Insights into Imaging, Feb 2017

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- CONTENTS: Insights Imaging (2017) 7 (Suppl 1):S1–S583 DOI 10.1007/s1324P4-0o17s-05t4g6-5raduate Educational Programme A Postgraduate Educational Programme EFOMP Workshop (EF) ESR/EFRS meets Sessions (EM) European Excellence in Education (E³) Headline Sessions Joint Sessions Mini Courses (MC) Multidisciplinary Sessions (MS) New Horizons Sessions (NH) Professional Challenges Sessions (PC) Pros & Cons Session (PS) Refresher Courses (RC) Special Focus Sessions (SF) State of the Art Symposia (SA) Wednesday, March 1 ............... 3 Thursday, March 2 ................ 38 Friday, March 3 ..................... 78 Saturday, March 4............... 118 Sunday, March 5 ................. 166 Wednesday, March 1 08:30 - 10:00 E³ - ECR Academies: Interactive Teaching Sessions for Young (and not so Young) Radiologists 08:30 - 10:00 E³ 121 Emergency radiology I A-001 08:30 A. Brain trauma M. Smits; Rotterdam/NL () Neurotrauma is a major cause of death and disability and accounts for up to 10% of all emergency department visits. Most patients with head trauma are classified as having minor head injury, defined as no or brief loss of consciousness, amnesia and a Glasgow Coma Score (GCS) of 13-15. Brain injury is, however, fatal in 10% of all head injury patients, while 5-10% suffer permanent serious neurological deficits. A further 20-40% of patients are left moderately disabled. CT is the modality of choice for assessment of brain injury in the acute setting, while MRI is more commonly used as a secondary modality in the subacute or chronic stage. Direct consequences of brain injury include fracture, contusion, haematoma and vascular injury, which are generally well known and easily appreciated. Findings of indirect consequences, however, such as herniation, brain swelling and vascular complications, are sometimes subtle and easy to overlook. In this case-based presentation, I will outline the common findings of direct brain injury consequences and specifically focus on the less common findings of indirect consequences. Learning Objectives: 1. To understand the different types of brain trauma. 2. To become familiar with the differential diagnosis. A-002 09:15 B. Peripheral vascular injury J. Ferda; Plzen/CZ () Penetrating vascular trauma is caused by direct vessel damage, which exhibits visible bleeding with an extensive blood loss. Blunt trauma injures vessels by crushing, distraction or shearing which leads to dissection, thrombosis and consequent ischaemia and/or invisible bleeding. Unrecognised and uncontrolled haemorrhage can rapidly lead to the demise of the trauma patient. Unrecognised and untreated ischaemia can lead to limb loss, stroke and multiple organ failure. Proper imaging has to be done to recognise the vascular injury and to decide if surgical or endovascular repair should be used. In injuries caused by high energy and/or high velocity, CT angiography is the method of choice to determine the site of active extravasation or the vessel occlusion even if the patient is in the condition of centralised circulation. Some bleedings are delayed after restoration of systemic blood pressure, especially in pelvic region. In low-energy low-velocity trauma, the development of the signs of vascular trauma could be hidden - ultrasound aims to detect the pseudoaneurysms as well as the intramural haematoma or thrombosis. The imaging of the bleeding artery or occluded vessel is crucial to consequent therapy. The injuries with tissue loss and destruction of the skeleton are preferably indicated to surgical treatment. Where it is possible to penetrate the injured segments by the wire, the endovascular approach is preferable, with the exception of the simple embolization to stop bleeding. During the presentation, the illustrative cases of penetrating injury, the blunt injury including the crossroads of imaging and treatment will be shown. Learning Objectives: 1. To understand the different types of peripheral vascular injury. 2. To become familiar with the different imaging techniques. 3. To become familiar with interventional treatment options. RC 101 Assessing inflammation and fibrosis in Crohn's disease A-003 08:30 Chairman's introduction A. Laghi; Latina/IT () Diagnostic imaging plays a major role in the decision-making process of patients affected by Crohn’s disease (CD), both at the time of diagnosis and throughout the course of the disease. One of the most relevant clinical problems in current management of patients affected by CD is represented by the assessment of inflammation and fibrosis. The two entities should not be considered separately, since they coexist in most of the patients. A correct quantification of the prevalent entity is extremely important, since the patient should be referred for medical therapy if inflammation predominates, whereas either endoscopic dilatation of the stricture or surgery becomes necessary if fibrosis is prevalent. Cross-sectional imaging (CSI) modalities, including ultrasound (US), multidetector-CT (MDCT) and MR imaging (MRI), can provide useful information, particularly for inflammation, less for fibrosis. Contrastenhanced US (CEUS) has been shown to correlate with disease activity and severity, in comparison with endoscopic score of severity. Data about CEUS and fibrosis are controversial, although a quantitative data analysis seems the most valuable approach. Very promising results have been recently obtained with US elastography. Current data with MDCT highly correlate with disease activity and severity, but not with fibrosis. Dual-energy analysis might improve MDCT performances. MRI correlates not only with inflammation, but also with fibrosis, particularly if multiparametric analysis is performed. This analysis includes the evaluation of pattern of enhancement, late enhancement and the analysis of T2 signal. In the next future, other MR techniques are under evaluation, such as T1 mapping and magnetization transfer contrast. A-004 08:35 A. Is sonography (CEUS and elastography) the right tool? E. Quaia; Edinburgh/UK (equaia@ex Crohn’s disease (CD) is a chronic transmural inflammatory disease of the gastrointestinal tract which can be assessed by ultrasound. Unenhanced ultrasound may evaluate the localization and the length of the affected intestinal segments and may suggest the presence of mural fibrosis based on the layered appearance of the bowel wall. Contrast-enhanced ultrasound of the bowel is performed by wide-band transducers including the microbubble resonance frequency. Contrast-enhanced ultrasound has become an important imaging modality in patients with CD for the grading of disease activity, the differentiation between small bowel stricture due to inflammation or mural fibrosis, and for the assessment of the response to specific pharmacologic therapy. New dedicated software packages allow the accurate quantification of the enhancement within the small bowel wall after microbubble contrast agent injection to obtain different kinetic parameters - percentage of the maximal enhancement, the time-to-the peak enhancement, and the area under the timeintensity curve - which may differentiate mural inflammation from fibrosis and responders from non-responders to the specific pharmacologic therapy. The main advantage of contrast-enhanced ultrasound in the real-time assessment of the perfusion of the bowel wall but the scan is necessarily limited to one single loop each time. US real-time elastography can be considered an additional tool to complete US assessment of the bowel wall in patients with CD. US real-time elastography allows to assess the bowel wall stiffness to distinguish acute inflammation from fibrosis in patients with CD and increases the diagnostic confidence if compared to contrast-enhanced US alone. Learning Objectives: 1. To learn about CEUS technique, including imaging acquisition and data post-processing. 2. To become familiar with US elastography, particularly with those techniques useful in the assessment of the small bowel. 