuhar;Zagreb/HR

Purpose: To assess the usefulness of virtual endoscopic cerebral CT angiogra-phy data analysis in patients with aneurysm rupture before making a decisionbetween neurosurgical intervention or endovascular treatment.Materials and Methods: During a one-year period, MSCTA was performed in 35patients after a conventional CT proven subarachnoid hemorrhage. Images wereacquired using MSCT LightSpeed Ultra, GE. Helical data acquisition followedafter rapid i.v. administration of contrast material (3.5 mL/sec), with 18-23 secdelay. Data was postprocessed on GE Advantage Workstation Ultra v4.0 usingreconstruction protocols MIP (maximum intensity projection), SSD (shaded sur-face display), VR (volume rendering) and VE (virtual endoscopy).Results: Detailed analysis of aneurysmal neck, dome, vessel of origin and sur-rounding vascular or bone structures was acquired by SSD, MIP or by high-accu-racy VR protocol. Modified surface rendering and VE protocol were used forendoscopic mode viewing to visualize neck shape, accessibility from the parentvessel, presence of thrombotic clots or calcifications inside the aneurysm andvessel of origin, as well as to define orifices of branches arising from the dome.Conclusion: Accurate characterization of morphology of the aneurysm, espe-cially depiction of orifices and aneurysmal neck are essential for choice betweenneurosurgical intervention or endovascular treatment. When endovascular treat-ment is an option, it is useful to know angulation between parent vessel and neckand real volume of aneurysmal dome for proper estimation of coil size and shape.VR and VE imaging of the aneurysmal sack and surrounding anatomy may pro-vide additional useful information for endovascular treatment or neurosurgicalintervention.

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C-765Imaging of spinal epidural lesionsI.A. Alorainy; Riyadh/SA

Learning Objectives: This educational exhibit provides a comprehensive reviewof imaging findings of lesions of the spinal epidural space on different imagingmodalities and an approach to the differential diagnosis based on these findings.Background: Spinal epidural space can be involved in several disease condi-tions, the distinction between which is highly dependent on knowledge of region-al anatomy and disease pattern on imaging. Management (medical or surgical)of the spinal epidural lesions is highly dependent on correct radiologic diagnosis.Imaging Findings: Many diseases can involve the spinal epidural space, eitheras primary lesions of this space or as an extension from a disease process in theneighbourhood. For sake of easy and accurate interpretation, the lesions of thespinal epidural space were classified etiologically/pathologically to degenerative,inflammatory/infective, neoplastic, traumatic/iatrogenic, hematologic/vascular andmiscellaneous lesions. Both CT and MRI have crucial role in imaging of spinalepidural abnormalities.Conclusion: The spinal epidural space is a site for several primary and second-ary diseases. Distinction between lesions of this space is helped by good knowl-edge of the spectrum of imaging findings of the abnormal spinal epidural space.

C-766Axial DW-EPI study of biexponential water diffusion in human cervicalspinal cordA. Jasinski1, B. Tomasz1, M. Konopka2, P. Pieniazek2, M. Hartel2, T. Skorka1,W.P. Weglarz1; 1Krakow/PL, 2Katowice/PL

Introduction: Diffusion weighted imaging (DWI) has a limited role in spinal cordstudies due to technical difficulties. Recent studies have shown that at high b-values, diffusion in the brain and in the animal spinal cord presents a biexponen-tial decay corresponding to fast and slow diffusion components, due to waterproperties in various compartments of the nervous tissue. To the best of our knowl-edge DWI of human cervical spinal cord (CSC) at high b-values has not beenpublished so far. We report results of transverse diffusion studies in the CSC athigh b–values using single shot axial DW-EPI.Methods and Materials: This study was conducted on 12 healthy volunteers.MR and DW images were acquired on 1.5 T system, with b = 450, 600, 750, 900,1200, 2000, 3000, 4000, 5000, 6000, 7000 s/mm2. Values of ADT were deter-mined for different ROI in the white (WM) and gray matter (GM) by fitting thesignal decay for different b after TE correction.Results: Good quality DWI were recorded for all b-values. The average values ofdiffusion components in the ventral horn in GM were: Df = (1.11 ± 0.17) 10-3 mm2/s, Af = 0.54 ± 0.07, Ds = (0.14 ± 0.03)10-3 mm2/s, As = 0.46 ± 0.07. For WM in theposterior funiculus the corresponding values were: Df = (1.35 ± 0.55)10-3 mm2/s,Af = 0.74 ± 0.07, Ds = 0.08 ± 0.02)10-3 mm2/s, as = 0.26 ± 0.07. Obtained datapresents bi-exponential dependence of diffusion parameters on b value.Conclusion: We have demonstrated the existence of non-monoexponential dif-fusion in the human CSC that can be approximated by fast and slow diffusioncomponents. Our results are within the limits of human brain and full DTI data forthe rat spinal cord.

C-7673D CISS imaging and vascular abnormalities of the spinal cordP. Martínez-Miravete, J. Zubieta, F. Bergaz, R. Gil Marculeta, P. Domínguez,M.J. Pons; Pamplona/ES

Purpose: The aim of this study is to assess the value of a novel high resolutionthree dimensional (3-D) technique CISS (Constructive Interference in SteadyState) in the investigation of suspected intraspinal vascular pathology.Materials and Method: All patients referred to evaluate the spinal cord under-went sagittal STIR, T1 and T2 turbo spin echo. A 3-D CISS examination wasundertaken in selected cases based upon the clinical context and review of theconventional images at the time of the examination. 1.5 T MRI unit was used.Results: In five cases, 3-D CISS sequences demonstrated the engorged andserpinginous pial venous plexus associated with a spinal ar teriovenousmalformations (dural fistulae). Cord expansion secondary to congestive venousmyelophaty was found in 3 cases. All cases were correlated to conventional arte-riography.

Conclusions: 3-D CISS technique must be included in the study of suspectedspinal dural fistulae and arteriovenous malformations because this sequencedemonstrates the features of a spinal vascular abnormality without the use ofcontrast agent. Spinal angiography remains as a technique for assessing thevascular malformations if therapeutic (interventional/surgery) procedures areconsidered.

C-768Imaging features of spinal hydatid cyst: CT and MRIC. Hafsa, S. Kriaa, M. Golli, M. Said, F. Eladeb, A. Gannouni; Monastir/TN

Purpose: To present the imaging features of primary spinal hydatid disease. Val-ue of MRI is emphasized.Method and Materials: We retrospectively studied 16 patients affected with pri-mary spinal hydatid disease confirmed by surgery and histopathological findings.Patients ranged in age from 25 to 70 years. All patients were studied with plainfilms and CT scan. MRI was available in 8 cases.Results: Imaging showed multicystic bony lesions. Thoracic involvement waspresent in 8 cases, lumbar involvement in 4 cases and sacral involvement in 4cases. Extension into the spinal canal was noted in all cases. Other sites of in-volvement were also noted, especially in adjacent soft tissues, liver and spleen.Conclusion: The presence of multicystic vertebral lesions with involvement ofadjacent soft tissues and/or distant organs should raise the possibility of spinalhydatid disease in endemic countries.

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C-769Imaging of the craniocervical junction: Development, normal anatomy andpathological statesJ. Rimola, A. Carvajal, A. Rovira Gols, M. Zauner, P. Bermúdez, A. Massuet;Sabadell/ES

Learning Objectives: The aim of this study is to review the embryology and thedevelopment of this structure. To describe the normal CT and MR appearancesand to show the neuroradiological findings of pathology that can effect the crani-ocervical junction.Background: The craniocervical junction is an anatomical crossroads with char-acteristic pathologic entities, mainly malformative and traumatic in origin. We il-lustrate the normal anatomy of the craniocervical junction and a wide spectrumof pathological conditions involving this structure through a selection of casesfrom a retrospective review of the CT, MR and plain-film examinations carried outin our centre over the last five years.Imaging Findings: Normal anatomy and a wide spectrum of pathologies affect-ing the craniocervical junction are illustrated by CT and MR examinations. Wegroup the findings according to etiology: Malformation, trauma, infection, inflamma-tory and tumor, placing emphasis on the radiological features and the differentialdiagnosis.Conclusion: CT depicts the bony structures of the craniocervical junction su-perbly while MRI shows the neurological components better, enabling excellentcharacterization of lesions and recognition of all potential types of disorders thatneed to be recognized by general as well as neuroradiologists.

C-770The spectrum of T1 hyperintensities of the sellar regionF. Bonneville1, K. Marsot-Dupuch2, F. Cattin3, D. Dormont1, J. Chiras1,J.-F. Bonneville3; 1Paris/FR, 2Le Kremlin-Bicêtre/FR, 3Besancon/FR

Learning Objectives: Recognize and understand normal T1 hyperintensities ofthe sellar region. Identify pathologic sellar and parasellar lesions demonstratingspontaneous T1 hyperintensity. Understand the different sources of T1 hyperin-tensities following medical or surgical therapy.Background: A very large variety of normal and pathologic conditions of thesellar region can demonstrate high signal intensities on T1-weighted images. Inthis exhibit, we will illustrate the spectrum of such T1 hyperintensities and givetips to approach the final diagnoses.Imaging Findings: Normal sellar T1 hyperintensities are related to vasopressinstorage in the neurohypophysis, bone marrow in normal and variant anatomicstructures, cellular hyperactivity of the anterior pituitary lobe (e.g. newborn, preg-nancy, breast-feeding) and magnetic susceptibility artifact.Pathologic T1 hyperintensities can be seen in hemorrhagic adenoma, apoplexy,Rathke's cleft cyst, craniopharyngioma, lipomatous lesions (lipoma, dermoid cyst,lipomatous meningioma), thrombosed aneurysm, calcifications of chondroma orchordoma, mucocele, melanoma and manganese deposit.Following treatment, T1 hyperintensities can result from subacute hemorrhage,packing material (gelfoam, fat), slow circulating or thrombosed veins in the cav-ernous sinuses and a small hyperactive remnant of normal anterior pituitary tis-sue.Conclusion: A very large variety of normal and pathologic conditions of the sell-ar region can demonstrate high signal intensities on T1-weighted images andshould be recognized.

C-771Role of multidetector CT in skull base tumors: Accurate diagnosis andsurgical planningV. Pineda, F. Romero, B. Ibarra, M. Sarrias, P. Coscojuela, L. Fernández,M. Fité; Barcelona/ES

Learning Objectives: To illustrate the usefulness of multidetector CT for the di-agnosis of skull base tumors and preoperative planning.Background: Several types of tumors can occur at the skull base. The site oforigin is an important key to diagnosis. Multidetector facilitates the performanceof advanced post-processing techniques that are very useful for locating, diag-nosing and determining the best surgical approach to treat these tumors.Procedure and Imaging Findings: All the cases presented were examined witha multidetector CT scanner (Philips MX-8000). Multidetector CT angiography was

also performed in some patients. Post-processing, which included 4D-volumerendering, MPR and MIP, was performed on a Silicon Graphics O2 workstation.The tumors were grouped according to their location and the tissue of origin. Themain imaging findings are provided. Examples of neurinoma, meningioma, epi-dermoid tumor, chondrosarcoma, ossifying fibroma, glomus jugulare, cholest-eatoma, chordoma, AV malformation, metastases, squamous cell carcinoma,medullary astrocytoma with intracranial invasion and myeloma are shown togetherwith their anatomic pathology correlations. The most relevant findings for deter-mining the surgical approach are illustrated. Post-processing reformations areuseful to clearly define the extent of the lesion and its relationship to the sur-rounding anatomical structures.Conclusion: Multidetector CT is a fast, accurate, noninvasive tool to character-ize skull base tumors, providing neurosurgeons with helpful information for de-ciding the surgical approach.

C-772High field MRI of the sellar spectrum of diseasesK. Pinker, A. Ba-Ssalamah, S. Wolfsberger, S. Mehrain, V. Mlynarik, E. Knosp,S. Trattnig; Vienna/AT

Learning objectives: 1. To demonstrate a large variety of sellar diseases and toeducate the radiologist about MR imaging techniques in high field strength. 2. Toillustrate the advantage of high field strength MRI for identifying anatomical struc-tures. 3. To highlight the value of high field strength MRI in the preoperative eval-uation of sellar processes.Background: To demonstrate the clinical value of high field MRI in the evaluationof a large variety of sellar processes in comparison to the standard field MRIusing the surgical specimen as the standard of reference.With the introduction of high field strength it is expected to overcome the limitedsignal to noise ratio and subsequently decreased spatial resolution in routinelyused standard field strength 1.0 - 1.5 Tesla MR scanners. This would have clini-cal impact in the preoperative work up of patients with sellar processes.Imaging Findings: In this exhibit we present a large variety of sellar diseasesusing 3 Tesla MR imaging with emphasis on detection of microadenomas andvisualization of anatomic structures.Furthermore, the differentiation between infiltration or just compression of themedial wall of the cavernous sinus in case of macroadenoma is illustrated.Conclusion: The excellent visualization of normal anatomy and tumor topographymakes this technique a very valuable tool for planning neurosurgical operations.

C-773CNS manifestations following stem cell transplantation: A pictorial reviewD. Beckett, A. Banerjee, J. Oliff; Birmingham/UK

Learning Objectives: To illustrate the spectrum of radiological manifestations inthe central nervous system and head and neck following stem cell transplanta-tion for haematological malignancy. To outline the advantages and limits of plainfilm radiography, cross-sectional imaging, interventional radiology and radionu-clide imaging.Background: Bone marrow transplantation (BMT) is a critical therapeutic inter-vention for a variety of pathological conditions. The complications of BMT includechemotherapy and radiation toxicity, graft versus host disease, recurrent malig-nancy, infection and miscellaneous conditions. Complications of allogenic BMTmanifest in a variety of clinical settings. The neurological system is commonlyaffected. In this presentation we will review the incidence, clinical presentationand the radiographic findings of CNS involvement following stem cell transplan-tation. Plain radiography, contrast material enhanced studies, sonography, CT,MRI and interventional techniques are essential in diagnosing these complica-tions and evaluating their response to therapy.Imaging Findings: Findings may be broadly classified into either infective, cere-brovascular or treatment induced. Common infective manifestations include hu-man herpes virus 6, invasive mucormycosis and central nervous systemtuberculosis. Classical image findings of haemorrhage and infarction are seen inaddition to graft versus host disease cerebrovascular angiitis. Infarcts, diffusewhite matter disease and cortical atrophy are seen following total body irradia-tion. The imaging findings of posterior leukoencephalopathy in cyclosporin toxic-ity is illustrated.Conclusion: The spectrum of imaging findings in the central nervous system isdiverse. A firm understanding of the clinical presentations and incidence in com-bination with typical radiological findings is essential in the successful manage-ment of this patient sub-group.

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C-774Nonvascular diseases with restricted diffusionW. Jun, B. Kwon, M. Han, K.-H. Chang; Seoul/KR

Learning Objectives: To systematically review nonvascular diseases with re-stricted diffusion on diffusion-weighted image (DWI).Background: Diffusion weighted imaging has been widely used in stroke pa-tients to detect early acute cerebral infarction and find out ischemic penumbra.However, we often unexpectedly encounter restricted diffusion on DWI of non-vascular origin mimicking hyperacute or acute infarction in clinical practice.Wereviewed nonvascular diseases with restricted diffusion on DWI for past threeyears by retrospective selection.Imaging Findings: The characteristic findings mimicking hyperacute or acuteinfarction are high signal intensity and low apparent diffusion coefficient values,mainly distributed in the white matter and incompatible with arterial territory withno stenoocclusive lesion on MR angiography or conventional angiography, andare reversible. These findings may increase possibility of nonvascular diseasessuch as infection, inflammation (viral or bacterial encephalitis), hemorrhage, leu-kodystrophy, toxic (anti-cancer drugs, CO poisoning), metabolic origin and tumors.Conclusion: We present various diseases, under certain clinical settings, andsystematically discuss the mechanism of restricted diffusion in a limited numberof specific diseases.

C-775The value of MRI in subacute combined degeneration: Vitamin B12-deficiencyR. Troescher-Weber, F. Reinhardt, M. Haslbeck, S. Strauss, B. Bison, W.J. Huk,B.F. Tomandl; Erlangen/DE

Learning Objectives: To illustrate typical MRI findings in patients with subacutecombined degeneration (SCD) due to vitamin B12 deficiency, including new tech-niques like diffusion weighted imaging (DWI).Background: In patients with vitamin B12 deficiency, symptoms related to thespinal cord may often help to find the diagnosis. However, in patients with atypi-cal symptoms MRI shows typical findings often diagnostic for SCD. Beneath ageneral discussion, we present 2 cases of SCD in whom MRI findings were lead-ing to the diagnosis of B12- deficiency.Patient 1 presented with tingling in her extremities. Neurologic examination showeda subacute loss of proprioception and profound loss of vibration sense. VitaminB12 serum levels were normal. T2W-MRI showed increased signal in the poste-rior columns of the spinal cord. DWI showed disturbance of diffusion in the samelocation.Patient 2, who practiced a vegan alimentation, was admitted with incompleteparaplegia with signs of spasticity. Vibration sense and proprioception were im-paired as well. MRI revealed the typical findings of severely increased signalwithin the posterior columns of the spinal cord.Both patients presented in very early stages of the disease. In summary, the MRIfindings showed typical signal hyperintensities in T2W images in the posteriorcolumns of the cervical and/or thoracic myelon-segments.Conclusion: Even in patients with subtle atypical symptoms, MRI with its typicalfindings often allows the diagnosis of SCD even in the rare case of normal levelsof vitamin B12.

C-776MR imaging findings of sellar and parasellar lesionsS. Cakirer, M. Basak, E. Serin, I. Ince, M. Birinci; Istanbul/TR

Learning Objectives: To illustrate the spectrum of sellar and parasellar lesions.To clarify the underlying reasons for specific MR appearances. To define the roleof MR imaging for differential diagnosis of the sellar and parasellar lesions withsimilar appearances.Background: Suspected lesions of the sella turcica and parasellar regions arefrequent indications for MR imaging. Although the sella and parasellar regionoccupies a small area in the cranium, their lesions are innumerable. BetweenAugust 2001 and August 2003, 487 patients with sellar and parasellar lesionswere studied in our institute. MR imaging characteristics of the lesions, the un-derlying reasons for the specific MR appearances and the differential diagnosisbetween the lesions were defined following the categorization of the lesions.Imaging Findings: The lesions might be categorized under six major categories.1. Congenital abnormalities: Pituitary gland hypoplasia, pituitary duplication, emptysella turcica, cephaloceles. 2. Tumors: Pituitary adenoma, choristoma, craniophar-yngioma, Rathke cleft cyst, meningioma, germinoma and teratoma, epidermoidand dermoid, hypothalamic and chiasmatic glioma, chordoma, neurinoma, me-

tastasis, perineural spread from the neighbouring structures. 3. Tumorlike condi-tions: Arachnoid cyst, tuber cinereum hamartoma, eosinophilic granuloma. 4. In-fectious lesions: Pituitary abscess, parasellar infections. 5. Inflammatory lesions:Lymphocytic hypophysitis, sarcoidosis, Tolosa-Hunt syndrome. 6. Vascular lesions:Aneurysms, carotid cavernous fistula, cavernous sinus thrombosis, cavernousmalformation.Conclusion: The above-mentioned lesions have been presented with their typi-cal MR imaging pictures. The underlying reasons for those appearances, the roleof MR sequences for their diagnosis and the differential diagnoses between thelesions with similar appearances have been evaluated.

C-777Fiber tracking and tensor metrics in diffusion tensor MR imagingC.C.T. Lim, H. Yin, M. Xu, F. Hui; Singapore/SG

Learning Objectives: To review anatomical patterns and distribution of whitematter tracts in the brain and to understand the potential uses of diffusion tensorimaging (DTI), including pathological disruption and destruction of fiber tracts.Background: DTI is a new MR imaging technique that non-invasively visualizeswhite matter fiber tracts and may have potential to assess demyelination andother brain disorders. Using single shot echo planar imaging (TR 7000-9000/TE90-100 ms, 3 mm section thickness, b value 800-1000 s/mm2 in 6-54 non-col-linear directions at 1.5 and 3 T) and offline post-processing of diffusion tensormetrics (fractional anisotropy, mean diffusivity and principal eigenvector) and fib-er connectivity images (using fast marching tractography) could be studied.Imaging Findings: In normal patients, the fractional anisotropy (FA) maps clear-ly visualized white matter tracts as areas of high FA compared to gray matter. Thecorticospinal tracts, corpus callosum and optic radiations could be consistentlyidentified. Abnormalities such as brain neoplasm, cerebral infarction and multiplesclerosis lesions showed decreased fractional anisotropy and elevated mean dif-fusivity. Principal eigenvector maps of water diffusion showed deviation in thedirection of the white matter tracts surrounding benign brain neoplasms andmalformations.Conclusion: Quantitative in vivo information on water diffusivity, degree of direc-tionality and directional vector in space, that are not available on conventionalMR imaging, can be measured in DTI studies. With a potential new clinical appli-cation of DTI, radiologists should be familiar with anatomy and pathology of thewhite matter fiber tracts.

C-778Neuroimaging of central nervous system complications inoncohaematologic neoplasmsM. González Rebollo, R. Manzanares Soler, M. Velasco Casares,M. Barxias Martín, R. de la Cámara Llanza; Madrid/ES

Objective: To show the neuroimaging features of central nervous system compli-cations in oncohematologic neoplasms.Material and Methods: The neuroimaging features in patients with oncohemato-logic neoplasms who presented with central nervous system complications in thelast five years in our hospital were retrospectively reviewed.Results: The main neuroimaging features in oncohematologic neoplasms withcentral nervous system complications have been classified into four main cate-gories: 1) Neoplasm disease: Primary and secondary neoplasms involving theparenchyma and the meninges. 2) Infections: Abscess, meningitis and sinusitisare frequents in the evolution of these patients, most of them immunodeppresseddue to their primary disease or secondary to the therapy. 3) Hematologic compli-cations: Intracerebral and extraaxial hemorrages, dural venous trombosis (some-times associated to venous infarctions) and cerebral infarctions. 4) Secondary tothe therapy: Toxicity secondary to chemotherapy and radiotherapy effects.Discussion: Central nervous system complications can be secondary to the pri-mary disease, to the therapy or to the immunossuppresion and they can occurseparately or some of them together in the same patient.Occasionally, it can be difficult to differentiate from another process by only theimaging features, so it is very important to know the characteristic imaging. Nev-ertheless an important number of cases are diagnosed finally by histology.Conclusion: It is important to recognise the central nervous system complica-tions in oncohematologic neoplasms and their imaging features, since they haveimplications in the final diagnosis and the possible management of these patients.

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C-779Multiple malignant gliomas: MRI findingsB. Wlachovska, L. Sidorova, D. Petersky, J. Steno, V. Belan; Bratislava/SK

Learning Objectives: To discuss retrospectively reviewed MRI features of multi-ple gliomas in patients who underwent surgery.Background: Multiple gliomas are rare findings with variable incidence (2.4 to10%). They can by classified according to: a) Time of presentation as early =synchronous (at initial diagnosis) or late = metachronous (diagnosed during thetreatment); b) The imaging characteristics as multicentric (arise independently indifferent sites, there is absence of macroscopic connections or way of dissemi-nation) or multifocal (they spread from primary tumor to other areas in the brain,with evidence of routes of dissemination). We reviewed documentations of 109patients with diagnosis of glial tumor WHO grade III-IV who underwent surgerybetween January 2001 and December 2002. In all patients radiological and his-tological diagnosis was performed and 8 cases were established as multiple gli-oma.Imaging Fingings: Most of the patients had one bigger lesion and 2 or 3 smallerones. The lesions were usually hyperintense on T2-weighted images and hypo-or isointense on T1WI with strong postcontrast enhancement. Most of them hadmoderate edema. We recognized 6 multicentric and 2 multifocal gliomas, 7 weresynchronous and one metachronous.Conclusion: Multiple gliomas are often radiologically reported as metastasis,sometimes as lymphomas or infectious diseases. The differential diagnosis ofmultiple masses in the brain is very important for therapeutic consequences andmultiple glioma should considered because of suggested increasing frequencyof this entity. If strong postcontrast enhancement and moderate edema aroundthe lesions are observed, this diagnosis should be suggested.

C-780Role of neuroimaging in the radiosurgical planning with gamma knifesurgery (GKS): MRI, CT, DSA and PETP.J. David, M. Levivier, N. Massager, D. Devriendt, C. Neugroschl, N. Sadeghi,P. Jissendi, J. Moreau, D. Balériaux; Brussels/BE

Learning Objectives: To illustrate the role of combined neuroimaging modalitiesin GKS.Background: GKS is a method of treatment allowing the delivery of a conformalradiation dose to a stereotactically defined target. The significant development ofinterest in the role of GKS as an alternative or adjunct to the neurosurgical man-agement of many brain disorders, requires accurate and reliable methods of ac-quisition of image modalities for the stereotactic planning.Imaging and Procedures: Between December 1999 and August 2003, we treat-ed 650 patients for a large variety of indications (metastases 26%, vascular mal-formations 7%, trigeminal neuralgia 14%, pituitary adenoma 3%, primary braintumor 8%, other tumors 6%, vestibular schwannoma 19%, meningioma 18%,other functional < 1%). All patients had an MRI combined with CT in stereotacticconditions. Some patients also benefited from stereotactic DSA (n = 43) or PET(n = 57). In all cases, MR was used to delineate a target before radiosurgery. CTwas always used as a control for MR distorsion. DSA was used in combinationwith angioMR for all arteriovenous malformations. When the tumor was ill-de-fined, we anticipated some limitation of target definition (infiltrative lesions, recur-rence of metastases, pituitary adenomas) and also used stereotactic PET.Conclusion: We present a pictorial review illustrating the role of neuroimagingfor appropriate targeting in GKS. These images are also critical for the evaluationof the potential risks and complications. The complementary information provid-ed by the combination of various imaging modalities allows appropriate and ac-curate delineation of a target volume before stereotactic irradiation.

C-781Preoperative evaluation of pituitary macroadenomas by MR imaging:Surgical and clinical implications of distinctive imaging featuresV. Katsiva, G. Pantazis, E. Kailidou, G. Michailidis, B. Kanellou, A. Seretis,M. Tibishrani; Athens/GR

Learning Objectives: To demonstrate the anatomic variants of the sellar regionconsidered disadvantageous to the transsphenoidal approach. To describe theMR imaging criteria for assessing the relationship of the pituitary macroadenom-as with their surrounding structures. To outline the surgical and clinical implica-tions of distinctive MR imaging features, that have been reported in recentliterature.Background: In this presentation, we describe a systematic approach for a com-plete preoperative MRI evaluation of pituitary macroadenomas with emphasis on

surgical considerations and distinctive imaging features with prognostic value.From our archives, we collected the preoperative MRI studies of 85 patients withpituitary macroadenomas that underwent transsphenoidal surgery. They includ-ed 55 non-secreting and 30 hormone-secreting adenomas (PRL = 3, GH = 24,ACTH = 2 and GH-PRL = 1). The MRI findings were compared with the surgicaland histological findings and correlated with the clinico-laboratory data of thepatients.Imaging Findings: In every case, we used recently described criteria to assesscavernous sinus invasion by the pituitary adenomas. We focused on the detec-tion of the bright spot of the neurohypophysis. We evaluated the signal intensityof the adenomas on T2-weighted images and the contrast enhancement patternwith emphasis on prediction of their consistency (soft/firm, fibrous).Conclusion: The MRI yielded 82% accuracy in diagnosing cavernous sinus in-vasion. The bright spot of the neurohypophysis was detected in 78% of the pa-tients and none of them developed permanent diabetes insipidus postoperatively.6 adenomas demonstrated signal hypointensity on T2-weighted images, 4 non-functioning of fibrous consistency and 2 GH-producing of soft consistency.

C-782The etymology of Greek terms used in neuroradiologyE. Testempassi1, M. Kalomenopoulou2, N. Kartakis2, M. Kolios1, D. Chondros1;1Athens/GR, 2Rethymno/GR

Learning Objectives: To present a comprehensive essay of various Greek med-ical terms and eponyms which are encountered in daily neuroradiology practice.To familiarize non-Greek radiologists with the definition of Greek eponyms and toemphasize on those terms and words that have been derived from Greek mythol-ogy.Background: Medical eponyms serve as mnemonics, add color to medical writ-ing and are useful shorthands in medical communications. A long catalogue withthe most representative Greek medical terms is listed. The exact definition andmeaning of each word is explained and a short narrative of the relative myth ispresented for the neuroanatomical terms which gained their name from Greekmythology.Conclusion: Accurate knowledge of the meaning of these words will help theradiologist to remember the terms and make their learning fun.

C-783Preoperative mapping of eloquent white matter using diffusion tensorimagingC.V. Salvan, A. Aralasmak, J.L. Ulmer, R.W. Prost, E.A. DeYoe, L. Hacein-Bey,D.L. Daniels, H.G. Krouwer, W.M. Mueller; Milwaukee, WI/US

Purpose: To present the potential of diffusion tensor imaging (DTI) and coloredcoded fractional anisotropy (FA) maps in identifying the anatomy of white mattertracts for pre-operative planning.Materials and Methods: DTI data were acquired using DW-SE-EPI sequencesand a 1.5 T MR-unit, with the following parameters: TR 6000-10000, 18-28 slic-es, 5 mm slice thickness, 1.5 mm intersclice gap, 64 x 64 matrix and gradientsencoding in 25 directions, b- 1500 sec/mm2. Data were acquired in normal sub-jects and 13 patients with brain tumors, AVM's or seizure foci being consideredfor surgery. FA images and corresponding colored coded maps were generated.Also, FSE T2 or FLAIR images were acquired in identical locations for compara-tive use.Results: Major white matter tracts (intrahemispheric, interhemispheric, and brainstem) were readily visualized, including the following: superior longitudinal fas-ciculuus, superior fronto-occipital fasciculus, inferior longitudinal fasciculus, infe-rior fronto-occipital fasciculus, uncinate fasciculus, corpus callosum, cingulum,optic radiations, anterior commissure, corona radiata, internal capsule, pyrami-dal tracts, medial lemniscus, medial longitudinal fasciculus, cerebellar pedunclesand gracile and cuneate fasciculi. The spatial relationships of these tracts andresectable lesions were analysed, with particular attention to the risk of a post-operative deficit. All results were correlated with the pre- and post-operative def-icits.Conclusion: White matter anatomy can now be imaged using DTI/FA and ac-cess to pre-operative eloquent white matter mapping has great potential to im-prove the outcomes of neuro-surgical candidates. The future management ofneuro-surgical patients will be impacted by future refinements and developmentsof this technique.

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C-784High resolution MR neurography application in patients with cervicalradiculopathyZ. Erdem, O. Erdem, F. Cagavi, M. Kalayci, S. Gündogdu, B. Acikgoz;Zonguldak/TR

Purpose: To directly image and analyse, both quantitatively and qualitatively, thecervical spinal nerves in the patients with clinical and radiographic evidence ofcervical radiculopathy by high resolution MR neurography.Method and Materials: Fourty consecutive symptomatic patients and five asymp-tomatic volunteers were studied. A magnetic resonance imaging phased-arraycoil system was used to obtain high-resolution coronal T1-weighted spin echoand coronal/axial short tau inversion recovery (STIR) images of the cervical spineand spinal nerves. On the axial STIR images, nerve/muscle signal intensity ratioof the cervical spinal nerves were measured on the two sides and were com-pared with paired samples T test. p values < 0.05 were considered to be statisti-cally significant.Results: Markedly increased signal in the distal portion of the affected spinalnerves was determined. In the patients, nerve/muscle signal intensity ratio meas-urements of the affected spinal nerves showed a significantly increased intensitycompared with that of the non-involved spinal nerves (p < 0.01). In the controls,nerve/muscle signal intensity rate of the spinal nerves was nearly identical on thetwo sides (p > 0.05).Conclusion: According to us, MR neurography using phased-array coils sequenc-es can detect signal abnormalities within compressed cervical spinal nerves inpatients with corresponding radicular symptoms and findings. This technique maybe particularly helpful in evaluating patients with multi level disc disease of thecervical spine.

C-785Endovascular coil embolization for the treatment of ruptured vertebralartery dissecting aneurysmsW. Yoon, J. Seo, J. Kim, Y. Moon, T. Kim, H. Kang; Gwangju/KR

Purpose: To present a retrospective analysis of our experience in the endovas-cular coil trapping for ruptured vertebral artery (VA) dissecting aneurysms.Materials and Methods: We treated 9 patients who presented with acute sub-arachnoid hemorrhage due to rupture of a vertebral artery dissecting aneurysm.Embolization of the entire segment of the dissected site with detachable platinumcoils (internal trapping) was performed in all patients. In one patient with posteri-or inferior cerebellar artery (PICA)-involved VA dissecting aneurysm, internal trap-ping of the aneurysm followed by occipital artery-PICA bypass was performed bya neurosurgeon.Results: Coil embolization was successful in all 9 patients. There were no proce-dure-related complications. There was no sign of infarction in the PICA territoryin all patients. There was no recurrent bleeding or ischemic symptoms during thefollow-up periods. Follow-up angiography showed complete occlusion of the an-eurysm without recurrence in all patients.Conclusion: Endovascular coil embolization is a safe and highly effective treat-ment of ruptured VA dissecting aneurysms.

C-786Diffusion-weighted magnetic resonance imaging (DW MR) after carotidartery stent placementE. Blanc, J. Martínez-Rodrigo, A. Ruiz, E. Lonjedo, C. Poyatos, D. Monedero;Valencia/ES

Purpose: To assess the incidence of new cerebral ischemic lesions with diffu-sion-weighted (DW) MR imaging after carotid artery stent placement without cer-ebral protection and to evaluate the number, size, location and the association ofthese lesions with neurological symptoms.Methods and Materials: Between November 2002 and July 2003, 15 patientswith 16 high-grade stenoses of the carotid artery were treated with stent implan-tation. DW MR imaging of the brain was performed a day before and after theendovascular treatment. All patients underwent neurological examination beforeand after the procedure.Results: DW MR images showed a total of 12 new hyperintense lesions in 5(31%) of the 16 procedures performed. Eight lesions were ipsilateral to the treat-ed vessel and 4 lesions, in 2 patients, were contralateral. These patients withcontralateral lesions also had new ipsilateral lesions. The lesions were located inparietal lobe (n = 5), periventricular (n = 2), occipital lobe (n = 1), frontal lobe(n = 1) and corona radiata (n = 1). All lesions measured < 5 mm in diameter. Noneof the patients had neurological symptoms.

Conclusion: Carotid stent placement was associated with new lesions on DWMR images in 31% of the procedures, indicating the occurrence of cerebral mi-croemboli during the procedure. In all patients the new lesions were clinicallysilent and not detected at neurological examination. DW MR imaging of the braincan be a useful tool for monitoring patients after stent placement, demonstratingnew diffusion abnormalities that are infrequently symptomatic.

C-787Self-reported neck pain and MR imaging findingsE. Arana, L. Martí-Bonmatí, E. Mollá, S. Costa; Valencia/ES

Purpose: To correlate cervical spine MR imaging findings with outcome meas-ures questionnaire.Material and Methods: A total of 226 patients submitted with neck pain with orwithout radiculopathy were studied. There were 74 men and 152 women, aged42.6 ± 13.8 years. Patients with previous surgery, neoplasm or traumatic epi-sodes were excluded. Every patient completed the validated Northwick Park NeckPain questionnaire with nine core items, providing a score of pain and disabilityfrom 0 to 100. All patients had sagittal gradient-echo T1 and fast spin-echo T2,axial gradient-echo and MR myelography weighted images. MR images of thetwo most affected disc levels were read obtaining a MR score ranging from zeroto 30.Results: There were no gender differences regarding MRI and symptoms score.Overall, MR findings did not correlate with overall symptoms score (Spearman'sRho, r = 0.034, p = 0.56). No particular disc level was associated with symptoms(Kruskal-Wallis, p = 0.65). On the regression linear model of MRI score, the onlyitems included from the questionnaire were sleeping pain (p = 0.03) and paininterference with work (p = 0.01). No other associations were found with othersymptoms. The pain and disability score was not statistically associated with anyparticular disc level. MR score correlated with age (r = 0.656, p = 0.001) but notwith symptoms (r = -0.032, p = 0.62).Conclusion: In patients with neck pain, only pain interference with work andsleeping were related to MRI findings. Imaging score score did not correlate glo-bally with self-reported pain score.

C-788Neuroimaging abnormalities in Lyme disease encephalitisR.A. Ikonomov; Sofia/BG

Purpose: Lyme disease is caused by the tick-borne spirochaete Borrelia burg-dorferi. Pathological reactions found in peripheral nerve, root or plexus and CNSinclude meningeal inflammation, perivascular inflammatory cell formation andfocal demyelination. In view of multiform clinical signs, the diagnosis of the dis-ease is often difficult.Methods and Materials: We have observed four patients (two men and two wom-en) with Lyme disease encephalitis. They were bitten by a tick between one andthree years ago. The patients had a headache, drowsiness, personality changes,impairment of memory, cognitive slowing, weakness and pyramidal signs. Thepatients underwent the following examinations: native CT scan, contrast-enhancedCT scan, native MRI, contrast-enhanced MRI, CSF examination and serologicexamination.Results: Neuroimaging techniques mainly showed lesions in the basal cerebralstructures. CT showed mild hypodensities in the midbrain (cerebral peduncles),diencephalic areas and basal ganglia. MRI demonstrated increased signals onT2 in the anterior and/or posterior limb of internal capsule, thalamus, ventral ar-eas of cerebral peduncles and hippocampus, with decreased signals on T1 in thesame structures. Contrast enhancement MRI showed significantly increased sig-nals on T1 in the described areas and in the meninges in two of the patients. CSFexamination showed lymphocytic pleocytosis with a normal glucose concentra-tion and a mildly or moderately elevated protein concentration. The serum andCSF positive serology (ELISA) confirmed the diagnosis.Conclusion: This study demonstrated that the main lesions in Lyme diseaseencephalitis are localized in basal cerebral structures: rostral midbrain, diencephal-ic areas and basal ganglia.

C-789Percutaneous transluminal angioplasty using single lumen balloon catheterwith non-valve wire for acute middle cerebral artery embolismY. Hori, Y. Sagara, T. Nakamura, M. Saino, H. Nagatomi, H. Kiyosue,M. Okahara, S. Tanoue, H. Mori; Oita/JP

Purpose: Percutaneous transluminal angioplasty (PTA) using a single lumenballoon catheter (STEALTH) with a valve wire has been performed to treat acute

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middle cerebral artery embolism (MCAE). However, we found use of STEALTHwith a valve wire could be associated with a poor manoeuverability of valve wirein some cases with tortuous access route, which may lead to an unsuccessfulprocedure. The purpose of this study was to evaluate the safety and efficacy of amodified PTA technique using STEALTH with a non-valve wire for acute MCAE.Methods and Materials: Five patients with acute MCAE were treated with mod-ified PTA technique. STEALTH was advanced into the occlusion site with a non-valve wire. PTA was performed with inflation of STEALTH with the same wire at 2to 4atm for 30-60 seconds. Local fibrinolysis was added when distal emboli wasobserved. Follow-up CT was performed within 24 hours and 3-7 days after onset.Success rates of the procedure, recanalization rates, complications and clinicaloutcome assessed by modified Rankin Scale (mRS) were evaluated with com-parison of control group of patients treated with standard PTA or local fibrinolysisalone.Result: Complete recanalization was achieved in all patients. There were no tech-nical complications. After 24 hs, CT showed no cortical infarction in 3, corticalinfarction in 2. Three patients recovered to mRS 0 or 2. One patient died fromsymptomatic intracerebral hemorrhage.Conclusion: This technique showed the high rate of recanalization and may pro-vide a safe and effective treatment for acute MCAE.

C-790Predictors of the immediate anatomic and clinical results of embolization ofintracanial wide-necked aneurysms using three-dimensional coilsJ.-N. Vallée1, H.M. Barragan-Campos1, L. Pierot2, D. Lo1, A. Bonafé3,R. Guillevin1, J. Chiras1; 1Paris/FR, 2Reims/FR, 3Montpellier/FR

Purpose: To evaluate the immediate results of treating intracranial wide-neckedaneurysms using three-dimensional coils.Materials and Methods: Over a 2-year period, 160 aneurysms (neck of 4 mm orsmaller: 116, group A; and greater than 4 mm: 44, group B) in 157 patients weretreated. The procedure consisted of framing the aneurysm with one or more spher-ical Micrus coils and filling it with helical Micrus coils. Multivariate analysis wasused to identify independent predictors of the results.Results: Angiographic occlusion was complete in 84 (72%) and 30 (68%) aneu-rysms in groups A and B, respectively. Mean percentage of volumic occlusion inthese groups was 30.9 and 29.2%, respectively. Perioperative morbidity andmortality rates were 4 and 2%, respectively in group A, and were respectivelysimilar in group B. No significant difference between the two groups was observed.However, percentage of volumic occlusion correlated with sac-to-neck ratio smallerthan 1.5 (P = 0.061) and with sac size (P = 0.002), except when 3 or more three-dimensional coils per aneurysms were used (P = 0.222). The better the percent-age of volumic occlusion, the better the percentage of angiographic occlusion(P = 0.004). Percentage of volumic occlusion was an independent predictor ofangiographic complete occlusion (P = 0.001). WFNS grade 5 was an independ-ent predictor of perioperative mortality (P = 0.043).Conclusion: The use of three-dimensional coils improved the coil-packing andangiographic and volumic occlusion of aneurysms with a neck greater than 4 mmat the time of treatment, provided the sac-to-neck ratio was 1.5 or greater and thelargest number of three-dimensional coils were positioned first.

C-791Minimum apparent diffusion coefficient: A quantitative parameter forprediction of malignancy of gliomas preoperativelyX. Yun; Sendai/JP

Introduction: In gliomas, choline signal (Cho) correlates with total membranemetabolism, apparent diffusion coefficient (ADC) inversely with cell density,Cho*meanADC with each cell's metabolism. We examined which parameter isthe most reliable in prediction of malignancy of gliomas.Methods: Twenty-three pathologically proven glioblastomas (GBM) and 22 ana-plastic gliomas (AG) were retrospectively evaluated with preoperative MRI withMR spectroscopy (MRS) and DWI. Ki67 index was counted to evaluate patholog-ical malignancy. To evaluate clinical malignancy, we selected 31 cases in whichat least enhancing lesions were removed and classified into progressed and sta-ble groups.Results: The minimum ADC (mADC) of GBM was shown to be significantly low-er than AG (P = 0.0001). The highest value of mADC in GBM was 0.964, and thelowest in AG was 0.698. Using this threshold, 31 subjects were divided into 3groups; A: GBM with mADC < 0.698 (n = 9); B:GBM and AG with 0.698 < mADC< 0.964 (n = 15), C: AG with mADC < 0.964 (n = 7). Six cases in group A wereclassified as progression (4 pathologically proven recurrence, two dissemina-tion) and all cases in group C were stable. Six cases in group B showed progres-

sion (2 recurrence, 1 dissemination). Fisher test showed significance (P = 0.03).In group B, the mADC of 5 progressive GBMs was significantly lower than 3 sta-ble GBMs (P = 0.033). The nCho and nCho*meanADC showed no differencebetween GBM and AG (P = 0.12, P = 0.28). Inverse correlation was found be-tween Ki67and mADC (P = 0.0005), no correlation was found between Ki67 andnCho (P = 0.22) and meanADC*nCho (P = 0.58).Conclusions: The mADC suggestive of cell density was the most reliable in pre-diction of malignancy of gliomas preoperatively.

C-792Usefulness of imaging fusion for surgical planning in skull base lesionsE. Puglielli, F. Iannessi, A. Ricci, R. Galzio, C. Masciocchi, M. Gallucci;L'Aquila/IT

Objective: To propose critical considerations on the usefulness of CT, MRI andfunctional MRI (fMRI) fusion for neuronavigation in skull base surgery.Methods: Forty-one cases of skull base lesions (24 meningiomas; 6 petroclival,7 clinoidal, 4 olfactory, 2 in foramen magnum, 2 spheno-petro-clival, 1 in the pla-num sphenoidale, 1 in posterior pyramid and 1 in PCA; 5 acoustic schwannomas,3 epidermoids, 2 pituitary adenomas, 2 craniopharyngiomas, 2 posterior fossaaneurysms, 1 trigeminal schwannoma, 1 dermoid and 1 juvenile angiofibroma)have been evaluated. Data was collected, fused, integrated and reconstructed bya dedicated StealthStation system for neuronavigation. CT images were acquiredon axial non-overlapping slices, 1-3 mm thick; MRI images were obtained with1.5 T device, same field of view and thickness.Results: Neuronavigation was possible in all cases and was successfully ap-plied in pre-operative planning and during surgical procedures. We calculatedsome data to check the efficacy of the method, having a mean fiducial error of0.7 mm and an accuracy value at 6 cm of depth 1.7 mm.Discussion and Conclusion: Imaging fusion for pre and intra-operative neuron-avigation provided, in all cases, great advantages in the choice of the best ap-proach, placing of bone flap, early identification of deep normal or distortedanatomic or pathologic structures and their eventual encasement or involvementby the pathologic primary process, correct definition of tumor boundaries andmeningeal implant and relationship with functional areas.Neuronavigation appeared ideal for skull base meningiomas making surgicalmaneouvres safer, more effective and less invasive.

C-793A study of MR diffusion changes in normal appearing white matter (NAWM)of patients with relapsing remitting multiple sclerosis (MS)F. Gaudiello, S. Marziali, A. Ludovici, E. Ferone, R. Floris, G. Simonetti;Rome/IT

Background and Purpose: The aim of our study was to monitor water diffusionchanges over time in NAWM of patients with relapsing-remitting MS and to mon-itor water diffusion changes in patients with different disability status (EDSS) andwith different clinical status (Poussè).Methods: We selected 18 subjects who had completed a 6 month follow-up. TheMR scans were obtained at baseline, at 3 months and at 6 months. Two regionsof interest (ROI) were placed in each hemisphere in the NAWM in each MR studyand the apparent diffusion coefficient (ADC) value were calculated in patientsand in 15 healthy controls.Results: TADC in NAWM in patients was significantly higher then in controls(controls mean tADC ± sd = 0.731 ± 0.015 mm2/sec x 10-3; patients mean tADC ±sd = 0.7655 ± 0.108 mm2/sec x 10-3; p < 0.01). In NAWM in patients with higherEDSS, tADC was significantly higher then in patients with lower EDSS (patientswith higher EDSS: mean tADC ± sd = 0.778 ± 0.044 mm2/sec x 10-3; patients withlower EDSS: mean tADC ± sd = 0.752 ± 0.050 mm2/sec x 10-3; p < 0.01). TADCin NAWM in patients with Poussè was significantly higher then in patients withoutPoussè (patients with Poussè mean tADC ± sd = 0.786 ± 0.022 mm2/sec x 10-3;patients without Poussè mean tADC ± sd = 0.760 ± 0.049 mm2/sec x 10-3;p < 0.01).Conclusions: Diffusion MRI can usefully detect alterations in NAWM of patientswith relapsing-remitting MS. These alterations are correlated with disability sta-tus and clinical activity.

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C-794The accuracy of retrospective point-based intermodality image registrationusing original stereotatic adapterA.A. Stanzhevsky, L.A. Tyutin, N.A. Kostenikov, R.A. Shalek, D.V. Ryjkova;St. Petersburg/RU

Purpose: To determine the accuracy of point-based MRI/PET image registrationusing the original stereotatic adapter (SA)Materials and Methods: MRI and 18F-FDG PET of aqueous phantom were per-formed by using original SA. SA was actually a mask rigidly fixed to the table.Markers were made in advance on the phantom. Variances of markers localiza-tion (VML) were measured along each axis on the linear accelerator table meantfor stereotactic radiation therapy. Coordinates were marked by the marks in thethickness of fixing mask ("zero" points). VML were measured under the guidanceof X-ray from "zero" points. PET and MRI were then carried out. VML on PET andMRI modalities were also conducted as regards "zero" points. Then fiducial local-ization error (FLE) was calculated, PET and MRI images were matched and fidu-cial registration error (FRE) and target registration error (TRE) were calculated.Results: Root-mean-square (RMS) FLE of the phantom for PET and MRI modal-ities were 0.8 mm and 1.1 mm, respectively. RMS FRE and RMS TRE for a phan-tom registration was 1.8 mm and 4.8 mm, respectively. A strong direct correlationwas noted between the markers number and FRE (r = 0.99, p < 0.05) and FLE(r = 0.99 p < 0.05). Beside reliable correlation between the markers number andthe value of TRE were not received (r = -0.44, p > 0.05).Conclusions: The received data testify relatively high accuracy of point-basedMRI/PET image registration using original SA. The most objective criteria of theassessment of registration accuracy is a TRE.

C-795Uveal melanoma: CT and magnetic resonance MR. Correlation with A and Bultrasound (US) findingsC.A. Kouskouras, A. Charitanti, A. Lefcopoulos, I. Tsinopoulos, N. Michailidis,E. Papadopoulou, A. Vakali, A.S. Dimitriadis; Thessaloniki/GR

Purpose: Evaluation of uveal melanoma imaging characteristics in ultrasound,computed tomography and magnetic resonance imaging and correlation of thosefindings suggestive of melanoma.Material and Methods: Eleven patients (8 men, 6 women, age 30-75 years) withpossible diagnosis of uveal melanoma were evaluated. The patients underwentophthalmoscopic and ultrasonographic examination followed by CT and MR ex-amination. CT imaging was performed with 3 mm axial pre-and post-contrast andcoronal post-contrast sections. Axial and coronal 3 mm T1 and T2 images wereobtained, followed by post-contrast T1 images in axial and coronal direction. Ad-ditional T1 fat-sat post contrast images were also obtained depending on therelative position of the melanoma in order to evaluate possible extra-orbital ex-tension.Results: Of the melanomas, six were located in the left globe, ranging from 2 mmto15 mm in size and most commonly on the lateral wall. The tumors appeared ashyperechoic lesions on US with a reflectivity range of 50-70%, suggestive ofmelanoma. Retinal detachment was detected in four patients. On CT images themelanomas appeared as homogenous slightly enhancing lesions, while in twopatients, the tumor was less obvious due to the retinal detachment. On MR imag-es the tumors appeared as homogenous hyperintense lesions on T1WI in fivepatients. Characteristic signal void on T2WI due to melanin deposition was notedin three patients.Conclusion: Ultrasonography appears to be a valuable tool in tissue differentia-tion of uveal melanoma although magnetic resonance, and to a lesser degree,computed tomography are more specific in evaluating the extra-orbital extension.

C-796MR evaluation of central nervous system abnormalities in patients withleukemiaJ. Zielonko, J. Mechlinska, M. Dubaniewicz, D. Skaja; Gdansk/PL

Purpose: The aim of the study was to present MRI findings of CNS involvementin patients with leukemia.Materials and Methods: We evaluated MR images of 32 patients (19 males, 13females, age 3-59) with various types of leukemia (acute 28 cases, chronic 4). Allthe patients demonstrated the symptoms indicative for CNS damage. MRI exam-inations were performed with 0.5 T Gyroscan (Philips). The protocol included 3plane images with T1SE, T2TSE, FLAIR and MTC sequence (coronal plane);axial T1FFE scans were used as well. Slice thickness range was 1.5-6 mm. In allcases, scans after administration of Gd-DTPA were obtained.

Results: MRI findings included the following cerebral lesions: parenchymal (7cases) and meningeal infiltration (3), cranial nerve involvement (2), treatment-related changes (16), hemorrhage (6), infection (1), second primary neoplasm(1), non-determined foci (5). Additionally, in 4 patients MRI examinations detect-ed leukemia-related changes in other sites such as bones (5), maxillary sinus (1)and soft tissues (3). Final diagnosis was confirmed by histopathologic examina-tions (5) or further radiological and clinical observation.Conclusion: Direct CNS involvement in leukemic patients may be demonstratedas a wide range of changes. Familiarity with the spectrum of CNS complicationsand their imaging appearance is essential to make the early diagnosis. Clinicalinformation such as prior or current therapy and presenting symptoms must beconsidered with MRI findings.

C-797MR imaging of the CNS: Do high relaxivity contrast agents haveadvantages?M. Kirchin1, M. Essig2, M. Knopp3, G. Pirovano4, A. Spinazzi4; 1Milan/IT,2Heidelberg/DE, 3Columbus, OH/US, 4Princeton, NJ/US

Purpose: Gadobenate dimeglumine (Gd-BOPTA: T1 relaxivity in blood =9.7 mmol-1s-1) was evaluated to determine whether the high relaxivity offers ad-vantages over other agents for CNS imaging.Methods: Preliminary studies evaluated Gd-BOPTA at cumulative doses up to0.3 mmol/kg to ascertain the optimal dose for MRI of cerebral metastases. TwoPhase III controlled trials were conducted to compare Gd-BOPTA at cumulativedoses up to 0.2 mmol/kg with gadodiamide (Gd-DTPA-BMA) at cumulative doseup to 0.3 mmol/kg. Two intra-individual, blinded, fully randomized comparativestudies were conducted in patients with cerebral gliomas or metastases to deter-mine differences in quantitative (tumor contrast, CNR ratios) and qualitative (le-sion contrast, delineation, internal morphology, structure) enhancementparameters versus gadopentetate dimeglumine (Gd-DTPA) and gadoteric acid(Gd-DOTA) at a dose of 0.1 mmol/kg.Results: In patients with metastases a dose of 0.1 mmol/kg Gd-BOPTA provedsufficient for most situations while a cumulative 0.2 mmol/kg dose provided addi-tional information in certain cases. Comparative studies revealed that 0.1 mmol/kg Gd-BOPTA offers improved performance compared to 0.1 mmol/kg Gd-DTPA-BMA and that cumulative 0.2 mmol/kg Gd-BOPTA is equivalent to cumulative0.3 mmol/kg Gd-DTPA-BMA. The intra-individual comparative studies revealedsuperior qualitative enhancement performance for Gd-BOPTA compared to bothGd-DTPA and Gd-DOTA for all evaluations. The subjective assessments wereconfirmed by the objective measurements of signal intensity and CNR which weresignificantly higher for Gd-BOPTA (p < 0.01).Discussion: Gd-BOPTA is a safe and valuable contrast agent for the assess-ment of CNS neoplasms offering statistically significant advantages over Gd-DTPA, Gd-DOTA and Gd-DTPA-BMA for brain lesion enhancement.

C-798The possibility of 18 F-FDG PET for anxiety-obsessive disorders (AOD)diagnosis and estimation of treatment efficiencyA.A. Stanzhevsky, L.A. Tyutin, A.V. Korzenev, N.A. Kostenikov, R.A. Shalek,V.I. Shustin, T.A. Skoromets; St. Petersburg/RU

Purpose: To study the possibility of 18F-FDG PET for AOD diagnosis and estima-tion of treatment efficiency.Methods: Twenty-four PET-examinations were carried out in 11 patients with AOD.In 5 cases the examinations were performed before the treatment, in 4 patientsas an assessment of drug treatment. In 7 cases the efficacy of stereotactic effect(SE) was assessed on the suitable target structures.Results: A metabolism decrease (MD) in the right caudate head (CH) was notedin two patients before drug treatment. In two patients hypermetabolism was ob-served in the anterior cingulate (AC). Follow-up examinations revealed a MD inthe AC and an metabolism increase (MI) in the right CH in these patients. In onecase an MI in both dorsal thalami (DT) was observed. A MD in both DT beforedrug treatment was seen in two cases. A bilateral MI was noted in DT by follow-up examinations in these patients. In all cases of SE, it revealed a MD in suitablestructures. In 3 cases, a MD was observed in AC and both the CH. In two cases,a MD was seen in the AC, in 2 a bilateral MD in the DT. Changes of glucosemetabolic rate were associated with severity of clinical manifestations in all cases.This data proves participation of limbicostriatal system in forming AOD. Our re-sults demonstrate the possibility to use 18F-FDG PET for AOD diagnosis andestimation of treatment efficiency.

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C-799Magneting resonance imaging in 120 patients with intractable partialseizures: A preoperative assessmentA. Lefkopoulos, A. Kalogera-Fountzila, C. Kouskouras, N. Fotiadis, G. Spanos,E. Papadopoulou, A.S. Dimitriadis; Thessaloniki/GR

Purpose: The aim of this study was to assess the prevalence of detected struc-tural abnormalities in medically intractable epilepsy, especially those who areamenable to a surgical therapy, and also to evaluate the sensitivity of differentdedicated MR sequences.Materials and Methods: One hundred and twenty patients (aged 6 months-64years) with medically intractable partial seizures underwent an MRI examinationin a 1.5 T unit, with T1 and PD/T2 SE in an axial plane and fluid attenuatedinversion recovery (FLAIR), T2FSE and inversion recovery (IR) in a plane per-pendicular to the long axis of the hippocampus. Whenever necessary, we appliedT1 SE + Gd DTPA in axial and coronal planes.Results: Seventy-nine of the 120 patients had a pathological scan (65.8%). Ab-normalities were hippocampal sclerosis (HS) in 30 patients (25%), cerebral tu-mors in 12 patients (10%), vascular malformations in 9 patients (7.5%), corticalinfarcts in 8 patients (6.7%), cerebral infections in 4 patients (4.2%) and 15 pa-tients with developmental disorders (5 cortical dysplasias, 4 pachygyrias, 2 pol-ymicrogyrias, 3 subcortical heterotopias and 1 patient with tuberous sclerosis).All patients with cerebral tumors and eight patients with HS were operated andthere was a pathologic confirmation of the diagnosis. Patients with vascular mal-formation underwent a therapeutic embolization.FLAIR had higher sensitivity in detecting hippocampal sclerosis and cerebralinfarcts while IR was particularly useful in detecting developmental disorders.Conclusions: MR imaging, with an epilepsy dedicated protocol, plays a cardinalrole in locating and characterizing anatomic epileptogenic foci in patients withrefractory epilepsy and helps in defining the type of treatment.

C-800The first experience of combined PET/CT imaging in neurooncology inRussiaG. Trufanov, V.M. Cheremisin, V.E. Parfenov, A.A. Speranskaya, B.V. Martynov,A.V. Sevostianov; St.Petersburg/RU

Purpose: The aim of this study was to evaluate the possibilities of combinedPET/CT imaging in detecting glioblastomas and in estimation of efficiency of theirsurgical treatment and radiotherapy.Materials and Methods: Seven patients (4 men, 3 women, age between 26–70years) with biopsy-proven glioblastomas were scanned before and/or after treat-ment by PET/CT (Biograph, Siemens). A dose of 180 to 220 MBq fluorine-18fluorodeoxyglucose (FDG) was administered for each PET scan with an acquisi-tion time of 6 minutes for bed and interactive reconstruction. Acquisition time forCT was 25 seconds, bringing the total acquisition of combined PET/CT study to15 minutes.Results: Three patients with high-grade astrocytomas demonstrated hypometa-bolic FDG nodules without contrast enhancement at CT scan before surgery. Twopatients showed nodules with hypermetabolism of FDG (SUV 16-18) and inten-sive enhancement of contrast medium due to the recurrence of tumor after com-bined therapy. In one patient, after radiation therapy, the region of treatment haddecreased uptake of FDG and increased enhancement of contrast medium at CTbecause of radionecrosis.Conclusion: It was confirmed that combined PET/CT study could effectivelydetermine whether a lesion was malignant and provide evidence of tumor recur-rence.

C-801Venous angiomas incidentally discovered on MR studies: Specification byMR angiographic images and pathognomonic findings on 3D-TOFsequencesM. Lidón-Lorente, M. Marín Cárdenas, E. Mayayo Sinués, R. Jiménez Monreal,V. Mazas Artasona; Zaragoza/ES

Purpose: Venous angioma (VA), so-called developmental venous anomaly, is an"umbrella-like" group of dilated white matter veins converging radially on a singleenlarged tubular draining vein. This large collector vein drains into a dural sinusor deep ependymal vein. Solitary VA constitutes the anomalous venous drainagefrom a cerebral portion, sited in deep white matter, near the frontal horn or fourthventricle and is exclusively venous and asymptomatic. Traditionally, intravenousangiography was the diagnostic method to assess accurately VA. Our objective isto demonstrate the ability of MR angiographic images, especially contrast-en-

hanced 3D-TOF sequences, in the accurate diagnosis of VA, offering the possi-bility that an asymptomatic vascular anomaly can be detected by non-invasiveimaging methods.Materials and Methods: MR images of the brain from June 2000 to September2003 were evaluated. Subjects with MRI signs of VA were selected and MR ang-iographic images and gadolinium enhanced 3D-TOF sequences were assessed.Results: A linear area with flow void is found, sometimes just intuited dependingon sequences, crossing the white matter to the cortical area. This finding showshigh signal intensity on gadolinium enhancement MR sequences.The collection of prominent medullary (white matter) veins appears like a "medu-sa head" on MR angiographic images and gadolinium-enhanced 3D-TOF se-quences; this sign is considered pathognomonic.Conclusion: MRI is of great value in the accurate identification and morphologicspecification of vascular abnormalities. Traditionally, these cases required inva-sive diagnostic imaging. VA correct identification is very important because thisanomaly is asymptomatic but the ablation can induce venous infarctions.

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Pediatric

C-802Spinal ultrasound in newbornsM. Torres, S. Dieguez, M. Rasero, M.M. Miralles, C. Serrano; Madrid/ES

Learning Objectives: To discuss the indications for spinal ultrasound (SUS). Todescribe the features of a normal and an abnormal spinal ultrasound based on aseries of 251 patients. To outline the advantages and disadvantages of SUS incomparison with spinal MRI.Background: Diagnosis of congenital and acquired diseases of spinal cord hasimplications for management, therapy and functional prognosis. Spinal MRI hasbeen called the gold standard of screening for spinal cord diseases, but it is time-consuming, costly and invasive in neonates.Procedure Details: Between January 1992 and June 2003, 270 SUS were per-formed in 251 patients. Suspicion of dysraphism and cutaneous stigmata werethe most frequent clinical indications. The SUS examination technique, anatomyand imaging findings are described and illustrated, and compared to MRI (69exams). Spinal dysraphism was observed in 17.5% of patients (36 myelomenin-goceles, 1 diastematomielia and 7 dermal sinnus). Eleven intraspinal tumors werediscovered (9 lipomas, 2 epidermoid and 2 neurogenic tumors). Six arachnoidcysts, 2 intraspinal infections and 1 medular trauma were the other pathologicalfindings. MRI better demonstrated all the abnormalities except infections. MRIshowed no pathological findings when carefully performed SUS exams were nor-mal.Conclusion: SUS accurately demonstrated both intraspinal anatomy and pa-thology in the newborn and should be considered as the initial screening imagingmodality. MRI does not seem to be necessary when the SUS examination isnormal.

C-803Abdominal manifestations of cystic fibrosis in children beyond the neonatalperiodD. Kumar, S. Deftereos, P. Moyle, H.M.L. Carty; Liverpool/UK

Learning Objectives: To illustrate the abdominal manifestations of cystic fibro-sis (CF) in children beyond neonatal period.Background: Although pulmonary involvement is the major problem in CF pa-tients, they also have various abdominal manifestations. The abdominal manifes-tations of CF in the newborn are detailed in many reviews. The purpose of thisposter is to illustrate the same in children beyond the neonatal period. Illustrativeexamples are demonstrated based on the radiographs of 240 CF children fromour institution.Imaging Findings: Gastrointestinal tract (GI), hepatobiliary system and the pan-creas are involved in CF. The GI complications include obstructive (distal intesti-nal obstruction syndrome, intussusceptions, fibrosing colonopathy, post surgicaladhesions) and non-obstructive conditions (pneumotosis intestinalis, gastro-esophageal reflux, duodenitis, and rectal prolapse). Liver pathology includes st-eatosis, cirrhosis, and portal hypertension. The pathological mechanism ofcirrhosis may be due to obstruction of the biliary ductules with thickened secre-tions and secondary inflammation producing fibrosis. Biliary tract abnormalitiesinclude gallstones, micro gallbladder, and sludge. Excessive loss of faecal bileacids due to pancreatic insufficiency is associated with increased lithogenicity ofthe bile. The pancreatic abnormalities include fat infiltration, fibrosis, atrophy andoccasionally cysts and calcification. The primary problem is the plugging of theintralobular ductules by inspissated viscid mucus.Conclusion: Abdominal symptoms in patients with CF may be due to the variouscauses related to CF or may be due to coincidental pathology e.g. appendicitis,renal disease. The radiologist should keep an open mind and not restrict his thoughtprocess only to the conditions related to CF.

C-804Neck masses in infants and children: A pictorial reviewJ.R.A. Turkington, A. Paterson, L.E. Sweeney, G. Thornbury; Belfast/UK

Learning Objectives: This poster presents a pictorial review of pediatric neckmasses and their imaging features. Particular emphasis is applied to the anatom-ical site of the mass to aid in differential diagnosis.Background: Infants and children with neck masses frequently present to theradiologist for further evaluation. The most common aetiologies include congen-ital lesions and their complications, lymphadenopathy and malignant masses.The role of the radiologist is to differentiate between these conditions using im-

aging modalities such as ultrasound and colour Doppler, CT and MRI. Whereappropriate, the radiologist will also stage lesions for management purposes,and aid in guiding aspiration or biopsy.Imaging Findings: The radiological appearance of congenital lesions such asthyroglossal duct cysts, branchial cleft cysts, cystic hygromas, haemangiomas,dermoid cysts and sternomastoid "tumours" are discussed. Cervical lymphaden-itis and abscesses, and neoplastic masses such as neurogenic tumours, rhab-domyosarcoma, neuroblastoma and lymphoma are also described. Lastly, lesionsof the thyroid and salivary glands are evaluated. It must be emphasised that theradiological findings should always be interpreted in conjunction with the patient'sage, the clinical history and the findings on physical examination.Conclusion: Neck masses are common in children and a frequent cause of at-tendance at A&E departments. Identifying the anatomical site and radiologicalappearance aids the differential diagnosis.

C-805Pediatric SAPHO syndromeP.L. Moyle, S. Kumar, A. Cleary, H.M.L. Carty; Liverpool/UK

Learning Objectives: We present an educational poster to illustrate our experi-ence of pediatric SAPHO and the diversity of radiological presentations in thiscondition.Background: The term SAPHO first was used in 1980's to link a variety of skinand sterile musculoskeletal disorders together, namely: Synovitis, Acne, Pustu-losis, Hyperostosis and Osteitis. This forms a relapsing and remitting syndromewith some or all of the above features. We retrospectively reviewed the imagingof 12 children aged 8-15 years with SAPHO that were seen at our institution from1994-2002. A diagnosis of SAPHO was made on clinical and radiological groundswith a few children having additional histology.Image Findings: The pattern of SAPHO in children is different to adults. Spinallesions may be the only manifestation of this condition which can be misdiag-nosed as vertebra plana with infective spondylisis. We illustrate the radiologicalfeatures in spinal, clavicular, long bone and pelvic lesions. All modalities of imag-ing are reviewed.Conclusion: A typical osteoarticular lesion in a typical site can alert you to thediagnosis of SAPHO, but an unusual site or a primary presentation with no skinlesions will make diagnosis harder or there may be misdiagnosis. Children maybe seen in a number of specialties, which can lead to unnecessary delays indiagnosis and possible incorrect treatments. This makes the radiologist pivotal inthe diagnosis of SAPHO, although the differential diagnosis should always beconsidered.

C-806Spectrum of imaging findings after intestinal transplantation:Post-transplantation anatomy and pathologyK.M. Unsinn, M.C. Freund, M. Rieger, H. Ellemunter, A. Koenigsrainer,R. Margreiter, W.R. Jaschke; Innsbruck/AT

Learning Objectives: To be familiar with the different surgical techniques of in-testinal transplantation. To illustrate the spectrum of imaging findings after intes-tinal transplantation utilizing different imaging modalities with regard to anatomyand pathology.Background: Intestinal transplantation represents a potential treatment optionin patients with irreversible, chronic intestinal failure. Several types of intestinaltransplantations can be performed: isolated intestinal transplantion, combinedintestinal and liver transplantation or multivisceral transplantation.Imaging Findings: Correct interpretation of imaging studies after transplanta-tion depends on familiarity with the surgical anatomy. For these reasons this pic-torial essay schematically illustrates the intra-operative appearances duringvarious procedures of intestinal transplantation performed in children. Each pro-cedure is supplemented by examples of typical anatomy as shown by severalimaging modalities including sonography, CT, MRI, gastrointestinal contrast ex-amination and angiography. Additionally, this pictorial essay displays the spec-trum of imaged pathology including abdominal infections (e.g. abscess, peritonitis,fistula), vascular graft complications (e.g. arterial dissection, venous thrombosisincluding the inferior vena cava or portal vein), intestinal graft complications (e.g.anastomotic dehiscence and strictures, intestinal motility disorder) and other trans-plant-associated complications (hematoma, lymphocele, post-transplant lympho-proliferative disorder).Conclusions: This pictorial essay displays the spectrum of imaging findings af-ter various types of intestinal transplantation in children utilizing different imagingmodalities with regard to anatomy and pathology.

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C-807Misinterpretation of trauma films by radiographersD.W. Pilling, H.S. Lloyd; Liverpool/UK

Learning Objective: To demonstrate the problems which can be caused whentrauma X-ray films are incorrectly marked when using the red dot system.Background: Many radiographs are returned to Accident and Emergency de-partments without formal radiological reports, and the red dot system, wherebyradiographers attach a red dot to radiographs which they suspect to be showinga fracture, is a widely practised system, used throughout the National HealthService. It is acknowledged that whilst this system can be beneficial to Accidentand Emergency departments it is not without its problems.Procedure Findings: Our poster examines the problems which can arise in chil-dren where normal variants are often highlighted as "fractures" by radiographers.Most of the common misinterpretations occur in the appendicular skeleton, e.g.normal variants of epiphyseal ossification or accessory epiphyses, especially ofthe metacarpal and metatarsal bones. Other common "errors" include the pisi-form, or os trigonum and accessory ossification centres for the medial and lateralmalleoli. In the axial skeleton, vascular markings in the skull, facial bone suturesand end plate ossification centres for the vertebral bodies are some of the com-moner areas of concern.Conclusion: Issues are raised for both Accident and Emergency departmentsand for Radiology departments if these "errors" are not minimised, including pa-tient complaints of over-diagnosis and potentially unnecessary treatment andfollow-up visits.

C-808The radiology of pediatric extracorporeal membrane oxygenation: Normalappearances and complicationsA.M. Barnacle, M.P. Hiorns; London/UK

Learning Objectives: To demonstrate the normal appearances of the pediatricchest during extracorporeal membrane oxygenation (ECMO). The spectrum ofradiological abnormalities arising from the complications of ECMO is illustrated,including cannula position and anticoagulation complications.Background: ECMO is a means of cardiopulmonary bypass therapy used inpatients with cardiorespiratory failure who are unresponsive to conventional in-tensive care interventions. There is a range of indications for ECMO therapy inthe pediatric population, which include congenital diaphragmatic hernia and car-diac disease. There are a number of complications associated with the use ofECMO, many of which are related to the high levels of anticoagulation requiredduring therapy. Radiological assessment prior to the commencement of treat-ment and sequential imaging during therapy are mandatory, and appropriate im-aging protocols are discussed.Imaging Findings: The normal radiological appearances of the chest duringECMO therapy are demonstrated, including the correct positions of both VA andVV ECMO cannulae. Several technical points are highlighted, to avoid the misin-terpretation of certain radiographic appearances. The radiological manifestationsof a wide range of complications are illustrated. These include intracranial haem-orrhage and extra-axial collection, haemothorax, peritoneal collections and vas-cular complications. Inappropriate cannula positions are also reviewed.Conclusion: The radiologist must be familiar with both the normal and abnormalimaging appearances during ECMO therapy and should be aware of the range ofpotential complications. The importance of sequential imaging is highlighted andappropriate imaging protocols discussed.

C-809Acute disseminated encephalomyelitis or multiple sclerosis: What tips thebalance?S. Avula, A. Ghatak, N. Wright, R. Appleton; Liverpool/UK

Learning Objectives: To identify the imaging features and clinical parameterswhich help to distinguish between acute disseminated encephalomyelitis (ADEM)and multiple sclerosis (MS) in children.Background: Both ADEM and MS are disseminated inflammatory disorders af-fecting the central nervous system. Distinction between the two is difficult, espe-cially at the initial presentation when the prognosis and risk of relapse is animportant issue. This exhibit will highlight the salient distinguishing features stat-ed in the literature and illustrate cases of ADEM and MS which presented over athree year period.Procedure Details: Literature review of childhood ADEM and MS was carriedout and a retrospective review of cases presenting over a three year period witha subsequent diagnosis of ADEM or MS was performed.

Conclusion: There is a considerable overlap between the imaging and clinicalfeatures of ADEM and MS. Though there are a few features that predominate ineither condition, the temporal progression of the disease with presence of newlesions with or without relapse of symptoms as noted in MS, is the most impor-tant factor in distinguishing the two.

C-810MRI in assessment of fetal renal anomaliesJ.L. Hughes, W. Jan; London/UK

Introduction: In patients with renal anomalies causing severe oligohydramnios,the lack of fluid around the fetus significantly degrades the ultrasound image,making assessment of the fetal abdomen difficult. The presence of renal anoma-lies has great postnatal significance and successful antenatal counselling de-pends on the availability of the most complete information. The advent of fast MRsequences has allowed the acquisition of high signal to noise ratio images of thefetus even in the absence of amniotic fluid. We discuss the technique of MR ofthe fetal renal tract. We describe the normal appearances fetal kidneys on MRand present data on illustrative cases where MR provided additional informationover and above a detailed ultrasound examination.Methods: T2W single-shot Rapid Acquisition with Relaxation Enhancement(RARE) and T1W 2D Fast Low Angle Shot (FLASH) were obtained of the fetalkidneys in the three orthogonal planes. All images were acquired without fetalsedation with the mother in the supine position within 20 minutes. Comparisonultrasound and MR images are presented.Results: MRI is able to diagnose and assess a variety of renal anomalies suchas renal aplasia, dysplastic renal tissue, polycystic kidney disease, congenitalhydronephrosis, and ectopic renal tissue.Conclusions: Fetal MR offers further information over ultrasound examinationand hence allows appropriate ante-natal counselling.

C-811Pediatric urethral anomaliesA. Sharma, S. Maroo; Glasgow/UK

Learning Objective: To demonstrate urethral anomalies in the pediatric popula-tion.Background: The MCU and ascending urethrogram are important techniques inthe evaluation of the pediatric urethra. Anomalies such as posterior urethral valvesare frequently encountered, and are associated with serious clinical implications.Good technique and image interpretation are essential in making the correct di-agnosis. Imaging Findings: Anomalies include fistulae, valves, webs, duplica-tions, phimosis and strictures. Occasionally, incidental findings such as prostaticor cowper's gland extravasation are seen.Conclusion: To educate and familiarise radiology trainees and radiologists withthe evaluation of the pediatric urethra.

C-812Post mortem CT examination of neonatesB. Lagesen, R.M. Tjonneland, H. Aure; Oslo/NO

Learning Objectives: To determine whether or not the use of post mortem totalbody CT examination in cases of intrauterine death and sudden infant death syn-drome (SIDS) can give valuable and satisfactory information and be a supple-ment for the investigation of cause of death.Background: There has been a decline in autopsies performed in Norwegianhospitals during the recent years explained by general ethical attitudes, as wellas by cultural and religious prohibitions to autopsy, particularly in the immigrantpopulation.Procedure Details: The examination must be carried out within 12 hours of thetime of death. The CT examination is carried out by a helical technique within onescan. Scout view: 0o and 90o. SFOV: Small / medium. Algorithm: Standard. Slicethickness: 2 mm. Pitch: 1.5. Table movement: 3 mm. Reconstruction interval:1.1 mm. Tube current: 230 mA. Multiplanar reconstruction and 3D images wereevaluated at the CT workstation, with the possibility of viewing the images atdifferent degrees of rotation.Conclusion: The images of the brain and skeletal have high image quality andgive exceptional information. The image quality for thorax and abdomen are notas high, but give useful information. Rigor mortis and autolysis are to be consid-ered and the results of the examination are dependent on how long after deaththe examination is carried out. Total body CT examinations give valuable andsatisfactory information and can be an alternative to autopsy in cases whereparents refuse permission due to general ethical, cultural and religious attitudes.

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C-813MRI in the evaluation of children with NF type IH. Kaur, S. Ryan, V. Donoughe; Dublin/IE

Learning Objectives: Illustrate MRI findings in NF type I in children. To giveindicators to help distinguish benign and malignant complications of this disease.Torecommend a strategy for follow-up imaging in these children.Background: Children with NF I may have a variety of manifestations includingbenign and malignant brain and spinal cord abnormalities, vascular complica-tions, bone and other mesodermal abnormalities.Imaging Findings: MRI scans done over 42 months on patients known to haveneurofibromatosis were reviewed. Indications for the scan, the scan findings,operative and pathological findings when available, were reviewed. We demon-strate a range of manifestations of optic nerve gliomas and their progression. Weindicate features that distinguish benign lesions such as "neurofibromatosis brightobjects (NBOs)" from astrocytomas. We demonstrate a variety of spinal mani-festations of the disease and their varied clinical features. We show the useful-ness of MRI in the evaluation of soft tissue and bony complications of this disease.Finally, we review the literature and our experience to propose a role for imagingfindings in the diagnosis of NF 1 and propose a strategy for the follow-up imagingin children diagnosed with this condition.Conclusion: MRI is valuable in the diagnosis and follow-up of children with NF 1.We recommend MR imaging be considered in children with NF 1 who presentwith any change in clinical condition.