3. To understand potential advantages and possible limitations of CEUS and elastography in the assessment of inflammation and fibrosis in Crohn’s disease. Author Disclosure: E. Quaia: Speaker; Bracco Imaging and GE Healthcare Board Speaker. A-005 08:58 B. Is there space for MDCT (spectral imaging, iodine map)? J. Podgorska; Warsaw/PL () Many aspects of managing patients suffering from Crohn’s disease (CD) remain unclear. It is still unknown which factors trigger disease chronicity, and which promote the development of intestinal fibrosis. On the other hand, antiinflammatory treatment such as steroids, immunosuppressants and anti-TNFalpha have serious side effects; moreover, the decision for surgical treatment is also difficult. Because of many factors that influence the disease management, there is a strong need for a reliable tool of inflammatory activity and fibrosis assessment. Recently, apart from MR enterography (MRE), CT enterography (CTE) is being used to detect and monitor intestinal inflammation. Bowel wall and mesenteric changes such as mural thickening and hyperenhancement, increased attenuation of perienteric fat, and mesenteric hyperaemia have been reported to indicate CD activity. Recently introduced dual-energy CT modality allows creating monochromatic spectral images at energy levels ranging from 40 to 140 keV and water and iodinebased material decomposition with quantitative analysis. This method has already been applied in abdominal imaging, e.g. urinary stones, renal cell carcinoma and hepatocellular carcinoma. There are also preliminary reports about implementation of spectral imaging in CTE technique for an objective assessment of Crohn’s disease activity and coexistent fibrosis. The aim of this lecture is to give an overview of the CTE bowel inflammatory changes, and the possible advantages of spectral imaging for assessing activity and fibrosis in CD. Learning Objectives: 1. To understand basic principles of spectral imaging, including data postprocessing. 2. To appreciate the strengths and limitations of spectral imaging in the abdomen. 3. To learn about advantages and possible limitations of spectral imaging in the assessment of inflammation and fibrosis in Crohn’s disease. A-006 09:21 C. Will MRI (DWI and perfusion) solve the problem? S.A. Taylor; London/UK () Crohn's disease (CD) is a relapsing and remitting inflammatory condition of the GI tract. Clinical management essentially resolves around use of immunosuppressive medication and surgery. Crucial to clinical decision making is assessment of the underlying inflammatory activity, those with active inflammatory disease tend to undergo immunosuppressive therapy whereas those with fibrosis may benefit from surgical resection. In reality, however, inflammation and fibrosis tend to coexist. Both DWI and perfusion are abnormal in CD. However, the relationship between both DWI and contrast enhancement and the histopathological phenotype is complex. Whist data suggest active Crohn's disease tends to result in restricted DWI, the balance between increased inflammatory infiltrate and tissue oedema influences ADC values and recent data using surgical resection specimens suggest fibrosis also leads to restricted diffusion. Similarly, whilst perfusion tends to increase in active CD, tissue angiogenesis which increases in chronic disease also affects contrast uptake. Enhancement patterns may help radiologist grade activity. For example, a layered enhancement pattern is reported in active disease, but again overlap with fibrosis is seen. Recent data suggest delayed contrastenhanced sequences at around 7 minutes can help quantify fibrosis. This presentation will describe clinical protocols used to acquire DWI and perfusion imaging in CD and present the data as to their utility in clinical practice. Learning Objectives: 1. To understand basic principles of DWI applied to Crohn’s disease. 2. To learn about MR-perfusion protocols and data analysis. 3. To learn about advantages and possible limitations of MRI in the assessment of inflammation and fibrosis in Crohn’s disease. Author Disclosure: S.A. Taylor: Investigator; Robarts. 08:30 - 10:00 RC 104 Pneumonia A-007 08:30 Chairman's introduction I.E. Tyurin; Moscow/RU () Pneumonia is a major health care and economic problem because of high morbidity and mortality rate, and due to direct and indirect costs of its management. The most common cause is community-acquired pneumonia, caused by common bacteria like S. Pneumonia as well as different viral agents. Tuberculosis is one of the most important respiratory infections in developing countries and in immune-compromised patients with AIDS everywhere. Tuberculosis pneumonia can easily mimic bacterial CAP and other pulmonary infections. Viral and mycotic infections represent a common course of febrile neutropenia in immune-compromised patients under aggressive therapy. In most of all these patients, a diagnosis is made on the basis of a combination of clinical, radiographic, and laboratory findings. Highresolution CT is usually performed in patients with nonspecific clinical and radiologic findings and in patients with progression of disease despite therapy. A large number of acute and chronic infectious and noninfectious diseases may also result in parenchymal lung disease in both immune-competent and immune-compromised patients. Thin section CT is also performed in patients with noninfectious causes of acute parenchymal lung disease such as organizing pneumonia, acute interstitial pneumonia, hypersensitivity pneumonitis, acute eosinophilic pneumonia, pulmonary oedema and haemorrhage. These diseases often have clinical and functional features similar to one another but obviously requiring different treatment. Therefore, the differential diagnosis of these entities is important in daily clinical practice. Session Objectives: 1. To review the role of imaging in infectious lung diseases. 2. To become confident in recognising typical patterns. A-008 08:35 A. Community-acquired pneumonia I. Hartmann; Rotterdam/NL () Community-acquired pneumonia (CAP) refers to pneumonia acquired outside of hospitals or extended-care facilities and is one of the most common infectious diseases. CAP is an important cause of mortality and morbidity worldwide. According to the IDSA/ATS/AAFP guidelines, a chest radiograph is required for the routine evaluation of patients with suspected CAP to exclude conditions that mimic CAP (e.g., acute bronchitis) and to confirm the presence of an infiltrate compatible with the presentation of CAP. Although chest radiography findings usually do not allow identifying the causative organism, they may be helpful in narrowing down the differential diagnosis, prognosis, and detection of associated conditions. Serial chest radiography can be performed to observe the progression of CAP. CT scanning is increasingly used in clinical practice. Performing CT should be considered if any of the abnormalities at presentation or at follow-up are not consistent with the diagnosis of pneumonia, if concomitant disease is suspected such as an underlying bronchogenic carcinoma, for the confirmation of pleural effusion, and for the detection of pulmonary complications. The aim of the presentation is to provide an overview of the imaging findings of the most common aetiologic organisms in patients with CAP. In addition, imaging findings that may help in the differentiation between pneumonia and other common noninfectious causes of abnormal chest radiographs in patients with suspected CAP will be discussed. Learning Objectives: 1. To appreciate the role of imaging in the management of community-acquired pneumonia. 2. To consolidate knowledge of how to discriminate from noninfectious diseases. A-009 08:58 B. Tuberculosis E. Castañer; Sabadell/ES () Pulmonary tuberculosis (TB) remains a common worldwide infection that produces high mortality and morbidity, especially in developing countries. In 2013, an estimated 9.0 million (360 000 of whom were HIV-positive) people developed TB and 1.5 million died from the disease. Chest radiographs play a major role in the screening, diagnosis and response to treatment of patients with TB. However, the radiographs may be normal or show only mild or nonspecific findings in patients with active disease. We will review the chest radiograph findings of TB, which vary widely in function of several host factors, age, prior exposure to TB, and underlying immune status. CT is useful, in detecting TB incidentally, in resolving cases with inconclusive findings on chest radiographs and in assessing disease activity. Cavities, centrilobular nodules and tree-in-bud appearance are the most common CT findings of active pulmonary tuberculosis. We will discuss the classic, and some not-so-classic, signs that should suggest the diagnosis of TB. Learning Objectives: 1. To appreciate typical and atypical tuberculosis manifestations on imaging. 2. To differentiate between acute and chronic tuberculosis infection. A-010 09:21 C. Fungal pneumonia in immunocompromised hosts C.P. Heussel; Heidelberg/DE () The radiological characterisation of infiltrates gives a first and rapid hint to differentiate between different types of infectious (e.g. typical bacterial, atypical bacterial, fungal) and non-infectious aetiologies. Follow-up investigations need careful interpretation according to disease, recovery, concomitant treatment and eventually vessel erosion requiring contrast-enhanced angio-CT. Due to a high incidence of fungal infiltrates in immunocompromised hosts, interpretation of the follow-up of an infiltrate must use further parameters besides the lesion size. Learning Objectives: 1. To learn the patterns of fungal lung infection depending on the type of immune depression. 2. To become familiar with CT signs suggesting angioinvasive fungal infection. Author Disclosure: C.P. Heussel: Consultant; Schering-Plough, Pfizer, Basilea, Boehringer Ingelheim, Novartis, Roche, Astellas, Gilead, MSD, Lilly, Intermune, Fresenius, Olympus. Grant Recipient; Siemens, Pfizer, MeVis, Boehringer Ingelheim. Patent Holder; Method and Device For Representing the Microstructure of the Lungs. IPC8 Class: AA61B5055FI, PAN: 20080208038, Inventors: W Schreiber, U Wolf, AW Scholz, CP Heussel. Shareholder; Stada, GSK. Speaker; Gilead, Essex, Schering-Plough, AstraZeneca, Lilly, Roche, MSD, Pfizer, Bracco, MEDA Pharma, Intermune, Chiesi, Siemens, Covidien, Pierre Fabre, Boehringer Ingelheim, Grifols, Novartis, Basilea, Bayer. 09:44 Panel discussion: What is the role of radiologists in the diagnosis and management of lung infections? 08:30 - 10:00 ESR Working Group on Ultrasound WG 1 Ultrasound of the lung parenchyma: a diagnostic tool for the paediatric radiologist or for the clinician? Moderator: C. Owens; London/UK A-011 08:30 How I perform and interpret lung parenchymal ultrasound M. Riccabona; Graz/AT () The objective of this presentation is to present and discuss the role, the potential and the limitations of ultrasonography (US) in paediatric lung and chest conditions. The technical equipment, transducer selection and device setting will be listed. Furthermore, the course of the examination is demonstrated. Requirements for standardisation will be discussed, such as sitting position for quantifying potentially associated effusions. Typical queries that can be addressed by US will be listed and normal as well as abnormal findings will be demonstrated. Besides the great potential of US in pleural and lung conditions, limitations have to be respected and artefacts have to be known to avoid pitfalls and mismanagement. Particularly, one needs to accept that US cannot replace plain film or chest CT, despite its huge potential for many queries. Lung (and chest) US have become a valuable tool for addressing chest conditions in childhood both for diagnosis as well as for follow-up. US helps to reduce other irradiating imaging, but restrictions and artefacts have to be acknowledged and other imaging such as plain film and CT need to be considered as additional methods helping to solve sonographically equivocal findings. Learning Objectives: 1. To define technical requirements and main protocols for use in lung ultrasound. 2. To describe normal and abnormal findings in childhood. 3. To understand artefacts and limitations in lung ultrasound. A-012 08:55 How does lung parenchymal ultrasound change the clinical management of the sick child: the paediatric radiologists' perspective P. Tomà; Rome/IT () The imaging of the chest in paediatrics needs a specific cultural approach planned to integrate and optimise the techniques available. The prevalence of air represents a particular challenge for the radiologist. It limits the intrathoracic ultrasound (interfaces between soft tissue and lung generate very strong echoes due to a large acoustic impedance gradient), is a problem for the MRI (low proton density and the susceptibility differences between tissue and air), determines an excellent contrast resolution for the conventional radiology and CT that remains the gold standard. Technically, CT is conditioned by a cost/benefit ratio that means dose/diagnosis relationship. Risk of chest PA and lateral is negligible. Classical indications for chest US (in the presence of an acoustic window) are opaque hemi-thorax, assessment of vascular abnormalities, evaluation of diaphragmatic motion and juxta-diaphragmatic processes, detection characterisation of a suspected mediastinal disease, evaluation of chest wall lesions, to confirm and characterise pleural effusions guiding for pleural drainage procedures. New extensive use of sonography as clinical portable tool takes information also from physical acoustic phenomena that are not directly convertible into images of the human body. These artefacts are non-anatomical images, which are at best a sensitive but, unfortunately, a very nonspecific sign of lung injury common to many conditions. Young paediatric radiologists can easily learn the traditional chest ultrasound and they should know strengths and weaknesses of “new” imaging. Learning Objectives: 1. To discuss the appropriate use of US, x-ray, CT and MRI in the management of children presenting with thoracic diseases. 2. To define if and how paediatric radiologists should be trained in chest US. 08:30 - 10:00 Special Focus Session Room O A-013 09:20 How does lung parenchymal ultrasound change the clinical management of the sick child: the clinicians' perspective L. Cattarossi; Udine/IT () In the last two decades, lung ultrasound (LUS) has become popular both in adult and children for the clinical evaluation of pulmonary diseases. In neonatal and paediatric age, LUS has been utilized by the clinician as point of care tool to address the decision making process. LUS features of the most common neonatal respiratory diseases (respiratory distress syndrome, transient tachypnoea of the newborn, meconium aspiration, pneumothorax, pleural effusion, pulmonary haemorrhage) as well as its functional application on the respiratory therapy will be presented. Learning Objectives: 1. To illustrate the role of bedside lung parenchymal US in comparison with xray and CT in management of sick children. 2. To define and discuss the paediatricians perspective. SF 1 Assessing age, based on bone maturation: scientific and ethical aspects A-014 08:30 Chairman's introduction K. Rosendahl; Bergen/NO () Age assessment is an important, yet complex and challenging issue that authorities may need to perform to determine whether an individual is an adult or a child in circumstances where their age is unknown. There is currently no method which can identify the exact age of an individual and there are concerns about the invasiveness and accuracy of the methods in use, namely analysis of documentary evidence, interviews, physical or other form of medical examination such as imaging. The main imaging methods include carpal, collar bone and dental examinations. Whilst many countries make use of these methods they do not apply them in the same way and often use different combinations and/or order. One of the main reasons for this is the fact that age assessment procedures remain to a large extent determined by national legislation, with procedures evolving through national jurisprudence (Ref.: European Asylum Support Office (EASO Age Assessment Practice in Europe)). During this session, different methods of bone age assessment, their precision and accuracy will be addressed by experts within the field, followed by a presentation/discussion on ethical and legal aspects of using bone age to determine age. Session Objectives: 1. To become familiar with current indications for bone age assessment. 2. To learn about the methods' precision and accuracy. 3. To appreciate the caveats in using bone maturation to determine chronological age. A-015 08:35 Bone age assessment: indications and methods F. Dedouit, P. Baumann, T. Uldin, S. Grabherr; Lausanne/CH () The use of appropriate methods for determining the age is necessary for medical, medico-legal, and sporting contexts. Paediatric endocrinologists have an important interest for bone maturation to evaluate children for advanced or delayed growth and physical development. The developmental status of a child can be assessed by analysing various parameters such as height, weight, secondary sexual characteristics, bone age (BA) and dental age. The factors determining a normal skeletal maturational pattern are not clearly defined; however, genetic, nutritional, metabolic, social and emotional as well as environmental factors and hormones have an impact on bone development. BA assessment is a common procedure used in the management of children with various endocrinopathies and growth disorders. A significant discrepancy between BA and chronological age (CA) indicates abnormalities in skeletal development. When integrated with other clinical findings, clinicians can separate the normal from the relatively advanced or retarded physical development. The literature concerning age assessment, especially hand and wrist radiographies is oversized. Besides chronological methods, some morphological methods can be performed with a citation method (TannerWhitehouse, Fels, Sempé, Fishman) or with an atlas (Greulich and Pyle [GP], Gilzang-Ratib, Thiemann-Nitz-Schmeling). Different automated software have been developed for this purpose. The future seems to be represented by nonionizing techniques like MRI. Nevertheless, the GP atlas, published in the 1950s, is still the most world-wide used method, although the reference sample compared to contemporary European population presents a different socioeconomic status and a different ethnics. Learning Objectives: 1. To learn about current medical indications for bone-age assessment. 