C-8143D extremity angiography with multi-detector CT in childrenM. Karcaaltincaba, D. Akata, U. Aydingoz, G. Leblebicioglu, M. Haliloglu,D. Akinci; Ankara/TR

Learning Objectives: To describe a technique of extremity angiography usingmulti-detector CT in pediatric patients. To illustrate normal anatomy and abnor-malities of the extremity vasculature.Background: Extremity angiography using multi-detector CT is a non-invasivemodality used for evaluation of vasculature as an alternative to conventional an-giography. Recent studies demonstrated feasibility of this technique in adult pa-tients. 3D images allow display of vascular and osseous structures. In this exhibit,we will describe the use of extremity MDCT angiography in pediatric patientswith suitable indications, potential clinical applications, the advantages and thelimits of this technique compared to conventional angiography. Between Decem-ber 2002 and September 2003, 7 pediatric patients underwent extremity CT an-giography. Normal and abnormal extremity CT angiography studies will beillustrated.Procedure Details: Extremity multidetector CT angiography was performed byusing a 4-channel multidetector CT. Technical parameters: detector collimation:4 x 1 mm; pitch: 1.75; reconstruction interval 1 mm; slice thickness 1.25 mm; ta-ble speed per second, 14 mm; gantry rotation time 0.5 sec. Contrast injectionrate varied from 2 to 3 cc/sec witha volume not exceeding 2 mL/kg of body weight.Mean acquisition time was 21 sec (range 17-25 sec). 3D volume rendered andMIP images were obtained from axial images to display vascular and osseousstructures. Indications for the CT angiography studies were vasculitis, osteomy-elitis, preoperative anatomic evaluation, soft tissue mass, and arterial injury.Conclusion: Technical success was achieved in all patients (100%) who under-went extremity CT angiography studies. In pediatric population extremity multide-tector CT angiography is feasible and can be used as an alternative to conventionalangiography.

C-815The MR spectrum of anatomical variants of the hypothalamo-hypophysealaxis in pituitary stalk interruption syndromeG. Zuccoli1, G. Tognini2, F. Nicoli1, M. Uccelli3, F. Ferrozzi3; 1Reggio Emilia/IT,2Parma/IT, 3Cremona/IT

Learning Objectives: The purpose of this study is to describe the full spectrumof pituitary axis anomalies seen in pituitary stalk interruption syndrome (PSIS) bymeans of MR findings, and the association with other CNS anomalies.Background: The detection of anatomical abnormalities of the hypothalamo-hy-pophyseal axis represents a diagnostic marker of hormonal deficiency. Absenceor hypoplasia of the pituitary stalk, hypoplasia of the adenohypophysis and ecto-pia of the neurohypophysis (pituitary stalk interruption syndrome; PSIS) are fre-quent MR findings in patients affected by isolated growth hormone deficiency ormultiple pituitary hormonal deficiency and represents a distinct pathological enti-ty. Septo-optic dysplasia represents a possible associated anomaly. Co-existent

periventricular nodular gray matter foci have been recently described, suggest-ing a common genetic origin of PSIS and other development anomalies.Procedure Details: MR study protocols of the hypothalamo-hypophyseal axisinclude sagittal and coronal T1-weighted thin section (3 mm) images acquiredwith a standard head coil, 256 x 256 matrix and 20 cm field of view. Coronal oraxial T2-weighted images should be also performed in selected patients.Conclusion: We present MR images showing different locations of the neurohy-pophysis (at the stalk level or at the median eminence level), different morpho-logical aspects of the "bright spot" (single or double) and of the stalk (thin orinterrupted). Furthermore we describe the association of PSIS with other devel-opment anomalies such as neuronal migration disorders.In concludion, we showthe full spectrum of MR presentations of this syndrome, emphasizing the useful-ness of performing a complete brain study to find associated anomalies.

C-816Radiology of pediatric liver tumours: A pictorial reviewA.S. Shaw, D.F.Q.C. Yu, P.A. Kane, J.B. Karani; London/UK

Learning Objectives: To review the clinical presentation, radiological appear-ances and further management of benign and malignant primary liver tumours.Background: Primary liver tumours are relatively uncommon within the pediatricpopulation. The third commonest site of primary abdominal neoplasia, they ac-count for only 3% of tumours in this age group. The clinical presentation, histo-logical classification, radiological appearances and management of these tumoursare diverse.Imaging Findings: We present the radiological appearances of benign and ma-lignant liver tumours at ultrasound, computed tomography and magnetic reso-nance imaging, with a brief overview of clinical presentation and furthermanagement.Conclusion: Primary liver tumours are a heterogeneous group of disorders whichcan usually be differentiated with a knowledge of the clinical and radiologicalfeatures.

C-817Pediatric brain MRI in neurofibromatosis type IH.-J. Mentzel, J. Seidel, C. Fitzek, J.R. Reichenbach, W.A. Kaiser; Jena/DE

Learning Objectives: To evaluate the frequency, evolution, and diagnostic im-pact of characteristic central nervous MR imaging lesions in children with Neu-rofibromatosis type I (NF I). To give recommendations about diagnostic proceduresin children with NF I.Background: NF I has a prevalence of 1:3-4000 and is inherited as an autosom-al dominant condition with a high degree of penetrance. Optic gliomas occurs in5-15% of patients with NF I, brain gliomas occur in 1-3%, and are usually low-grade astrocytomas although approximately 50% became malignant gliomas.Imaging Findings: We reviewed 27 patients with NF I. MRI was performed every12m and in cases of tumors every 6m. 4 patients had optic gliomata (14.8%), 2chiasma gliomata (7.8%), 4 pilocytic astrocytomata (14.8%). Unknown BrightObjects (UBO's) on long TR sequences were detected in 81% (n = 22), involvingbasal ganglia, cerebellum, and brainstem. Change of the UBOs in size and/orintensity with age was observed in 22 patients. Learning disabilities were diag-nosed in 30% of the patients with UBO's.Conclusion: UBO's may be useful as an additional imaging criterion for NF I.Contrast administration is useful in baseline MR studies to maximize tumor de-tection and characterization, to add confidence to the diagnosis of benign proba-ble myelin vacuolization, and to document stability of neoplasms on follow-upexaminations. We recommend performing serial MR in children every 12 months.The frequency of follow-up in children with known brain tumors will vary with thetumor grade, biological activity, and treatment.

C-818Conventional and color Doppler sonography of scrotal pathology inchildren: An updateM. Fité, C. Aso, G. Enriquez, J. Carreño, N. Torán, J. Lucaya; Barcelona/ES

Learning Objectives: Scrotal lesions are common in children. Ultrasound is thefirst imaging modality used to examine children with suspected scrotal pathology.Moreover, Doppler US has increased the radiologist's ability to assess flow in theprepuberal testis. The aim of this exhibit is to illustrate ultrasound findings incommon scrotal processes, in order to facilitate earlier diagnosis and treatment.Background: We present a retrospective review of 750 children with scrotal le-sions studied with ultrasound.Imaging Findings: The lesions were divided into the following groups: Perito-

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neal-vaginal complex lesions, epididymo-orchitis, torsion of the testes or theirappendages, benign and malignant testicular tumors, traumatic lesions, testicu-lar microlithiasis and scrotal involvement in systemic conditions such as Schon-lein-Henoch purpura, Kawasaki disease and congenital suprarenal hyperplasia.Conclusion: Clinical symptoms are often nonspecific in scrotal processes yetsome of these conditions require urgent surgical treatment; thus, knowledge oftheir ultrasound features is highly relevant in clinical practice.

C-819Imaging evaluation of neonatal cystic pelvic massesV.V.T. Mascarenhas, A. Duarte, L. Lobo, J. Fonseca-Santos; Lisbon/PT

Learning Objectives: To describe imaging features of cystic pelvic masses (CPM)in the newborn. To outline main differential diagnosic pitfalls. To emphasise therole of imaging evaluation in treatment and follow-up orientation.Background: Neonatal CPM are among the most common abdominal masses inthe neonate and usually first suspected during fetal ultrasonography. A more pre-cise diagnosis in the neonatal period is essential to an adequate orientation intreatment and follow-up. On this regard, imaging evaluation, particularly US andMRI as the main techniques, undertake a pivotal role. We describe diagnosticimaging features, differential diagnosis limitations and a systematic diagnosticapproach to CPM among selected cases in our department.Imaging Findings: We reviewed the referred cases based on sex, location, rela-tion to adjacent anatomic structures and morphological features. Main diagnosticentities considered were pre-sacral (sacrococcygeal teratoma and myelomenin-gocele) and non pre-sacral masses (genitourinary related namely hydrocolpos,ovarian cyst, bladder diverticulum; digestive tract related e.g. duplication cyst;others, particularly lymphangioma).Morphological imaging findings according to their uni- or multilocularity, simpleor complex components and the presence of specific findings were considered.Ultrasound was the first and sometimes the only imaging modality performed.Selected cases were further evaluated with other imaging modalities such asconventional contrast studies (e.g. cystography) or MRI.Conclusion: Although there is a wide range of entities presenting as a CPM inthe neonate, a systematic imaging approach allows a more precise diagnosis orat least a considerable narrowing of diagnostic possibilities in the majority ofcases, which is essential for therapeutic orientation.

C-820Normal sonographic appearance of kidneys and adrenals in neonates andyoung infants: Unique distinctive featuresM. Vakaki, G. Pitsoulakis, H. Manoli, C. Koumanidou; Athens/GR

Learning Objectives: To familiarize residents in radiology or pediatric radiologywith the sonographic characteristics of neonatal and infantile kidneys and adrenals.Backround: The kidneys are the most commonly sonographically examined ab-dominal organs during the first months of life. The adrenals, due to their positionadjacent to kidneys, are almost always clearly visualized during the renal sono-gram. Their sonographic appearance is quite different from that in older childrenand adults and often causes misleading incorrect diagnoses.Imaging Findings: Examples of various normal sonographic findings of the kid-neys and adrenals in neonates and young infants are presented and embryolog-ically, anatomically or functionally explained. They include the hyperechogenicityof the renal cortex, the "enlarged" hypoechoic pyramids, the fetal lobulation, theinter-renicular septum, the transient neonatal renal medullary hyperechogenicity,the papillary projections in the pyelocalyceal system, the renal pyelectasis, thelarge and hyperemic neonatal adrenals and even more. These sonographic inter-pretations are often misdiagnosed as abnormal conditions, which are also pro-vided.Conclusion: This exhibit will allow an interesting way for young radiologists andpediatric radiologists to learn the common, but also the rare sonographic appear-ances of neonatal and infantile kidneys and adrenals. This knowledge is essen-tial in order to prevent misdiagnoses and needless further investigation.

C-821US-guided intraarticular corticosteroid injection of the subtalar joint inchildren with juvenile idiopathic arthritis (JIA)M. Valle1, A. Ravelli1, F. Rossi1, S. Bianchi2, P. Tomá1, C. Martinoli1; 1Genoa/IT,2Geneva/CH

Learning Objectives: To assess the reliability of US-guided technique as com-pared with blind technique in the injection of the subtalar joint in children withjuvenile idiopathic arthritis (JIA). To describe the procedure and outline the ad-vantages of this method.

Background: Difficulties with blind corticosteroid injection of the subtalar jointare commonly encountered in children with JRA. Ultrasound (US) guidance canmake the puncture more accurate by directly showing the needle tip within thejoint.Procedure Details: Twelve consecutive patients with JIA who had clinical signsof active arthritis and intraarticular fluid or synovial proliferation in the subtalarjoint detected at US received either a blinded injection (n = 7) or a US-guided(n = 5) injection with free-hand technique using high resolution (12-5 MHz) US.Patients were assessed at 24 hours, 2 months and 6 months of follow-up to com-pare the level of clinical response and the frequency of complications betweenthe two treatment groups.Conclusion: Although significant improvement was documented in both groupsof patients with respect to baseline, those injected under US-guidance had alower clinical dysfunction score at 24 hrs and 2 months follow-up. No major com-plications were noted. Our preliminary results indicate that intraarticular corticos-teroid injection of the subtalar joint in children with JIA is more accurate andsuccessful when performed under US guidance.

C-822Duplex, colour, power, and contrast-enhanced Doppler sonography:A pictorial essay of conventional and new applications in the pediatricabdomenI. Pinilla, T. Berrocal, P. Cortés, M. Parrón, A. Bravo, I. Pastor; Madrid/ES

Learning Objectives: To update the diagnostic value of duplex, colour, and pow-er Doppler US in the study of the abdominal paediatric pathology. To analyseapplications and indications for more recently developed techniques such as echo-enhanced colour Doppler sonography, 3-D contrast-enhanced sonography, andharmonic imaging techniques. To emphasise the limitations, restrictions, and pit-falls of each Doppler modality.Background: Doppler sonography is a well-established technique to evaluate anumber of pediatric abdominal conditions, but the field of diagnostic applicationsis now on the brink of major changes. Many contrast-specific modalities havebeen developed in recent years by academic researchers, ultrasound scannermanufacturers, and pharmaceutical companies. Our aim is to update the diag-nostic value of conventional Doppler modalities, and to analyse potentially usefulapplications and indications for the more recently developed techniques. Imag-ing Findings: Specific entities will be used to illustrate clinical principles that canbe applied to multiple clinical situations. Topics addressed include: vascular pat-ency (arterial or venous thrombosis or stenosis, biliary atresia, liver and boweltransplantation, and surgical shunts); anomalous vessels and tubular structures(dilation of the biliary tree vs. blood vessels, pulmonary sequestration, varicocele);and evaluation of hyperemic and ischemic lesions (appendicitis, intussusception,pyelonephritis, orchitis / testicular torsion).Conclusion: B-mode sonography, as well as Doppler techniques, have a keyrole in pediatric diagnosis for several reasons (non-invasivity, lack of ionizingradiation, sonographic access is better than in adults, no need for anesthesia orsedation). Understanding the physical principles that govern Doppler imaging isessential for its successful clinical application.

C-823Duplex and color Doppler evaluation of surgical portosystemic shunts inpediatric patientsY. Herrero, T. Berrocal, I. Pastor, C. Prieto, B. Rodriguez-Vigil, A. Alvarez;Madrid/ES

Purpose: Portosystemic shunts are constructed to palliate symptomatic portalhypertension or to provide decompression of the hepatic vasculature in Budd-Chiari syndrome. The aim of this exhibit is to show the utility and limitations ofduplex, color and power Doppler sonography in the evaluation of portosystemicshunts performed in pediatric patients.Methods and Materials: Twenty-one portosystemic shunts were performed in19 patients aged six to 18 years (12 females, 6 males) for the management ofportal hypertension (portal vein obstruction, Budd-Chiari syndrome, congenitalhepatic fibrosis, and cirrhosis). Follow-up protocol included a preoperative con-trol, an immediate postoperative control one day to 1 week after surgery, andlong-term postoperative controls three months, six months, and one year aftersurgery. We illustrate the vascular connections and demonstrate the expectedpostsurgical direction of flow in the blood vessels involved. The US techniquesand the criteria for inferring patency are discussed. Advantages, limitations, andpitfalls of every Doppler modality are emphasized.Results: Types of shunt were 10 meso-cava, 6 distal splenorrenal, 1 proximalsplenorrenal and 4 porta-caval. All were adequately assessed by Doppler sonog-

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raphy. Stenosis of the shunt was diagnosed in two patients and thrombosis in onepatient, all confirmed at arteriography.Conclusion: Duplex Doppler US provided physiologic flow information, and colorDoppler US was capable of directly imaging shunt flow and, in most cases, iden-tifying shunt anastomosis. The majority of surgical portosystemic shunts can befully evaluated and complications detected with Doppler sonography if the hemo-dynamics of the surgical procedures are understood.

C-824Optic nerve ultrasound in assessment of raised intracranial pressure: Itsrole in clinical practiceL.C. Bamford, A. Paterson, G. Cran, J. Turner, S. McKinstry, P. Flynn,L.E. Sweeney; Belfast/UK

Purpose: Early diagnosis of acute intracranial hypertension enables prompt treat-ment. Elevated intracranial pressure (ICP) is reflected by enlargement of the du-ral optic nerve sheath with the formation of papilloedema. Published referencevalues of ONSD in "normal" children are: children less than 1 year < 4 mm diam-eter, children over 1 year ≤ 4.5 mm in diameter.Methods and Materials: A total of 63 children with spina bifida and shuntedhydrocephalus were included in the study. ONSD readings were taken 3 mm be-hind the optic nerve head using a 7 MHz sector probe. Eight children re-present-ed with signs and symptoms suggestive of raised ICP and had CT brain scansperformed.Results: Asymptomatic cases: n = 63. Mean ONSD right eye = 4.5 mm (SD = 1.1),mean ONSD left eye = 4.6 mm (SD = 0.9).A Pearson calculation showed botheyes to be highly correlated. A cumulative percent calculation showed 70% (44/63) of children had ONSD > 4.5 mm.Symptomatic cases: n = 8. Mean ONSD right eye = 5.5 mm (SD = 0.7), meanONSD left eye = 5.7 mm (SD = 0.9). A Wilcoxon Signed Ranks Test showed nosignificant difference between these results. Using the largest reading for eacheye when well and symptomatic: mean asymptomatic ONSD = 4.8 mm (SD = 0.8,n = 8), mean symptomatic ONSD = 6 mm (SD = 0.8, n = 8). A Wilcoxon SignedRanks Test showed a significant difference in these results (p = 0.008).Conclusion: ONSD increases in acutely raised ICP. Our results suggest thatchildren with spina bifida and shunted hydrocephalus cannot be assumed to haveONSD within the normal range even when clinically well. In the long term we aimto compile new ONSD reference ranges for children with shunted hydrocephalus.

C-825Magnetic resonance urography in the diagnostic work-up of infants andsmall childrenG.I. Kirova, M. Minkov, T. Georgieva, G. Hadjidekov; Sofia/BG

Purpose: The aim of the study is to evaluate the feasibility and diagnostic poten-tial of MRI examination for detection of renal abnormalities in small children.Materials and Methods: 35 children (20 days to 14 years) referred from theurology service, in whom urinary tract abnormalities were strongly suspected,underwent MR exam. The technique included unenhanced and enhanced MRUimages of the abdomen and pelvis. The examination as a whole took 20-30 min.Transverse images and 3D reformations were assessed on a satellite consoleand 3D data were reviewed with different rotating angles. Findings were retro-spectively compared with results of urinalysis, ultrasonography and surgery.Results: MR examination of urogenital tract depicted different clinically suspect-ed urinary tract abnormalities, including 4 duplex systems, 3 renal distopias, 12obstructive megaureters, 3 uretheroceles, 6 PUJ obstructions, 5 with accompa-nying renal parenchymal disease, 6 urinary tract calculi, 6 tumors, one extra re-nal mass, 3 with bladder abnormalities and one transplanted kidney. Most of thechildren had complex pathology. MRU demonstrated anatomy better than IVU,particularly the renal parenchyma and poorly functioning dilated systems. MRUwas superior to US in showing ureteral pathology.Conclusions: MR urological examination could prove especially advantageousin a number of clinical applications, including urinary tract obstruction, renal tu-mors, transplanted kidney and a wide range of congenital anomalies. It is a safe,noninvasive, and relatively fast technique for imaging children's renal tract disor-ders. MRI thus has the potential to replace other ionizing imaging techniques andoffers better results for many indications.

C-826Choledochal cysts in pediatric patients: Preoperative evaluation with MRcholangiographyY.A. Akhmetov; Almaty/KZ

Purpose: The aim of this study was to evaluate the use of magnetic resonance(MR) cholangiography in accurately demonstrating the presence, extent, and typeof choledochal cysts.Methods and Materials: Eight patients with sonographically suspected choledo-chal cysts were evaluated with a 2D and 3D FASE MR cholangiography tech-nique. The presence, extent, and type of choledochal cyst were determined. MRcholangiographic findings were correlated with the gold standard of endoscopicretrograde cholangiography and surgery in all patients, and with additional CT infive.Results: There were six (75%) Todani type I and one (12.5%) Todani type IVcholedochal cysts. The extent of the involvement was correctly demonstrated onall MR cholangiograms. Calculi and sludge were correctly identified on the MRcross-sectional images in four patients (50%) but were not seen on MR cholang-iograms in one (12.5%). In one patient with an initially misinterpreted choledoch-al cyst, MR sectional images showed the typical appearance of a hydatid cyst,which was confirmed at surgery.Conclusion: MR cholangiography can be used to confirm the diagnosis ofcholedochal cysts and define the extent of involvement preoperatively. Non-bil-iary cysts such as a hydatid cyst can mimic a choledochal cyst on the MR cholan-giogram and should be correlated with the MR cross-sectional images to avoidmisinterpretation.

C-827Effects of EC guidelines implementation on effective dose reduction inspinal investigation for childhood scoliosisD. Baranska, M.A. Staniszewska, T. Bieganski; Lodz/PL

Purpose: To reduce the radiation exposure in children in conventional X-ray ex-amination of spine according to the EC guidelines.Methods and Materials: 78 children diagnosed for scoliosis were randomisedinto groups of either standard or improved radiographic tehnique: 1. Standardtechnique: AP projection, focus-skin distance - FSD 1 m (FFD ~ 1.3 m), tubevoltage 73 kV, inherent filtration of 3.5 mm Al, no additional filtration. 2. AP, FSD1 m, 73 kV, additional filtration of 1 mm Al and 0.2 mm Cu 3. PA, FSD 1 m, 73 kV,additional filtration as above 4. PA, FSD 2 m, 73 kV, additional filtration as above5. PA, FSD 2 m, 102 kV, additional filtration as above.The children were then divided into two groups corresponding to the mathemat-ical phantoms representing 10 and 15 year-old children. The air kerma measuredwith LiF, TLD-100; effective doses calculated by Monte Carlo simulation.Results: All the new condition settings diminished exposure. The reduction ofthe effective doses, as compared to standard technique was as follows: tech-nique 2 - 64% effective dose reduction in the groups of both 10 and 15 year-oldchildren; technique 3 - 77% and 67% in 10 and 15 year-old patient groups re-spectively; technique 4 - 58% and 60% respectively; technique 5 - 83% and 72%respectively.Conclusion: Optimising of the imaging conditions according to the EC guide-lines in paediatric radiology allows for evident effective dose reduction, with nosignificant loss of image quality.

C-828Comparison of semiquantitative bone marrow scintigraphy and MIBGscanning in diagnosis of neuroblastomaJ. Soukhova, V. Soukhov, E. Karetkina, B. Kolygin; St.Petersburg/RU

Purpose: To compare results of semiquantitave bone marrow scintigraphy (BMS)and whole body MIBG-scanning used for staging and therapeutic effect assess-ment in patients with neuroblastoma.Materials: BMS and MIBG-scanning were performed in 24 consecutive children(1-14 y.o.) with histologically proven neuroblastoma before and after the treat-ment. BMS using 99mTc-millicolloids started 1-1.5 hr after i.v. injection of 222-370 MBq; MIBG-scanning - 24 hours p.i. of 123I-MIBG (37-74 MBq). Quantificationwas performed on MIBG images of affected bone: count density, measured with-in a region of interest, was divided by background count density. This value rep-resents coefficient of tracer uptake (CTU). Semiquantitative grading of BM imageswas as follows: grade 1-absence of image, grade 2- markedly diminished traceruptake, grade 3 - slightly reduced tracer uptake, grade 4 - normal BM scan.Results: The following correlation coefficients were observed for evaluated re-gions with "hot spots" of MIBG uptake taken as evidence of metastases in the

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indexed sites: 4.97 ± 1.80 before treatment and 1.51 ± 0.53 - after. Focal or dif-fuse defects of tracer uptake (grade 1 or 2) by BMS considered to representmetastatic involvement. Marrow regeneration can be considered in regions withimage grade 3-4. In all cases p < 0.001.Conclusion: Statistically significant correlation was observed between BM sem-iquantitative image grades and MIBG CTU. Whole body BMS can be effectivelyused for the initial diagnosis of BM invasion by neuroblastoma and BM regener-ation. Quantitative results of MIBG-scanning reflect therapy response and influ-ence choice of treatment schedule.

C-829Application of low-dose scan protocols in 16 row computed tomography:Dose reduction in pediatric examinationsM.F. Khan, C. Herzog, H. Ackermann, H. Schmidt, T. Vogl; Frankfurt a. Main/DE

Purpose: Optimization of different low-dose CT protocols for dose reduction inpediatric radiology.Methods: 30 children aged between 2 and 12 years consecutively received a 16row computed tomography examination. Thorax, spine and neck were examined.Scan parameters were individually adapted: T: I 500 ms, collimation: 16 x 0.75 mmand 16 x 1.5, 120 - 80 KV, 50 - 11 mAs. Follow-up examinations allowed a con-tinuous variation of selected scan parameters. Evaluation criteria included imagequality, image noise, delineation and resolution of selected structures as well asgeneral assessability. Age, gender, body weight, dose - length product and effec-tive mAs were recorded.Results: In examinations focusing on the spine, soft tissues of the neck, andpulmonary infiltrations as well as most of the interstitial pulmonary diseases asatisfactory image quality was achieved by using 80 kV and 11 mAs (mean im-age quality: 2.1 (spine), 2.3 (pulmonary infiltration), 1.9 (soft tissue neck) and 2.7(interstitial pulmonary diseases), grade 1 (very good) to 5 (poor)). Topographicoverviews turned out to be extremely dose dependent and were therefore omit-ted in most cases. A mAs dose reduction up to 70% (110 mAs to 33 mAs) ascompared to conventional CT imaging protocols could be achieved in chest andneck exams. In spinal examinations a dose reduction up to 94.1% (244 mAs to15 mAs) was possible.Conclusion: Appropriate selection of scan parameters in 16 row computed tom-ography allows a clear dose reduction in pediatric CT examinations as comparedto conventional CT imaging techniques.

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C-831Hyperechoic foci in the kidney: An incidental sonographic finding inneonates and infantsM.A. Pourbagher, A. Pourbagher, F. Tiker, Z. Koc, E.A. Niron; Adana/TR

Purpose: The purpose of this study was to determine the incidence and signifi-cance of non-shadowing hyperechoic foci in the kidney and to evaluate metabolicdisturbances in these patients.Materials and Methods: In a period of 3 years abdominal ultrasonography (US)was performed as a screening procedure in 2532 neonates and infants. A follow-up US was performed in 50 of 76 (38 female and 38 males) patients with hyper-echoic foci in the kidney approximately 2-24 months after the initial examination.All patients underwent metabolic evaluation, including serum electrolyte meas-urement and 24-hour urine collection.Results: Non-shadowing hyperechoic foci were detected in 76 (3%) patients (100kidneys). The size of foci were 1-5 mm (mean 2 mm). The foci were located in thelower pole calix in 66%, upper pole calix in 4% and middle zone calix in 30%kidneys. Sixty kidneys had single, 12 had 2 and 28 had 3 or more foci. At 2-24months follow-up the clearance for foci was 74%. Size and site of foci has norelation with foci clearance. Urinalysis showed elevated urinary calcium in 3 andhematuria in 8 patients. In 2 patients foci were passed without intervention, anduric acid was the dominant foci composition in both patients. Serum electrolytemeasurement were normal in all patients.Conclusion: The incidence of hyperechoic foci in our study was 3%. That is usu-ally discovered incidentally during sonography of the abdomen and generallyresolve spontaneously. Follow-up of the patients is advocated with US and uri-nalysis.

C-832Germinal matrix morphology in antenatal ventricular dilatationK.M. Koprivsek1, T. Vanderheyden2, S. Counsell2, J. Allsop2,A. Stonebrige-Foster2, S. Kumar2, N. Fisk2, M.A. Rutherford2;1Sremska Kamenica/YU, 2London/UK

Purpose: The germinal matrix (GM), a densely cellular zone lining the lateralventricles, and give rise to the developing cortex. The MRI appearance of GMduring fetal development has been well-documented, but data about GM mor-phology in pathological conditions is sparse. Antenatal ventricular dilation (VD) isassociated with significant neurological morbidity. We used antenatal magneticresonance imaging (MRI) to measure the GM in fetuses with and without VD.Methods: Retrospective analyses were conducted of fetal MR images acquiredover a 2-year period, using fast T2 weighted sequences. In 70 fetuses (normalventricles in 44, VD in 26 cases), we evaluated the signal characteristics and themaximum germinal matrix diameter (GMD) at three sites: the anterior and poste-rior ventricular horns and the caudothalamic notch (CTN). Between-group com-parisons of GMD in normal and fetuses with VD were made using a Studentst-test.Results: GM had the same low signal intensity regardless of GA and/or ventricu-lar volume. None of the infants with VD had evidence of GM haemorrhage. Themean GMD in controls showed a linear decrease with brain maturation. In fetus-es up to 28 weeks of GA with normal ventricles the GMD was greatest at theCTN. The similar pattern of changes in GMD was measured in VD group, wherethe mean GMD at the TCN were slightly, but not significantly lower then in con-trols (t = 1.48: p > (0.05)).Conclusion: GM diameter decreased with increasing gestational age. We didnot detect any significant difference in GM morphology in the group of fetuseswith antenatal VD.

C-833Contrast enhanced color Doppler ultrasonography in diagnosis of scrotallesions in childrenU. Zaleska-Dorobisz, E. Czapiga, K. Moron; Wroclaw/PL

Purpose: To investigate the usefulness of ultrasound with contrast agent Levo-vist- Schering (USCA) for the detection scrotal lesions in children.Material and Methods: Between 2000- 2002, 39 boys with scrotal masses wereexaminated. Mean age was 13.6 years and ranged from 1-17. Diagnostic assess-ment included in all cases conventional US, color Doppler and power Dooplerbefore and after the adminstration of contrast agent keeping the same methodol-ogy in every examined patient. Focal testicular lesions (cystic and solid tumor)and extratesticular structures were documented regarding size, localization, range,vascularity and ultrasound diagnosis. In testicular tumors, the degree of tumorvascularity was subjectively graded from 0 to IV. The ultrasound diagnoses werecompared to the final diagnoses based on clinical tests, surgical and histologicalexamination.Results: 11 testicular and extratesticular tumors showed more enhancement thanadjacent testicular parenchyma, seen between 15 to 60 s (mean 29 s) and 55 to252 s (mean 83 s) after injection. The duration of enhancement was 15 to 210 s(mean 80 s). Cross sections and adjacent vessels were only seen in: teratoma,embryonal carcinoma and yolk sac tumor.Conclusions: USCA is an important and significant aid in the diagnosis of scro-tal diseases, in the assessmentof of degree of vascular change and is predictiveof malignancy.

C-834MR features of the preterm children with athetotic cerebral palsyK. Hayakawa, T. Kanda, Y. Yamori; Kyoto/JP

Purpose: The recent development of the neonatal intensive care medicine hascaused not only a dramatic decrease in the incidence of kernicterus, but alsomarked improvement in the survival of premature babies. Consequently, the inci-dence of pure athetotic cerebral palsy has decreased, whereas the incidence ofspastic cerebral palsy associated with athetosis, termed mixed cerebral palsy,has increased. The purpose of this study is to evaluate the brain MR features ofthis condition and to assess the frequency of basal ganglia injury.Methods and Materials: The subjects consisted of 14 boys and six girls diag-nosed with mixed cerebral palsy. Their gestational age range from 28 to 34 weeks(average = 29 weeks) and the birth weight ranged from 635 g to 2732 g (average= 1455 g). MR brain scans were assessed with particular attention to the basalganglia.

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Results: MRI revealed periventricular leukomalacia in 17 children, periventricu-lar hyperintensity in 2 children, and hypoplasia of the corpus callosum in onechild. Basal ganglia injury was observed in 15 children (75%). MR abnormalityconsisted of T1 shortening in the neonatal period and T2 prolongation after theneonatal period. The incidence of MRI signal abnormality were 35% in thamalus,10% in putamen and 45% in globus pallidus.Conclusion: In premature children, basal ganglia injury is demonstrated in 75%patients. MRI is very useful to assess basal ganglia damage and to predict theprognosis of the preterm children.

C-835Cortical malformation of cerebrum in undermyelinated brain: The use ofT2WI with narrow window width and 3D RF spoiled FAST imagingS. Kim, W. Cho, J. Kim, S.-J. Bae, J. Kim, J.-Y. Kim, J. Ja; Seoul/KR

Purpose: To describe the MRI findings of cortical malformation of cerebrum inundermyelinated brain, and to evaluate the use of T2-weighted imaging (T2WI)with narrow window width and three-dimensional RF spoiled FAST (3D RF spoiledFourier acquired steady state) imaging for detection of cortical abnormalities.Methods and Materials: The subjects were sixteen patients with epilepsy, agedunder 2 years. The subjects had pathologically-confirmed cortical malformationof cerebrum (n = 4) or abnormalities well localized with PET or SPECT and EEGfindings (n = 12) (9 boys and 7 girls, age ranging from 4 months to 21 months).T2WI and 3D RF spoiled FAST imaging using thin (1.6 to 2 mm) partition sizeswere performed. Two radiologists reviewed the imaging.Results: On T2WIs, cortical abnormalities were not detected in 10 of the 16patients. On T2WIs with narrow window width, cortical abnormalities were de-tected in all patients. Bright foci were seen in 7 patients, dark foci in 5 patientsand delayed myelination in 4 patients on T2WIs with narrow window width. On 3DRF spoiled FAST imaging, delayed myelination as compared with the contralater-al side was detected in 7 of the 16 patients.Conclusion: T2WI with narrow window width is useful for detection of corticalmalformations of the cerebrum in undermyelinated brain and 3D RF spoiled FASTimaging shows delayed myelination.

C-836Imaging of pancreatic disorders in pediatric patientsY. Herrero, T. Berrocal, C. Prieto, J. Fernández, M. Parrón, R.R. Lemos;Madrid/ES

Purpose: The aim of this teaching exhibit is to illustrate a wide spectrum of usualand unusual disorders involving the pancreas in children, and to evaluate theefficacy of ultrasound (US), duplex and color Doppler sonography, endoscopicretrograde cholangiopancreatography (ERCP), Computed tomography (CT) andmagnetic resonance (MR) imaging in the diagnosis and management of theseconditions.Methods and Materials: The imaging findings of patients with disorders involv-ing the pancreas were reviewed from our database of pediatric pancreatic pa-thology. Ultrasound was performed in all cases, while CT, and MRI were performedin all tumors and whenever US and Doppler images were not conclusive. ERCPwas used to study the pancreatic ducts. The embryologic and pathologic basesof the imaging findings are discussed in appropriate cases. The key findings ateach imaging modality are shown and compared with the underlying pathologicfeatures when available. Pitfalls, diagnostic difficulties and differential diagnosesare emphasized.Results: Specific topics addressed include congenital anomalies (pancreas di-visum, annular pancreas, ectopic pancreas, pancreatic cysts, cystic fibrosis,Shwachman-Diamond syndrome, von Hippel-Lindau syndrome, and nesidiob-lastosis); acute and chronic pancreatitis; pancreatic cyst and pseudocysts; pri-mary neoplasms (insulinoma, cystadenoma, and papillary cystic carcinoma);metastasis of Burkitt lymphoma; and miscellaneous (hemochromatosis, Cush-ing's disease, steroid and cytostatic therapy, and parenteral nutrition).Conclusion: Evaluation of patients with pancreatic disorders frequently requiresmultiple imaging modalities for diagnosis and planning surgical correction. Be-cause many of these disorders have characteristic imaging appearances, thisexhibit will help practicing radiologist to better understand and recognize patho-logic processes affecting the pancreas.

C-837Imaging congenital vertebral disorders in pediatric patientsM. Fernández -Velilla, T. Berrocal, A. Royo, A. Fernández, J. Gutierrez,N. Gómez-León; Madrid/ES

Purpose: To illustrate a wide spectrum of usual, unusual and exceptional con-genital anomalies involving the vertebrae, and to evaluate the efficacy of plainradiographs, computed tomography (CT) and magnetic resonance (MR) imagingin the management of these conditions.Methods and Materials: We retrospectively reviewed the imaging findings ofpatients with congenital abnormalities involving the vertebrae from our databaseof spinal pathology. Abnormalities were divided into isolated vertebral anomaliesand anomalies associated with systemic diseases or syndromes. Plain radio-graphs were performed in all patients. CT or MR were performed whenever plainradiographs were inconclusive. The embryology and pathologic basis of the radi-ographic findings are discussed. Pitfalls, diagnostic difficulties and differentialdiagnoses are emphasized.Results: Specific topics addressed include anomalies in number (vertebral agen-esis, sacral agenesis, omovertebral bone); anomalies in size and shape (verte-bral and sacral hypoplasia, hemivertebra, occipitalization of C1, os odontoideum,lumbarization, sacralization); anomalies of fusion (blocked vertebra, Klippel-Feilabnormality, spina bifida, butterfly vertebra, coronal cleft vertebra); anomalies ofalignment (spondylolisthesis, spondilolysis, scoliosis); neural arch defects (ab-sence of the pedicle and lamina); caudal spinal anomalies with anorectal andurogenital malformations (terminal mielocystocele, caudal regression syndrome,VACTER association, OEIS complex, Currarino triad); and skeletal dysplasias(achondroplasia, thanatophoric dwarfism, chondrodysplasia punctata, spondy-loepiphyseal dysplasia, and mucopolysaccharidoses).Conclusion: Evaluation of patients with vertebral abnormalities frequently re-quires multiple imaging modalities for diagnosis and planning treatment. Becausemany of these disorders have characteristic imaging appearances, this exhibitwill help trainee radiologist to better understand and recognize pathologic proc-esses affecting the vertebral spine.

C-838Defecography in chronically constipated childrenA.D. Yang, M.-T. Cheng, K. Lee; Changhua/TW

Purpose: To evaluate the defecographic findings in children suffering from chronicconstipation.Materials and Method: Between May 1999 to August 2003, we performed aprospective study of 47 children (24 boys, 23 girls) with an age range of 3 - 18years old who fit the criteria for chronic constipation in our institution. Defecogra-phy was performed using flouroscopy with radiographs were taken during differ-ent phases of defecation; the whole study was video recorded.Results: Of the 47 children studied (42) children were found to have abnormaldefecographic findings: Partial relaxation to non-relaxation of the puborectalismuscle on defecation was found in 18 patients; anterior rectocele in 16, posteriorrectocele in 11, rectal intussusception in 20, mucosal prolapse in 17, rectal pro-lapse in 4; sigmoidoceles in 15: grade I (11), grade II (2), grade III (2).Conclusion: 1. The defecographic findings that are seen in adults could also befound in children. 2. Defecographic evaluation could be a potentially valuable andsimple radiologic study which could be used in the evaluation of children suffer-ing from chronic constipation.

C-839Evaluation of the usefulness of 3D CT reconstructions of multifragmentedfractures in childrenM. Wozniak, E. Dybiec, P. Wieczorek; Lublin/PL

Purpose: The aim of the study was the evaluation of the usefulness of 3D CTreconstructions in the imaging of post-traumatic alterations of the bones in children.Methods and Materials: The analysis was based on 39 three dimensional CTreconstructions of the fractured bones. There were cases of extensive, complexbone fractures, when evaluation based on conventional radiographs was insuffi-cient. All examinations were performed on a Shimadzu SCT 7800TX scanner.Surface and volume rendering were employed in the processing.Results: The results of the study show that 3D reconstructions allow very pre-cise evaluation of post-traumatic alterations, especially in the bones of complexanatomical structures. They enable the imaging of small fracture fissures invisi-ble on conventional radiographs and CT. In the cases of bone indentations 3Dreconstructions allow very detailed evaluation of the depth of indented fragments,their displacement and rotation.

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Conclusion: 3D CT reconstructions are a very useful diagnostic method andplay a very important, irreplaceable role in modern diagnostics of complex frac-tures, especially in pediatrics, where the patient cooperation is very difficult. Theapplication of 3D CT image processing has created new diagnostic opportunitiesin cases of fracture imaging.

C-840Color Doppler and power Doppler sonography in the diagnosis of the acutescrotum in boysU. Zaleska-Dorobisz, B. Jankowski, J. Wawro, K. Moron; Wroclaw/PL

Background: The aim of this study was to estimate of the color Doppler andpower Doppler imaging efficacy in diagnosis of acute scrotum in children.Material and Methods: 140 boys with acute pain and scrotal oedema with anage range between 4 days and 14 years were admitted to hospital. The clinicaland ultrasound examinations with CD and PD showing acute changes in thetestes and scrotal structures are presented with special focus to vascular flow.Results: The accuracy of ultrasound findings verified intraoperatively and by his-topathologic examinations was 82%. In 118 (80.5%) cases the morphologicalchanges were directly related to the duration of the signs and symptoms. Testic-ular arterial flow was compromised in testicular torsion and was normal in adnex-ial torsion. Transitional blood flow changes were noted in 25 boys after testiculartrauma. Pathological vascularity was recognized in 5 cases of accidentally-diag-nosed testicular tumors with acute inflamation.Conclusions: Color Doppler imaging is useful in diagnosis evaluation of the acutescrotum in children.

C-841Pictorial display and review of life threatening fetal conditionsK. Aratani, H. Hyodoh, H. Akiba, M. Tamakawa, K. Hyodoh, M. Hareyama;Sapporo/JP

Purpose: We reviewed our clinical and MRI files of patients with life threateningfetal conditions for the prenatal diagnosis of fetal malformations as well as for thematernal disorders during pregnancy.Methods and Materials: From July 1999 to December 2002, 60 women withcomplicated pregnancies were referred for MRI. Imaging was performed in a 1.5 Tsystem using SSFSE sequences. The pathologies presented include CNS tu-mor/developmental anomaly, gastrointestinal atresia/hernia, abdominal tumors,genitourinary anomaly, superficial tumor (hemangioma), other multiple anoma-lies of fetal malformations, and placental bleeding/hematoma, bicornuate uterus,myoma, cervical cancer, ovarian tumor of the maternal disorders. This exhibitaffords the observer an opportunity to review the appearances of some of therarer pathological conditions.

C-842A simple dose reduction protocol for pediatric multislice CTR.A. Allen, A.J. Watt; Glasgow/UK

Purpose: In pediatric CT examinations, failure to adjust parameters based onweight or age may result in unnecessarily high radiation doses. Radiation dose isdirectly proportional to the tube current for a given CT scanner and kilovoltage.The aim of this study was to assess the parameters used for CT scanning in alarge tertiary referral centre.Methods and Materials: CT scans performed at The Royal Hospital for SickChildren, Yorkhill, Glasgow from April 2002 to December 2002 were examined. Aweight-based protocol was designed based on the current literature. The tubecurrent & kV selected for each examination before and after introduction of theprotocol was compared.Results: 797 CT examinations were performed over the nine month study peri-od. Examinations using tube current of more than 100% greater than protocolwere noted. These reduced from 37% of examinations prior to the introduction ofthe protocol to 16% following its introduction. Reductions were most noticeable inhelical examinations of thorax, abdomen and pelvis.Conclusion: Weight related protocols reduce the tube current used and thus theradiation dose in a large percentage of paediatric CT examinations. This hasproved to be an effective method of reducing dose both in this study and in previ-ous studies.

C-843Bone sarcomas as a second malignancy in childrenC. Hadjigeorgi, J. Nikas, G. Pitsoulakis, V. Theodoropoulos, K. Stefanaki;Athens/GR

Purpose: The aim of this study was to investigate the correlation of bone sarco-mas with pre-existing malignancies in children.Materials and Methods: We retrospectively reviewed the cases of 103 patientswith histologically confirmed bone sarcomas (54 osteosarcomas and 49 Ewing'ssarcomas) treated at children's hospitals in Athens, Greece, during a 12-yearperiod (1991-2003) for pre-existing malignancy.Results: 8 children, 3 male and 8 female, aged 8-19 years-old (median age 13.75)presenting with bone sarcoma (6 osteosarcomas and 2 Ewing's sarcomas) hadpre-existing primary malignancies: 3 Non-Hodgkin Lymhomas (NHL), 2 AcuteMyeloblastic Leukemias (AML), 1 Medulloblastoma, 1 Neuroblastoma, 1 OvarianSertoli tumor and 1 intraabdominal Rhabdomyosarcoma. All sarcomas located inthe long bones were radiologically evaluated with X-rays, CT and, in 5 cases,with MRI.Conclusions: In 62.5% of cases with secondary bone malignancy the primarycancer was of hemoproliferative origin (NHL, AML). The secondary bone sarco-mas may be therapy related (radio and/or chemotherapy) or due to genetic alter-ations.

C-844Benign lymphoepithelial parotid lesions (BLL) in HIV-infected pediatricpatients: A study based on ultrasonographic and clinical evaluationF. Pretolesi, L.E. Bacigalupo, R. Rosso, M. Buscaglia, V. Del Bono, L.E. Derchi,D. Bassetti; Genoa/IT

Purpose: Non-specific parotid lesions in HIV infected patients are often noted tobe lymphoepithelial benign cysts of the gland and are uncommon in the othersalivary glands. In our study, we analyzed ultrasonographic (USG) findings cor-related to clinical parameters in an HIV-infected pediatric cohort of patients allwith parotid enlargement to assess if BLL may be considered an early manifesta-tion of HIV disease.Methods and Materials: USG of parotid glands was performed in 34 pts (23 M,11 F). None had xerostomia or sicca syndrome symptoms. Mean age was 9.7years (range 1-19). Twenty-three patients were on HAART regimen, 8 were givenonly two NRTIs, one had no therapy and 2 had therapy interruption due to adverseevents. Only three patients had diagnosis of full-blown AIDS. Mean CD4+ cellcount was 865/ìl (range 56-5126) with a mean CD4+ percentage of 26.8% (range2.2-44.2%). Mean viral load was 4.3 Log10 (range < 50-182,000 copies/ml).Results: USG assessed three different patterns of intraparotid lymphoid hyper-plasia: markedly evident in 13 subjects (classified as type 1), barely noticeable in16 patients (type 2) and only parotid enlargement without lymphoid hyperplasiain five patient (type 3).Conclusions: BLL may indeed be considered an early manifestation of HIV dis-ease: 33/34 pts were in a stable clinical condition, with a good response to anti-retroviral therapy. Due to the reported possible malignant transformation of BLLin adults, it is also advisable to perform USG at least once a year or in concomi-tance with any modification of the parotid lesions.

C-845High resolution chest tomography (HRCT) in very low birth weight infantsP.A. Daltro, R.R. Mello, M. Boechat, J.M. Lopes; Rio de Janeiro/BR

Purpose: To study the prevalence of HRCT abnormalities in very low birth weightinfants, since there is very little information about this technique in the neonatalperiod, especially in very low birth weight infants who are most suceptible to lunginjury at this critical period of the development.Methods and Materials: All babies with birth weight of less than 1500 g and upto 34 weeks gestational age born at Instituto Fernandes Figueira (FIOCRUZ,Brasil) between January 98 and August 2000 had HRCT of the thorax just beforedischarge, whilst in stable clinical condition. We used Pro-Speed-S CT HRCT.Informed consent was obtained and the study was approved by the Ethics Com-mittee for Research at Instituto Fernandes Figueira.Results: We studied a total of 86 infants with a birth weight of 1113 ± 232 g anda gestational age of 28.5 ± 2.3 weeks. HMD was diagnosed in (52.3%) and BDPin 24 (27.9%). There was good agreement between the two examiners (Kappa:0.68). A total of 24 HRCT studies were considered normal (27.9%). The mainabnormalities found were: parenchymal bands: 30 (34.9%), aeration disturbance:33 (38.4%), ground glass: 18 (20.9%), subpleural bubbles: 8 (9.3%), atelectasis:27 (31.4%), consolidation: 6 (7%). All infants with a diagnosis of bronchopulmo-

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nary dysplasia (DBP) had abnormal HRCT and 40% of non-DBP infants hadabnormal HRCT.Conclusions: At the time of home discharge, asymptomatic very low birth weightinfants show a high prevalence of abnormalities on HRCT of the thorax.

C-846Evaluation of contrast enhanced duplex Doppler and power Dopplerultrasonography in diagnosis of the thyroid nodules in childrenU. Zaleska-Dorobisz, T. Zak, E. Czapiga, K. Moron; Wroclaw/PL

Purpose: The aim of this study was to establish the usefulness of power Dopplersonography and evaluation of contrast agent utility in ultrasound diagnosis in theassessment of thyroid nodules in children.Materials and Methods: 84 children were operated on for nodular goitre. Meanage was 13.6 years and ranged 7-18. Diagnostic assessment in all cases includ-ed US, thyroid hormones evaluation and US-guided needle aspiration biopsy. Allpatients were examined by power Doppler before thyroidectomy, 30 children wereexamined by power Doppler sonography after intravenous injection of Levovist.The vascular pattern on CDD and USCA divided the nodules on the Lagalla cri-teria. Definite diagnosis was based on histologic examination of the resectedthyroid tissue.Results: Thyroid US aimed to assess precisely the morphology and topography.Multiple nodular lesions were diagnosed in 37 children and single nodule wasidentified in 28. Suspicion of malignancy was noted on cytology in 13 children. In30 children using Levovist the study assesed the vascularity of 78 thyroid lesions.Analysis of the impact of contrast agent on the number of vessels visualized withregard to their histological status i.e. malignant or benign was performed.Conclusion: CDD and PD are important and are significant aids in the diagnosisof thyroid nodules in children, and in assesment of the degree of vascular change.Findings on USCA become highly predictive for malignancy only when multiplesigns are simultaneously present in the thyroid nodule.

C-847Renal dysplasia and intrarenal reflux in boys with posterior urethral valves:High resolution sonographic findingsM. Vakaki, G. Pitsoulakis, H. Manoli, C. Koumanidou; Athens/GR

Purpose: Voiding cystourethrography (VCUG) is considered the gold standardfor the diagnosis of the posterior urethral valves (PUV) and the accompanyingvesicoureteral reflux (VUR) in boys. However, its contribution to the characteriza-tion of intrarenal pathology, which is considered to be of great prognostic value,is minimal. It is only with recently introduced high resolution ultrasonographicequipment that details of disturbed renal architecture can be visualized.Materials and Methods: 12 infant boys with PUV, aged 1 day to 7 months wereexamined sonographically with 5-8 MHz convex and 5-12 MHz linear transduc-ers. The presence of PUV was confirmed with VCUG in all cases.Results: Apart from the classic sonographic findings of PUV, which were alsodemonstrated, findings specific to the kidney included: a) bilaterally increasedrenal parenchymal echogenicity and loss of corticomedullary differentiation (12/12), which with b) small cortical cysts (8/12) imply renal dysplastic lesions, c)increased medullary echogenicity, cupping of dilated calyces, which is attributedto intrarenal reflux (3/12), d) hypoechoic lines pointing towards rounded calyces,corresponding to the pelvotubular backflow of urine (2/12), e) small subcapsularurinomas (2/12), f) urinoma and urine ascites (1/12) and g) intrarenal abscesses(1/12) and fungal balls in the collecting system (2/12), due to post-surgical candi-diasis of the urinary tract.Conclusion: Ultrasonography with high-resolution transducers is able to visual-ize underlying renal pathology and to image the parenchymal architecture, con-tributing not only to the diagnosis but also to the definition of the prognosis inboys with PUV.

C-848Meningiomas: Rare pediatric tumorsM. Hasiotou, M. Zarifi, G. Sfakianos, K. Stefanaki, G. Pitsoulakis,F. Prodromou; Athens/GR

Purpose: Meningiomas are rare tumors of childhood: according to the interna-tional literature, they represent approximately 1.4-3% of primary brain tumors.Meningiomas within the vertebral column are even rarer.Methods and Materials: We present the imaging characteristics of 7 meningi-omas (5 intracranial and 2 intracanal) in 4 girls and 3 boys, aged 3.5-14 years(mean age 8.6 years). These meningiomas were diagnosed during 10 year peri-od (1992-2003). None of the studied children had previously been treated with

radiotherapy. Both children with vertebral meningioma suffered from neurofibroma-tosis. The imaging studies included brain CT (5/7) and MR of the brain (5/7) andvertebral column (2/7) before and after intravenous administration of Gd-DTPA.Results: The histologic examination after the surgical tumor resection showedmeningioma of the transitional type in 6 children and co-existing malignant ele-ments in the 7th child. Following tumor resection, 6 children were free of symp-toms and no other treatment was required. In contrast, the patient with themeningioma with malignant elements was treated with chemotherapy and radio-therapy, after subtotal tumor resection.Conclusion: Imaging of meningiomas (intracranial and intracanal) provides es-sential information for surgical planning, demonstrating the extraparenchymalnature of the neoplasm, its location, its dimensions, possible calcifications, aswell as its effects on adjacent anatomic structures.

C-849Rare hepatic vascular anomalies in pediatric patientsZ. Harkanyi, G. Balazs, G. Tasnadi; Budapest/HU

Purpose: To present a selection of rare cases of hepatic vascular anomalies inpediatric patients. US, helical CT and MR were used in the diagnosis and in thefollow-up of these lesions.Materials and Methods: Various venous anomalies were detected including in-trahepatic arterio-portal and porto-hepatic shunts. A case of porto-caval shuntwas also identified. The most frequent anomaly was portal cavernoma due toportal vein thrombosis. One case of caval web has been followed up for 15 years.Another case of Budd-Chiari syndrome has been followed up for two years. Sev-eral cases of hepatic and portal vein anatomic variations are also documented.2D and color Doppler US was used as the first line examination in the diagnosisand follow-up different congenital hepatic vascular anomalies. Helical CT, CTAand, more recently, MRA has been used for further analysis of these lesions.Conclusions: US is still the first method for the evaluation of the pediatric liverand the hepatic vessels. Color Doppler is the modality of choice for functionalevaluation of the vascular anomalies and is also useful in the follow-up of thepatients. Contrast-enhanced MRA and CTA is helpful in selected cases to dem-onstrate the extent of the lesions and other associated anomalies, such as devel-opment of systemic collaterals.

C-850Acute pelvic osteomyelitis and septic arthritis of the sacroiliac joint:Imaging findings in childrenM. Hasiotou, I. Anastasopoulos, M. Zarifi, H. Manoli, G. Matsinos, I. Karanikas;Athens/GR

Purpose: To highlight the contribution of imaging modalities in the diagnosticworkup of children with acute pelvic osteomyelitis and/or septic sacroiliitis.Methods and Materials: During the past 12 years (1992-2003), 24 (n = 24) chil-dren with septic sacroiliitis and/or acute osteomyelitis of the pelvic bones wereimaged by our Radiology Department. Other laboratory tests were already per-formed and in 15 (15/24) young patients, material from needle aspiration hadbeen sent for cytological examination. The imaging initial approach included plainfilm study and triple-phase 99Tc radiophosphate scan. In addition, 19 (19/24) pa-tients underwent MRI examination and 12 (12/24) children had CT.Results: The laboratory results confirmed the diagnosis of osteomyelitis and/orthat of septic sacroiliitis. The retrospective study of the imaging examination re-sults indicated the superiority of scintigraphy and of MRI in the diagnosis of theseentities. Plain film radiographic signs of disease were observed only in 5 patients(5/24) though the bone scintiscan was positive in all 24 patients (24/24). The CTexamination was positive in 10 young patients (10/12) while MRI's sensitivity was100% (19/19). At the end of therapy all patients recovered completely.Conclusion: A bone scan is warranted in every case of clinically suspected os-teomyelitis and/or septic sacroiliitis in which the radiographs are unrevealing.However, MRI is a useful adjunct in the evaluation of the bone edema, the detec-tion and localization of abscess and in the demonstration of the soft tissue extentof the infectious process.

C-851The role of high resolution computed tomography in children with recurrentpulmonary infectionsS. Bayramoglu, T. Cimilli, S. Aksoy, S. Yildiz, B. Salihoglu; Istanbul/TR

Purpose: The purpose of this study is to evaluate the role of high resolutioncomputed tomography (HRCT) in children with recurrent respiratory infections.Materials and Methods: 51 cases, aged 2 months-13 years, who had a history

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of recurrent respiratory infections were examined with chest radiography andHRCT.Results: HRCT showed that 16/51 of the cases had bronchiectasis, with cysticfibrosis as the underlying cause in 5 cases. 2 cases had bronchiolitis obliteransand 2 cases had Macleod's syndrome. 2 cases with aspiration pneumonia hadgastroesophageal reflux, and a intrabrochial foreign body was detected in onecase. One case had bronchopulmonary dysplasia, and 2 had TB lymphadenitiscompressing bronchi. Chest radiography revealed findings of bronchiectasis onlyin 5 of the 16 cases. Hyperaeration was detected in the chest radiographs of only3 cases out of 18, whose HRCT revealed air trapping. HRCT showed peribron-chial thickening in 18 cases, however, chest radiography showed the same findingin 5 patients. HRCT made it possible to observe linear densities caused by linearatelectasis / scars in 12 cases. HRCT showed the underlying pathology and con-sequent pulmonary lesions in 22 out of 51 cases, and linear densities in 12.Conclusion: HRCT has a significant role in detecting the underlying abnormali-ties and consequent lesions in children with recurrent pulmonary infections. Com-pared to chest radiography, HRCT gives much more information.

C-852Analysis of Doppler signals: Application for detection of fetal movementsA. Kribeche, S. Benderbous, M. Berson, D. Kouame, L. Pourcelot; Tours/FR

Purpose: The objective is to develop and validate a new Doppler ultrasoundsystem allowing the imaging of fetal movements in real time. We describe theprototype of new ultra-sound sensors and present the results obtained in preg-nant women.Methods and Materials: The apparatus enabling us to acquire the signals com-ing from fetal activity consists of 12 ultrasonic sensors, a Doppler module and acomputer provided with a chart of acquisition of the signals. After suitable record-ing and signal processing, Fetal Heart Rhythm (FHR) and the Fetal BreathingMovements (FBM) are extracted. Study of the Doppler signals after fast FourierTransform enables us to characterize the fetal movements in term of the ampli-tude, displacement and frequency. Estimate of displacement is obtained by cal-culating the phase of the signal resulting from the analytical filtering of the Dopplersignal and to separate the direction from the Doppler signals.Results: Twenty recordings were carried out on four women in their last quarterof pregnancy. During the last quarter of pregnancy, the FHR is approximately 130Beats.min-1. however, the FHR that we detected is about 134 Beats.min-1. We arethus in the presence of the fetal heart rhythm.Conclusion: This is the first time that parameters giving the fetal movements areextracted. As a first approach, the FFT gives satisfactory results.

C-853Assesment of skeletal age with hand and wrist sonography: Could astandardised method replace radiography?S. Megremis, G. Cavallo, M. Michalakou, E. Kehagias, N. Segkos,E. Agianniotakis, E. Sfakianaki; Iraklion/GR

Purpose: To investigate the capability of hand and wrist sonography in skeletalage assessment, and to propose a technique that could be commonly used.Materials and Methods: Forty-two children, aged 0 months to 16 years, under-went a left hand radiograph for skeletal evaluation. They were also sonographi-cally examined on the same hand, with focus on distal epiphyses of radius andulna, carpal ossification centers, adductor sesamoid bones of metacarpophalan-geal joint of the wrist and the cartilage of the third's finger distal phalange. Scan-ning and measurements were obtained in both transverse and longitudinal planes,and the images were digitally recorded for further evaluation.Results: All areas of interest were identified both in the left hand radiograph aswell as in the sonographic examination, for each individual. Furthermore by dor-sal and palmar scanning of the carpal ossification centers, accurate mappingand measurements were feasible. Gaining experience, and developing a com-mon procedure, we were able to progressively minimize most technical difficulties.Conclusion: Hand and wrist sonography promises an accurate, safe and costeffective assessment of skeletal age. Detailed knowledge of hand and wrist anat-omy, and familiarization with a standardized method, as the one we propose, inacquiring and interpreting images is indispensable. In addition, the designationof sonographic charts for the evaluation of skeletal age could be possible in thefuture.

C-854The role of hepatobiliary scintigraphy in the differential diagnosis ofneonatal hepatitis, intrahepatic cholestasis, and biliary atresiaE. Palócz, T. Györke, K. Bártfai, L. Balogh, L. Szönyi, I. Máttyus, É. Kis,T. Verebély, E.K. Makó; Budapest/HU

Purpose: Biliary atresia (BA), intrahepatic cholestasis (IHC) and neonatal hepa-titis (NH) are the main causes of neonatal direct hyperbilirubinaemia (NDH). Thedistinction of BA needing early surgical intervention from NH and IHC syndromesis essential, but difficult. The impact of hepatobiliary scintigraphy (HSC) in thedifferential diagnosis of NDH was evaluated.Methods and Materials: 28 HSCs of 25 patients (age: 10 days-6 months) withNDH were included in our retrospective study of a five years period. After admin-istration of 1.85 MBq/kg (min.: 9 MBq) 99mTc-BrIDA serial abdominal imageswere performed up to 24 hours. The scintigraphic diagnoses (SD) of BA, IHC, NHand indeterminate (IND) were defined based on visual scoring of liver uptake,intrahepatic radiopharmaceutical transport and bowel activity. SDs were com-pared with clinical diagnoses (CD), which were based on laboratory, histologicalor operative findings and/or clinical follow-up.Results: The CDs were: 12 BA, 9 IHC, and 7 NH. The SDs were: 10 BA, 5 IHC, 7NH, 6 IND were correct in 14 and false in 8 cases, while the CD in the 6 INDcases was BA. Regarding the shortage of bowel activity as a basis for SD of BAthe sensitivity and specificity of HSC in the diagnosis of biliary atresia were 100and 75% respectively.Conclusion: Our results suggest that hepatobiliary scintigraphy is a useful toolin distinguishing BA requiring urgent surgical intervention from other kinds ofpathologic conditions causing NDH, but that it is unreliable in further narrowing ofthe differential diagnosis.

C-855Various radiologic findings of Wilms' tumorY.-W. Kim1, W. Kim2, I.-O. Kim2, K. Yeon2; 1Busan/KR, 2Seoul/KR

Purpose: Wilms' tumor is the most common pediatric renal mass. Although itusually manifests as a solid intrarenal mass with a pseudocapsule and distortionof the renal parenchyma and collecting system, some atypical radiologic findingsmay produce diagnostic confusion. The purpose of our exhibit is to illustrate var-ious radiologic findings of Wilms' tumor.Materials and Methods: We retrospectively reviewed radiologic findings of 60cases, which were pathologically proven from 1996 to 2001 (the age of patients;between 2 months and 9 years).Results: This exhibit includes: 1) typical intrarenal Wilms' tumor (n = 19), 2) Wilms'tumor with vascular invasion (n = 7; renal vein 4, IVC 4, right atrium 3), 3) Wilms'tumor with perirenal extension (n = 11; psoas & LN 1, perirenal hematoma 6,subcapsular hematoma 2), 4) Wilms' tumor with extension into the urinary tract(n = 6; renal pelvis 4, ureter & bladder 2), 5) Wilms' tumor with metastasis (n = 6;lung 4, bone 1, pleura 2, mediastinum 1, scrotum 1), 6) bilateral Wilms' tumor(n = 4), 7) Wilms' tumor in a Horseshoe kidney (n = 1), 8) Atypical Wilms' tumor(teratoid Wilms'; n = 1, cystic Wilms'; n = 3, extrarenal Wilms'; n = 1, intrapelvicWilms'; n = 1).Conclusion: The knowledge of these various radiologic findings of Wilms' tumorcan be helpful in the diagnosis and management of the tumor.

C-856Extracorporeal shock wave lithotripsy monotherapy for pediatric urinarytract calculiZ. Siric, A. Slavkovic, M. Radovanovic, M. Mrvic; Nis/YU

Purpose: To show the safety and efficacy of extracorporeal shock wave lithotrip-sy (ESWL) for the urolithiasis in the pediatric age group and to evaluate the com-plications encountered after the treatment.Material and Methods: 84 children (age range 8 months to 14 years) with 183stones underwent ESWL. KUB were taken on the day after treatment. If stone-free status was achieved, the patient was followed with ultrasonography and uri-nalysis every six months. If fragments < 4 mm were present, follow-up wasrepeated every 3 months.Results: Stone size ranged from 0.5 to 2.5 cm. 64 kidneys, 27 ureters and 3bladers underwent 165 ESWL sessions. Retreatment was required in 43% pa-tients. The mean number of sessions per child was 1.9. Mean fluoroscopy timeper session was 0.79 min. The overall success rate was 90%, but the stone -freestatus was achieved in 62% of children. The composition of the stones were stru-vite and calcium oxalate in the majority of the patients. Auxiliary procedures (JJstents) were used in 27% children. Transient hematuria, ecchymoses and colic

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were the complications encountered after treatment in 31% of children. Perirenalhaematoma was identified in one patient. 22 (26%) children developed obstruc-tion and 11 required nephrostomy.Conclusions: ESWL is non-invasive procedure suitable for stones in all loca-tions in the pediatric patients. It may be the first-line treatment for all pediatricurinary tract calculi, although the long-term effects of lithotripsy on the kidney areunknown.

C-857Imaging features of non-idiopathic intussusception in childrenC. Hafsa, M.A. Jellali, S. Kriaa, M. Golli, M. Belguith, M. Said, A. Nouri,A. Gannouni; Monastir/TN

Purpose: In most cases, bowel intussusception is idiopathic in children - indirectcauses are rare. The study aim was to evaluate the abilities of imaging in second-ary intussusception.Material and Methods: Between 1996 and 2003, 26 children, 16 boys and 10girls (mean age: 5 years) were hospitalized for an acute abdominal syndrome. Allchildren were imaged by plain radiography, abdominal ultrasonography and ene-ma. A laparotomy was performed in all cases.Results: Abdominal ultrasonography showed intestinal intussusception. Mostcases of childhood intussusception are secondary to lymphoid hyperplasia (n:3),to Meckel's diverticulum (n:9), small bowel tumour (n:2), duplication enteric cyst(n:1), postoperative (n:6) and bowel wall hemorrhage (as in Henoch-Schonleinpurpura (n:5). The enema failed to reduce the intussusception in all cases. Allchildren underwent definitive surgery rather than inappropriate treatment by at-tempted radiological reduction.Conclusion: Abdominal sonography is the most efficient examination for the di-agnosis of intestinal intussusception. Various pathological lead points in intus-susception can now be defined by ultrasound. Secondary intussusceptiontreatment is surgical.

C-858Diagnostic value of diffusion weighted MR imaging in pediatric cerebralneurological diseasesY. Oksuzler, H. Cakmakci, S. Kurul, M. Oksuzler, E. Dirik; Izmir/TR

Purpose: To detect the diagnostic value of diffusion weighted (DW) magneticresonance (MR) imaging in different diseases involving the cerebral white andgray matter and to compare the diffusion properties with age matched normalchildren.Materials and Methods: Conventional and DW MR imaging was performed in18 children with neurologic disorders, and 25 normal control subjects. Neurolog-ical disorders included neurodegenerative brain diseases (n: 6), anoxic enceph-alopathy (n:4), acute disseminated encephalomyelitis (ADEM) (n:3), encephalitis(n:1), subacute sclerosing panencephalitis (SSPE)(n:4). Apparent diffusion coef-ficients (ADC) were measured from the brain lesions and 12 normal appearingwhite and gray matter areas in study group. 12 normal appearing areas were alsomeasured in the control group.Results: ADC values obtained from the normal subjects were similar to valuesdescribed in the literature. ADC values of study groups were significantly differ-ent from the control subjects. ADC values for the neurodegenerative diseasegroup, anoxic encephalopathy group, ADEM group, encephalitis, SSPE group,were respectively between 0.33 x 10-3-2.1 x 10-3 cm2/s, 0.10 x 10-3-2.03 x 10-3 cm2/s, 0.55 x 10-3-0.93 x 10-3 cm2/s, 1.02 x 10-3-1.58 x 10-3, 1.07 x 10-3-1.46 x 10-3 cm2/s.Conclusion: Although this study is limited due to population size and diseaseheterogeneity DW MRI provides useful and complementary information regard-ing the degree of involvement in different pediatric neurological disorders.

C-859Clinical presentation and MRI findings in non-accidental trauma in childrenunder two years of ageP.C. Sundgren1, M. Petrou1, J. Jennings1, J. Ksar1, J. Smythe1, B. Foerster2,P. Maly1, P. Eldevik1; 1Ann Arbor, MI/US, 2Lund/SE

Purpose: To describe the clinical presentation and illustrate the MRI findings insuspected non-accidental brain trauma in children under two years of age.Materials and Methods: We reviewed the hospital charts and the MR reports of15 patients examined due to clinical suspicion of non-accidental brain trauma.We noted the clinical presentation and the MRI findings in each case. Both theradiological diagnoses and the final diagnoses were extracted and compared,and the impact of the MRI examination on the clinical course of the patient wasevaluated.

Results: Subdural hematoma was the most common finding seen in 13 of the 15patients, petechial hemorrhages and brain edema was other common findings inthese patients.Discussion/Conclusion: Non-accidental brain trauma is not uncommon and inmost cases CT of the brain is the method of evaluation. MRI is only performed ina limited number of cases, for example, when dating the abnormalities is crucial,and to evaluate for additional findings of axonal shearing injury. Examples of thiswill be illustrated.

C-860Congenital hip dysplasia: MRI after reduction of the femoral headE. Svedström; Turku/FI

Purpose: In the treatment of developmental dysplasia of the hip, maintenance ofthe correct position of the reduced femoral head is very important. Many modal-ities such as conventional X-ray images, tomography, CT and US have beenused in the evaluation of the femoral head position after reduction. These tech-niques either use ionizating radiation or require an experienced examiner. Theymight even be subject to technical limitations or sometimes be inaccurate. Thisposter describes the use of MRI in the assessment of femoral head position afterclosed or open reduction.Methods and Materials: MRI studies with an open-configured 0.23 T MR-imag-er were performed on four children. Some of these children (0-8 months of age)were studied multiple times during the follow-up. No sedation was used. Coronaland axial sequences were used. Position of the femoral head, appearance of thelimbus and formation of the pseudoacetabulum were noted.Results: All MRI studies were successfully performed without any sedation. Theplaster did not reduce image quality in any of the studied hips. In four still-dislo-cated hips MRI showed correct diagnosis. In two of these hips an inverted limbuscould correctly demonstrated.Conclusions: Accurate diagnosis is very important after reduction of the femoralhead. These children commonly require multiple imaging studies during follow-up. Therefore, MRI and US, which do not use ionizating radiation, are the pre-ferred modalities. After reduction, MRI findings are easily reproduced and areaccurate. Even other findings like inverted limbus in interposition and formationof pseudoacetabulum can be demonstrated.

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C-861Practical experience with the application of the "Digital addendum of theEuropean protocol for quality assurance in mammography"H. Bosmans1, F. Rogge1, A.-K. Carton1, K. Young2, R. van Engen3,M. Thijssen3, G. Marchal1; 1Leuven/BE, 2Guildford/UK, 3Nijmegen/NL

Learning Objectives: To teach different aspects of the digital addendum (DA) tothe European protocol for quality control in mammography:• The purpose of the tests as described in the document. • The test methods. •The applicability of the test methods and the discussion of the first measurementresults.Background: Digital mammography is a new imaging modality for mammographicapplications. In order to assure sufficiently high quality standards, new test proto-cols had to be developed. A group of European medical physicists has cooperat-ed under the coordination of the European Breast Cancer network and Euref.The first publication is expected for October 2003. The (pre-released) version(Aug. 2003), work in progress, has been evaluated on different full field digitalmammography (FFDM) systems and is the basis of the present teaching session.Procedure Details: Following systems were included: Senographe 2000D (GE),Senoscan (Fischer), 5000MA (Fuji), AC3 (Fuji), Embrace CR (Agfa) and Em-brace DR (Agfa). The tests as described in the protocol included direct perform-ance tests, contrast detail analysis, patient dose measurements and physicalmeasurements such as MTF and DQE. For these last measurements, accepta-ble and achievable levels have not yet been defined. The help of a service engi-neer was necessary in most systems to get access to raw data. The tests asproposed in the protocol could then be performed. Contrast detail analysis is themost critical part and should be automated to reduce interobserver variability.Patient doses were comparable or lower than doses in conventional mammogra-phy. The acquisition of MTF and DQE requires a further standardization of themethod.Conclusion: The Digital Addendum in its current phase was applicable to allsystems tested so far. Practical experience is growing and will add to the applica-bility and value of the document.

C-862Anisotropic resolution in helical cone-beam CT reconstructionD. Heuscher1, S. Utrup1, F. Noo2; 1Highland Heights, OH/US,2Salt Lake City, UT/US

Learning Objectives: To describe how the different aspects of helical cone-beamreconstruction affect spatial resolution in all three dimensions. To demonstratethat depending on the radial and angular position of a voxel, this resolution canbe anisotropic. To describe appropriate filtering and interpolation steps that canbe taken to reduce these effects.Background: A number of methods have been described recently that provideeither exact or near-exact reconstructions of helical cone-beam scan data. In thisexhibit, we will describe key aspects of the implementation of these reconstruc-tion algorithms that affect spatial resolution. We will show how the anisotropy ofin-plane resolution can be related to the corresponding effect in single-slice 2Dreconstructions. Alternative filtering and interpolation steps will be suggested.Procedure Details: FWHM slice-sensitivity profile and in-plane resolution meas-urements were performed on helical reconstructions of a phantom consisting ofseventeen 0.25 mm diameter spherical beads located at 0, 100, and 200 mmradii. The scans used an MX8000-IDT 16 x .75 mm detector configuration with a1.25 pitch factor. Single-slice 2D reconstructions were performed on the samephantom using both fan and parallel convolution-backprojection algorithms toproduce comparative in-plane measurements. Alternative hi-order interpolationand voxel-dependent filters were investigated to produce nearly isotropic resolu-tion.Conclusion: Significant spatial variation in resolution can be observed in exactor near-exact helical cone-beam reconstructions. A more uniform and isotropicresult can be achieved by using hi-order interpolation to produce parallel projec-tion data along with longitudinal voxel-dependent filtering.

C-863Comparison of standardized uptake values (SUV) in whole-body studies:FDG-PET/CT versus PETT. Beyer, U. Orth, L. Freudenberg, G. Antoch, S. Müller, A. Bockisch; Essen/DE

Purpose: CT contrast agents can affect physiologic SUV values in the PET com-ponent of PET/CT. We compare SUV of normal organs in whole-body PET andPET/CT studies with and without CT contrast.Methods and Materials: 136 PET/CT (78 (5) kg) and 60 PET (76 (17) kg) pa-tients were included. Mean and lean-body-mass SUVlbm were estimated. Attenu-ation correction was performed with the available rod- and CT-transmissioninformation in PET and PET/CT, respectively. All patients were injected with 370(30) MBq FDG, and scanned 89 (30) min and 71 (22) min post injection in PET/CT and PET. PET/CT-imaging included: (A) non IV-contrast, (B) IV-contrast(300 mg/mL, 120 mL at 3 mL/s, 30 s delay), (C) negative oral contrast, and (D) IVand oral contrast. ROI values were estimated from the central transverse/coronalviews of PET/CT and PET images of the neck, right lung, liver, mediastinum andcolon.Results: PET/CT SUV values were lowest for (A) without contrast agents: 1.4(0.4) in neck, 0.4 (0.1) in right lung, 1.9 (0.4) in mediastinum, and 2.2 (0.4) in liver.Standard PET-SUV were similar: 1.2 (0.2), 0.5 (0.1), 1.6 (0.3), and 2.1 (0.4). InPET/CT studies IV contrast agents increased the SUV of the mediastinum to 2.5(0.5) and the liver to 2.8 (0.6). These increases in SUV were coincident withchanges in CT density from 30 HU to 156 HU (mediastinum) and from 52 HU to97 HU (liver). SUV values in the colon wall seem unaffected by positive oral con-trast compared to PET: 1.5 (0.4) vs 1.3 (0.2).Conclusions: Physiologic SUV from PET/CT appear somewhat higher than SUVfrom standard PET when the CT is acquired with standard volumes of IV contrastmedia.

C-864Adventures in non medical radiographyA.A. Alhajeri, D. McKenna, B. Tuohy, C. Roche, P. McCarthy; Galway/IE

Learning Objectives: To demonstrate the non-radiological use of familiar imag-ing modalities and show how far we have come since the first X-rays of Mrs.Roentgen's hand.Background: Today, X-rays technology has a wide application and is presentlyin use in fields as diverse as engineering, art, forensic pathology and security.Procedure Details: Through a pictorial review we show how X-rays have a rolein non-medical applications. We demonstrate how law enforcement agencies haveadapted X-ray technology to screen luggage at airports, sometimes even usingCT. Furthermore newer technology in use in Europe has been developed, termed"Back scatter", which makes possible the detection of illegal immigrants and con-traband material concealed within trucks. The characterisation of the bony skele-ton with the aid of X-rays is not only helpful in identification but sometimes canalso indicate to the forensic pathologist the mode of death. Industrial engineersare able to evaluate the integrity of a structure with the aid of X-rays. Examplesinclude the examination of airplane engines and pipes for hairline fractures, uni-dentifiable to the unaided eye. In the art world, X-rays have been used to detectforgeries and even to create original art works.Conclusions: This poster reaffirms the benefits of different imaging modalitiesshowing how technology developed for medical imaging has been adapted foruse in non-medical areas.

C-865Radiation-induced temporary hair loss after cerebral perfusion studies withmulti-detector CTY. Imanishi, A. Fukui, H. Niimi, S. Nakaji, K. Nozaki, Y. Furuya, M. Uzura,S. Hashizume, Y. Nakajima; Kawasaki/JP

Learning Objectives: Learning presence of complications by a cumulative ormultiplier effect of radiation exposure from multiple diagnostic techniques.Background: As various imaging technologies become increasingly advanced,they make it possible to get various kinds of information and large amount ofimaging data. In some imaging technologies, the radiation dose increases withthe ability to obtain better images or more detailed information.Imaging Findings: We encountered 3 cases of temporary bandage-shaped hairloss, which was caused by perfusion studies of the head by multi-detector com-puted tomography (MDCT) for evaluation of blood flow in the brain. In all of the 3,digital subtraction angiography of the head was performed within a period of theCT perfusion studies. This suggested the possibility that radiation exposure fromangiography performed in serial examinations, combined with the perfusion studies

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of the head with MDCT, played an important role in this temporary, bandage-shaped hair loss.Conclusion: Radiologists should be aware that radiation exposure from diag-nostic techniques might result in hair loss and other kinds of radiation complica-tions.