2. To become familiar with the different methods. 3. To understand the differences between the different methods. A-016 08:50 Precision and accuracy of an automated radiographic method H.H. Thodberg; Holte/DK () The automated method for assessing bone age from radiographs has recently been extended up to 19 years of bone age for boys. The precision of the automated method is defined as its ability to give the same results on repeated x-rays of the hand, and it is reported as the SD = 0.18 years of such repeated determinations. Manual reading by different rater has a precision error of SD = 0.58 years. The accuracy of the automated method is defined as the SD error when compared to manual rating and it has been determined to be 0.75 years, when comparing to a single rater and to 0.52 years when compared to the average of many raters. When the automated method is used to predict the age, the accuracy is larger, with SD approx. 1 years. This holds for Caucasians in Western Europe; for other populations, the age assessment is biased to the extent that maturation proceeds differently in these populations. This has been studied by the automated method by presenting bone age reference curves, where the average bone age advancement (i.e. average BA-CA, BA = bone age, CA = chronological age) is shown versus CA. Such curves have been established for eight populations. The magnitude of BA-CA can be up to 1 year, in particular at the end of puberty. Such differences should be taken into account when using bone age to estimate age, so new studies need to be performed in countries wherefrom asylum seekers originate. Learning Objectives: 1. To learn about an automated radiographic method. 2. To understand the difference between the method’s precision and its accuracy. 3. To acknowledge the need for different reference standards by ethnicity. Author Disclosure: H.H. Thodberg: Owner; Owner of Visiana, which develops and markets the BoneXpert method. A-017 09:10 Precision and accuracy of MRI S. Diaz; Stockholm/SE () Magnetic resonance imaging (MRI) emerged as a potential technique in the assessment of bone age maturity in the context of international football competitions supported by the Fédération Internationale de Football Association - FIFA - due to the need to estimate the ‘real’ age of healthy adolescent football players. Meanwhile, the clinical use of MRI in the assessment of bone age is limited to the field of endocrine disorders related to alterations in developmental age. Lately, and due to war situation in different countries, MRI has been proposed as a forensic tool to establish the age of migrant unaccompanied children without official documents evidencing their ‘real’ age. MRI technique not only avoids the radiation that conventional radiography leads to but also provides detailed image of the growth plate. With this purpose, several groups in the world have been working with different magnetic fields (0.2, 0.3, 1.5, 3T), sequences and gradients (T1 tse, ge, vibe/flash, T2, PD, FFE), body areas (wrist, hand, clavicle, knee, ankle), grade scales and consequently with different results. The majority of the studies have been conducted with males and Caucasians. No consideration regarding other potential factors of influence such as ethnicity, gender, height and weight, nutritional level and socioeconomic factors was taken into account. Whatever the purpose to use MRI for assessment of bone age, there is a pressing need to coordinate our efforts to get consensus not only elaborating standard MRI protocols and grade scales to use, but also in other influencing factors. Learning Objectives: 1. To learn about MRI in the assessment of bone age. 2. To become familiar with the method's precision and accuracy. 3. To appreciate potential pitfalls. A-018 09:30 Ethical and legal aspects of using bone age to determine age K. Chaumoitre; Marseille/FR () Numerous bone age (BA) methods have been used by clinical practitioners in assessing growth or developmental disorders. BA does not reflect the child’s chronological age, which is an objective element that does not take account of individual variability. Many studies carried out in diverse populations have not always yielded concordant results, but one constant finding emerges: large individual variability exists whatever the method. A princeps study, revealed a link between socioeconomic, health level and BA. The existence in the Greulich and Pyle (GP) atlas of age categories of up to 19 years in boys may perpetuate the illusion that the GP atlas enables classification of individuals aged under or over 18 years. It appears indispensable to apply the recommendations of the Study Group for Forensic Age Estimation. To assess the age of persons who are assumed to be at least 18 years, an additional CT examination of the clavicles is possible. The use of methods of BA estimation in a judicial context raises a number of ethical problems, especially for a delinquent minor. The width of the prediction intervals and the limits of agreement make it possible to emphasize some restrictions when a BA method is used to estimate the age of an individual in a judicial context. In individuals with a bone age of more than 10 years, the prediction interval is nearly 4 years. This raises the question of whether it is relevant to use bone age in judicial context. Learning Objectives: 1. To understand the difference between bone age as "a marker of disease", and "a substitute for age". 2. To become familiar with ethical aspects. 3. To appreciate legal aspects. 09:50 Panel discussion: Should bone age be used to estimate chronological age - alone or in combination with additional methods? 08:30 - 10:00 Head and Neck RC 108 Head and neck imaging: don't sell your ultrasound yet! Moderator: D.W. Tshering Vogel; Berne/CH A-019 08:30 A. Salivary gland imaging with ultrasound P. Gołofit; Koszalin/PL () Ultrasound examination is often the first-line modality for imaging patients suspected of having salivary gland disease. Indications for this procedure include swelling with suspected sialadenitis or obstructing calculus, autoimmune diseases, palpable solitary or multiple masses suggestive of a benign or malignant neoplasm or floor of the mouth lesion. A thorough knowledge of the anatomy is crucial for reliable diagnosis of the pathology in this area. Although having considerable limitations (e.g. limited visualization of the deep lobe of the parotid gland) ultrasound can be very useful in selecting patients who require CT or MR imaging, provide biopsy guidance and, in some cases, gives the final diagnosis. Learning Objectives: 1. To understand the limitations of clinical examination. 2. To learn about the diagnostic approach to salivary glands. 3. To appreciate how to differentiate salivary gland pathology. A-020 09:00 B. Masses of the soft parts of the neck P.K. Srivastava; Lucknow/IN () The neck constitutes a broad anatomic region, which has many aero-digestive, salivary glands, lymphatic, endocrine, neural and vascular structures. A good number of pathological conditions affecting these organs system are very well evaluated on high-resolution ultrasound. It is also very useful for ultrasoundguided needle aspiration for cytology, culture and hormone assay, ultrasoundguided core biopsy and molecular markers. The excellent tissue details and anatomical landmarks in the neck such as thyroid cartilage, trachea, strep muscles and neck vessels have made assessment of the neck masses a practical proposition. The neck masses are divided into two major groups: 1. thyroid neck masses; 2. non-thyroid neck masses. The non-thyroid neck masses include congenital masses, cervical masses, lymph node mass, salivary gland masses, nerve tumours, vascular masses, inflammatory masses, parasitic infestations, foreign body, benign and malignant neck tumours. Highresolution ultrasound is a multi-planner, non-invasive, cost-effective imaging modality which is having advantage of CT scan and MRI as the spatial resolution of ultrasound is much better than CT and MRI. The biggest advantage is that it is a dynamic modality which does not require any sedation or special preparation for evaluation of neck masses. The excellent tissue characterization of various structures in the neck on ultrasound clearly differentiate different pathology. The 3D ultrasound with multi-planner, panoramic and colour flow imaging increases the diagnostic accuracy. Learning Objectives: 1. To become familiar with cervical ultrasound anatomy. 2. To learn about benign neck masses. A-021 09:30 C. Lymph nodes: differential diagnosis and fine-needle aspiration R. Maroldi; Brescia/IT () There are several clinical scenarios where imaging is required to investigate the neck lymph nodes. 