C-866Effectiveness of a new dual-energy subtraction system using CsI:Tlamorphous silicon flat-panel technologyH. Tagashira, N. Bandai, M. Yoshimoto, Y. Yasuhara; Ehime/JP

Learning Objectives: To describe the theory of the new dual-energy subtractionsystem. To demonstrate the system with chest radiology cases.Background: Lung cancer is the current leading cause of cancer death and con-tinues to be increasing. Chest radiography has been shown to have relatively lowsensitivity and specificity for the detection of the pulmonary nodules. This newdual-energy subtraction system allows the fast (200 millisecond) acquisition oftwo, high and low voltage images and provides soft tissue and bone structureimage of the chest with relatively low dose.Procedure Details: The radiologists' performance for reporting chest radiographswas evaluated by use of receiver operating characteristic (ROC) analysis. Theperformance of radiologists was improved significantly when the dual-energysubtraction image was used (P < 0.01).Conclusion: Diagnostic accuracy will be improved by using this dual-energysubtraction system.

C-867Longitudinal filters for uniform cone-beam resolutionD. Heuscher, S. Utrup; Highland Heights, OH/US

Purpose: This presentation demonstrates the non-uniform longitudinal resolu-tion inherent in today's cone-beam reconstructions and how, through the appro-priate use of longitudinal filtering, improvements in image quality can be achieved.Simulations and scans for acquisition geometries of 16 or more detector rowswere evaluated.Methods and Materials: A circular half-scan (HS) and a helical scan (pitch fac-tor 1.25) were performed on an MX8000IDT using a 16x.75 mm detector config-uration. A phantom consisting of 17 steel beads was used to measure longitudinalresolution at 8 angles and 3 radii. Simulations were performed using the samephantom geometry, including a 32x.75 mm helical scan. A voxel-dependent filterwas used to achieve uniform longitudinal resolution and compared to projection-based filtering. Both real and simulated thorax phantoms were used to evaluatethe effects on image quality.Results: Resolution measurements demonstrate an angular variation in longitu-dinal resolution for large-pitch helical and circular HS cone-beam scans. TheFWHM SSP measurements varied by over 15% and 25% at 100 and 200 mmradii respectively. Reconstructions with projection-based filters did not reducethis variation. Similar results were observed for helical scans with the larger coneangle (32 x .75 mm detectors), wherein the resolution pattern varied at half thefrequency along the longitudinal direction. Applying voxel-dependent longitudinalfiltration achieved uniform resolution, demonstrating improved image quality inboth real and simulated scans.Conclusion: There is an inherent non-uniformity of longitudinal resolution forcone-beam scans, particularly for large-pitch helical and circular half-scans. Uni-form resolution can be achieved using voxel-dependent filters.

C-868Potential of phase contrast in X-ray imagingP. Monnin1, R. Meuli1, J. Hoszowska2, J.-F. Valley1, F.R. Verdun1;1Lausanne/CH, 2Grenoble/FR

Purpose: One of the limitations of conventional radiology is that small or weaklyabsorbing structures cannot be detected on images. Coherent properties of anX-ray beam produce phase contrast images where a change of the refractionindex of tissues translates into an edge enhancement phenomena on the imagesthat allows the detection of weakly contrasted structures. This study shows thefeasibility of implementing the in-line holography principle with an aim to imagingvery small structures.Material and Methods: Phase-contrast images were obtained using synchro-tron radiations at ESRF (Grenoble, France). Images of 20 to 100 micrometernylon wires, immersed in different media, were recorded with a CCD camera (1.8micrometers pixel size) in different imaging conditions. Images were comparedwith the results obtained by means of Fresnel diffraction theory.

Results: The coherent X-ray beam and the defocusing distance between thestructures to be imaged and the detector produced phase contrast images of thewires. The comparison of the recorded images with the predicted image forma-tion from the Fresnel diffraction theory revealed the performance of this tech-nique in terms of sensitivity, geometrical and energy requirements. Images of abiological sample (i.e. pork kidney, cam's) were also produced where very finelow contrast structures, unnoticed in pure absorption contrast, appeared. Thepotential of the technique in neo-vascular process imaging will also be discussed.Conclusion: The potential of in-line holography techniques to improve imagecontrast of biological tissues has been demonstrated.

C-869Experimental evaluation of a YAG:Ce phosphor for application in medicalradiography detectorsD. Margetis, D. Linardatos, E. Nirgianaki, M. Roussou, D. Nikolopoulos,A. Episkopakis, I. Sianoudis, D. Cavouras, I. Kandarakis; Athens/GR

Purpose: The aim of the present study was to evaluate Y3Al5O12:Ce (YAG:Ce)phosphor for radiographic and mammographic imaging. YAG:Ce, which has nev-er been previously used in diagnostic radiology, emits green light with very shortdecay time (70 ns). It is expected to match the spectral sensitivities of most pho-todetectors.Methods and Materials: Radiographic test screens of various coating thickness(13-166 mg/cm2) were prepared in laboratory employing YAG:Ce phosphor inpowder form with 8.0 µm median grain size. Luminescence emission efficiency(emitted light over X-ray exposure) and light emission spectrum were experimen-tally evaluated as a function of X-ray tube voltage employing both tungsten andmolybdenum target X-ray tubes. In addition, the spectral compatibility of YAG:Ceemission spectrum with orthochromatic films, photocathodes, CCD arrays andamorphous silicon photodiodes, used in both conventional and digital radiogra-phy, was determined. Results were compared with other phosphor materials (Gd2-O-2S:Tb, CsI:Tl) currently employed in medical imaging.Results: Maximum YAG:Ce emission efficiency was observed for 107 mg/cm2

screen at 40-50 kV using tungsten target X-ray tube. Emission spectra peaked at553 nm. The spectral compatibility with amorphous silicon photodiodes (0.937)and CCDs (0.951) was found to be very high, better than the corresponding com-patibility of CsI:Tl, as mostly used in digital radiography detectors currently.Conclusion: Considering the YAG:Ce performance, its short emission decay timeand its spectral compatibility with amorphous silicon detectors and CCDs, thisphosphor material is appropriate for use with digital radiography detectors.

C-870Determination of arterial input function for measurement of brain perfusionindex with Tc-99m compounds using a solid-state gamma cameraY. Uenishi, K. Murase, M. Nagayoshi, M. Kawamata, M. Takasawa, N. Oku,A. Takahashi, J. Hatazawa; Osaka/JP

Purpose: Cerebral blood flow (CBF) can be non-invasively quantified using thebrain perfusion index (BPI) determined from radionuclide angiography (RA). Formeasurement of BPI, accurate determination of arterial input function (AIF) isnecessary. We have developed a method for the automatic extraction of AIF us-ing fuzzy clustering and a solid-state gamma camera (Digirad).Methods and Materials: RA was performed using Tc-99m HMPAO for 120 secwith a Digirad placed on the heart and a 4-head SPECT (SPECT2000H). Forcomparison, the data were also acquired using a conventional gamma camera(RC-2600I). The AIFs were obtained using fuzzy clustering (AIFa) and manualdrawing of a region of interest (ROI) (AIFm) from the region of aortic arch. TheROIs were also drawn over the left and right cerebral hemispheres. The BPI val-ues were calculated using spectral analysis (BPIa: BPI obtained using AIFa, BPIm:BPI using AIFm). The deadtimes of Digirad and RC-2600I were measured usingthe reference source method.Results: The mean and SD of BPIm became larger with increasing ROI size,while the BPIa was almost constant regardless of ROI size. The SD of BPIa wassmaller than that of BPIm. The deadtime of Digirad (0.92 ± 0.63 µsec) was muchless than that of RC-2600I (5.00 ± 0.95 µsec). Furthermore, the deadtime of Di-girad was almost constant regardless of the volume of phantoms, while that ofRC-2600I increased with increasing volume.Conclusion: The proposed method appears promising for calculation of the BPI,because it allows automatic and objective determination of AIF.

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C-871Reduction of eddy current artifacts in echo planar diffusion tensor imagingwith a stimulated echo preparationG. Steidle, F. Schick; Tübingen/DE

Purpose: Diffusion-tensor-imaging (DTI) using SE-EPI in tissue with short T2values, such as kidney or skeletal muscle, suffers from a poor SNR for higher b-values. Using a stimulated-echo diffusion preparation, sufficiently high b-valuescan be obtained by increasing the mixing time (TM) rather than TE. A diffusion-weighted stimulated-echo EPI sequence is proposed which minimizes the influ-ence of eddy currents (EC) without any increase in the minimum TE or acquisitiontime.Methods and Materials: Assuming a monoexponential decay for the EC withtime constant λ, gradient pulses can be implemented within the TM interval suchthat eddy current effects proportional to exp (-λ x t) will vanish. In-vivo DTI meas-urements were performed in human calf musculature on a 1.5 T Siemens Sonataunit. Measurement parameters were TE = 37 ms, TM = 100 ms, TR = 4000 ms,b = 0 resp. 500 s/mm2, Matrix 64 x 64, FOV 200 mm, NEX = 4, slice thickness8 mm. Diffusion weighting was applied in six directions in order to calculate thediffusion tensor.Results: Diffusion images were acquired with and without EC correction. Imageswithout EC correction showed obvious scaling and shearing distorsions whereasin images obtained with EC correction no significant distorsions were observed.Conclusion: Diffusion-weighted MR imaging using EPI is very sensitive to im-age distorsions caused by eddy currents. Inserting additional gradient waveformsin a stimulated-echo EPI sequence drastically reduces these artifacts and allowsa calculation of the diffusion tensor in various tissues with low T2/T1 ratios with-out significant misregistration.

C-872RF-induced artifacts due to aneurysm clips in MRT at 3.0 TU.A. Lauer, H. Graf, F. Schick, C.D. Claussen; Tübingen/DE

Purpose: Metallic implants such as aneurysm clips may cause enlarged artifactsat higher magnetic field strengths, not only due to susceptibility effects. Aneu-rysm clips made of Ti-alloy were investigated with special respect to MR-imagingresults and possible RF-induced artifacts.Materials and Methods: 10 aneurysm clips were measured in Gd-DTPA dopedwater at 1.5 T and 3.0 T with adapted SE-sequences. Additionally, two modelsmade of copper were investigated at 3.0 T. To separate RF induced effects, thetransmitter voltage was bisected stepwise to verify the RF-induced deviation ofthe local flip angle near to the implant. This was also done with 3D-TSE sequences.Results: In comparison to 1.5 T, more pronounced hyperintense zones were foundat 3.0 T. They were independent of the exchange of phase- and frequency-en-coding direction (swap) and became more pronounced at reduced transmittervoltage. Comparative investigation of two Cu-models and one selected Ti clip atreduced transmitter voltage revealed RF induced effects depending on inductiveand capacitive structures of the clip.Conclusion: Metallic implants have to be considered carefully at 3.0 T due to theelectrical conductivity. RF- induced artifacts can appear not only for longish ob-jects but also on smaller devices. In the case of aneurysm clips, a slight RF-induced effect could be detected. Potential patient endangering due to a localenhancement of the secific absorption rate (SAR) can be estimated as negligible.

C-873Optimum selection of monitor display function of thoracic CT imaging byvisual contrast index analysis: Grayscale Standard Display Function (GSDF)versus CIELABM. Yamaguchi1, H. Fujita1, M. Uemura2, Y. Asai2, M. Ishifuro3, T. Hirano4,T. Johkoh5; 1Habikino/JP, 2Sayama/JP, 3Hiroshima/JP, 4Sapporo/JP, 5Osaka/JP

Purpose: DICOM Grayscale Display Function (GSDF) is currently recommend-ed as a consistent image display function. However, while the CIELAB function isstill in use in Europe, comparative evaluation of these two functions for optimumdisplay function has not yet been reported. The purpose of the present study wasto identify which of GSDF and CIELAB is the optimum display function for thorac-ic CT imaging by means of visual contrast analysis (VCI), i.e. the ratio of lumi-nance contrast to CT value contrast.Methods and Materials: Monochromatic 1M LCD monitor and photometer ofluminance calibration tool kit (Data Ray Corp, Westminster, USA) were used. Theluminance contrast of this monitor was measured by a photometer displayingGSDF and CIELAB. Luminance change and digital driving level (DDL) that corre-sponded to CT value (HU) were tabulated. CT value was represented by window

setting of thoracic CT imaging, i.e. for mediastinum (ww:150~350, wl:30) andlung (ww:1400~2000, wl:-500) using GSDF and CIELAB. The ratio of luminancecontrast to CT value contrast was calculated as visual contrast index (VCI). TheVCI of GSDF and CIELAB was evaluated using t-test.Result: Using t-test, VIC of CIELAB was significantly higher than that of GSDF inwindow setting of thoracic CT imaging (p < 0.01). Based on visual contrast indexanalysis, CIELAB was more useful than GSDF as a monitor display function ofthoracic CT imaging.Conclusion: We suggest that CIELAB is the optimum monitor display function ofthoracic CT imaging because it intrinsically has excellent luminance contrastcharacteristics.

C-874Follow-up of patients subjected to high skin radiation dose as aconsequence of repeated interventional cardiology proceduresR. Padovani, G. Bernardi, E. Quai, M. Signor, H. Toh; Udine/IT

Purpose: As part of a quality assurance program, to retrospectively evaluatecumulative skin dose (CSD) received by patients subjected to repeated interven-tional coronary procedures and to detect radiation induced skin injuries in pa-tients who have received the highest dose.Materials and Methods: From April 1998 to February 2002, 5039 cardiac proce-dures, coronary angiography (CA) and percutaneous transluminal coronary an-gioplasty (PTCA) have been performed on 3332 patients. Mean DAP was78.6 Gycm2. Patients with a cumulative dose-area product (DAP) higher than300 Gycm2 have been extracted. They were 78 patients (2.3%), 17 female and 61male, mean age 71 years, who underwent a mean number of 4.5 proceduresresulting in a mean cumulative DAP of 335 Gycm2 and a maximum value of995 Gycm2. From DAP, CSD has been estimated adopting 4.3 and 8.7 10-3 cm-1

as conversion factors for CA and PTCA, respectively. Clinical follow-up has beenperformed adopting the LENT-SOMA methodology and scale.Results: The highest CSD estimated was 6.7 Gy and only 25 patients (32%)exceed a skin dose of 3 Gy. No skin injuries were detected at clinical follow-up.These results allow to estimate a frequency for skin injuries of less than 3.10-4 inpatients undergoing repeated cardiac procedures.Conclusion: The results of this study implies that the frequency of skin injuriesmay be very low when a quality assurance programme, including regular patientdose monitoring, periodic evaluation of procedure protocol, quality control of equip-ment and operator training, is established.

C-875Ultrasound computed tomography: A new method supplying standardized,reproducible cross section imagesS.O.R. Pfleiderer1, R. Stotzka2, T.O. Mueller2, H. Gemmeke2, W.A. Kaiser1;1Jena/DE, 2Karlsruhe/DE

Purpose: Ultrasound is the most frequently used diagnostic imaging modality.The main problem of ultrasound, however, is interobserver variability. The inten-tion of the development of ultrasound computer tomography was to increase thereliability of ultrasound imaging and to supply standardized images similar toother cross section imaging procedures.Methods and Materials: Instead of a manually-controlled linear transducer ar-ray, we used ultrasound computer tomography (USCT) to image a volume direct-ly. A few thousand ultrasound transducers were arranged in a cylindrical arrayaround a tank containing the object to be examined coupled by water. Everysingle transducer was small enough to emit an almost spherical sound wave.While one transducer was transmitting all other transducers worked as receiverssimultaneously. Afterwards a different transducer emitted the next pulse. For vol-ume reconstruction each transmitted, scattered and reflected signal was used. Inan experimental set-up a phantom containing nylon filaments, straws, and a ca-daveric forearm were investigated.Results: Nylon filaments with a diameter of 0.1 mm were visualized. The skinand soft tissue of the cadaveric forearm were clearly detectable but the bonestructures could not be delineated sufficiently. USCT supplied reproducible im-age sequences.Conclusion: USCT promises to supply standardized high quality three-dimen-sional images without ultrasound shadowing artifacts and without interobservervariability. Furthermore, the tissue is not deformed, in principle offering multimo-dal image fusion with other cross section imaging modalities. Prior to clinical setup extended development especially of large transducer element tubes and im-provement of software is necessary.

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C-876Multicentre assessment of a complexity index for PTCA procedureA. Peterzol1, E. Quai1, R. Padovani1, G. Bernardi1, J. Kotre2, A. Dowling3;1Udine/IT, 2Newcastle/UK, 3Dublin/IE

Purpose: Multicentre assessment of a procedure-severity-based complexity in-dex (CI) for the introduction of reference levels (RLs) in percutaneous translumi-nal coronary angioplasties (PTCA) as a function of procedure complexity.Materials and Methods: 204, 75 and 104 PTCAs performed at three differentcentres were investigated. Multiple linear stepwise regression analysis, includingclinical, anatomic, and technical factors, was performed in order to obtain fluor-oscopy time (FT) predictors. Based on the regression coefficients of the emerg-ing model a scoring system was defined, and a CI was obtained by adding up thesingle scores for each individual procedure. Since a good correlation (r = 0.41;p < 0.001) was found between the dose-area product (DAP) and the resulting CI,the latter was used to classify dose values into three groups. CI groups weredetermined by means of an ANOVA test: different sets of groups were exploreduntil the matrix of pairwise comparison probabilities reached a minimum value(p < 0.001). The resulting DAP and FT third quartiles corresponding to each CIgroup are suggested as preliminary RLs in PTCA as a function of procedurecomplexity.Results: PTCA preliminary RLs: (i) for DAP values: 54, 76 and 127 Gycm2, and(ii) for FT: 12, 20 and 27 min, respectively for the three CI groups: low, mediumand high complex procedures.Conclusion: The possibility to introduce RLs as a function of procedure com-plexity, as confirmed by this multicentre study, can improve the process of patientdose optimisation in interventional cardiology.

C-877Investigation of the radiation detection properties of Lu2SiO5:Ce andGd2O2S scintillators for applications in medical imagingD. Nikolopoulos, P. Liaparinos, D. Margetis, D. Linardatos, P. Mellisaropoulos,K. Kourkoutas, G. Panayiotakis, D. Cavouras, I. Kandarakis; Athens/GR

Purpose: The aim of this study was to use Monte Marlo techniques to examinethe detection efficiency of three Ce-doped fast emitting scintillators, YAP (YAlO3:Ce), LSO (Lu2SiO5:Ce) and GOS (Gd2O2S:Pr, Ce, F) when used with photonenergies and coating thicknesses employed in medical imaging.Methods and Materials: A general Monte Carlo code has been generated fortracking photons in the energy range covering all medical imaging applications(diagnostic radiology, nuclear medicine). Simulated scintillator materials wereselected to be in blocks and arrays of dimensions equal to those usually em-ployed in medical imaging.Results: The results for the YAP scintillator, showed that the fraction of the inci-dent photon energy which was totally absorbed decreases very rapidly for ener-gies higher than 80 keV (e.g. from 65% at 100 keV to 10% at 511 keV for 0.01 mmcoating thickness). LSO was better than YAP, its absorption efficiency being sig-nificantly higher (p < 0.001) at 20-25 keV (mammography), 60-100 keV (X-rayimaging), 140 keV (gamma ray imaging) and at 511 keV (positron imaging). GOSwas also found to exhibit significant detection efficiency in the whole energy rangeexamined (e.g. from 100% at 10 keV to 98% at 100 keV for 0.01 mm coatingthickness), however its applications are limited due to its longer decay time.Conclusion: LSO was found to be of adequate efficiency for most imaging appli-cations, while YAP could be considered most suitable for X-ray mammographyapplications.

C-878Analyses of physiological kinetic functions in dynamic chest radiographyby the use of time series spectroscopyY. Tsuchiya1, Y. Kodera2, M. Tsuchiya1, A. Fukui1, S. Itou1, Y. Machida2;1Shizuoka/JP, 2Nagoya/JP

Purpose: The purpose of this study was to distinguish between movement ofdiaphragm and heart wall, and to evaluate the kinetic function of these structuresin dynamic chest radiography with computer aided diagnoses.Methods and Materials: We obtained a dynamic chest radiograph of one healthyvolunteer during respiration to assess the distinction between structures andanother radiograph of a patient during a left ventriculogram to evaluate heartbeatcalculation using an image intensifier system. We performed FFT and band passfilter processing to obtain an intensity curve of the spectrum of dynamic chestradiography and detected the "change-point" of the phase by using characteristicanalysis. Fifty-five kinds of band pass filters were used to compare "detectionrate of change-point", "matching rate of heartbeat" and "heartbeat error".

Results: Movement of diaphragm and heart wall could be extracted selectivelyby the use of an extreme low pass filter (0.0~0.03 cycle/mm) and middle frequen-cy pass filter (1.4~2.2 cycle/mm). We obtained 100% of matching rate, whendetection rate was 100% with these two kinds of filters. There was correlationsignificantly between them (r = 0.779, p < 0.05). Improvement of detection ratedecreased heartbeat error. But there was no significant difference between themby the non-repeated measures ANOVA (p = 1.061).Conclusion: Our method was effective in analysing the dynamic chest radio-graph in order to evaluate precise kinetic function, when suitable filters were used.Therefore it is expected to apply for computer-aided diagnoses.

C-879Reduction of ionising radiation exposure in patients as a consequence ofnew imaging technology for medical diagnostics of the spine:A retrospective study covering 20 years in a Norwegian referral hospitalA. Nyquist1, H. Olerud2, B. Bjørnarå1, L. Borgen1, T. Gudmundsen1;1Drammen/NO, 2Oslo/NO

Purpose: To examine possible changes in ionising radiation doses to patients(collective effective dose) undergoing diagnostic imaging procedures for spinalproblems over the last 20 years in view of the shift in modalities from convention-al X-ray examination and myelography to computed tomography (CT) and lateron to magnetic resonance imaging (MRI).Methods and Materials: Retrospective study of all patient files for the periodfrom 1983 to 2002. The main modality groups for each of the three parts of thespine (cervical, thoracal, lumbar) were: Conventional radiographs, myelography,CT, and MRI. For each type of examination the mean effective radiation dosewere obtained from the Norwegian Radiation Protection Authority (NRPA) aspublished in 1997.Results: The number of conventional X-ray examinations performed was nearlyunchanged. Use of myelography reduced by 50%, 100%, and 95% for the cervi-cal, thoracal and lumbar regions, respectively. CT usage increased steadily, re-mained nearly unchanged, and was reduced by nearly 90% for the cervical,thoracal, and lumbar regions, respectively. The annual collective effective dosefrom examinations the spine was reduced by 48% in our hospital from 6.1 manSvin 1983 to 3.2 manSv in 2002.Conclusion: The shift in modalities from conventional X-ray and myelography toCT and MRI resulted in a significant reduction in patient exposure to ionisingradiation. The results may be explained by our intended policy to select MRI inst-ed of CT whenever possible, and is an overture to the discussion of the furtherdevelopment and structure of diagnostic imaging in general, and for the spine inparticular.

C-880Dose evaluation for clinical proton beam with standard dosimetry 01H. Ohtani1, T. Hiraoka2, H. Saitoh1, T. Irifune1, T. Katoh1; 1Tokyo/JP, 2Chiba/JP

Purpose: The standard dosimetry was revised on August 2002 in Japan; it hadcalling standard dosimetry of absorbed dose in external beam radiotherapy (stand-ard dosimetry 01). The purpose of standard dosimetry 01 are the establishmentof traceability for dose of radiotherapy and quality assurance / quality control,according as we measure the dose of high-energy radiation using the standard-ized international method.Methods and Materials: We explained the dosimetry of absorbed dose with thestandard dosimetry 01 for proton beams and the depth dose was measured withthe reference ionization chamber and the parallel plate ionization chamber. Themaximum energy of the proton beam used in this study was 70 MeV. Electricseparation induced radicals were calibrated for squarer field of 3×3 cm2 with someionization chambers.Results: The absorbed dose to water calibration factor is obtained by the refer-ence ionization chamber calibrated 60Co gamma rays. The remainder range inwater calibrated the beam quality conversion factor for proton beam. Using thesecoefficients, the absorbed dose was calibrated. The absorbed dose used theparallel plate ionization chamber was relatively decided by the results for thereference ionization chamber.Conclusion: The absorbed dose for proton beam was calibrated at each depth.Dosimetry in water was recommended on the standard dosimetry 01. However, itis difficult that we have the waterproof dosimeter. We suggested that the methodand problem for proton dosimetry using the standard dosimetry 01.

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C-881Kinetic analysis of the temporomandibular joint with computer-aideddetection systemN. Bandai1, S. Sanada2, K. Ueki2, S. Funabasama2, S. Tsuduki3, Y. Otani2,T. Matsui2; 1Onsen-gun/JP, 2Kanazawa/JP, 3Otsu/JP

Purpose: The purpose of this study was to develop a method of kinetic radiogra-phy and a computer-aided detection (CAD) system for quantitative evaluation ofthe temporomandibular joint (TMJ).Methods and Materials: Dynamic images of the TMJ were obtained from onehealthy volunteer by digital fluoroscopy in the lateral view on the right and leftsides. The accumulated image subtraction technique extracted the condyle ineach image. A sequential similarity detection algorithm (SSDA) was employed totrace the movement path and the velocity of the condyle.Results: There were no significant differences between by manual and computeranalysis. The shape of the path of the right condyle was smoother than that of theleft condyle. The size of the maximum vertical and horizontal movements of thecondyle were 4.6 ± 0.1 mm and 15.0 ± 0.2 mm, respectively. The velocity of themovement of the condyle was higher in the area close to the articular eminencethan in any other area during the opening and closing of the mouth.Conclusion: Our CAD system will contribute to the kinetic analysis of the TMJfor screening, follow-up study, and informed consent, providing speed, quantita-tion, and cost-effectiveness.

C-882Assessment of fetal dose in X-ray examinations of pregnant patientsA.J. Servomaa1, A. Kettunen2; 1Helsinki/FI, 2Oulu/FI

Purpose: When a pregnant woman undergoes examination of the lower abdo-men or pelvic area, the fetus is directly irradiated. Determination of the absorbeddose to the fetus is therefore of interest as a basis for risk estimates. In Finland,the practice with regard to both estimation of the dose to the fetus and recordingof the examination in patient records varies considerably. The fetal dose calculat-ed by means of various dose calculation methods are compared and the resultspresented.Methods and Materials: Using the "FetDose" and "PCXMC" programs, the nor-malized fetal dose was calculated for abdominal and pelvic examinations of var-ious radiation qualities, ESD and conceptus depths. The doses obtained werecompared against those reported in the literature.Results: The calculated NUDs (normalized uterus doses) obtained for variousparameters by means of various calculation methods agree, with reasonableaccuracy. The NUD occurring in a pelvic AP examination (80 kV, 3 mmAl filtra-tion, FSD 80 cm) is about 0.40 for a gestational age of 0-7 weeks and for a fetaldepth of 8 cm. The dose to the ovaries differs slightly from the dose occurring tothe uterus during the same examination. Detailed data about the NUDs in vari-ous common radiography examinations are presented.Conclusion: The results of calculations obtained with different programs showthe same NUD with reasonable accuracy. Normalized fetal doses and radiationrisks corresponding to the European ESD recommendations in conventional ra-diography examinations may help the radiological staff to assess the significanceof the exposure to the fetus.

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C-884Quality advances via noise reduction in laser imagingT.R. Lindquist; Oakdale, MN/US

Purpose: Noise sources in medical imaging and printing can limit diagnosticaccuracy but are often not assessed quantitatively. A method is described forobjectively quantifying noise by means of a film digitizer and analysis software. Asecond method, based on human perception of simulated nodules on films withvarying amounts of noise, is also described.Methods and Materials: In the first method, a film digitizer scans a print of aconstant gray level image. The scanned digital image file is then processed bysoftware that: (1) extracts and averages density data from narrow horizontal andvertical strips, and (2) performs one-dimensional Fast Fourier Transform (FFT)processing to yield a Noise Power Spectrum (NPS) for each horizontal or verticalstrip. In the second method, a computer program is used to synthesize a testimage with very low contrast dots ("nodules") superimposed on a gradually chang-ing background. In timed experiments, prints of these images are placed on a

light box, and an observer is asked to mark the locations where the dots arebelieved to be present, after which the true and false positives are counted.Results: Prints were made on a variety of medical imagers, using film with avariety of quality levels. Prints made with the latest laser imager and film yieldedlower measured noise and higher perception scores than prints made with priortechnology.Conclusion: Measurable progress has been made in reducing the noise level ofmedical imaging printers. This is further demonstrated by improved perception ofsubtle details.

C-885Estimation of maximum skin dose and average lung dose in coronaryangiography proceduresA. Karambatsakidou, P. Tornvall, N. Saleh, P.-O. Löfberg, A. Fransson;Stockholm/SE

Purpose: A comparison of phantom and patient based techniques to estimatethe maximum skin dose (MESD) and average lung dose from coronary angiogra-phy procedure is described.Methods and Materials: Conversion factors for the dose to the skin and lung,normalized to the dose-area-product (DAP), have previously been obtained frommeasurements using an Alderson phantom. In this study, measurements on pa-tients using slow radiographic film and diodes were used in combination with thesoftware WinODS to evaluate the impact of different operators, and of variationsin patient size, on these factors. The transmission ion chamber integrated into theangiographic unit was used to measure DAP.Results: The conversion factor for MESD from the phantom simulation was re-ported as 3.8 mSv/Gycm2. The corresponding value for measurements on pa-tients in this study was 3.7 ± 0.7 mSv/Gycm2 (1 SD; 18 patients). No significantdifference in conversion factor between the operators was found. The lung dosevaried with the body mass index (BMI). In slightly overweight patients (BMI: 27-30), the lung dose was about 16% lower than in normal sized patients (BMI:19-26) for the same DAP-value, while for overweight patients (BMI > 30) this differenceincreased to 24%.Conclusion: Measurements on phantoms and on patients yield similar conver-sion factors for MESD in coronary angiography procedures. The BMI-value seemsto be a robust indicator of the variation in dose to internal organs from suchprocedures. With film/diode measurements, the differences in techniques (geom-etry; projections) between operators can be easily verified, and as such be inte-grated into the training of new angiography operators.

C-886Radiation doses in a newly installed flat-panel digital system ininterventional cardiology departmentV. Tsapaki, S. Kottou, N. Kollaros, P. Dafnomili, V. Neofotistou; Athens/GR

Purpose:The purpose of the study was to investigate the radiation doses of thenewly installed flat-panel fluoroscopy (FPF) system in an Interventional Cardiol-ogy (IC) department and to examine possible methods of technique optimizationregarding the new digital system.Materials and Methods: Fifty coronary angiographies (CAs) and 50 percutane-ous transluminal coronary angioplasties (PTCAs) were investigated. Patient datawere: sex, age, weight, height, Dose Area Product (DAP), fluoroscopy time (T)and total number of frames (F). Further more, dose rates in all fluoroscopic andcine modes were measured. Image quality was assessed using a dedicated testtool.Results: Median values of DAP, T and F were: 27.7 Gycm2, 4.1 min and 876 inCA and 51.1 Gycm2, 12.7 min, 1184 in PTCA. Our results are comparable withthose found in the recent literature. Regarding the technical characteristics of thedigital system, the high contrast resolution (HCR) is not affected by fluoroscopicmode, whereas low contrast resolution (LCR) is slightly decreased in the lowestmode.Conclusion: The results of the study concerning the FPF system lead to theconclusion that the lowest fluoroscopic mode and the lowest frame rate shouldbe used routinely for dose optimization and that the new digital technology hascomparable radiation dose to the conventional technology.

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C-887Dynamic functional imaging of cutaneous melanoma and environment:Evidence of multiparameter transcutaneous electrointroscopy (MTE)Y.F. Babich, M.A. Nuzhdina; Kiev/UA

Purpose: An earlier study using the MTE scanner enabled us to register in vivowave-like activity of the skin electrical landscape (SEL), which is supposedlymacroscopic manifestation of intercellular communication. The present study ofthe chaotic SEL activity was done to try to find out distinctive dynamic featuresbetween melanoma and adjacent tissues.Methods and Materials: MTE is a new functional, non-invasive digital imagingmodality, which enables dynamic visualization of the skin and underlying tissuesin terms of spectral electroimpedance and electropotential parameters, with highspatial and temporal resolution (~ 0.5 mm). Non-thermal mm-EMF (4 min) andweak MF (< 0.001 T) were used as test influences. Initial and induced SEL dy-namics have been graphically and statistically analyzed. Specifically, the through-image-sequence analysis resulted in detailed dispersion maps of the scan-area.The SELs of (i) healthy and allergic subjects, and (ii) those with cutaneous melano-ma were investigated.Results: Primary melanoma manifested not only as a sharp electro-abnormality,but also as a distinctly stable/hyposensitive zone (sigma = 0.0 – 1.0%) in all meas-urement parameters.This hyposensitive zone(s) was surrounded by islet areasof marked hypersensitivity (sigma is up to 50%). Dispersion range of the moredistant environment had intermediate values. In cases of allergy, strongly pro-nounced dependence of the mm-EMF response upon time of investigation wasobserved at the same subject, i.e.: from sharply marked reactions at the stage ofsensitization to practically indistinguishable ones during remission. In healthysubjects, in most cases, significant trigger reversible changes of histograms wereregistered in response to both tests.

C-888Intracranial elastance analysis using MRI in normal-pressurehydrocephalusT. Miyati1, M. Mase2, M. Onoguchi1, H. Kasai2, M. Hara2, K. Yamada2,Y. Shibamoto2, S. Matsunaga1, T. Kasuga1; 1Kanazawa/JP, 2Nagoya/JP

Purpose: In order to assess the state and dynamics of the intracranial system innormal-pressure hydrocephalus (NPH), intracranial elastance (ICE) was meas-ured with magnetic resonance imaging (MRI).Methods and Materials: The ICE index, which is the ratio of pressure to volumechange, was obtained with Alperin's method; intracranial volume and pressurechanges during the cardiac cycle were calculated from the net transcranial bloodand cerebrospinal fluid (CSF) flow measured with phase-contrast (PC) cine MRI.ICE indices were determined in patients (n = 13) with NPH, brain atrophy or asymp-tomatic ventricular dilation (VD), and in healthy volunteers (control group; n = 11).Concurrently, a time constant of the integral of the CSF response function, whichrepresents the intracranial mechanical property was determined with PC cineMRI. The changes in ICE indices were also analyzed after intravenous injectionof acetazolamide. These values were then compared with the volume-pressureresponse (VPR) during the shunt operations.Results: The ICE index in the NPH group was significantly higher than in thecontrol or VD group, but no difference was found between the control and VDgroups. The ICE index increased in all groups after an acetazolamide injectionbecause of an increase in cerebral blood volume. There were significant correla-tions between the ICE index and the time constant. A positive correlation wasnoted between the ICE index and the VPR.Conclusion: ICE analysis measured by PC cine MRI makes it possible to non-invasively obtain a detailed assessment of intracranial state and dynamics in theNPH and to assist in diagnosis of the NPH.

C-889Quantification of magnetization transfer by sampling the transient signalusing MT-prepared single-shot EPIG. Helms1, G.E. Hagberg2, C.D. Claussen1, F. Schick1; 1Tübingen/DE, 2Rome/IT

Purpose: Using trains of MT-pulse and EPI readout, the transition to steady statecan be measured with higher accuracy than the steady state. A novel quantifica-tion method based on sampling transitions at different repetition periods (PR) isintroduced.Methods and Materials: Gaussian MT-pulses of 6.4 ms duration and flip angleof 720 degrees were repetitively applied at 1 kHz offset at PR = 8, 16, 26, 100,200 ms. An axial slice through the centrum semiovale of the brain was measuredby single-shot SE-EPI (50 ms TE, 5 mm thickness, 20 cm FOV, 64 x 64 matrix).

In brain tissue, the signal dependence was described by analogy to progressivepartial saturation, where the direct saturation is increased by PR-dependent MT-contribution proportional to macromolecular content and differential saturation.Macromolecular content, kinetic and relaxation parameters and the saturationwere estimated by a global non-linear least-square fit of the signal equation forROIs in cortical grey matter (GM) and central white matter (WM).Results: The macromolecular content was (15.6 ± 0.6)% in WM and (9.5 ± 0.6)%in GM, the apparent relaxation rates (0.92 ± 0.2) 1/s and (0.70 ± 0.05) 1/s. Theapparent transfer rates were (30.1 ± 0.7) 1/s and (23.4 ± 2.8) 1/s. Macromolecu-lar saturation of a single MT-pulse was (38.2 ± 0.1)% in WM and (40.0 ± 3.2) inGM; the direct effect on water less than 1%. Signal correction for CSF contribu-tions was necessary.Conclusion: Quantitative MT-mapping of the whole brain may become feasiblein vivo at higher field strengths by means of permutation of the slice order.

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Radiographers

C-890The concept of radiography in health sciences: A concept analysisS. Sorppanen1, A. Servomaa2; 1Oulu/FI, 2Helsinki/FI

Learning Objectives: To clarify the content and uses of the concept of radiogra-phy in health sciences and to compare it to the concept of radiography in physicsand technology.Background: In the field of radiography, theoretical research related to conceptshas so far being rare. Nevertheless, the concept development is an importantpart in constructing theories and clarifying the identity of a discipline. In Finland,the discipline of radiography started in 1999 at the University of Oulu, and sincethen it has offered radiographers academic education in their own field. For beingable to build its own knowledge base and theories to be used in developing theprofession and education of radiographer, and for being able to stand for its posi-tion as an independent academic discipline, the young discipline of radiographyneeds systematic conceptual clarification and development.Procedure Details: The concept of radiography was analysed using so-calledevolutionary method of concept analysis (presented by Rodgers). The contentsand uses of the concept were studied by determining the concept's characteris-tics and by observing these characteristics in the cross-disciplinary comparison.The data consisted of literature and Internet pages, and were analysed usingdeductive-inductive content analysis.Conclusion: The concept of "radiography" in health sciences can be determinedas "dual, dynamic, social and situation-related expertise of radiographers in theuse of radiation, which is based on a versatile synthesis". It seems to be wide andcomplex in nature, and radiographer-centered. The content and the use of theconcept varies according to the discipline.