1. Imaging is indicated to integrate the clinical examination in the evaluation of unknown neck masses. In this clinical setting, the first task of imaging is to differentiate between non-nodal lesions and adenopathies. If the clinical examination cannot detect a primary neoplasm in the head and neck area, fine-needle aspiration (FNAC) is indicated. Ultrasound (US) is the technique of choice for the initial evaluation and for FNAC. 2. In case of acute/subacute neck infection with enlarged adenopathies, imaging is required to assess nodal changes (abscess), spread outside the lymph node capsule, potential extent into deep neck spaces, with great risk of mediastinal involvement. While US can be accurate in assessing superficial cervical node changes, CT with contrast agent is indicated to survey the deep spread of infections. 3. If a malignant neoplasm arising from the mucosa of the upper aerodigestive tract (UADT) is identified at clinical examination, imaging techniques are required to detect nodal metastases in the ipsilateral (if the primary tumour arises far from midline) and the contralateral neck. Besides detecting the abnormal node, extra-nodal spread and key vessels invasion (carotid, jugular vein) are key information to be acquired by imaging. US, MDCT and MR can be used: their greatest limitation is the low sensitivity for non-enlarged metastatic nodes. A different setting is the assessment of thyroid papillary carcinoma where microcalcifications inside even very small metastatic nodes can be detected by US. Learning Objectives: 1. To get acquainted with normal and abnormal findings. 2. To understand the patterns of nodal involvement. 3. To learn about technique of fine-needle aspiration. 08:30 - 10:00 Professional Challenges Session PC 1 Will emerging technology replace the radiologist? A-022 08:30 Chairman's introduction L. Donoso; Barcelona/ES () Call it artificial intelligence, deep learning, cognitive computing; whatever its name, it is the same thing, machines recognizing clinical problems in digital images ahead of the radiologists charged with making the diagnosis. Regardless of whether machine- or human-based aids are leveraged, radiology needs such aids. Never has improving performance been so important to its future. The liquid biopsy as a test is done on a sample of blood to look for cancer cells from a tumour that are circulating in the blood or for pieces of DNA from tumour cells that are in the blood. A liquid biopsy may be used to help find cancer at an early stage. It may also be used to help plan treatment or to find out how well treatment is working or if cancer has come back. The clinical impact of these developments together with the ones in molecular imaging, quantification and biomarkers will be discussed in this session. Session Objectives: 1. To become familiar with the emerging technologies in the imaging field. 2. To learn about the new concepts behind the computerised image analysis and diagnosis. 3. To understand the potential benefits and threats related to its implementation. A-023 08:35 Computer-aided and computer-determined diagnosis K.J. Dreyer; Boston, MA/US As computers outperform humans at complex cognitive tasks, disruptive innovation will increasingly remap the familiarity with waves of creative destruction. In healthcare, nowhere is this more apparent or imminent than at the crossroads of radiology and the emerging field of clinical data science. As leaders in our field, we must shepherd the innovations of cognitive computing by defining its role within diagnostic imaging, while first and foremost ensuring the continued safety of our patients. If we are dismissive, defensive or selfmotivated, industry, payers and provider entities will innovate around us achieving different forms of disruption, optimized to serve their own needs. To maintain our leadership position, as we enter the era of machine learning, it is essential that we serve our patients by directly managing the use of clinical data science towards the improvement of care. In this session, we will explore the state of clinical data science in medical imaging and its potential to improve the quality and relevance of radiology as well as the lives of our patients. Attendees will learn the basics of clinical data science, understand the potential impact of data science on the field of radiology, understand the transition of radiology from visualization to quantification in preparation for precision healthcare, and understand the value of deep learning in the era of MACRA and MIPS payment reform policies. Learning Objectives: 1. To lean about the different tools related with "computer assisted" diagnosis. 2. To understand the challenges in management and radiologist practice of introducing these technologies. 3. To become familiar with "real-life" implementations. A-024 08:50 Liquid biopsy: a new kid on the block M. Ignatiadis; Brussels/BE () Circulating tumour cells and circulating tumour DNA often referred as a ‘liquid biopsy’ are promising tools that have the potential to improve cancer diagnosis, prognosis assessment and real-time monitoring of treatment efficacy. In June 2016, the Food and Drug Administration (FDA) approved a test to screen for EGFR mutations in plasma samples to identify patients with metastatic nonsmall cell lung cancer that are eligible for treatment with erlotinib. In the future, more liquid biopsy tests are expected to complement other approaches used today for the prediction of treatment efficacy towards precision medicine. Learning Objectives: 1. To understand the concept of liquid biopsy. 2. To learn about the advantages of liquid biopsy in the diagnostic process. 3. To understand the impact that these techniques will have on clinical practice. Author Disclosure: M. Ignatiadis: Consultant; Novartis, Roche. Research/Grant Support; Roche, Janssen Diagnostics. A-025 09:05 Novelties in molecular imaging K. Riklund; Umea/SE () Molecular imaging with hybrid imaging such as PET/CT is integrated in many clinical pathways. The selected tracer for the PET part will determine which biochemical or molecular information the examination with the PET part will return. On the other hand, the section of study protocol for the CT or MR on the case of PET/MR imaging will decide which information that part of the examination will return. The major role for PET/CT or PET/MR is staging of oncologist diseases but applications in cardiac and neuro-imaging are emerging. There are also non-oncologic applications for these modalities. In the field of oncology, we are aware of several hallmarks in cancer that are involved in disease development as well as in treatment strategies and treatment response. A major challenge is to develop imaging so we can visualize the behaviour of these hallmarks and during the talk the possibility of using hybrid imaging to do this will be discussed. The interest and attempts to quantifying biomarkers is higher than ever; however, there are many challenges in this field. Quantification and how it can be used will be briefly discussed. Learning Objectives: 1. To understand the role of hybrid imaging in the current clinical practice. 2. To become familiar with the new hybrid imaging applications in relationship to disease presentations. 3. To learn about quantification in hybrid imaging: its benefits and limitations. A-026 09:20 Deep learning and biomarkers: the engineer's view A. Alberich-Bayarri; Valencia/ES () Quantitative imaging biomarkers are driving the paradigm shift in radiology towards precision medicine. Although the lack of standardization can hinder their appropriate use in clinical practice and drug development trials, alliances like QIBA and EIBALL allow for arriving to a consensus in image acquisition and image processing algorithms, which are the main current sources of uncertainty. The adoption of quantitative imaging solutions in the clinical setting requires, however, from the synthesis of the most relevant information, moving from redundancy to relevancy in the data evaluated by the radiologist and the clinical specialist, avoiding information overload. Therefore, data clustering and data reduction techniques, consisting of machine learning approaches have to be implemented. One of the most promising artificial intelligence techniques in the field of medical imaging is deep learning, which allows for the supervised (based on given features like imaging biomarkers) or non-supervised (learning features from data) by means of convolutional neural networks (CNN). Such networks have been applied for the automated classification of medical images as computer-aided detection (CAD) systems; however, the high number of data (millions of cases) required to train the CNNs and obtain efficacy is influencing the research evolution to new network configurations such as generative adversarial nets (GAN), which are expected to have a highly significant impact in the field of artificial intelligence and medical imaging. Learning Objectives: 1. To learn about the specific engineering challenges of developing new quantification methods. 