C-891Measurement of distribution of horizontal dose amount to chest X-ray byGafchromic filmK. Nishikiori1, M. Miyazawa2, A. Otonashi3; 1Habikino/JP, 2Itabashiku/JP,3Suita/JP

Learning Objectives: To illustrate horizontal dose distributions of human diag-nostic level in the chest phantom by Gafchromic film and glass dosimeters. Topoint out the characteristics of horizontal dose distributions by materials in tenshots and in fluoroscopy.Background: In general, we use an ionization chamber dosimeter or TLD tomeasure dose distribution of diagnostic level. However TLD can not indicate hor-izontal and consecutive dose distributions, because it has only scattered dosedata. Consequently, we used Gafchromic film to obtain a horizontal consecutivedose distribution of human diagnostic level.Imaging Findings: 1. First, we placed a Gafchromic film and glass dosimeters inthe specific place of the chest phantom. Then we irradiated the chest phantomwith diagnostic level X-rays. The dose distribution which was acquired by the filmand glass dosimeters was then analyzed. 2. Next, we examined the result offluoroscopy. 3. The results of the first method were compared with the result ofthe fluoroscopy and the difference between the distributions in 1 (Gafchromic filmand glass dosimeters) and 2 (fluoroscopy) examined.Conclusion: The characteristic dose distributions of the incidence dose in diag-nostic level were confirmed by both horizontal dose distributions. 1. Horizontaldose distribution which was specific and consecutive data could be obtained fromthe Gafchromic film. 2. Horizontal dose distribution which was specific and scat-tered data could be acquired by glass dosimeters.We obtained almost the same as results in fluoroscopy.Horizontal dose distribution of fluoroscopy showed a sharp reduction on the sub-cutaneous tissue of the chest phantom.

C-892Barium enemas: Are radiographers up to it?P. Vora, A. Chapman; Leeds/UK

Aim: To determine the types and rates of complications encountered by radiog-raphers when performing double contrast barium enemas. A similar complicationrate to those encountered by radiologists will reassure those who have adoptedthis new skill mix and encourage its further development whereas an increase incomplications may point to areas where radiographer training needs to be im-proved.Materials and Methods: 741 questionnaires were posted to radiographers who

had in the last 5 years attended one of the biannual Leeds barium enema trainingcourses.Results: Of 741 questionnaires posted 407 (54.9%) were returned completed.Approximately, 348,433 barium enema examinations had been performed. 59radiographers reported 87 complications, including 13 intraperitoneal and 11extraperitoneal perforations. There were five deaths (mortality rate - 1 in 69,687).The five deaths included two of the twenty-four (10%) perforations, two of theforty-five (5%) cardiac events and one CVA that occurred during an examination.Conclusions: Radiographers have been regularly performing DCBEs for almosta decade. The mortality rate for radiographer performed double contrast bariumenemas is similar to that reported for radiologists. A slightly higher than expectedrate of perforation is noted in this study and so this is an area where radiographertraining should be targeted.

C-893The level and incidence of the fear in patients subjected to radiologicalexaminationsE. Czekajska-Chehab, M. Makara-Studzinska, A. Koczynasz, I. Nowak,A. Drop; Lublin/PL

Purpose: Analysis of incidence and intensity of fear in patients subjected to di-agnostic procedures.Methods: An anonymous survey concerning the occurrence and level of fearconnected with radiological examinations was conducted among 320 individuals:170 patients attending for various contrast examinations and 150 women beforemammography, using the questionnaire prepared by the authors. The level of fearwas evaluated according to the adopted scale in relation to the obtainable maxi-mum values.Results: 252 out of 320 individuals (79%) reported their fears before plannedradiological examinations. The frequency of fear was extremely high for mam-mography (98%) and lower for contrast procedures (61%). The strongest fearwas associated with the uncertainty of diagnosis and length of waiting for results(86-94%). The fears of patients before contrast examinations were mostly relatedto results and harmful effects of radiation. The fears concerning allergic reactionswere reported by almost a half of patients before CT, urography and barium ene-ma. In patients before contrast procedures the highest fear level was related tothe uncertainty of results (77-86%). The lower level (45%) was associated onlywith urography. The fears about the examination itself, allergic reactions or harm-ful effects of radiation showed similar intensity (52-79%), irrespective of the kindof examination.Conclusions: Fears before radiological examinations are common and concernover a half of patients subjected to contrast procedures and almost all of thosebefore mammography. The most common causes of fear include: uncertainty aboutdiagnosis, exposure to harmful effects of radiation and length of waiting for results.

C-894Audit of adequacy of inpatient CT requests: Implications and consequencesW. Chooi, P. Heath, M.J. Bull; Sheffield/UK

Purpose: Vetting of CT requests ensure that the examination is justified in ac-cordance to local guidelines and also allow the radiologist to select the mostappropriate CT protocol. However the provision of poor clinical information se-verely limits this step. This audit aims to determine the prevalence of inadequateclinical details in CT request forms and also identify trends that result in poorreferring technique.Methods and Materials: For a two week period all inpatient electronically gener-ated CT request were prospectively monitored. Outpatient & out-of-hour requestswere excluded.Results: Out of a total of 126 requests, 102 were successfully audited (81%).The types of examinations included CT head 63 (62%), abdomen 19 (19%), tho-rax 13 (13%), abdomen and thorax 2 (2%), and musculoskeletal 2 (2%). Prob-lems were encountered with 39 requests (38%). The most common problemencountered was that of inadequate or misleading information (n = 20). Othersissues included better alternative examination (n = 2), undisclosed renal impair-ment (n = 4), failed examinations due to agitated patients (n = 2), ward cancella-tions (n = 4), requests without contact details (n = 7), and wrong ward details(n = 5). As a result 20 of these requests were not performed. The majority ofthese requests are completed by junior doctors.Conclusion: Vetting of CT requests is an essential first step towards a success-ful CT examination. The provision of inadequate clinical information is prevalentand junior doctors require closer supervision when completing CT requests.

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C-895Technical inadequacies of plain films in an emergency departmentB. Rajashanker, F. Jabeen, R.W. Whitehouse; Manchester/UK

Purpose: 1. To assess the diagnostic quality of radiographs performed in theemergency department in a major referral hospital. 2. To determine the type andnumber of inadequacy encountered most often.Materials and Methods: Two specialist registrars (Trainees) in radiology, reviewed800 plain films performed in a busy emergency department. Films were exam-ined for inadequacies, which impair the diagnostic quality of the examination.Despite artefacts or exposure problems, if a reasonable diagnostic conclusioncould be made, the film was considered to be adequate. If a film was found to beinadequate, clinical details (that could have contributed to the poor quality) werelooked at, and taken into consideration. Artefacts obscuring the area of interest,inadequate collimation, incomplete examinations and improper exposure factorswere considered as inadequate. The number and the type of inadequacy, thetype of examination were noted.Results: 1. The study showed that about 9% of the total films performed wereinadequate. There are no national figures we could find to compare our resultswith to evaluate the performances on our emergency department. 2. The type ofinadequacy encountered most often was the presence of jewellery obscuring thearea of interest (27%), followed by artefacts caused by clothing (10%). Chestradiograph was the most frequently encountered inadequate examinations (55%).Conclusion: National guidelines regarding target quality radiographs that needto be achieved in institutions need to be published. The inadequacies were point-ed out for better performance in future.

C-896Drug courier pays a high price for easy moneyB. Szabó, Z. Mocsári, S.O. Farkas, P. Magyar, Á. Takács, K. Karlinger,E.K. Makó; Budapest/HU

Purpose: The aim of this study is to show the most common methods for exam-ining drug couriers and their results.Method: Native abdomen CT scans and native abdomen X-rays and US exami-nation were performed on probably positive patients.Results: In the year 2003 until now we examined 19 patients. Four positive caseswere found. One of them after the CT examination died in the hospital, becauseleakage of a capsule.Conclusion: Swallowers before traveling swallow 2-3 cm long, 1 cm diametercapsules, which they hope to retrieve after traveling. Stuffers insert drug filledcorpus alienums into the rectum or vagina. The danger of this type of drug smug-gling is the braking or bursting of the capsules, leading to potential fatal drugoverdose.

C-897Steps to European Union from Europe: Reforms of education of HungarianradiographersA. Maléta, Z. Mocsári, S.O. Farkas, Á. Mester, K. Karlinger, E.K. Makó;Budapest/HU

Purpose: The aim of this presentation is to show a short summary of the educa-tion of Hungarian radiographers currently and in the future.Method: Assessment based on the Bologna contract new education system withthe cooperation between the Society of Hungarian Radiographers and Hungari-an Ministry of Education according to the European directives.Results: The base of the Modular Education system is already laid down. Theconstruction and edition of the new scientific books and the preparation of theteachers and professors has already commenced.Conclusion: Since the Hungarian educational system of radiographers has ahistory of nearly ninety years we need to use the lessonst of the past into the newsystem. Since the result of the reforms requires a long time, well-organized feed-back mechanisms is needed to ensure the effectiveness of the reforms.

C-898Origin of military radiology: First use of X-rays in Ottoman EmpireA. Tunaci, N. Yildirim, Y.I. Ulman, E. Yekeler, H. Genchellac, M. Tunaci,G. Acunas; Istanbul/TR

X-ray usage as a diagnostic device was realized in Turkey first time at the MilitaryMedical School in 1896 by Esad Feyzi, who was an intern and physics assistant.This new invention attracted attention so much that Dr. Salih and Rifat Osmanalso joined him and they started to work in a small unit, where they practicedradiographic examination.

The following year, Yildiz Portable Military Hospital was reserved for woundedpatients from the battlefield of the Ottoman-Greek War. This mobile hospital, whichwas activated in 1892, was exported from Germany and comprised Duquer sys-tem pavilions that were reassembled within 10 hours. They took away the X-rayequipment from the Military Medical School to Yildiz and began to produce imag-es of bullet and shrapnel pieces from the patients sent from the battlefield. Kut-tner and Nasse from German Red Cross came to Istanbul in 1897. They weresurprised to see that this new invention was already being used there. On theGreek side English physicians used two X-ray devices that were transferred fromEngland to Pire Harbour on May 1897.Therefore the Ottoman-Greek war took its place in medical literature as the firstwar that radiographic images were taken, first by the Turkish and soon after byGerman and English physicians. References stated that English physicians tookX-ray images of wounded Greek soldiers and there is no record about Greekphysicians taking part in this work. Turkish physicians continued to work on radi-ographic images during the war which they had started shortly after the discov-ery of X-rays.

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C-8994D visualisation of cardiovascular pathologies: Computational fluiddynamics (CFD) utilizing isotropic CT-angiography datasetsT. Frauenfelder, E. Boutsianis, T. Boehm, N. Teodorovic, B. Marincek,S. Wildermuth; Zürich/CH

Learning Objectives: To explain the basics of CFD. To demonstrate how to per-form a numeric flow simulation in patient-specific vessels based on isotropic CT-datasets. To illustrate the possibilities of this promising tool on clinical cases.Background: CFD was introduced recently to investigate the behaviour of bloodflow. Different studies determined CFD as a valuable method to demonstrate theflow and pressure. Most studies use simplified standard models for the simula-tions. This exhibit explains methodological aspects of CFD and how numeric flowsimulations are performed in patient-specific vessels based on high-resoloutionCT datasets. Possible applications of CFD in the cardiovascular field are dis-cussed.Procedure Details: Isotropic CT-angiography data are used to segment the ves-sels. After generation of a surface mesh using the marching cube algorithm, themodel is transferred into a volume mesh and the different entities and walls weredefined. Specific parameters as velocity at the inlet boundary, flow parameters,and material specific parameters have to be assigned in a next step.The simulation itself provides detailed information about flow-behaviour and pres-sure. This helps to identify possible zones for development of artherosclerosis or,especially in aneurysms, locations for a possible rupture. Furthermore, blood flowcan be quantified and e.g. effects of stent-graft implantations or the benefit of acoronary bypass can be demonstrated.Conclusion: CFD in combination with patient-specific patient-data is a promis-ing method to visualise flow-effects. In the near future CFD will also gain in-creased importance for pre-interventional planning of vascular procedures.

C-900Contrast-enhanced MR venography of the central veinsC.J. Johnston, J. Mc Cann, E. Laffan, J.F.M. Meaney; Dublin/IE

Learning Objectives: To describe the technique of contrast enhanced MRV, showits clinical applications and describe associated pitfalls in image acquisition.Background: Evaluation of the central veins is easily achieved with contrast-enhanced MR angiography. "Indirect" CE-MRV, a technique where the veins areevaluated during the "venous" phase has been largely replaced by "direct" CE-MRV, a technique whereby dilute contrast agent is injected into the upper extrem-ity veins and imaging is performed during the first-pass.Imaging Findings: In order to overcome T2*-induced susceptibility-effect com-mercial strength contrast-agent is diluted with saline. In our institution we use a6% solution (3 cc of contrast agent in 50 cc saline). 1-3 cc of contrast is injectedover the duration of the breath-hold scan (TR/TE/Flip 5 msec/2 msec/40 deg,Matrix 512 x 200, FOV 400-450 mm x 360 – 450 mm. 32-60 slices, 4 mm inter-polated to 2 mm). Mask subtraction of a pre-contrast scan is performed. The spec-trum of findings in normal and diseased veins is illustrated. Examples ofthrombosis, stenosis and occlusion of the central veins will be illustrated. Com-mon pit-falls and artefacts will also be emphasised.Conclusion: "Direct" CE-MRV is an effective modality for evaluating the centralveins. A simple robust method is presented, along with examples of the appear-ance in normal and pathological states.

C-901Multidetector row CT angiography of the lower extremities for theassessment of traumatic vascular injuryE.E. Williamson, J.C. Hellinger, A. Napoli, G.D. Rubin, D. Fleischmann;Stanford, CA/US

Learning Objectives: 1. To describe the CT angiographic (CTA) technique usedin the evaluation of traumatic lower extremity (LE) vascular injury. 2. To illustratethe spectrum of vascular and nonvascular pathology found during LE-CTA in thesetting of trauma.Background: Digital subtraction angiography (DSA) has long been consideredthe imaging standard for traumatic vascular injury. CTA is a more readily availa-ble, noninvasive imaging alternative which is less expensive, less resource inten-sive and can be used to assess bone and soft tissue injuries without the need foradditional imaging tests. In this exhibit we highlight our experience with CTA in 27trauma patients.

Procedure Details: All examinations were acquired using 8 or 16-channel multi-detector-row CT (MDCT). Contrast media was administered at 4-5 cc/sec usingbolus-tracking technique. Thin section images were obtained from one vascularsegment above the level of trauma through to the foot with collimation of 1.25 andpitch of 1.35-1.5. Table feed and gantry rotation speed were adjusted to optimizescan duration to match the peripheral delivery of IV contrast. All studies werereformatted in 3-dimensions using volume rendering, maximum intensity projec-tion and curved planar reformation techniques.Conclusion: The spectrum of direct vascular injuries included large and smallvessel occlusions, pseudoaneursyms, active extravasation, and vasospasm. Non-vascular pathology with indirect effects on the vascular system included complexfractures, open soft tissue wounds, hematomas, and joint effusions. CT angiog-raphy of the extremities is a promising technique in the evaluation of traumatic LEarterial injury with the ability to assess nonvascular injuries without the need foradditional studies.

C-902Magnetic resonance venography (MRV) of the central chest veins:Acquisition methods, imaging findings and drawbacksC.J. Johnston, S. Ford, D. Rea, J.F.M. Meaney; Dublin/IE

Learning Objectives: a. To describe different methods of MRV in the chest. b. Toshow the wide range of pathologies demonstrable by MRV of the central chestveins. c. To show common problems in image interpretation and ways of avoidingthese pitfalls.Background: MRV is an under-utilised technique in the assessment of the cen-tral chest veins (SVC, brachiocephalic, axillary), where ultrasonographic evalua-tion is of limited value and CT comes at the expense of ionising radiation. Themultiplanar capabilities of MRV are well suited to imaging the central veins. Thereis a wide range of imaging techniques available for MRV evaluation of the centralchest veins, including conventional non-contrast time of flight imaging and con-trast enhanced methods such as the newer VESPA (venous enhanced subtract-ed peak arterial) sequences.Imaging Findings: Examples of common central venous pathologies will be il-lustrated from our database of over 120 patients, who underwent MR at 1.5 Tusing various sequences including non contrast time-of-flight, and post gadolin-ium true FISP, T1-weighted VIBE and 3D FLASH sequences. Typical scan pa-rameters included matrix 512 x 200, FOV 400-450 x 360-450 mm, 32-60 slices,4 mm interpolated to 2 mm.Common pathologies demonstrated included thrombo-embolic disease, centralvenous obstruction due to local tumour extension, congenital and acquired ve-nous stenoses, AV fistulas and infected venous pseudo-aneurysms.Conclusion: MRV is a robust, highly accurate and non-invasive technique forassessment of central venous pathology.

C-903Accuracy of automated centerline approximation algorithms for lowerextremity vessels in a CTA phantomA. La Cruz1, M. Straka1, A. Köchl1, M. Šrámek1, E. Gröller1, D. Fleischmann2;1Vienna/AT, 2Stanford, CA/US

Purpose: The accurate determination of the central vessel axis is a prerequisitefor automated visualization (curved planar reformation) and quantitation. Thepurpose of this work was to assess the accuracy of different algorithms for auto-mated centerline detection in a phantom simulating the peripheral arterial tree.Materials and Methods: Six algorithms were used to determine the centerline ofa synthetic peripheral arterial vessel (aorto-to-pedal arteries, diameter 18-0.6 mm)dataset (256 x 256 x 768, voxel size 0.5 x 0.5 x 0.5 mm). They are ray-casting/thresholding (RCT), ray-casting/maximum gradient (RCMG), block matching (BM),fitting to ellipse (FE), center of gravity (CoG), and Randomized Hough transform(RHT). Gaussian noise with a sigma: 0, 5 and 10 was used to observe the accu-racy of the method under noise influence. The accuracy of automatic centerlinedetermination was quantified by measuring the error-distance between the de-rived centerlines, and the known centerline course of the synthetic dataset.Results: BM demonstrated unacceptable performance in large vessels (> 5 mm)when the shift used was less than 3 voxels. RCMG demonstrated a greater error(mean of the error 4.73 mm) in large diameter (> 15 mm) vessels than in smalldiameter (< 15 mm) vessels (mean of the error 0.64 mm). Because RHT and FEuse Canny edge detector preprocessing, both are sensitive to noise. CoG andRCT keep the mean of the error-distance significantly smaller (0.7 mm and 0.9 mmrespectively) than all other algorithms.Conclusion: CoG and RCT algorithms provide the most efficient centerline ap-proximation over a wide range of vessel diameters.

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C-904Detection of the Adamkiewicz artery by subtraction magnetic resonanceangiographyH. Hyodoh, R. Shirase, H. Akiba, M. Tamakawa, K. Hyodoh, K. Aratani,N. Kawaharada, K. Morishita, M. Hareyama; Sapporo/JP

Purpose: To assess the ability of magnetic resonance angiography (MRA) todepict the Adamkiewicz artery.Materials and Methods: Fifty-one patients with thoracoabdominal disease un-derwent MRA of the bypass graft region. Subtraction maximum intensity projec-tion (MIP) images and cine-mode displays were produced to identify theAdamkiewicz artery, its side of origin and branching level, and the drainage vein.For statistical analysis, signal intensity ratio (SNR) and contrast noise ratio (CNR)were also calculated.Results: In 46 (90.2%) of the 51 patients, at least one Adamkiewicz artery wasseen to arise from an intercostal artery. Two Adamkiewicz arteries were identifiedin 9 (19.6%) of the 46 patients. Spinal drainage veins were visualized in 41 (80.4%)of the 51 patients, a single drainage vein in 30 of the 41 (58.8% of the total patientgroup) and two drainage veins in the remaining 11 (21.6% of the total patientgroup). In 19 of the 46 patients, both the Adamkiewicz artery and the drainagevein were detected during the early phase.Conclusion: Subtraction MRA depicts the Adamkiewicz artery in a high percent-age of patients.

C-90516-row multislice computed tomography of pulmonary veins: Assessmentbefore and after cryothermal energy ablationR. Maksimovic1, F. Cademartiri2, M. Scholten2, L. Jordaens2, P.M.T. Pattynama2;1Belgrade/YU, 2Rotterdam/NL

Purpose: Electrical isolation of the pulmonary veins (PVs) with radiofrequencyablation in treatment of patients with paroxysmal atrial fibrillation is associatedwith PV stenosis. Cryothermal ablation (CA) is a new promising method in treat-ment of these patients. Although initial experience of CA showed no associatedPV stenosis, results at follow-up have not been reported. The aim of the studywas to assess PVs for the presence of stenosis three months after CA by con-trast enhanced angiography on 16-row detectors multislice computed tomogra-phy (MSCT).Materials and Methods: Twenty four patients (mean age 52.6 ± 7.6 years, 15males) with symptomatic atrial fibrillation underwent CA in 46 PVs. All patientsunderwent complete clinical work-up, electrophysiological study, ultrasonogra-phy and MSCT angiography before CA. MSCT pulmonary angiography was per-formed three months after the procedure to evaluate ostium and the proximal10 mm of all PVs.Results: Dimensions of the treated PVs remained unchanged: the coronal ostialdiameter was 19.1 ± 2.4 preprocedural vs. 18.6 ± 2.4 mm at follow-up, p < 0.05,ratio of coronal and axial diameter 1.2 ± 0.2 vs. 1.2 ± 0.1, p < 0.05, respectivelyand the coronal diameter of the proximal 10 mm from the ostium 17.1 ± 2.5 mmvs. 16.5 ± 2.2 mm, p < 0.05, respectively.Conclusions: CA of PVs in atrial fibrillation has not been associated with steno-sis at the orifice and proximal 10 mm of the PVs after three months follow-up.MSCT pulmonary venography is a reliable, noninvasive method for assessmentof PVs in a three-dimensional manner prior to ablative treatment and during thefollow-up period.

C-906Magnetic resonance venography without contrast media for patients withlower extremity varicose veinsJ. Koizumi1, M. Wada2, T. Horie1, E. Kimura1, I. Muro1, K. Myojin1, T. Niibori2,Y. Imai1; 1Isehara/JP, 2Wako/JP

Purpose: To compare three different sequences of magnetic resonance (MR)venography without contrast media for patients with varicose veins below theknee.Materials and Methods: For 23 patients with lower extremity varicose veins,MR-venography using time-of-flight (TOF), fat suppressed T2-weighted turbo spinecho (TSE) and balanced turbo field echo (bTFE) were compared.The originalimages on 1.5 Tesla Gyroscan (Philips) were transferred to a workstation (M900Quadra, ZIOSOFT Inc.) and 3D images were reconstructed using maximum in-tensity projection (MIP), multiplaner reformation (MPR), and volume rendering(VR) techniques. For analysis, the veins were divided into superficial, deep ve-nous systems, perforating and varicose veins, and were evaluated using threepoints scale by a radiologist and a surgeon.

Results: Superficial, deep venous systems and perforating veins were best vis-ualized on bTFE (p < .05), while varicose veins were equally visualized on TSEand bTFE. TOF provided poor visibility except in popliteal veins. Coexisting arte-rial system seen on bTFE could be discriminated from the deep venous systemespecially on axial reconstructed images. The varicose veins connected with thesuperficial venous systems and perforating veins on the surface of the musclewere easily recognized on VR only using bTFE.Conclusions: MR-venography using bTFE displays the best images of the wholevenous system in patients with varicose veins below the knee.

C-907Magnetic resonance angiography in potential live renal donors: A jointradiological and surgical auditA. Mizzi, G. Roditi, M. Subramaniam; Glasgow/UK

Purpose: To assess the impact of joint surgical and radiological audit on theaccuracy of MRA reports in the evaluation of potential live renal donors.Materials and Methods: We analysed the case records of live renal donors whounderwent gadolinium enhanced MRA as part of pre-operative evaluation to as-sess renal vasculature between August 1999 and July 2002. In cases of discrep-ancy between MRA reports and surgical findings, studies were retrieved to theMRI workstation and subjected to detailed joint clinical and radiological review.Scan quality was assessed and sources of discrepancy were identified.Results: There were 45 donors, 23 men and 22 women. Reported MRA findingswere fully confirmed at surgery in 38 of 45 cases. These scans were not ana-lysed further. In 7 donors, the findings at surgery were discrepant with the radio-logical reports. There were 4 cases of "missed" early branches and 3 cases of"missed" accessory arteries. In the first year of audit there were 4 discrepantcases out of 18 (22%), all of which were radiological reporting errors. The numberof discrepant cases in the second year dropped to 2 out of 19 cases (11%).Neither of these was a radiological reporting error.There was one "missed" early renal artery branch in the third year of audit, whichwas visualised on MRA review.Conclusion: The accuracy of preoperative MRA in potential live renal donors ishigh. Radiological reporting of MRA examinations is improved through carefulclinical feedback, audit and interdisciplinary co-operation.

C-9083D contrast-enhanced MR portography to scan the entire volume of upperabdomen with maximal spatial resolution using parallel acquisitiontechniques: Preliminary experienceD. Horák, M. Herman, J. Bucil, J. Klein, J. Nekula; Olomouc/CZ

Purpose: To assess the feasibility and to evaluate the benefit of a 3D contrast-enhanced (CE) MR portography (MRP) covering the entire volume of upper ab-domen with maximal spatial resolution using GRAPPA (GeneRalized Autocal-ibrating Partially Parallel Acqusitions).Materials and Methods: 12 patients were examined before or after surgical cre-ation of porto-systemic shunt. T1-weighted 3D angiographic sequence with 3Dcentric reordering optimized using a GRAPPA factor of 2 was performed at a1.5 T scanner (Siemens Symphony Maestro Class) in three phases after admin-istration of 30-40 mL of 0.5-molar or 15 mL of 1-molar gadolinium-DTPA followedby 20 mL saline solution into the canula in antecubital vein. Anatomical postcon-trast T1-weighted 3D spoiled GRE with Fat Saturation was added.Parameters of HiRes 3D-CE-MRA sequence: in-plane resolution = 1.5 x 0.9 mm,number of partitions = 80, slice = 2.5 mm, partial-Fourier = 6/8, FOV = 400, TR/TE/FA = 3.55/1.28/25, TA = 27 sec.Results: Large evaluated volume HiRes MRP sequence is suitable for detailedpostprocessing (subvolume MIPs) in any plane, imaging borderline vessels likerecanalized umbilical vein or retroperitoneal collaterals, usually best seen in por-tal phase. Robust protocol can be very easily adapted for uncooperative patientscovering the same evaluated volume. Functional information (flow direction) canbe added with Phase Contrast MRA flow quantification sequence.Conclusion: Our preliminary results show that the application of GRAPPA al-lows to capture the whole portal vascular system without missing any importantcollateral with high spatial resolution in cooperative patients and with sufficientspatial resolution in non-cooperative ones. It's possible to image the flow in surgi-cally placed porto-systemic shunts.

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C-909Gadobenate dimeglumine (MultiHance®) in contrast-enhanced MRangiographyM. Kirchin1, R. La Ferla1, M. Daprà1, G. Pirovano2, A. Spinazzi2; 1Milan/IT,2Princeton, NJ/US

Purpose: Gadobenate dimeglumine (Gd-BOPTA) has high T1 relaxivity in blood(r1 = 9.7°mM-1s-1) compared to other gadolinium agents. This review is aimed atdefining the usefulness of Gd-BOPTA for CE-MRA.Methods: Preliminary intraindividual, crossover studies were conducted in healthyvolunteers to compare Gd-BOPTA and Gd-DTPA at the same dose and injectionrate for MRA of the abdominal aorta and run-off vasculature. Subsequently, PhaseII multicenter trials were performed in the renal/abdominal arteries (n = 94 pa-tients), the pelvic arteries (n = 136 patients) and the carotid arteries (n = 163patients) to establish the optimum dose of Gd-BOPTA for CE-MRA. Standardunenhanced and contrast-enhanced sequences were employed and images wereevaluated by independent, off-site blinded radiologists on the basis of segmentaland overall diagnostic quality scores per patient and dose.Results: The crossover studies demonstrated significantly greater signal intensi-ty enhancement after Gd-BOPTA compared to Gd-DTPA both in the abdominalaorta and run-off vasculature. The Phase II studies revealed dose-related trendsfor the contrast-enhanced images in each territory and good correlation betweenreaders. The greatest increase in diagnostic quality from unenhanced MRA toCE-MRA occurred at 0.1 mmol/kg BW while a higher dose of 0.2 mmol/kg BWprovided little or no additional benefit. CE-MRA led to an increased number ofpatients with lesions detected and increased reviewer confidence for lesion char-acterization.Conclusions: CE-MRA with Gd-BOPTA is more efficacious than unenhancedMRA and appears superior to CE-MRA with conventional gadolinium chelates.The optimum dose for CE-MRA of vascular disease is indicated to be 0.1 mmol/kg BW.

C-910Influence of CT scanner and observer on volume measurement: A phantomstudy with regard to clinical use in follow-up CT angiography of abdominalaortic aneurysms after endovascular repairH. Schoellnast, E. Sorantin, M.J. Deutschmann, G.A. Fritz, H.A. Deutschmann,G. Schaffler, A. Berghold, K.A. Hausegger; Graz/AT

Purpose: To assess if volume measurements of phantoms are influenced byusing different CT scanners and by different observers with regard to clinical usein follow-up CT angiography examinations of abdominal aortic aneurysms afterendovascular treatment.Materials and Methods: Five glass phantoms filled with diluted contrast materi-al underwent one single-detector row CT (SDCT) and two multi-detector row CT(MDCT) examinations. For each CT scanner the clinical protocol for CT angiog-raphy of the abdominal aorta was used. In a first step the resulting 15 volumeswere measured using a special software with automatic outline detection withoutneed of manual segmentation and thus without intra- and interobserver variabil-ity to evaluate differences between the CT scanners. In a second step the vol-umes were measured by three observers using a standard software for manualoutline detection to assess inter- and intraobserver variability.Results: There was no statistically significant difference between the CT scan-ners with the corresponding standard protocols (p = 0.27). Inter- and intraob-server variability was 7.2 and 2.6 mL and lead to significant difference in volumemeasurement between the observers (p = 0.002).Conclusion: Volume measurement does not seem to be influenced by the usedCT scanner. The interobserver variability is significant, but slight. Consequently,changes of the volume of abdominal aortic aneurysms in follow-up CT angiogra-phy after endovascular repair can be considered as true change and not as scan-ner related.

C-91116-slice multi-detector CT angiography in the assessment of steno-occlusive disease of the carotid artery bifurcation and vertebral arteryoriginS. Lee, H. Roh, H. Byun; Seoul/KR

Purpose: To determine the accuracy of 16-slice multi-detector CT angiography(16-MDCTA) in the assessment of steno-occlusive disease of the carotid arterybifurcation and vertebral artery origin.Materials and Methods: In 24 patients, 48 carotid arteries and 48 vertebral ar-teries were evaluated with 16-MDCTA and conventional digital subtraction angi-

ography (DSA). Standardized 16-MDCTA acquired from the circle of Willis to theaortic arch. 16-MDCTA data were displayed with maximum intensity projection(MIP) for carotid and vertebral arteries and with volume rendering (VR) for carot-id artery. The percent diameter stenoses of the carotid artery bifurcation andvertebral artery origin were measured separately on MIP, and/or VR CT imagesand DSA. The carotid stenosis was graded as no, mild (< 30%), moderate (30-70%), severe (> 70%), and occlusion with NASCET criteria. The vertebral arterystenosis was also assessed with the same five-grade scale. The results of 16-MDCTA were correlated with the gold standard of DSA.Results: All carotid and vertebral arteries were assessable on MIP and/or VRCT images. Correlation between stenosis measured with 16-MDCTA and thatmeasured with DSA were good (Pearson correlation: on carotid MIP images,c = 0.983, < 0.001; on carotid VR images, c = 0.992, < 0.001; on vertebral originMIP images, c = 0.984, < 0.001). The aggrement rate of stenosis grading be-tween 16-MDCTA and DSA was also high (91.7% on carotid MIP; 93.8% on ca-rotid VR images; 91.7% on vertebral origin MIP images).Conclusion: 16-MDCTA has a high accuracy for the evaluation of carotid andvertebral artery stenosis and provides multiplanar information preoperatively.

C-912Does high iodine concentration contrast agent improve arterialenhancement in MDCT angiography of the run off vessels? Comparison ofthree different iodine concentration contrast agentsF. Venditti, C. Catalano, M. Francone, F. Fraioli, A. Napoli, V. Votta,R. Passariello; Rome/IT

Purpose: To evaluate whether a high iodine concentration contrast agent maydetermine a greater arterial contrast enhancement in the visualization of aorto-iliac and peripheral vessels.Materials and Methods: Sixty-six patients, randomly divided into two groups, Aand B, were studied with a multi detector-row CT (MDCT) scanner. Both groupswere divided in three subgroups (A1 = 300, A2 = 350 and A3 = 400 mgI/mL;B1 = 300, B2 = 350 and B3 = 400 mgI/mL) in which different iodine concentra-tions were injected. In group A variable flow rates were used. In group B the flowrate was kept constant at 3.5 mL/s. Quantitative and qualitative analyses wereperformed at predefined fixed vascular segments.Results: In both groups a greater density value was achieved using the highconcentration contrast agent, in particular at the level of the superficial femoralartery for subgroup A3 and at the level of the popliteal artery in subgroup B3. Forall vascular segments the best enhancement was visualized for group B3. Nostatistical significant differences were achieved between the two different groupsin the visualization of sub-popliteal vessels.Conclusion: Our study demonstrates that the use of a high iodine concentrationcontrast agent increases arterial enhancement of the peripheral arterial tree us-ing MDCT scanner.

C-913Multidetector CT angiography in arterial occlusive disease of the lowerextremities: A step forward in vascular diagnostic procedures?M. Maggi, S. Alborino, E. Paci; Ancona/IT

Purpose: Multidetector computer tomography (MDCT) angiography is a new avail-able technique for studying arterial disease of the lower limbs.In this study we report our experience with MDCT angiography in evaluating athero-sclerotic lesions of peripheral arteries.Materials and Methods: 60 patients (36/24 male/female, age 63 ± 10, 45 in 2and 15 in 3 Rutherford category) were investigated by MDCT between April 2002and March 2003, 30 patients underwent digital subtraction angiography (DSA) ofthe lower extremities within 20 days from MDCT angiography. We used a 4-8channels GE Medical System CT-scanner, 18 needle-cannula, flow rate 4 mL/sec, 150 mL iodinated contrast medium 300/350 mgI/ml, bolus tracking program(SMART PREP). MIP and Volume Rendering reformations were used. DSA andMDCT angiograms were blindly evaluated by two vascular radiologists accordingto the following parameters: stenosis (lumen reduction 50-99%), occlusion(> 99%), absence of lesion (< 50%) in 1140 arterial segments, 19 for each pa-tient. Therapeutical implications of MDCT angiography were also evaluated.Results: Concordance between MDCT angiography and DSA was 92.3% in de-tecting and 96.9% in excluding lesions, 66.7% in defining stenosis and 85.5% forocclusions. In 21/30 patients percutaneous approach was modified according toCT images.Conclusions: MDCT angiography could be considered as the first step in diag-nostic procedures of peripheral arterial disease and could also modify therapeu-tical strategy and vascular radiologist's performance. Further studies are needed

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to determinate whether use of high iodine concentration contrast medium offersmore complete information.

C-914Diagnosis and follow-up of aortic dissection with multislice computedtomographyY. Herrero, M. Martí, J. Echeveste, M. Fernández-Velilla, G. Garzón,N. Gómez-León; Madrid/ES

Purpose: To assess the utility of multislice computed tomography (MSCT) in thediagnosis and follow-up of aortic dissection.Materials and Methods: Seventy-one patients referred to rule out aortic dissec-tion underwent MSCT following a standardised protocol. The volume of interestwas the entire aortoiliac system, 120 mL of non-ionic iodinated contrast wereadministered at a flow rate of 3 mL/sec. A collimation of 3 mm, table speed of16 mm per rotation, pitch of 4 and reconstruction interval of 2 mm were used.Multiplanar (MPR) and three-dimensional reconstructions (external rendering)were obtained in a workstation (Vitrea 2; Vital Images Plymouth, Minn). Aorticdissection was diagnosed when an intimal flap separating the true and false lu-men was observed.Patients diagnosed with aortic dissection underwent an endovascular repair (stent-graft placement). Follow-up CT examinations after endovascular repair were ac-quired with the same MSCT protocol, after performing a basal nonenhaced study.Complete closure of the entry site, and both stent-graft and visceral arterial branch-es patency were considered as adequate stent-graft function signs.Results: Nine of the 71 patients were diagnosed with aortic dissection (six acuteand three chronic dissections), two of which involved the ascending aorta andseven the descending thoracic aorta. Follow-up demonstrated in all cases a re-sidual abdominal aortic dissection with progressive decrease in size of the falselumen.Conclusion: MSCT determined the exact anatomy of the dissection flap, thelocation of the entry and reentry sites, and the major branch vessels that weresupplied by the true lumen.

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C-915Endovascular stent-graft placement for treatment of thoracic aorticaneurysmsM. Fernández -Velilla, G. Garzón, I. Acitores, F. Ibáñez, L. Riera; Madrid/ES

Learning Objectives: To assess the safety and efficacy of endovascular stent-graft placement for repairing descending thoracic aortic aneurysms in high-riskpatients. To analyse the major associated complications. To show our experiencein the management of these patients over a six-year period.Background: By helping patients avoid open surgery, endovascular aneurysmrepair minimises the perioperative derangement of pulmonary, renal, cardiac, andgastrointestinal function. The greatest potential benefit is in high-risk patientswho have large aneurysms and who are poorly suited to any of the current alter-natives.Procedure Details: Endovascular aneurysm repair was performed in 39 high-risk patients who could not undergo conventional repair. The feasibility of en-dovascular treatment and the prosthesis' size was determined based onpreoperative spiral CT and intraoperative angiography findings. Stent-grafts weresurgically inserted through exposed femoral arteries with fluoroscopic guidance.The anaesthetic technique was either epidural or general. Endovascular graftswere constructed with Gianturco stents and polytetrafluoruroethylene (PTFE) graft.Stent-grafts were placed in 12 disecting, 21 atherosclerotic, five traumatic, andone post-coarctation descending thoracic aortic aneurysm. 68% of them werechronic. We analysed the results obtained in both stable patients, in which anelective treatment was performed of sacular, fusiform, traumatic and chronic dis-section aneurysms, and in emergency patients (intramural bruise, penetratingulcer, and aortic dissection).Conclusion: Endovascular treatment of thoracic aortic aneurysms offers consid-erable benefits. Long-term follow-up is needed to ascertain the durability of theprocedure especially in dissecting aneurysms. An interdisciplinary and experi-enced team is needed to manage endovascular and surgical treatment.

C-916Radiologic appearances of thoracic outlet syndrome: Evaluated by PAToptimized 3D contrast enhanced MR angiography and intraarterial DSAÖ. Özsarlak, O. D'Archambeau, F. Delrue, P.M. Parizel; Antwerp/BE

Learning Objectives: Thoracic outlet syndrome: PAT optimized contrast enhanced(CE) MRA and intraarterial digital subtraction angiography.Background: Seventeen patients clinically suspected of having a vascular tho-racic outlet syndrome were retrospectively reviewed. The patient population con-sists of 10 women, and 7 men with an age range between 14 and 65. In eightpatients, CE-MRA was performed in 1.5 T MR system. GRE Flash 3D MR angi-ography with CARE Bolus technique was used with a PAT acceleration factor oftwo. The remaining nine patients were examined by intraarterial, and intravenousDSA of the upper extremity. All examinations, including MRA were performedboth in neutral and in Adson positions with abduction of arms.Imaging Findings: None of the patients showed abnormality during neutral po-sition. Examinations repeated during Adson position revealed 22 subclavian ar-tery lesions in 17 patients: 8 occlusions, 8 high-grade stenoses, and 6 mild-gradestenoses. In 8 patients, the lesion was located on the left side, in 2 patients on theright side, and remaining 7 patients' lesions were bilateral.Conclusion: A review of the functional anatomy, clinical symptoms, CE- MRAand DSA findings are presented with illustrative cases. The advantages of PAT-optimized CE-MRA are highlighted.

C-917MRI evaluation of patients with peripheral vascular malformationsG. Calabrese, G. Falda, G. Lucchini, A. Cazzulani; Garbagnate Milanese/IT

Learning Objectives: To define a MRI protocol to study patients with angiodys-plasia in order to evaluate soft tissues and bone involvement and to demontratethe appearance of the vascular malformations.Background: Imaging studies must show all the abnormal vessels and provideinformation on the degree of surrounding tissue involvement. In this exibit wedescribe the MRI findings in 15 patients with angiodysplasia of the lower or upperlimbs.Procedure Details: T1 weighted FSE sequences and T2 weighted FE sequenc-es in the sagital and coronal planes were acquired. A sagital T2 FSE sequence

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with 16 echos and fat-saturation was used to demonstrate vessels with slow flow.DSA and DSV were performed to proceed to embolization or operation.T1 images gave good morphological demonstration of muscle involvement. OnT2 FE images the presence of small vessels within the subcutaneous fat or with-in the bones was easily shown.Images acquired with the 16 echos T2 sequence were processed with the M.I.P.function to show the abnormal vessels; this sequence was especially useful inthe venous malformations and in some cases the draining veins were also iden-tified.Conclusion: MRI is the technique of choice to demonstrate the anatomic extentof the lesions and their relationship to the adjacent soft tissues. Even if MRA isimproving from the technical point of view, still it remains quite complex and timeconsuming. In our protocol a simple T2 sequence showed to be a good method todemonstrate abnormal vessel with slow flow.

C-918Occlusion of the inferior vena cava: Findings on MRIJ.W.J. Mc Cann, E. Laffan, S. Ford, C. Johnston, S. O'Brien, C. Farrelly,J.F.M. Meaney; Dublin/IE

Learning Objectives: To demonstrate the findings on both conventional multi-planar magnetic resonance imaging (MRI), and contrast-enhanced magnetic res-onance angiography (CE-MRA), in patients with occlusion of the inferior venacava (IVC).Background: Thrombosis of the IVC and its tributaries is most commonly asso-ciated with malignancy, resulting from direct invasion by carcinoma of the kidney,liver or adrenal gland. Thrombosis of the IVC secondary to benign causes is lesscommon. Predisposing factors include pregnancy, connective tissues disordersand coagulation abnormalities. Recognition of caval thrombosis on ultrasoundmay be difficult. However, depiction of the IVC on both contrast-enhanced com-puterised tomography and MRI is more accurate. Although non-contrast MRI isuseful for demonstrating IVC occlusion, contrast-enhanced MR venography of-fers the opportunity for rapid evaluation in a single breath-hold.Imaging Findings: The normal appearance of the IVC as demonstrated by MRIis illustrated, along with examples of IVC occlusion associated with both benignand malignant pathology. Simple rules for differentiating bland versus tumourthrombus are presented and illustrated. A method for optimising the timing ofdata acquisition for CE-MRA is presented. The merits of "indirect" versus "direct"IVC MR venography are also discussed. Finally, artefacts that may mimic IVCthrombus are described.Conclusion: MRI/MRA accurately evaluates the IVC. The multiplanar imagingcapabilities, lack of ionising radiation, coupled with the added benefit gained fromthe use of intravenous gadolinium based contrast agents in MRA, makes MRI themodality of choice in evaluating patients with suspected IVC occlusion.

C-919The swollen leg: The various etiology and its CT venography findingsW. Jun, W. Lee, J. Chung, J. Park; Seoul/KR

Learning Objectives: To illustrate the various causes of swollen legs. To recog-nize the characteristic imaging findings of various causes of swollen legs. Toevaluate the accuracy of CT venography in the differential diagnosis of the etiol-ogy in patients with swollen legs.Background: The swollen leg is a common clinical problem that complicatesmany medial and surgical disorders. Clinical applications of computed tomogra-phy (CT) venography have increased with the improved technology of multide-tector CT systems. CT venography showed the diagnosis of DVT and other softtissue disease in patients with swollen leg. For the past two years, CT angiogra-phy of lower limbs was performed in 180 patient (age 19-92 years) with swollenlegs. The various causes and imaging findings of swollen legs are described andillustrated.Imaging Findings: The characteristic imaging findings of acute deep vein throm-bosis (DVT) are a definite intraluminal filling defect, venous distension and mus-cle compartment enlargement. Findings of chronic DVT are small, thick-walled,poorly enhancing veins and presence of collaterals. Findings of lymphedema areskin thickening, subcutaneous tissue thickening, fat infiltration: lines parallel toskin and perpendicular to skin. Findings of cellulitis including necrotizing fasciitis,are fascial thickening, fat infiltration, focal fluid collection, soft -tissue gas andmuscle involvement.Conclusion: CT venography showed promise for the diagnosis of DVT and othersoft tissue disease in patients with swollen legs. CT venography is the modality ofchoice when clinical and other imaging findings are indeterminate.

C-920The aorta revisited: Spectrum of findings on helical CTA.J. Madureira, J.P. Jesus, J. Loureiro, I. Ramos; Porto/PT

Learning Objectives: To review the imaging findings of the anatomical variantsand disease processes that may affect the aorta from the aortic valve to thebifurcation. To describe the pitfalls that may be encountered.Background: Helical CT is a frequently used method in the evaluation of diseas-es affecting the aorta. It provides invaluable information in the assessment ofacute aortic syndromes and is often employed in diagnosis and follow-up of dis-section, aneurysm and bypass surgery.Procedure Details: The imaging findings of the diseases that may affect the aortaare presented based on the experience of our tertiary care hospital and level 1trauma center. The anatomical variations of the aortic arch vessels, acute aorticsyndromes, aneurysmal disease and aortic bypass surgery are discussed andillustrated thoroughly.Conclusion: Helical CT is a firstline imaging method in the evaluation of aorticdisease due to it's widespread availability, good spatial resolution and speed.

C-921MR imaging findings in patients with near total and total carotid arteryocclusionD.J. Rea, N. Sheehy, J. Mc Cann, E. Laffan, C. Johnston, J.F.M. Meaney;Dublin/IE

Learning Objectives: To illustrate the MR findings that differentiate severe ca-rotid artery stenosis with a tiny residual distal lumen from patients with total ca-rotid artery occlusion.Background: Due to the small but substantial stroke risk in patients undergoingdigital subtraction angiography, contrast enhanced magnetic resonance angiog-raphy (M.R.A.) has become the standard for evaluation of carotid occlusive dis-ease in many centres.M.R.A. is highly accurate in differentiating significant stenosis (70%-99%) thatrequires carotid endarterectomy, from insignificant (< 70%) disease. M.R.A. isalso highly accurate in differentiating severe stenosis from occlusion. However,demonstration of a string sign depends on careful interrogation of the sourceimages as the residual patent lumen may not be visualised on standard maxi-mum intensity projections. Given the clinical importance of differentiating betweenthese two groups, we present and contrast the imaging findings of patients withsignificant carotid stenosis and those with total carotid artery occlusion.Imaging Findings: We describe the varied findings in both patients with totalcarotid artery occlusion and those with severe stenosis. We present a simplealgorithm for rapid evaluation of patients referred for differentiation of severe ste-nosis from occlusion.Conclusion: M.R.A. can accurately differentiate near carotid artery occlusionfrom total occlusion. This poster illustrates the relevant imaging findings.

C-922CT evaluation of the anomalies of the inferior vena cava and the left renalveinA. Buzzi, M. Mancini, A. Mancini; Buenos Aires/AR

Learning Objectives: To illustrate the CT features of the most common anoma-lies of the inferior vena cava (IVC) and the left renal vein (LRV). To describe theembryologic development and the malformative mechanism.Background: Anomalies of IVC and renal veins occur with a prevalence of 0.07%to 8.7%, and are easily identified on CT, frequently incidentally. If unidentified,they can be misinterpreted as pathology (adenomegaly, retroperitoneal masses,normal venous structures and/or collaterals during acquired obstruction) or canlead to morbidity during radiologic and surgical procedures (positioning IVC fil-ters, varicocoele sclerotherapy, renal venous sampling, shunt placement for por-tal hypertension, liver or kidney transplantation, IVC ligation for thromboembolicdisease, abdominal aortic aneurysm repair). We describe the CT findings in 48cases of anomalies of the IVC and the LRV.Imaging Findings: 20 female and 28 male patients, aged 20-76 years, werestudied. We found 4 anomalies of the suprarenal segment (interrupted IVC withazygos continuation), 26 anomalies of the renal segment (18 circumaortic LRV, 8retroarotic LRV), and 18 anomalies of the infrarrenal segment (1 retrocaval ure-ter, 6 transposition of the IVC, and 11 duplications of the IVC). One patient withagenesis of the IVC with azygos continuation had profound venous thrombosis,and another had bronchiectasis. In any other case the anomaly was responsiblefor the patient's symptoms.

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Conclusion: An understanding of the embryologic development of the vena cavaand its tributaries is necessary to understand the genesis of these anomaliesand their accompanying anatomic variants.

C-923Radiological criteria for resection of ascending aortic aneurysms inMarfan's syndromeV.A. Jakupov, A.O. Seidalin, R.S. Kalyshev, Y.A. Akhmetov, S.E. Serikova;Almaty/KZ

Purpose: The determination of radiological criteria for surgical intervention inMarfan's syndrome depending on size of aneurysms.Materials and Methods: Data on 20 Marfan's syndrome patients with ascendingaortic aneurysms treated from 1985 to 2003 were analyzed. The age of patients(90% male and 10% female) ranged from 26 to 41 years (mean 32). The data-base of studies included information of echocardiography, MRI and MRA, com-puted tomography and angiography.Results: Mean size of the ascending aorta in these patients at initial presenta-tion was 7.4 cm (range 5.0 to 12.5 cm). Dissection of the ascending aorta oc-curred in 50%. Median size of ascending aorta at time of dissection was 5.6 cm.All patients underwent surgery for their aneurysms. The postoperative mortalitywas 6.3%. We have compared the two groups of Marfan's syndrome patientswhom had dissections: with an aortic-root diameter from 7.0 to 12.0 cm (70%)and with an aortic-root diameter from 5.0 to 7.0 cm (30%). There is correlationbetween the aortic-root diameter and the probability of aortic dissection. Analy-sis to isolate risk factors for dissection revealed that size larger than 6.0 cm in-creased the probability by 40%.Conclusions: The incidence of dissection increased with aneurysm size and theradiological criteria for surgical intervention in Marfan's syndrome are aneurysmdiameter of 5.0 cm. Maximal information about size and dissection of aneurysmsin Marfan's syndrome patients are obtained from analysis of angiography data.

C-924An evaluation of internal carotid artery and cerebral blood flow volumeusing color duplex sonography in patients with vertebral artery hypoplasiaM. Acar, B. Degirmenci, A. Yucel, R. Albayrak; Afyon/TR

Purpose: Vertebral artery hypoplasia (VAH) may be defined as VA flow volumebelow ~ 30 to 40 mL/min using color duplex sonography. The aim of this studywas to evaluate the effect of VA hypoplasia on internal carotid artery (ICA) flowvolume and cerebral blood flow (CBF) volume.Materials and Methods: In this study, 17 patients with VA hypoplasia and 20control subjects with normal VA flow volume were enrolled. The patients andcontrol subjects were 50-75 years of age. The ICA and VA flow volumes weredetermined by using color duplex sonography. Cerebral blood flow volume wascalculated as sum of flow volumes in the ICA and VA of both sides. The ICA andCBF volumes of patients with VA hypoplasia were compared with control groupflow volumes.Results: In VA hypoplasia and control group, there were no significant differenc-es between ICA flow volumes of right and left sides (222 ± 70 versus 260 ± 87 mL/min; p = 0.16 on the right side, 211 ± 117 versus 236 ± 73 mL/min; p = 0.45 onthe left side) or sum of flow volumes of both ICA (434 ± 144 versus 495 ± 127 mL/min; p = 0.18). However CBF volume tended to be lower in patients with VA hypo-plasia than control group.Conclusion: Evaluation of CBF using color duplex sonography is noninvasiveand easily applicable to all patients and provides valuable diagnostic data. To thebest of our knowledge, this is the first study demonstrating lower SBFV and nor-mal ICA flow volume in patients with VA hypoplasia.

C-925The floating layer: A new sonographic sign of ruptured abdominal aorticaneurysmA. Nunziata1, O. Catalano2, M. Mattace Raso2, F. Sandomenico2, A. Siani2;1Naples/IT, 2Pozzuoli/IT

Purpose: In patients with ruptured abdominal aortic aneurysm we have occa-sionally seen a floating layer, similar to the intimal flap recognizable in patientswith aortic dissection but slightly thicker. We reviewed our series to assess theoverall prevalence, specificity and diagnostic significance of this finding.Materials and Methods: In a 6 year period (from January 1997 to December2002) we have evaluated with US, 388 consecutive patients with abdominal aor-tic aneurysm (larger axial diameter of the aorta > 30 mm). Twenty-nine aneu-rysms were proven to be ruptured (sonographic and/or CT diagnosis) and were

surgically confirmed. The remaining 359 patients were not symptomatic and wereproven to have a non-ruptured aneurysm at follow-up.Results: A floating membrane was found in 8 out of 29 patients with rupturedaneurysm (28%) and in none of the subjects with non-ruptured aneurysm. Theimage appeared as a thick layer floating within the aneurysm lumen, clearly de-tached from a more or less eccentrically placed luminal thrombosis (present in all8 cases), with a paradoxical movement unrelated to overall vessel pulsation.Conclusion: The floating layer is an uncommon but specific sonographic sign ofabdominal aortic aneurysm rupture. Recognizing this findings should lead toprompt surgical treatment, without need for further imaging (contrast-enhancedCT).

C-926Color duplex measurement of cerebral blood flow volume in patients withpolycystic ovary syndromeM. Acar, A.S. Cevrioglu, B. Degirmenci, A. Yucel, R. Albayrak, M. Yilmzer;Afyon/TR

Purpose: Polycystic ovary syndrome (PCOS), one of the commonest endocrin-opathies in the human, is known to be associated with risk factors for cerebrov-ascular disease. We want to determined whether there is a change in cerebralblood flow volume in PCOS.Materials and Methods: We reported 30 women with PCOS and 20 healthywomen with similar body mass index (BMI). Both groups of women were aged 16to 35 years. We detected internal carotid (ICA) and vertebral artery (VA) flowvolume using color duplex sonography. Cerebral blood flow (CBF) volume wasdetermined as the sum of flow volumes of internal carotid and vertebral arteriesof both sides.Results: There were no significant differences between patients with PCOS andcontrol group in CBF volume or the bilateral sum of flow volumes in the ICA andVA. But bilateral mean velocity of VA was significantly lower in patients with PCOScompared to control group. Correlation between age of patients and mean veloc-ity of VA and ICA were assessed with Pearson correlation analysis. In controlgroup, mean velocity of VA and ICA was inversely correlated with age (r = 0.61,p = 0.005 versus r = 0.59, p = 0.006). However no correlation was found for pa-tients with PCOS.Conclusion: This is the first study demonstrating normal CBF volume using du-plex sonography in PCOS. It is known that the increased risk factors for cerebrov-ascular disease does not increase stroke mortality in PCOS. Normal CBF volumeand absence of decrease in VA and ICA mean velocity by aging may be protec-tive mechanisms.

C-927Thoracic aortic calcification in the elderlyG.S. Karlsdottir, T. Aspelund, S. Sigurdsson, G. Eiriksdottir, L. Launer,T. Harris, V. Gudnason, R. Detrano; Kopavogur/IS

Purpose: Though demographic associates of coronary and abdominal aorticcalcification in elderly persons are known, similar information about the thoracicaorta is not available. We developed a protocol for scanning the thoracic aortafrom the aortic bulb to the descending aorta at the level of the cardiac apex.Methods and Materials: Computed tomographic images were acquired with aSiemens Sensation 4 scanner, using sequential mode and prospective ECG gat-ing. The CT images were processed using calcium scoring software for coronaryarteries, which is modified in order to label areas and quantify calcium in thethoracic aorta. The thoracic aorta is divided into three segments: arch, ascend-ing, and descending. These segments are labeled and calcium within them quan-tified and results expressed in Agatston scores.Results: Agatston scores were acquired from 676 individuals (263 men, 413women) with an age range of 66-92 (mean 75) years. There was a 34% increase(95%CI: 22%-45%) in the total Agatston score for every 5 years of age for men,and 49% (95%CI: 40%-58%) for women. There was no significant difference be-tween men and women in the age group 66-70 and, men in the age group 85+had significantly lower scores than women.Conclusion: A robust method for quantifying calcium in the thoracic aorta hasbeen established. Age and gender distributions of thoracic aortic calcification inthe elderly show strong age dependance for both genders but significantly strongerfor women than for men.

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C-928Value of long-term routine ultrasound assessment of hemodialysis fistulaein comparison with clinical parametersA. Wojciechowski, M. Golebiowski, M. Grzeszczyk, W. Kania; Warsaw/PL

Purpose: The aim of the study was to correlate the results of clinical and ultra-sonographic long term follow-up of hemodialysis fistulae. The utility of routineultrasound examination was discussed.Materials and Methods: 86 patients underwent Doppler ultrasound evaluationof dialysis fistulae. Patients were randomly assigned for evaluation. In additionroutine tests for blood cell count, hematocrit, Kt/V, URR and blood pressure in thevenous line were available in all patients. All patients had native fistulae. A singleunit (ATL ULTRAMARK 9 HDI) was used for ultrasound examinations.Results: Results of laboratory and clinical parameters were abnormal in almost50% of patients. Low levels of hematocrit (< 30%) were observed in 47.7%, albu-min (< 4.0 g/l) in 36.6%, elevated pressure in venous line (> 140 mmHg) in 22.1%.Abnormal Kt/V (< 1.0) and URR (< 60%) in 32.6 and 36.6% respectively. USrevealed: pseudoanerysms in 5.8% of patients, hematomas adjacent to the fistu-la 10.5%, arterial steal syndrome in 11.6%, stenosis in 25.6% and mural thrombiin 40.7%. In 8.1% of patients brachial artery blood flow was less than 300 mL/minand in 7% of cases dialysis fistula flow was greater than 2100 mL/min.Conclusion: Only 11.6% patients had no abnormal either clinical, morphologicalnor flow parameters. 44.2% of patients had abnormal clinical and US morpholog-ical parameters. Colour Doppler ultrasound is more sensitive than clinical or lab-oratory methods in detection of hemodialysis fistula dysfunction. It is stronglyrecommended to start regular ultrasound examinations of all dialysed patients.

C-929Improved diagnosis of vascular neck-dissection by ultrasound B-flowimagingD.-A. Clevert1, E.-M. Jung2, M.F. Reiser1, N. Rupp2; 1Munich/DE, 2Passau/DE

Purpose: The objective of this study was to evaluate of the efficiency of differentultrasound techniques: Color-coded Doppler, power Doppler and B-flow in vesseldissection diagnosis.Materials and Methods: 34 patients with 44 dissection were examined by vas-cular ultrasound for suspected vascular dissection. The study compared flow vis-ualization by color-coded Doppler sonography (CCD), power-mode Doppler (PD)and B-flow in dissections of the carotid artery (n = 19), the vertebral artery (n = 25).Reference standards were provided by contrast-enhanced magnetic resonanceangiography (MRA) in 30 cases and spiral computer tomographic angiography(CTA) in 14 cases.Results: B-flow imaging identified all 44 arterial dissections confirmed by CTA orMRA. Contrast-enhanced MRA supplied the best visualization of intramural he-matomas. The detection rates of CCD, PD imaging and B-flow imaging were 15,17 and 19 for 19 carotid artery dissections, 21, 22 and 24 for 25 vertebral arterydissections. The accuray of the diagnosis was 98% for B-flow imaging, 82% forCCD and 89% for the PD. In absence of overwriting artifacts B-flow imaging de-tected more precisely residual flow within the false lumen. The reduced effect ofultrasound probe angle facilitated the visualization of fissures, of membranesand of low flow phenomena and improved the identification of low-reflection wallstructures. B-flow showed undulating membrane movement most clearly.Conclusion: B scan ultrasound is limited in its ability to diagnose vascular dis-section and to depict membranes. With B-flow imaging the visualization of flowwithin the true and false lumen, of low-echo thrombi and of intramural hematomais greatly improved.

C-930Improved diagnosis of stenosis of hemodialysis fistula by ultrasound B-flowD.-A. Clevert1, E. Jung2, N. Rupp2; 1Munich/DE, 2Passau/DE

Purpose: To evaluate the new technique of ultrasound ultrasound B-Flow in de-tection of stenosis of hemodialysis fistula.Material and Methods: 50 patients with Brescia-cimino-shunts were examinedby independent examiners with i. a. DSA and vascular ultrasound. All patientshad a shunt-volume of less than 400 mL/min., an angiographical stenosis of theanastomosis of at least 50% or changes of the venous portion of the shunt wereexamined. Studies were performed with the aid of a multifrequency ultrasoundprobe (5-10 MHz, Logic 700, 9, GE) using B-mode, color coded Duplex (CCD)and B-flow, first of all in the brightness modification.Results: In the group of anastomotic stenosis measurements of intrastenoticdiameter gave for i. a. DSA values of (average: 2.33 mm), for B-mode (average:

2.56 mm), for CCD (average: 2.88 mm), for brightness mode of B-flow (average:2.27 mm) and for B-flow with B-mode information values of (average: 2.37 mm).The best agreement with DSA was achieved by brightness mode of B-flow. Whilein B-flow in cases of anastomotic lesion or venous stenotic lesions, hypoecho-genic vessel wall alterations were detected, they were not seen in B-mode in anycase and not reliably in CCD due to blooming artifacts. In cases of venous aneu-rysm and vascular elongation a flow detection free of artifacts was only demon-strated by B-flow.Conclusion: Ultrasound B-flow detects anastomotic stenosis of hemodialysisfistula better than other ultrasound modes. The visualization of hypoechogenicvessel wall alterations and the degree of stenosis is also better appreciated bythis mode.

C-931Ultrasonographic assessment of internal mammary artery in the screeningof radiotherapy induced coronary artery diseaseN. Tuncbilek1, O.O. Okten1, H.M. Karakas2; 1Edirne/TR, 2Malatya/TR

Purpose: Radiotherapeutically treated breast carcinoma patients are prone tothe development of iatrogenic fibrosis and plaque formation in coronary vascula-ture. In this group of patients, early changes in the diameter and the flow charac-teristics of internal mammary artery, hypothesised as the surrogate markers ofthe coronary artery disease, were ultrasonographically (USG) investigated.Matrials and Methods: The study group was consisted of 33 breast cancer pa-tients with ages between 23 and 77 (mean age 47.3 yrs) and 15 age-matchedcontrol subjects. All patients were radiotherapeutically treated 6 to 24 month ago.Internal mammary arteries were ultrasonographically investigated with 7.5 MHzlinear transducer in longitudinal planes. Diameters of the arteries were meas-ured in M-mode; resistivity indices (RI), pulsatility indices (PI), peak systolic andend diastolic values were measured with color Doppler USG. Mean values of theabove mentioned parameters were statistically compared among patient andsubject groups.Results: Mean diameter of the internal mammary arteries were found to be19.02 mm in patients and 36.57 mm in control subjects. There was a statisticallysignificant difference between two groups regarding the stated parameter(p < 0.001). In contrary, the difference of RI, PI, peak systolic and end diastolicvalues were not statistically significant in two groups studied.Conclusion: Shortly after radiotherapy the diameter of the internal mammaryartery significantly decreases but its flow spectrum does not change. Ultrasono-graphically performed simple diametric measurements may be used as rapid andnoninvasive screening tests to predict the development of coronary artery dis-ease.

C-932Assessment and follow-up of endovascular repair of aortic aneurysm withmultislice computed tomographyM. Fernández -Velilla, M. Martí, Y. Herrero, J. Echeveste, G. Garzón,N. Gómez-León; Madrid/ES

Purpose: To evaluate the usefulness of multislice computed tomography (MSCT)after placement of endovascular stent-grafts for treatment of aortic aneurysms.Matrials and Methods: Seventy-six patients underwent MSCT angiography fol-lowing treatment of thoracic or abdominal aortoiliac aneurysm with endoluminalstent-grafts. MSCT was performed from the supracoeliac aorta to the femoralartery bifurcation in patients with aneurysm affecting the abdominal aorta (n = 70),and from the thoracic inlet to the femoral bifurcation in patients with thoracicaneurysm (n = 6). The standardized protocol consisted of a nonenhanced CT(3 mm collimation, pitch of 4, reconstruction interval of 2 mm, table speed of 16 mmper rotation and a single-breath-hold acquisition), followed by a contrast-enhancedCT. All images were postprocessed in a workstation (Vitrea 2; Vital Images, Ply-mouth, Minn). The image postprocessing included multiplanar reformats, MIP,shaded-surface display, and volume rendering. The studies were assessed forstenosis, thrombosis, perigraft leakage, migration, angulation of graft, and en-larging sac size without visible endoleak (endotension). Follow-up CT was per-formed prior to discharge and at six and twelve months after intervention.Results: After stent-graft placement in the 76 patients, CT demonstrated graftpermeability in 76 (100%), perigraft leaks in 17 (22%), angulation of the graft in 9(12%) and endotension in 2 (2.6%).Conclusion: MSCT was able to study the entire aorta with a maximal and homo-geneus opacification. The MSCT technique allowed fast scanning, great anatom-ic coverage during a single breath hold, few motion artefacts, and high spatialresolution in the longitudinal plane, improving the diagnostic accuracy of the ex-aminations.

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C-933Evaluation of vertebral artery using color duplex sonography: Comparisonof vertebral artery velocity and flow volume measurements for diagnosis ofvertebrobasilar insufficiencyM. Acar, B. Degirmenci, A. Yucel, R. Albayrak; Afyon/TR

Purpose: The aim of this study was to compare the measurements of vertebralartery (VA) flow velocity and flow volume for diagnosis of vertebrobasilar insuffi-ciency.Matrials and Methods: We examined 96 patients referred for evaluation of ver-tebrobasilar insufficiency. Net VA flow volume and mean systolic flow velocitywere determined by using color duplex sonography. We grouped the patients intothree: group 1 consisted of patients with severely damped VA flow volume(< 120 mL/min), group 2 moderately damped (120-200 mL/min) and group 3,normal (> 200 mL/min). The mean systolic flow velocities in each group werecompared by one-way ANOVA.Results: Damped VA flow volume was determined in 56 of 96 patients, of thesepatients 18 had severely damped, 38 had moderately damped, 40 had normal VAflow volume. Mean VA systolic flow velocities of group 1, 2 and 3 were 32 ± 12,42 ± 10 and 46 ± 8 cm/sec, respectively. Mean VA systolic flow velocity in group1 was significantly lower than that of group 2 (p = 0.001). However there were nosignificant differences between VA systolic flow velocities in group 2 and group 3(p = 0.2).Conclusion: According to our findings, measurement of VA velocity is enoughfor diagnosis of vertebrobasilar insufficiency in patients with severely damped VAflow volume but may not always be helpful in differentiation of moderately dampedflow volume from normal. Therefore we conclude that for the diagnosis of verte-brobasilar insufficiency, measurement of volume in addition to velocity is neces-sary in detection of moderately damped VA flow volumes.

C-934Rotational angiography of femoropopliteal arteries after percutaneoustransluminal angioplasty (PTA): Preliminary resultsF. Pozzi-Mucelli, M. Belgrano, G. Tona, R. Pozzi-Mucelli; Trieste/IT

Purpose: To report our experience in rotational angiography (RA) after PTA ofthe femoropopliteal arteries and to compare this modality to standard antero-posterior (AP) projection.Materials and Methods: Forty patients underwent PTA of the femoropoplitealarteries in the last 12 months. Twentysix were stenoses (lenght: 1-5 cm) and 14occlusions (lenght: 3-10). In all cases PTA was successful and the result waschecked with AP projection and with an RA acquisition. The procedure were per-formed on the Philips Integris Allura System providing the RA tool.Results: RA after PTA was successful in all cases. In 42% of cases there was nodifference between the static AP projection and RA, whereas in 47% the staticacquisition, compared to RA, underestimated the degree of residual stenosis by10-30%. In about 40% of these cases a disagreement on the presence and ex-tent of subintimal flaps between static and rotational acquisition was identified. Inanother 11% of cases there was substantial agreement on the residual stenosisbut not on the PTA-induced dissection which was always better identified on RA.Conclusions: RA allowed optimal evaluation of all cases improving the informa-tion on the conventional technique based on one or two projections. In our expe-rience this information modified our therapeutic approach leading to repeatedballoon angioplasty or stenting in 46% of cases.

C-935Usefulness of CT angiography in the follow-up of abdominal aorticaneurysm treatmentC. Capuñay1, P.M. Carrascosa1, T. Sampere1, M. Ulla1, E. Martin Lopez1,M. Vembar2, J. Carrascosa1; 1Buenos Aires/AR, 2Cleveland, OH/US

Purpose: To determine the usefulness of CT angiography (CTA) in the detectionof complications after abdominal aortic aneurysm treatment.Material and Methods: In a 150 patients series (123 male, 27 female; mean age63.5 years) CTA was performed as post-treatment control; 128 (85.3%) patientshad endovascular stent graft placement and 22 (14.7%) patients open aneurysmrepair. CT were performed in two different scanners (helical CT scanner, PQ5000;Picker and 4-row CT scanner, Mx8000; Philips Medical Systems) with slices of 4and 2.5 mm thickness, every 2 and 1.3 mm reconstruction interval respectively,and 120 mL of contrast material was injected using a power injector.Post-processing volume rendering, MPR and MIP images were obtained.Results: 32 complications were detected, 24 cases in the post-endovascularstent-graft placement's group and 8 cases in the post open surgical repair's one.

All the diagnosis were confirmed by digital angiography or surgical treatment. Inthe first group (endoluminal repair), the complications were: a) periprosthetichematoma (n = 2); b) neointinal hyperplasia (n = 2); c) partial stent-graft throm-bosis (n = 4); d) total stent-graft thrombosis of an iliac branch (n = 7); e) endoleaktype II (n = 4); f) endoleak type III (n = 4), separation of the stents' components(n = 1). In the second group (surgical repair) we observed: a) periprosthetic in-fections (n = 3); b) supraprosthetic aneurysm (n = 1); c) pseudoaneurysm (n = 2);d) aortoenteric fistula (n = 2).Conclusion: CTA is accurate, fast and minimally invasive imaging method in theevaluation of complications after abdominal aortic aneurism repair.

C-936Interobserver agreement in the CT evaluation of carotid artery stenosisP.M. Carrascosa1, F. Meli1, C. Capuñay1, T. Sampere1, E. Martin Lopez1,D. Smith2, S. Chandra2, J. Carrascosa1; 1Buenos Aires/AR, 2Cleveland, OH/US

Objective: To determine the usefulness of CT angiography (CTA) in the detec-tion and quantification of carotid stenosis in comparison with DA.Materials and Methods: Thirty-eight carotid arteries were evaluated in 19 pa-tients with transient ischemic attacks. CTAs were performed with a Helical CTScanner (PQ 5000; Picker). Images were evaluated by two radiologists, who wereblinded to the percentage of stenosis determined by DA. The stenosis were con-sidered positive if they were ≥ 70%. Different methods of stenosis quantification(NASCET(N), ESCT (E) and area quantification (A)) were performed on the samevessel to determine the sensitivity and specificity of each one in comparison withDA. Interobserver variability of the three methods was evaluated.Statistical Analysis: kappa coefficient was performed to determine the interob-server variability.Results: Observer 1: Sensitivity: N: 94%, E: 77% and A: 94% and specificity:91%, 87.5% and 87.5% for each method, respectively. Observer 2 = Sensitivity:N: 77%, E: 77% and A: 74% and specificity: 91%, 87.5% and 95% for each meth-od, respectively. Kappa: 0.83, 0792 and 0.78 for N, E and A respectively.Conclusion: CTA showed high S and Sp in the carotid stenosis quantification,specially with the NASCET method.

C-937Emergency multislice CT angiography (MSCTA) in patients with suspectedaortic dissectionR. Stern Padovan, M. Lusic, B. Oberman, K. Potocki; Zagreb/HR

Purpose: The purpose of the study was to evaluate positive MSCT-angiographyfindings in patients with spontaneus-nontraumatic aortic dissection. MSCTA is anoninvasive, time-saving radiological procedure for patients with aortic dissec-tion because they need prompt and accurate diagnosis and treatment. Aorticdissection is defined as a separation of the inner aortic wall layers. It is divided byStanford classification into type A that involves the ascendent aorta and type Binvolves distal to the origin of the left subclavian artery.Materials and Methods: MSCTA was performed in 42 patients (14 (33.5%) fe-male and 28 (66.7%) male age 18 – 81) with clinically suspected aortic dissec-tion over a period of 14 months on Lightspeed Ultra 8 Slices, GE. Slice thicknesswas 2.5 mm with 50% overlap of reformatted images. We injected 100-120 mL ofnonionic contrast material at a flow rate of 4 mL/sec with Smart Prep feature. MIPand MPR were usually used.Results: Aortic dissection was found in 29 (67.4%) patients. 21 (72.4%) hadacute aortic dissection and 8 (27.6%) chronic type. Acute aortic dissection Stan-ford type A was found in 13 (62%) and type B in 8 (38%). In 13 patients we did notfind aortic dissection but other CT findings could explain the symptoms: AA, rup-ture of AA, mesenteric ischemia, pericardial effusion.Conclusion: MSCTA is noninvasive, rapid and relatively comfortable radiologi-cal procedure for patients with suspected acute aortic dissection in cardiovascu-lar emergency. This technique enables correct and detailed diagnostic informationand obviates catheter aortography.

C-938Diagnosis of aortic and supraaortic emergency with CT angiography: Howdoes aortic morphology influence the choice of treatment?C. Engelke1, K. Marten1, A. Chavan2, J.F. Reidy3, A.-M. Belli3, E.J. Rummeny1;1Munich/DE, 2Hannover/DE, 3London/UK

Objective: CT angiography (CTA) is the imaging method of choice for diagnosisof aortic and supraaortic emergency. In this retrospective evaluation of patientswith aortic or supraaortic emergency undergoing intial CTA at four european cen-tres diagnosis and determination of treatment are reviewed.

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Materials and Methods: CT scans of fourty patients (mean age 70 years, 18female: previous aortic repair (n = 13), atherosclerosis (n = 10), trauma (n = 8),other (n = 9)) with aortic or supraaortic emergency were reviewed for aortic rup-ture (AR), aortic or supraaortic fistula (AF), covered aortic perforation (CAP) withtransection (AT), dissection (AD), or ruptured ulcer (RAU), and rapid aortic aneu-rysm expansion (RAAE). Morphological findings were correlated by DSA, sur-gery or post-mortem.Results: There were 10 AR, 8 AF (4 tracheobronchial, 3 oesophageal, 1 duode-nal), 17 CAP (4 AT, 7 AD, 6 RAU) and 5 RAAE. CTA was diagnostic in all casesexcept five AF: four were diagnosed by DSA, one at post-mortem. In 34 cases,CTA correctly determined the decision of patient management. One separatevertebral artery origin was missed. Two patients died before surgery. 36 patientsunderwent emergency repair (22 surgical, 14 endovascular); two were observed.Five thoracic AF were treated by endovascular repair, two by surgery, one infra-diaphragmatic AF by surgery.Conclusion: CTA is valuable for diagnosing aortic and supraaortic emergenciesand determining their treatment. However, in suspected AF complementation byDSA is usually required.

C-939Low dose multidetector row CT angiography versus DSA in the evaluationof patients with peripheral arterial disease: Brand new technique andresultsF. Venditti, C. Catalano, M. Francone, M. Danti, P. Nardis, A. Roselli,R. Passariello; Rome/IT

Purpose: To compare low-dose multidetector CT angiography (MDCTA) with DSAin the evaluation of patients with peripheral arterial disease.Materials and Methods: Seventy-five patients with peripheral arterial disease,divided into three groups of 25, underwent MDCTA. MDCTA scanning protocolwas: collimation 4 x 2.5 mm, thickness 3 mm, gantry rotation time 0.5 s, kV 120,delay time 28 s. The only variable among the three groups was mAs, respectively130, 100 and 80, with a resultant CTDIw of 13.2, 10 and 7.9 mGy. All patientsunderwent DSA within 72 hours from CTA. The volume of contrast medium (0.7 gI/kg of iomeprol 400 mgI/mL), injected at 3.8 mL/s, was flushed with 40 mL of sa-line. 3D real time interaction approach on a dedicated workstation was performedin all cases, with different reconstructions algorithms. Image quality and degreeof stenosis were independently evaluated by 2 blinded readers.Results: Regarding image quality no significant difference was found amongthree protocols. Slight artefacts related to beam hardening were present in thepelvis with the lower mAs protocol without impairment of diagnostic quality. Inter-observer agreement was substantial to almost perfect in all cases. The sensitiv-ity, specificity and accuracy resulted of 96, 93 and 94%, independent of the mAsvalue.Conclusions: Low-dose MDCTA provides qualitatively acceptable images. It alsoappears accurate in the assessment of patients with peripheral arterial diseaseproviding results comparable to higher dose protocols. Image noise on nativelowest dose protocol can be reduced or eliminated by thickening MIP or MPRimages.

C-940Diseases mimicking thrombosis of the limb-a retrospective sonographicstudyA. Tsikkini, V. Bizimi, H. Antipa, P. Brestas, E. Manopoulou, Z. Nikolakopoulou,P. Hadjilira, G. Karidas, M. Tsouroulas; Athens/GR

Purpose: This study supports the recommendation that ultrasound imaging isnow the investigation of choice as a diagnostic test, in patients presenting withsymptoms and signs that are suspected to be caused by deep venous thrombo-sis or as a means to distinguish other causes of leg swelling.Methods and Materials: We reviewed the results of lower extremity duplex ve-nous scans, performed in 456 patients (476 limbs; 436 unilateral and 20 bilater-al), with a 4-7 MHz linear and 5-2 MHz curved array transducer, between June2002 and May 2003, on an emergency basis. All patients were symptomatic withclinical suspicion of lower extremity deep vein thrombosis, regardless of the pres-ence or not, of risk factors.Results: Of the 476 limbs, 138 had no obvious pathology, 160 (33.6%) had deepvenous thrombosis, 53 (11.1%) had deep venous compression resulting from apopliteal (Baker) cyst ruptured or not. Forty limbs (8.4%) had cellulitis, 30 (6.3%)had lymphadema, 26 (5.5%) had superficial venous thrombosis, 6 (1.3%) hadpopliteal vein or artery aneurysm. Nine (1.9%) limbs had pseudoaneurysms (8femoral and 1 located at the tibial-peroneal trunk), 4 (0.8%) had AVF (3 detectedto be femoral and 1at the level of the external iliac artery). Four (0.8%) had either

abscess, or enlarged lymph nodes in the groin, compressing the veins, and 6(1.3%) had some kind of musculoskeletal problem (muscular tear).Conclusion: Complete venous evaluation with duplex imaging can be very help-ful in the determination of the underlying cause of leg swelling. DVT is the com-monest.