2. To become familiar with the process of adapting the use of biomarkers in the clinical setting. 3. To understand the impact of deep learning on these diagnostic tools. Author Disclosure: A. Alberich-Bayarri: CEO; QUIBIM. Patent Holder; Lung Emphysema quantification. Shareholder; QUIBIM. 08:30 - 10:00 Moderator: P. Vilela; Almada/PT A-027 08:30 RC 111 Management of acute stroke A. A critical appraisal of the current literature W. van Zwam; Maastricht/NL () In 2015 and 2016, eight randomised controlled trials were published, reporting a clear benefit of endovascular treatment over standard care for patients with an acute ischaemic stroke caused by a large vessel occlusion of the anterior intracranial circulation. Individual patient data from five of these trials were pooled in the HERMES collaboration project and first results were published in 2016. After publication of the first positive trial, MRCLEAN, stroke treatment underwent a revolutionary change since the introduction of intravenous therapy with thrombolytics more than twenty years before. The different trials used different inclusion criteria and showed differences in outcome. In this lecture, a short history of acute stroke treatment trials, an overview of the differences between the 2015 and 2016 trials, new studies with subgroup analyses, and the pooled data from the HERMES collaboration will be presented and discussed. Learning Objectives: 1. To understand the strengths and shortcomings of the relevant multicentre trials assessing the role of endovascular treatment in patients with acute ischaemic stroke. 2. To understand the outcomes of these trials, the context in which they were achieved and how they can be ensured in a different environment. 3. To appreciate potential differences in management of patients with anterior vs posterior circulation strokes. Author Disclosure: W. van Zwam: Grant Recipient; Dutch Brain Council, Dutch Heart Foundation. Speaker; Codman, Stryker. A-028 09:00 B. Which techniques can we use to reopen an occluded cerebral blood vessel? T. van der Zijden; Edegem/BE () Since the 90s, the mainstay of primary stroke treatment is the use of clotdissolving medication. Nowadays, mechanical thrombectomy has established itself as a very powerful tool in the management of acute ischaemic stroke in the (hyper)acute setting. The number of mechanical thrombectomy procedures has increased considerably in the last few years. An occluded cerebral blood vessel can be reopened in a swift and efficient way with quite acceptable complication risk rates using stent retrievers and/or thrombosuction catheters. In this presentation, not only an illustration of different mechanical thrombectomy techniques will be provided, but, next to an introduction to intraarterial primary stroke treatment, also an overview of several accessory matters, such as tandem lesions, stenting and complications, will be discussed. Learning Objectives: 1. To understand the principles underlying endovascular clot aspiration. 2. To become familiar with the different materials available for mechanical clot retrieval. 3. To understand the circumstances in which stenting of an intracranial blood vessel is needed. A-029 09:30 C. Endovascular stroke treatment: ethical and economical concerns K.-O. Løvblad; Geneva/CH () While stroke has known advances both in imaging and treatment since the 1990s, it has been the breakthrough with the use of stentrievers that has caused the most response. We have seen that with these methods, it is now possible to on the one hand extract safely and quickly the thrombus without the adverse effects of secondary haemorrhage. While this is extremely encouraging, a few things need to be considered: on the one hand, there will be an enormous demand in a very strictly organized stroke treatment system based on stroke units and stroke centres. Some that will carry out the initial examination and maybe treatment while the patients that need endovascular treatment may be referred to centres that dispose of 24/7 state-of-the-art imaging and post-treatment setups. The costs incurred will be caused on the one hand by and increase in treated patients, then an increase in the management and treatment costs themselves due to the stents. However, this should be counterbalanced by a decrease in morbidity and mortality with decreased readaptation costs. One major concern is the case of the increased need for improved informed consent ways for these patients that may not be initially be able to agree or disagree to the treatment, which is critical due to the short time-window available. Also while the industry is necessary to continue to support the needed R&D in this field, it should allow physicians freedom to provide the best choice of materials adapted to the patient. Learning Objectives: 1. To appreciate the structure that is necessary to organise interventional stroke treatment for a large population. 2. To understand the cost implications and their mitigation. 3. To become familiar with the associated ethical concerns (such as informed consent) and the different ways of addressing them. 08:30 - 10:00 E³ - Rising Stars Programme: Basic Session Room F1 BS 1 Neuroradiology Moderator: E. Tali; Ankara/TR A-030 08:30 White matter disorders A. Rovira-Cañellas; Barcelona/ES () MR imaging is highly sensitive for the detection of white matter signal abnormalities, which can be identified in 5-10% of the adult population. Evaluation of this focal white matter hyperintensities (WMHs) on MR imaging, particularly in young adults, is always challenging since clinical and imaging features are commonly non-specific. Although most of these signal abnormalities are incidental and age related, or secondary to different types of vascular disorders, they also may be caused by a wide variety of infectious, inflammatory, neoplastic, and demyelinating disorders. In this regard, the most common difficulty, by far, is to distinguish multiple sclerosis from acquired hypoxic/ischaemic small-vessel disease, due to the high prevalence of this last group of disorders even in young adults. While it is recognized that a combination of findings from clinical history, physical examination, and laboratory tests is commonly required to correctly establish a firm and clear aetiological diagnosis, a detailed analysis of different MR imaging features should also be considered essential, e.g. lesions shape, size, and distribution; contrast-uptake; associated structural lesions (microbleeds, infarctions, etc.). Knowledge of these features, will assist the diagnostic workup of patients presenting with WMHs, and should be considered a first step to take full advantage of the potential of MRI, and in doing so should result in a reduced chance of misdiagnoses and facilitate the correct diagnosis of sometimes treatable disorders. Learning Objectives: 1. To have a basic understanding of classification of white matter disorders. 2. To describe the typical imaging features of noninfectious, noninflammatory disorders. 3. To identify and describe the imaging features of brain infectiousinflammatory disorders. A-031 09:00 Brain tumours J. Walecki; Warsaw/PL () Neuroimaging techniques are essential tools for the diagnostic process and management of brain tumours. Early and accurate diagnosis is usually possible using various brain imaging techniques. Brain tumours are classified by cell origin and how the cells behave, from the least aggressive (benign) to the most aggressive (malignant). Malignant tumours can be divided into two categories: primary and metastatic. A malignant tumour usually grows rapidly and often invades or crowds healthy areas of the brain, where most benign brain tumours are characterised by slow growth. Based on analysis of all imaging features/imaging biomarkers/tumours are rated or graded by their level of malignancy. Many factors which determine tumour grade include how fast the tumour is growing, how much blood is supplying the tumour’s tissue, the presence of the tumour necrosis and peritumoural oedema leading to high intracranial pressure/mass effect. Brain tumours are one of the most challenging disorders encountered; however, experiences of numerous authors as well as my own affirm the highest efficacy in the diagnostic process using multiparametric MR imaging: DWI, PWI or MRS. Lecture will present most common brain tumours and selected imaging modalities to their detection as well as postoperative follow-up and/or tumour’s recurrence. Learning Objectives: 1. To identify and describe the imaging appearance of malignant tumours. 2. To identify and describe the imaging features of benign tumours. 