C-941Sonographic assessment of intima-media thickness (IMT) and plaquemorphology of the carotid system: A comparative studyA.A. Kotis1, P. Brestas2, L. Guindaglia1, G. Chatzakis1, K. Papanastasiou1;1Rhodes/GR, 2Athens/GR

Purpose: To investigate the potential association of increase in IMT with carotidartery disease extension, plaque morphology and formation of carotid bifurcationstenosis.Materials and Methods: 250 patients 140 females and 110 males referred forcolor duplex ultrasound were included. Risk factors for cerebrovascular diseasewere recorded. Measurements of common carotid (CCA) IMT adjacent to thebulb and carotid bifurcation plaque characterization and classification were real-ized. Coefficients of variation and k-statistics were used for assessment of varia-bility in IMT measurements and plaque characterization respectively. Controversycases underwent SHU 508A contrast agent injection.Results: Significantly higher IMT values were measured a) in men than in wom-en (p < 0.05) b) on the left side compared with the right (p < 0.01). Mean IMTmeasurements showed positive linear relationship with age. We identified plaquesin 205 of 280 carotid bulbs and stenosis (> 50%) in 60 of them. Echogenic USplaque appearance (121/280) predominated in comparison with echolucent (84/280) and relationship of lumen stenosis with the presence of echolucent plaques(p < 0.05) was found. Multiple regression model revealed significantly higher IMTvalues in patients with plaques at any side (p = 0.019), with more evident differ-ence in those with stenosis (p < 0.001). The magnitude of plaques correlatedsignificantly with IMT. There was no relationship between plaque echogenity andIMT (p > 0.05).Conclusion: We realize the existence of correlation between increase in IMT inCCA and extent of carotid bifurcation atherosclerotic disease. Color doppler ul-trasonography is accurate and reproducible for assessment of IMT and detectionof carotid plaque morphology and evolution.

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C-942MRA evaluation of renovascular hypertension: PAT optimized 3D contrastenhanced, phase-contrast, and time-of-flight MR angiography using 12-channel phased array body coilÖ. Özsarlak, P.M. Parizel; Antwerp/BE

Purpose: To emphasize the role of MR angiography in the evaluation of renovas-cular disease, and to discuss the performances, advantages and limitations ofdifferent MR angiography techniques.Materials and Methods: More than 200 MR angiograms of renal arteries werereviewed for the presence of any anatomic variations, the number of renal arter-ies, the presence of renal artery stenosis, occlusion, or other arterial diseasestogether with the limitations, artifacts and pitfalls of the technique. More than 100examinations were performed after applying parallel acquisition technique withacceleration factors up to 4, using a 12-channel phased array body coil. Influenceof PAT on slice thickness, image matrix, total examination time, and image qualityare discussed.Results: Phase contrast acquisitions are extremely helpful in evaluating flowpatterns in the renal arteries, and offer unique information about the flow velocitypatterns. PAT using SENSE reconstruction algorithm leads faster 3D MRA acqui-sitions. This results in, not only shortening the examination time, but also short-ening the breath-hold time, and providing better image quality due to decreasedmotion artifacts. PAT-optimized 3D contrast enhanced MR angiography is uniqueamong noninvasive imaging modalities in that it offers a comprehensive 3D eval-uation of renal anatomy, and renal vascular territories in a very short acquisitiontime.Conclusion: The main challenge in the evaluation of renovascular hypertensionis the detection of hemodynamically significant renal artery stenosis. A combina-tion of different techniques (phase contrast and contrast-enhanced MRA) yieldsthe best results, comprising both morphologic and functional information.

C-943Possibilities of contrast-enhanced MRA in visceral artery lesionsE.K. Iakovleva, L.A. Tyutin; St. Petersburg/RU

Purpose: To determine possibilities of ce-MRA in pathologic findings of the vis-ceral arteries.Materials and Methods: 45 patients (29 male, 16 female) with suspected viscer-al ischemia have been examined. The study was performed by Magneton "Vi-sion" of Siemens (1.5 T) with the use of Body coil and turbo MRA flash 3d afterintravenous bolus injection of contrast medium (0.2 mL/kg). US was perfomed in45 patients, conventional angiography - in 35 patients.Results: Pathologic changes in the visceral arteries were revealed in 31 cases,including 14 findings with various grades of stenosis of the coeliac trunk, 11 -with stenosis of the SMA, 6 - occlusion of the splanchnic arteries. Causes ofvisceral ischemia were: atherosclerosis (the main cause), found in 23 patients,aorto-arteriitis - in 2, coarctation of abdominal aorta - in 1, extravasal compres-sion- in 5.High correlation between conventional angiography and ce-MRA was determinedin 28 patients.The functional phase-contrast MRA was done in 18 patients with stenoses ofsmall and middle degree; it gave an opportunity to acquire information on flowparameters and to elaborate the grade of stenotic changes.Conclusions: The ce-MRA with pc-MRA gives a chance to determine the gradeof stenosis with high accuracy, visualize colateral vessels, to get information onflow parameters in damaged splanchnic arteries.

C-944Depiction of arterial branches in the abdomen using multidetector-row CTN. Terayama1, O. Matsui1, K. Ueda2, T. Kobayashi1, J. Sanada1, T. Gabata1;1Kanazawa/JP, 2Matsumoto/JP

Purpose: We attempted to visualize the arterial branches in the abdomen onreformat ion images.Materials and Methods: Contrast enhanced CT using multidetector-row CT(MDCT, LightSpeed Ultra16, GE Medical Systems) was performed for 22 pa-tients (9 male and 13 female). Contrast medium (300 mgI) was administered in-travenously at a rate of 3 mL/sec. Parameters of data acquisition were as follows:a slice thickness of 0.625 mm, reconstruction intervals of 0.4 mm, a pitch of 1.375,

and FOV of 35 cm. Axial images were transferred to Advantage Workstation 4.0(GE Medical Systems) and multi-projection volume reconstruction (MPVR) im-ages were obtained. If the origin of each arterial branch and the route until thetarget organ was depicted, we regarded that the branch was visible.Results: Coeliac, superior and inferior mesenteric, renal, intercostal, lumbar, rightand left hepatic, and anterior and posterior pancreaticoduodenal arteries werevisible in all cases. Cystic, right gastric and dorsal pancreatic arteries were visi-ble in 20 cases (95%), in 18 cases (82%) and in 17 cases (77%), respectively.Right inferior phrenic artery was visible in all cases, and left inferior phrenic ar-tery in 20 cases (91%).On average, 2.5 of adrenal arteries were visible. Bilateral ovarian arteries werevisible in 3 cases (23%), and unilateral in 3 cases (23%). Testicular arteries werevisible in 4 cases (44%), and in 4 cases (44%), respectively.Conclusion: Reformation images of MDCT can visualize thin arterial branchesin the abdomen. It could take place of diagnostic angiography.

C-945The assessment of diagnostic value of Vmax, Vmin, PI, RI measurements inthe diagnosis of coeliac trunk stenosis before and after Levovist injection -ROC curves analysisA. Drelich-Zbroja, T. Jargiello, W. Krzyzanowski, P. Kurczab,M. Szczerbo-Trojanowska; Lublin/PL

Purpose: To assess the diagnostic value of Vmax, Vmin, PI, RI measurements inthe diagnosis of coeliac trunk stenosis before and after Levovist injection.Materials and Methods: In 100 patients Doppler examination of coeliac trunkbefore and after Levovist injection was performed measuring Vmax, Vmin, PI, RI.In conventional Doppler 23 and after Levovist administration 29 stenoses werediagnosed. Number of diagnosed stenoses in relation to number of normal coeli-ac trunks was representative enough to perform the statistical analysis usingROC curves.Results: 1. The areas under curves (AUCs) for Vmax, Vmin, PI, RI, before andafter Levovist. 1a. Before Levovist: AUCVmax = 0.947*, AUCVmin = 0.860*,AUCPI = 0.537NS, AUCRI = 0.509NS. 2a. After Levovist: AUCVmax = 0.984*,AUCVmin = 0.918*, AUCPI = 0.551NS, AUCRI = 0.546NS.*p < 0.05 when compared with AUC = 0.5; NS-not significant when comparedwith AUC = 0.52. The comparison of AUCs for Vmax and Vmin before and after Levovist. AUCV-max after Levovist – AUCVmax before Levovist = 0.037NS, AUCVmin after Levo-vist – AUCVmin before Levovist = 0.058NS, AUCVmax before Levovist –AUCVminbefore Levovist = 0.087*, AUCVmax after Levovist –AUCVmin after Levovist =0.066*. *p < 0.05; NS-difference not significantConclusions: Only Vmax and Vmin are useful in the diagnosis of coeliac trunkstenosis. The diagnostic value of Vmax is significantly higher than diagnosticvalue of Vmin. The use of Levovist has no an effect on diagnostic value of Vmaxand Vmin.

C-946The effect of body mass index on the ultrasonographic measurements ofthe portal venous systemN. Tuncbilek1, O.O. Okten1, S. Guldiken1, H.M. Karakas2; 1Edirne/TR,2Malatya/TR

Purpose: The effect of body mass index (BMI) on portal venous diameter andpulsatility index was investigated.Materials and Methods: The study group consisted of 29 obese and 12 controlsubjects with normal BMI. Inferior vena cava (VCI) and portal vein (PV) diame-ters and their pulsatility indices (PI) were prospectively evaluated with 3.5 Mhzconvex transducer. Diametric measurements were employed in M-mode imag-ing. The difference between obese and normal subjects regarding above men-tioned parameters and their correlations with PI are investigated.Results: BMI varies between 16.8 and 22.2 kg/m2 in control, and between 28.3and 44.5 kg/m2 in obese subjects. In control subjects, mean PI is 0.65 for PV and0.75 for VCI. In obese patients, these values are 0.49 and 0.65, respectively. PIfor PV significantly differs between two groups (p < 0.01) whereas vascular di-ameters for VCI and PV, and PI for VCI are not statistically different. In both groupsthere is a negative correlation between PI and BMI (for control subjects: r = -0.415, p < 0.01; for obese subjects r = -0.519, p < 0.01).Conclusion: PI of the portal venous system is regarded as the surrogate markerof right cardiac function. However factors such as inspiratory and expiratory in-traabdominal pressure changes are known to affect this parameter. When con-sidering PI as a marker of right cardiac function, attention must be paid to therelation of PI and BMI, proved by this study to be one of these factors.

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C-947Significance of patent pyloric branch in hepatic arterial infusionchemotherapyS. Yoshioka, Y. Yasuhara, T. Murakami, S. Kumano, T. Mochizuki; Ehime/JP

Purpose: To investigate the clinical significance of the patent pyloric branchesafter right gastric artery (RGA) embolization for arterial infusion chemotherapy.Materials and Methods: Sixty-six patients who received catheter placement inthe hepatic artery for arterial infusion chemotherapy were retrospectively recruit-ed from the pool of clinical records between 1998 and 2003. Two interventionalradiologists reviewed the digital subtraction angiographies (DSAs) and clinicalrecords of these patients. They assessed the following items by consensus: 1)location of the RGA, 2) frequency of the patent pyloric branchs after coil embol-izaton of the RGA, 3) outcome of arterial infusion chemotherapy through thecatheter.Results: The location of the RGA could be determined in 58 patients. RGA-coilembolization was performed in 36 patients. In 7 patients, fine pyloric branchswere patent after embolization. They were too fine to be embolized by the cathe-ter technique. In 2 of these 7 patients, the catheter was successfully placed toavoid the drug infusion into the pyloric branch. The clinical outcome of the other 5patients were as follows: One patient received the arterial infusion chemotherapywithout any complication. One patient experienced transient abdominal pain inthe course of arterial infusion chemotherapy. Two patients received replacementof the catheter because of abdominal complication. The last patient received sur-gical ligation of the RGA because of reopening of the RGA.Conclusion: The frequency of abdominal complication in arterial infusion chem-otherapy was not negligible in the cases with patent pyloric branchs after RGAembolization.

Vascular

Miscellaneous

C-948Erdheim-Chester disease: Imaging featuresC. Graef, E. Dion, P. Cluzel, R. Renard-Penna, J. Haroche, B. Wechsler,C. Beigelman-Aubry, P.A. Grenier; Paris/FR

Learning Objectives: To be familiar with the radiologic features of Erdheim-Ches-ter disease, a rare form of non- Langerhans cell histiocytosis of unknown etiology.Background: The disease is characterized by tissue infiltration with lipid-ladenfoamy histiocytes, polymorphic granuloma of inflammatory cells and collagen fi-brosis. The patients have a mosaic of infiltrative involvement of various organs.Bone involvement is almost always present but often clinically asymptomatic.The prognosis depends on the severity of cardiovascular, renal or cerebral in-volvement. Imaging features of 10 histologically proven cases were reviewed.Imaging Features: Radiological bone involvement was present in all cases, char-acterized by bilateral and symmetrical spongy bone densification, cortical thick-ening and periostosis of long bones from the metaphysis to the diaphysisassociated with scintigraphic tracer uptake. Renal and perirenal involvement seenon CT scans consisted of bilateral and symmetrical perirenal tissue infiltration(hairy kidney) (n = 6), extended to the adrenal fossae, the renal sinuses, and theproximal ureters. Cardiovascular involvement consisted in 1) thoracic and ab-dominal circumferential periaortic tissue infiltration (coated aorta) with extensionto the coronary, supraaortic and pulmonary arteries, and abdominal branches, 2)stenosis of renal or mesenteric arteries (n = 3), 3) involvement of pericardium(n = 2) and myocardial mass (n = 1). Tissue infiltration involved pituitary in onecase and orbits in another one.Conclusion: A diagnosis of Erdheim-Chester disease should be considered inpatients who demonstrate bilateral and symmetric densification of the long boneswith increased uptake on scintigraphy in association with perirenal fat infiltrationand/or a periaortic fibrosis.

C-949Ultrasonography in the ICU: Basic physics technology and technique ofcritical US examinations (a DVD-based teaching file)A. Karampinis, D. Matamis, G. Momferratos, I. Mastorakou, D. Dalakostas,D. Schizas, S. Kiriazi, K. Chatzimichail; Athens/GR

Learning Objectives: To illustrate the main indications of US in emergency con-ditions of an ICU and explain the basic physics and technology of US machinesand probe positioning, in order to achieve quick production of useful diagnosticsemiology.Background: A series of US lectures on "US in Emergency Medicine and theICU" has been used as the main source of the educational material contained inthis teaching file. Only useful physics and technical information is furnished inorder to help a trainee become familiar with US equipment and probes. "Hands-on" video files are used to show the importance of probe positioning and to teachthe proper propagation of the US beam.Procedure Details: Basic technique and US semiology is presented for the mainUS examinations performed in the ICU: carotids (B-mode and color + power Dop-pler), arteries and veins of the lower extremities, transcranial doppler for the vis-ualization of the circle of Willis, heart (with the main indications of transesophagealprobe), abdominal and pelvic US. Emphasis is given on the US semiology inTraumatology.Conclusion: US is a crucial imaging technology with many critical indications inthe context of an ICU. Basic knowledge of physics technology and technique areimportant factors for the efficient use of this modality in the emergency care con-ditions.

C-950Vascular complications of injection drug useC.J. Johnston, C. Farrelly, M.T. Keogan; Dublin/IE

Learning Objectives: This poster demonstrates the wide range of vascular com-plications seen secondary to injection drug use, including both direct vessel dam-age and complication secondary to the substance injected.Background: Vascular complications secondary to injection drug use are com-mon and can be life-threatening. Adequate clinical assessment is difficult due tosurrounding inflammation and coexistent infection. Early imaging is important toplan appropriate modes of therapy.A search of our database of patients presenting with vascular injury secondary toinjection drug use was performed and their imaging studies reviewed.

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Imaging Findings: All degrees of local vascular damage were seen. Variousimaging modalities may be employed in characterising such lesions, includingCT, MRI and conventional angiography and venography. An addict may injure anyvessel during injection and the superficially placed femoral vessels are particu-larly susceptible to damage. Septic vascular complication is common.Arterial injury resulting in haematoma formation, arterial dissection and throm-bosis, arteriovenous fistula and mycotic aneurysm formation is shown. A case oftorrential haemorrhage from a ruptured pseudo-aneurysm treated with coil em-bolisation is demonstrated. Deleterious effects secondary to the injected sub-stance, including distal ischaemia and tissue necrosis, are demonstrated.Venous thrombosis is common and can be shown by multiple imaging modalities.Infected venous pseudo-aneurysms with secondary septic embolisation mayoccur.Conclusion: It is important for radiologists to become familiar with the appear-ance of vascular complications occurring in the setting of injection drug use. Ear-ly imaging to define disease extent and possible complication is important in thisdifficult patient group.

C-951Carotid intima-media thickness (IMT) relates to endothelial cell adhesionmolecule ICAM-1 in end-stage renal disease (ESRD) patientsM. Kalovoulos, A. Papagianni, V. Sygounas, D. Kirmizis, S. Dovas,A.-M. Belechri, E. Alexopoulos, G. Grollios, D. Memmos; Thessaloniki/GR

The aim of the study was to investigate the probable association of atherosclerot-ic disease with endothelial cell adhesion molecule ICAM-1, VCAM-1 and E-se-lectin levels. Carotid IMT was measured by high resolution ultrasonography ofthe common carotid arteries in 45 predialysis patients with ESRD, 83 patients onchronic haemodialysis (HD) and 35 controls. Compared with controls, ESRD andHD patients had increased IMT (p < 0.01 and p < 0.01 respectively), as well asserum ICAM-1 (p < 0.0001 and p < 0.0001 respectively) and VCAM-1 (p < 0.0001and p < 0.0001 respectively) levels. IMT was correlated with age in controls, ESRDand HD patients (p = 0.002, p = 0.001 and p = 0.0001 respectively). No correla-tion was found between IMT and other cardiovascular (CV) risk factors such asgender, lipid levels, mean arterial blood pressure, Ca x P products or HD dura-tion in HD patients. In univariate analyses, IMT was correlated with history of CVevents, logCRP and ICAM-1 both in ESRD (p = 0.01, p = 0.04 and p = 0.03 re-spectively) and HD patients (p = 0.04, p = 0.02 and p = 0.003 respectively). More-over, compared with patients with normal IMT, ESRD and HD patients withincreased IMT (> 0.82 mm) had increased ICAM-1 (p = 0.03 and p = 0.003 re-spectively). Multivariate analyses showed that ICAM-1 was a strong independentcorrelate of IMT values both in ESRD and HD patients (p = 0.03 and p = 0.004respectively). VCAM-1 and E-selectin levels failed to be a significant contributorto IMT. In conclusion, chronic uraemia is associated with advanced atherosclero-sis. In patients with ESRD, both on conservative treatment and on HD, ICAM-1levels are potentially a useful surrogate marker of the extent of atherosclerosis.

C-952Evaluation of tumor microvessels using monochromatic X-ray afteradministration of angiogenesis inhibitorT. Yamashita, S. Imai, N. Maehara, A. Yamamoto, M. Kobatake, Y. Kajihara;Kurashiki/JP

Purpose: To quantitatively evaluate changes in tumor microvessels using syn-chrotron radiation in vivo after FR-118487 administration as an angiogenesisinhibitor.Materials and Methods: The FR-118487 agent (using propylene glycol as a sol-vent) was continuously infused subcutaneously to 30 rabbits with VX2 carcinomaimplantation at auricles. The rabbits were divided into six groups: Control-3 andControl-7 received only propylene glycol for three or seven days, FR-1-3 and FR-1-7 received 1 mg/day/kg of FR-118487 for three or seven days, FR-3-3 and FR-3-7 received 3 mg/day/kg for three or seven days. Microangiograms using asynchrotron radiation system were obtained to evaluate the tumor microvesselsand tumor size.Results: Compared to Control-3 group, FR-x-3 groups showed no significanttumor size difference (FR: diameter = 4.03 ± 0.59 mm, volume =38.38 ± 8.48 mm3, Control-3: 5.07 ± 0.57 mm, 55.40 ± 8.41 mm3), but microan-giologically fewer vessels were observed. FR-x-7 groups presented significantdifference (FR: diameter = 5.37 ± 0.45 mm, volume = 68.02 ± 14.40 mm3, Con-trol-7: 9.91 ± 0.56 mm, 512.66 ± 71.14 mm3), and many irregular vessels, find-ings similar to Control-3. There was no significant difference in tumor size andmicroangiographic findings between FR-1-x and FR-3-x.Conclusion: Our study demonstrates the application of new technique to exam-ine antiangiogenic effects in vivo. The growth of the VX2 carcinoma were sup-

pressed remarkably in the FR-7-day-groups, and the microangiographic findingswere similar to those of Control-3. The synchrotron radiation microangiogram is auseful tool to evaluate antiangiogenic agent.

C-953Early atherosclerotic changes in HIV positive patients treated with proteaseinhibitorsM. Cristofaro, N. Petrosillo, L. Rovighi, C. Bibbolino; Rome/IT

Purpose: Antiretroviral therapies with protease inhibitors (PI) produce derange-ment of lipid metabolism with possible occurrence of early atherosclerotic chang-es. Aim of this study is to evaluate onset of early atherosclerotic changes ofepiaortic vessels in HIV positive patients, treated with PI.Materials and Methods: Eighty-four HIV positive patients, without symptoms ofvascular disease underwent Doppler US of epiaortic vessels (68 males, mean42 yrs old, range 24-65) and 118 consecutive HIV negative outpatients, non symp-tomatic for vascular disease, underwent neck US for suspected thirodeal pathol-ogy (58 males, mean 40 yrs, range 16-67). Intimal thickness and evidence ofatheromatis plaque (focal intimal and lamina media thickness > 1.2 mm) wereanalysed. Each patient was assessed for smoking behaviour, hypertension, dys-lipidemia and PI therapy duration (only HIV positive).Twenty-six percent (29/85) of HIV positive patients revealed hypercholesterolae-mia versus 19/118 (16%) among HIV negative group (p = < 0.005).Results: Among the HIV positive 27/84 (31%) had atheromatis plaques versus3/118 (2.5%) of controls (p = < 0.001). Intimal thickness was 0.99 mm amongHIV positive and 0.80 mm among controls (p = < 0.005).Conclusion: Preliminary data of our study suggest a high risk of occurrence ofatheromatis changes in epiaortic vessels of HIV positive patients treated with PIcompared to HIV negative controls.This study was supported by institutional research grant from INMI IRCCS L.Spallanzani Roma.

C-954Basical examination of an atherosclerotic protein-lipid composition modelfor the stabilization of atheroma by way of a photosensitivity agent orhematoporphyrinM. Machida, K. Kameyama, M. Onda, M. Endo, M. Hayashi, H. Tajima, Z. Naito,T. Kumazaki; Tokyo/JP

Purpose: Hematoporphyrin (HP) accumulates in arteriosclerosis selectively andshows specific fluorescence spectrum change in accordance with the stages ofthe sclerosis, and this fact is under discussion as to its availability to diagnosisand therapy. We paid our attention to the fact that HP accumulates in the inter-face of swollen collagen type IV and lipid. We assumed such a model of athero-ma, and we examined the possibility of a photodynamic therapy for arteriosclerosisusing collagen type IV and phosphatidyl choline liposome.Material and Method: We added HP to collagen type IV, then the liposome con-taining cholesterol to the mixture, and examined the agglutination state of theprotein-lipid complex. Afterwards, we irradiated that complex with LED pulse of680nm for one hour, and examined scattered spectroscopy, interference spec-troscopy using 680nm semiconductor laser and high sensitivity CCD in order toobserve the HP and the agglutination state of complex, and, then, analyzed thealteration of protein-lipid complex in terms of Fourier analysis.Result: HP gave influence to the various state of assembly of protein-lipid com-plex. In addition, protein-lipid integration state was changed by the irradiation oflight pulse and the change of scattered light that signifies the state of dispersionwas observed.Conclusion: This study suggested that the molecule composition of the protein-lipid complex in the plaque was changed by the irradiation of light pulse after theaddition of HP, and that the photo stimulation could contribute to the decomposi-tion of the cumulated lipid and the stabilization of plaque.

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C-955Optimized techniques for the labeling of human natural killer cells with ironoxide contrast agentsH.E. Daldrup-Link, G. Piontek, M. Rudelius, C. Uherek, J. Schlegel,E. Rummeny; Munich/DE

Purpose: To develop techniques for an efficient labeling of natural killer (NK)cells with iron oxide contrast agents and subsequent depiction of the labeledcells with a 1.5 T MR scanner.Materials and Methods: Human NK-92 cells were labeled with Ferumoxidesand Ferucarbotran using simple incubation, lipofection and electroporation tech-niques. Incubation times were varied from 2-24 hours and added contrast agentconcentrations were varied from 100-300 microgram Fe/1000000 cells. Pellets oflabeled cells and non-labeled controls were evaluated by MR imaging. The cellu-lar iron oxide uptake was proven by prussian blue stains and spectrometry as astandard of reference. In addition, cell viability was tested with the Trypan Blueexclusion test. Differences between labeled cells and non-labeled controls weretested for significance using the t-test.Results: NK-92 cells could be labeled with Ferucarbotran and Ferumoxides bylipofection and electroporation, but not simple incubation. Lipofection had to beperformed for 24 h, but resulted in only minor, not significant impairment of cellviablility (88-92%) compared to controls (96-98%), while electroporation causedcell labeling within seconds, but reduced the viablility of the cells significantly(61-74%), thereby necessitating additional cell culture time for cell recovery. Theintracellular iron oxide uptake was proven histologically and quantified by spec-trometry. Ferucarbotran and Ferumoxides-labeled cells could be depicted by asignificant signal decline on T2*weighted MR images.Conclusion: Human NK-92 cells can be labeled with Ferucarbotran and Feru-moxides by lipofection and electroporation. Optimized labeling techniques allowa subsequent cell depiction with a standard 1.5 T MR scanner.

C-956Which temporal frame rate is necessary in quantitative dynamic ³He-MRI?C. Heussel1, A. Dahmen1, F. Lehmann1, M. Salerno2, K.K. Gast1,H.-U. Kauczor1, J.P.I. Mugler2, E.E. de Lange2, W. Schreiber1; 1Mainz/DE,2Charlottesville, VA/US

Purpose: Dynamic ³He-MRI permits regional analysis of distribution ventilatorykinetics. Dedicated post-processing offers image-based lung function parame-ters. Sliding window reconstruction of interleaved-spiral acquisitions provides hightemporal rates, but do functional parameter values depend on the temporal framerate?Methods and Material: Single-slice coronal dynamic ³He-MRI was acquired con-tinuously for 15 s during free respiration. Image reconstruction was performedusing sliding window technique with 3.4 ms data sampling-time (repetition-time10 ms). Post-processing was performed using a self-written software with linearmotion correction for calculation of: Rise Time (TR, interval of lung-signal from10% to 90% of peak signal), delay-90 time (TD90, interval of trachea-signal 50%and lung-signal 90%), amplitude (peak lung-signal), and peak flow (PF, maxi-mum signal slope). Analysis was done for 6 ROIs using a temporal resolution of20 ms, 120 ms, and 240 ms (2nd, 12th, and 24th image). This study included 4exemplary patients (Asbestosis, 2 x Asthma, COPD) so far.Results: Post-processing of the data-sets lasted 30 to 120 mins at an actual PC(2.4 GHz P4, 2 GB RAM). TR ranged from 418 to 1707 ms (median 859 ms),TD90 ranged from 228 to 1427 ms (median 753 ms), amplitude ranged from 13to 557 a.u. (median 130 a.u.), PF ranged from 12 to 710 a.u. (median 207 a.u.).No relevant difference was detected in the evaluation of different temporal framerates for all patients or within an individual patient.Conclusion: Since these preliminary data suggest a limited effect of high tempo-ral frame rates, improvement of spatial rather than temporal resolution might bethe emphasis in the future.

C-957Anatomical and functional premotor correlations in supplementary motorarea lesionA. Krainik1, G. Marrelec1, H. Duffau1, P. Cornu1, L. Capelle1, A.-.L. Boch1,J.-.F. Mangin2, D. Le Bihan2, C. Marsault1, J. Chiras1, H. Benali1, S. Lehéricy1;1Paris/FR, 2Orsay/FR

Objective: To determine the compensatory mechanisms involved in recovery ofmotor function following resection of the supplementary motor area (SMA) andtheir relation to the clinical characteristics of recovery.Subjects and Methods: Thirteen patients referred for surgery of low-grade glio-mas located in the SMA were compared to nine healthy controls using fMRI be-fore and after surgery during self-paced movements of both hands, successively.Activation within regions of interest (ROIs) (primary sensorimotor cortex (SMC),premotor cortex (PMC), SMA) were compared and tested for correlation withanatomical characteristics of the tumor and resection, and clinical data. Interac-tion analysis between ROIs was performed using partial correlation.Results: Tumor growth induced preoperative underactivity in the adjacent SMAand overactivity in the opposite SMA. Postoperative recovery was associatedwith recruitment of the lateral premotor cortex in the healthy hemisphere. In theaffected hemisphere, pre- and postoperative correlations between SMA, PMCand SMC were decreased. In the healthy hemisphere, postoperative correlationsbetween PMC and SMA or SMC were increased. Shortened onset and durationof recovery was associated with preoperative changes in SMA activation.Conclusions: These findings suggest that tumors induced a dysfunction in acti-vation and connectivity of the ipsilateral SMA, which was partially compensatedby a recruitment of the SMA in the healthy hemisphere. This preoperative remod-eling of SMA activity did not prevent the occurrence of the postoperative deficitbut was associated with shortened recovery. SMA resection was compensatedby the recruitment of an ipsilateral premotor circuitry.

C-958The use of internet filters to build a radiology education and teachingresourceP. Davison, J. Revell, M.R. Rees; Bristol/UK

Purpose: To develop a resource for radiology undergraduate and postgraduateeducation from a series of research projects dealing with internet filter aidedsearch. Supported by a research and education grant from the EAR.Materials and Methods: Two independent research projects into internet searchwere examined for their application to radiology education and these methodswere compared to conventional image search protocols. This experience wastranslated into constructive advice for undergraduate students undertaking spe-cial study modules in radiology. The two internet filters developed were designedto improve accuracy of text search and to improve the search results from imagesearch enquiries in radiology and medical subjects. A second iteration of theimage search filter was developed to produce a web crawler that selected imag-es from previously carried out text searches. The text and image based filterswere tested with other search engines over a preset number of criteria.Results: Both the text based search facility and the image based facility showedadvantages when compared to conventional search methods. The image searchfacility was successful in handling medical searches compared to common searchengines and the web-crawler was efficient at producing a large number of imag-es from selected sites. These methods were used to develop medical studentsskills in the use of the internet and has been used in the construction of radiologyimage based special study projects.Conclusion: Web based filter programmes and education in search techniquescan result in improving the efficiency of internet based material for radiology ed-ucation.

C-959Single breath-hold subtraction: Novel approach to diagnosing pulmonaryembolism by multi-slice CT (work-in-progress)J.E. Wildberger1, A.H. Mahnken1, H. Ditt2, M.U. Niethammer2, E. Spüntrup1,E. Klotz2, R.W. Günther1; 1Aachen/DE, 2Forchheim/DE

Purpose: In the work-up of pulmonary embolism (PE), CT allows for direct visu-alization of emboli. In addition, perfusion defects permit direct assessment of theextent of PE, using color-coded lung densitometry. This new image processingtechnique has been deployed for a 4-slice multi-slice CT (MSCT) system. Forfurther improvement, a subtraction technique within a single breath-hold will bemandatory.Materials and Methods: Three healthy pigs underwent lung lavage to induce

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experimental lung injury prior to the CT examinations. In addition, segmental andsubsegmental pulmonary embolism was artificially induced in four healthy pigs.Scanning was performed using a 16-slice MSCT protocol (Sensation16; Siemens,Forchheim, Germany). All examinations were performed within a single breath-hold before and after contrast media delivery. Data were processed by a combi-nation of segmentation, non-rigid registration and normalized subtraction. Usingcontour finding and adaptive thresholding, both plain and enhanced CT volumeswere separated into lung parenchyma, vascular structures and airways. The highcontrast information was used to locally match and align sub-volumes. Thematched parenchymal volumes were low pass filtered, subtracted and normal-ized to the enhancement level in a major vessel.Results: Scanning was successfully performed during a total ~15 s scanningtime in all pigs. Post-processing was technically feasible, even in underlying ex-perimental lung injury. In PE, filling defects corresponded to areas of decreasedenhancement.Conclusion: It is expected that this imaging technique will increase the sensitiv-ity and specificity of MSCT, particularly in isolated segmental and subsegmentalPE.

C-960Assessment of the angioarchitecture and hemodynamic characteristics ofcerebral AVMs by contrast enhanced static and non enhanced dynamic MRangiographyM. Essig; Heidelberg/DE

Purpose: The aim was to improve the definition of the angioarchitectural compo-nents of the AVM based on a dynamic MRA (dMRA) and a high resolution 3Dmulti-bolus and multi-phasic contrast-enhanced MRA (CE-MRA). Both techniqueswill be compared with 3D-TOF-MRA and transfemoral high resolution plain filmangiography performed for treatment planning.Materials and Methods: DMRA will be performed by tracking a blood bolusthrough a vessel structure using the spin labeling technique STAR (Signal Tar-geting with Alternating Radiofrequency Sequences). Time-resolved CE-MRA willbe acquired with an ultrashort 3D fast low-angle shot (FLASH) sequence (TR/TE2.3/0.9 msec) using asymmetric k-space sampling in readout, phase-encoding,and partition directions.Results: All used sequences were successful in the assessment of patients' cer-ebral AVMs. The integration of acquired images into the treatment planning pro-tocol was possible for all modalities.The different AVM compartments, feeding arteries, AVM nidus, and draining veinswere detected easily and best on the dMRA. The method also allowed to hemo-dynamically assess the malformations: small AVMs generally showed shortershunt times, however, a short shunt-time was associated with a higher risk ofbleeding. CE-MRA also proved to be superior than TOF-MRA in the assessmentof the angioarchitecture, however, the time resolution of the dynamic varient wastoo slow to achieve a substantial hemodynamic characterisation.Discussion: DMRA and CE-MRA are better suited than TOF-MRA to assessAVM angioarchitecture. The differentiation of different compartments of the mal-formation and the hemodynamic assessment is best seen with dMRA.

C-961Diagnostic investigations in relation to determination of paramagneticcentres and free radicals in the model of testicular tumor metastasesM. Kekelidze, F. Todua; Tbilisi/GE

Purpose: To assess the possible connections between diagnostic imaging (spi-ral CT, MRI) of retroperitoneal metastases of testicular tumor and the detection ofparamagnetic centres and free radicals in the resected lymph node tissue afterretroperitoneal lymph node dissection (RPLND).Materials and Methods: 23 patients with stage I morphologically confirmed non-seminomatous testicular tumors were subjected to RPLND. Diagnostic imagingincluded abdominal spiral CT with IV contrast and MRI. Specific tumor markers(AFP, CGT) were detected. Highly sensitive (1010 -1011 spin/gas) electron para-magnetic resonance (EPR) of 46 resected lymph node tissue was performed todetect the presence of paramagnetic centres and free radicals (Fe2+, Mn 2+, N0)signals. CT or MRI scans were judged as positive or negative for Rp metastaseson the basis of size, contrast enhancement criteria and compared with morpho-logical and EPR data.Results: In 14 patients estimated as N0 on CT and MRI the increased signals offree radicals were revealed in 2 tissues. Among 9 patients (N1) with 18 resectedlymph node tissue, 5 showed low signals of Fe2+ Mn 2+ N0 and 13 material (mor-phologically confirmed as metastatic) high signals of free radicals, while the in-creased presence of paramagnetic centers were not detected in these tissues.Spiral CT and conventional MRI fail to detect micrometastases in 3 cases.

Conclusions: There exists real correlation (p < 0.02) between the increased sig-nals of free radicals (Fe 2+, Mn 2+, N0) and low stage metastatic lesions of Rplymph nodes, which can reflect the connection between particular molecular eventsand malignant degeneration.

C-962Diagnostic accuracy of Gadolinium-enhanced MR-angiography vs. contrast-enhanced helical CT in the diagnosis of pulmonary embolism in thepresence of lung infiltrate: An animal studyT. Franquet, S.E. Kalloger, A. Oikonomou, S.L. MacDonald, E.M. Baile,R.J. Mayo; Barcelona/ES

Purpose: To compare gadolinium-enhanced MR angiography with contrast-en-hanced spiral CT for the detection of small pulmonary emboli in pigs with andwithout pneumonia.Materials and Methods: Ten female juvenile pigs were anaesthetized, intubatedand ventilated. Sub-segmental sized pulmonary emboli were introduced by in-jecting 4.5 mm methacrylate beads into the external jugular vein. Lung infiltrateswere simulated by intra-bronchial injection of human plasma. Animals were im-aged in the supine position at suspended inspiration with 15 cm H20 PEEP. Con-trast media was injected via brachial vein. Dual gradient (TwinSpeed) 1.5 T MRimages were acquired using 3 dimensional spoiled gradient-echo time of flightsequence; TR 4.8 msec, TE 1.2 msec, 45* flip angle, 6 mm section thickness,32 cm FOV, 256 x 160 matrix, one average. Two MRA sets, pulmonary arterialand venous, were acquired in 39 seconds. Contrast enhancement was providedby 20 mL of Gd dimeglumine followed by 20 mL of normal saline, injected at2 mL/sec. Non-contrast and contrast enhanced CT images were obtained usingan 8 track spiral CT; 1.25 mm detector aperture, 90 mL contrast at 3 mL/sec.Subtraction perfusion images were calculated by subtracting contrast enhancedfrom non-contrast CT images. After imaging the pig was euthanized and a meth-acrylate cast of the pulmonary vasculature was obtained and used as a "gold-standard". CTA, CTA with subtraction perfusion images and MR images wereindependently interpreted by two observers in a blinded fashion.Results: No significant difference (p > 0.05) was seen between CTA, CTA withsubtraction perfusion images and MR for mean sensitivity (86%, 88% and 68%)or mean specificity (94%, 94% and 73%), respectively. No significant difference(p > 0.05) was seen in sensitivity or specificity between pigs with and withoutinfiltrates. A prospective power analysis based upon this preliminary data indi-cates that the addition of two more readers (N = 4) would yield significant differ-ences (p£0.05) between CTA and CTA with subtraction perfusion imagescompared to MRA for sensitivity and specificity.Conclusion: Preliminary results indicate that CTA and CTA with subtraction per-fusion images provide improved detection of sub-segmental sized PE in compar-ison to Gadolinium-enhanced MRA.

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