3. To have a basic knowledge of postsurgical evaluation of brain. A-032 09:30 Ischaemic stroke results from a sudden cessation of adequate amounts of blood reaching the brain. Imaging workup should be fast, readily available and reliable to detect early and subtle abnormal findings to suggest parenchymal hypoperfusion and, therefore, facilitate early diagnosis and intervention. Initial ischaemic stroke imaging using non-contrast CT has been effectively applied to exclude haemorrhage, estimate parenchymal abnormality and other intracranial pathologies that may mimic stroke. Even though non-contrast CT remains the mainstay of imaging, it has limited sensitivity in the acute setting of the ischaemic changes. Detection depends on the territory, time of the examination from onset of symptoms and experience of the interpreting radiologist. CT perfusion and angiography as a second step is a critical tool in increasing the accurate diagnosis. CT perfusion shows both the core of the infarct and the surrounding penumbra, the region which can be salvaged. CT angiography may be helpful to identify the thrombus within an intracranial vessel, establishing the stroke aetiology and also may guide treatment planning. MRI has significantly higher sensitivity and specificity in the diagnosis of hyperacute stage of ischaemic stroke. However, MRI is more timeconsuming and less available than CT particularly in the emergency departments. Diffusion-weighted MR imaging shows infarct core within minutes following the onset of ischaemia. MR perfusion imaging also provides information almost similar to the CT perfusion. Treatment planning can be done under the guidance of the imaging findings and can be performed as various reperfusion techniques (intravenous or intra-arterial thrombolysis, mechanical thrombectomy, etc.). Learning Objectives: 1. To learn about typical imaging features of haemorrhagic stroke. 2. To discuss current imaging techniques for evaluation of ischaemic stroke. 3. To have a basic knowledge of neuroradiological interventions revascularisation in stroke. 08:30 - 10:00 08:30 - 10:00 E³ - ECR Master Class (Oncologic Imaging) E³ 126a Oncologic imaging in the age of precision medicine Moderator: H. Hricak; New York, NY/US A-033 08:30 A. Precision medicine G. Frija; Paris/FR () According to the National Institutes of Health (NIH), precision medicine (PM) is "an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person". Its development is stimulated by the progresses in data intensive basic science, and is characterized by a high level of complexity. The key pillars of PM are: to develop a new taxonomy of diseases based on biological mechanisms, to develop correlations of phenotyping with genotyping, to increase the statistical power of research in developing networking and integrated databases. The main national plans or programmes, which are currently being developed, will be briefly presented in order to highlight the cost and the complexity of this concept. Imaging has certainly an important role in this framework: the development of reliable quantitative biomarkers and the delivery of structured data are crucial. Correlations between phenotype and genotype through radiogenomic approaches appear promising. Concrete examples will be presented to illustrate the potential of imaging in this context mostly in oncology (tumour heterogeneity mapping). The importance of companion diagnostics will be discussed as well as liquid biopsy, which potentially is a strong competitor as well. Learning Objectives: 1. To understand the meaning of precision medicine. 2. To document the role of radiologists in precision medicine. 3. To understand how precision imaging will have an influence on the practice of radiology. A-034 08:55 B. Radiomics: the role of imaging in precision medicine R. Kikinis; Boston, MA/US () Radiogenomics is the correlation between image-derived features and gene expression. Recent scientific progress has enabled the treatment of cancer based on targeting of specific mutations. Imaging, in contrast to biopsies, allows the assessment of the entire tumour volume. The presentation will explain the state of the art in the field and discuss the contributions that radiology can make. Learning Objectives: 1. To review how radiologists can contribute to radiomics investigation. 2. To explain state-of-the-art of radiomics, from science to practise. 3. To learn about the idea of radiomics. A-035 09:20 C. Precision medicine and imaging-guided interventions S.B. Solomon; New York, NY/US () Modern oncologic care is centred on the molecular characteristics of an individual’s cancer in what is termed precision medicine. The image-guided needle biopsy has been the key tool used to access the cancer for molecular analysis. Radiologists as central players in needle biopsy, thus, play a critical role in precision medicine. Recent data show that many specimens are insufficient to provide enough material for molecular analysis. This lecture will focus on optimising biopsies through improved techniques, tools and work flow. In addition, we will see how radiologists can use molecular status to help distinguish between responders and non-responders of locoregional therapies. Learning Objectives: 1. To explain what is the present and the future of imaging-guided interventions. 2. To learn about current concepts for precise imaging guidance during IR procedures. 3. To understand the practical implementation of such tools. Author Disclosure: S.B. Solomon: Consultant; AstraZeneca, Medtronic, Aperture, Innoblative. Research/Grant Support; GE Healthcare. RC 110 The elbow: a comprehensive approach A-036 08:30 Chairman's introduction A. Alcalá-Galiano; Madrid/ES () The elbow is a complex hinge joint commonly injured in trauma and subject to chronic overuse syndromes in both athletic and non-athletic individuals. Understanding of the anatomy, systematic image evaluation as well as structured reporting are crucial for accurate diagnosis and to assist in surgical decision making. Recognised pitfalls and normal variants should not be confounded with pathology. Chronic overuse injuries or instability may have subtle imaging manifestations and some injuries may clinically emulate or exacerbate other entities; therefore, imaging prior to intervention is essential. Relevant parameters of tendon injury for treatment planning and the imaging appearance of the different instability patterns of the elbow joint due to lesion of the valgus/varus stabilizers need to be identified. Ulnar neuropathy at the elbow is the most common and best recognised, but there are other nerve entrapment syndromes that should not be missed. The choice of imaging modality for soft tissue derangement at the elbow includes MR and US, whereas CT is usually reserved for osteoarticular evaluation. US allows dynamic evaluation and may demonstrate findings which would otherwise be missed at static examinations. This session will provide a profound review of the imaging appearance of tendon anatomy and pathology, ligament injury and instability and nerve entrapment syndromes at the elbow with different imaging modalities. Interventional techniques for treating elbow tendon disease will also be discussed Session Objectives: 1. To understand that assessing this joint requires a multimodality approach with careful attention to technique, imaging protocol, choice of coils and sequences. 2. To learn about the pivotal role of the radiologist in evaluating elbow imaging to provide relevant information to the arthroscopist. A-037 08:35 A. The tendons: anatomy, pathology and intervention P. Peetrons; Brussels/BE "no abstract submitted" Learning Objectives: 1. To become familiar with the normal imaging anatomy and pathological appearances of the elbow tendons. 2. To learn about interventional radiological techniques for treating elbow tendon disease. A-038 08:58 B. Ligament injury and instability: what to look for and what to say M.C. De Jonge; Amsterdam/NL () The elbow joint is an intrinsic very unstable joint. It derives its stability from the capsula, joint crossing muscles, tendons and ligaments. Ligament injuries are not frequent although it depends upon the patient population. In sports people, e.g. throwing sports like baseball, it is quite common. The most common stabilising ligaments are on the ulnar and radial side. On the ulnar side, the ulnar collateral ligament (UCL) is the most important one often injured in situations where acute (severe) valgus stress is applied to the elbow. The most common chronic instability due to a ligament injury of the elbow, however, is the posterolateral instability. The most important structure on the radial side involved in this type of instability is the lateral ulnar collateral ligament (LUCL). At the same time this is also one of the most challenging ligaments to visualise for the radiologist. After a brief introduction of the anatomy, the mechanisms of injury to the medial and lateral ligaments will be discussed. Optimisation of the imaging protocol will be reviewed with the respective values of ultrasound and MRI. Learning Objectives: 1. To become familiar with patterns of abnormality seen in elbow instability. 2. To learn about the imaging findings of elbow instability. A-039 09:21 C. Nerve entrapment at the elbow L.M. Sconfienza; San Donato Milanese/IT () The most common condition around the elbow is the cubital tunnel syndrome. It is a compression neuropathy that can occur either at the condylar groove or at the edge of the arcuate ligament. Causes of compression include direct extrinsic compression on the condylar groove, bone abnormalities, and soft tissue lesions. Clinical findings include elbow pain and sensory symptoms in the innervated area. Diagnosis is mainly based on electrophysiological studies but US may demonstrate the presence of nerve thinning/thickening and associated abnormalities. Ulnar nerve instability at the cubital tunnel is also common but is asymptomatic in up to 47% of patients. When symptoms are present, US may demonstrate nerve thickening with hypervascularisation. The median nerve is infrequently impinged around the elbow. Anterior interosseous neuropathy occurs where nerve branches off the median nerve, in proximity to the pronator teres and the tendinous bridge connecting the heads of the flexor digitorum superficialis. When this syndrome is clinically suspected, US evaluation is usually inconclusive. However, abnormal reflectivity of innervated muscles can be seen. The median nerve may also be impinged as passing the pronator teres muscle. Posterior interosseous neuropathy is an uncommon condition of impingement at three different locations around the elbow, but more typically near or behind the supinator muscle at the proximal third of the forearm, where the nerve enters a strong fibrous arcade (i.e. arcade of Frohse). Clinical presentation is typical and US is able to identify the thickened nerve impinging in the arcade of Frohse. Learning Objectives: 1. To understand the radiological anatomy of the peripheral nerves at the elbow. 2. To learn about the imaging findings of nerve entrapments at the elbow. Author Disclosure: L.M. Sconfienza: Author; Springer Verlag. Other; Travel grants from Bracco Imaging Srl and Esaote. 08:30 - 10:00 Physics in Medical Imaging RC 113 Single-dual-multi-energy CT A-040 08:30 Chairman's introduction J. Damilakis; Iraklion/GR Dual-energy CT acquisition is possible using either single-source CT or dualsource CT. In single-source CT units, a generator switches x-ray tube potential from 80 kVp to 140 kVp corresponding to photon energies from about 40 keV to 140 keV. For each exposure, the exposure time is only 0.5 msec, allowing simultaneous acquisition of low-kVp and high-kVp images. Dual-source CT scanners are composed of 2 tubes and 2 detector arrays. The 2 tubes are positioned at 90 degrees from each other. For dual-energy CT the potential applied across the 2 tubes is 80 kVp to 140 kVp. The tube load (mAs) is adjusted accordingly to 50 mAs for the high-kVp tube and 200 mAs for the lowkVp tube. Other approaches have been introduced through energy-sensitive detectors and photon counting detectors. All CT examinations should be optimised to achieve diagnostic image quality with the lowest radiation dose possible. Dose optimisation of dual-energy examinations is an area of great interest for both medical physicists and radiologists. The replacement of precontrast imaging by virtual non-contrast-enhanced imaging provides a great opportunity of radiation dose reduction. Moreover, several techniques and tools have been developed for CT dose optimisation and these methods are also applicable for dual-energy CT studies. For example, application of new iterative reconstruction algorithms, use of automatic exposure control and other dose saving tools may help to reduce patient doses considerably. Session Objectives: 1. To learn about the basics of dual-energy CT (DECT). 2. To understand today's photon counting detector technology. 3. To learn how DECT is applied in clinical practice. A-041 08:35 A. Basics of diagnostic dual-energy CT T. Klinder; Hamburg/DE () Although the first applications of dual-energy CT (DECT) were already introduced in the 1980s, they were not adopted in clinical practice. However, with advancements in the CT systems, DECT experienced its comeback and is now clinically emerging. In this talk, we will explain the technological basics of diagnostic DECT and show its clinical potential. First, the general idea of CT acquisition is reviewed to acknowledge the spectral information that DECT provides. The fundamental underlying physics of DECT is explained. In particular, it is derived how spectral acquisition allows to parameterise the energy-dependent attenuation coefficient inaccessible to single-energy CT. The different techniques for acquisition of DECT will be shortly compared. Dual-energy data can be post-processed and presented in various ways (e.g. monochromatic images, iodine maps or virtual non-contrast images). The individual possibilities are thereby described on the basis of the introduced physical principles. Finally, an overview of main clinical applications of DECT is given including the detailed review of different clinical example cases. Where appropriate, a comparison to single-energy CT is given to fully appreciate the additional value of DECT. Learning Objectives: 1. To learn about the underlying physics and today’s technology. 2. To see potential advantages compared to single-energy CT. 3. To appreciate the rationale behind clinical applications. A-042 08:58 B. Photon counting detector technology for diagnostic CT I. Blevis; Haifa/IL () Medical CT imaging has recently advanced due to the introduction of dualenergy techniques. Material composition and density in the body are disentangled using the energy information in the x-rays traversing the body. The added information can be combined with the conventional image using colours or other techniques. Realizing the full potential of the newly tapped energy information will require a major technological change from the scintillating crystals and light sensing electronics in current use to semiconductor detectors and electronics sensitive to each photon and its energy, individually. The current technology is called indirect and integrating detection, and the new and emergent technology is called direct conversion photon counting. Photons are absorbed in high Z, high band gap, high crystallinity, thick semiconductors, notably Cd(Zn)Te, producing a very compact ball of electric charge that is transferred to external electronics by a fine grid of contact electrodes on the semiconductor surface. The small size of the charge ball also permits a high resolution and contrast improvement in CT, potentially without an increase of patient dose. The new technology has been introduced commercially in the past decade in less demanding SPECT imaging at 10-1photons/s/mm2 and now in our CT research prototypes the detector development has permitted close to the 109photons/s/mm2 needed for CT. Verification images from phantoms and preclinical trials, including resolution tests, and high Z contrast agents will be shown. Learning Objectives: 1. To learn about the underlying physics and technological solutions. 2. To understand the potential advantages compared to dual-energy CT. 3. To appreciate how mature today’s photon counting technology is. Author Disclosure: I. Blevis: Employee; Philips Healthcare. Investigator; H2020 Grant Agreement No 668142. A-043 09:21 C. Do we really need multi-energy CT? S.T. Schindera; Aarau/CH () Dual-energy CT has been introduced more than ten years ago and since then various clinical applications from head to toe have been described in the scientific literature. A clear added value of each clinical application needs to be proven to transfer them into clinical routine. Besides optimization of the clinical workflow of dual-energy CT, including post-processing of the additional datasets, the radiation exposure to the patient is an important aspect which decides if dual energy maintains a success story. To promote the wide-spread use of dual-energy CT, there is a definite need for future investigations on the outcome of dual-energy CT, such as patient care, costs and workflow. Learning Objectives: 1. To learn about medical applications and potential benefits. 2. To see which single energy applications should be replaced by dual-energy applications, and why. 3. To find out what additional multi-energy CT applications would be nice to have. Author Disclosure: S.T. Schindera: Advisory Board; Bayer Healthcare. 09:44 Panel discussion: How many 'energies' do we need in CT? 08:30 - 10:00 Radiographers Moderators: V. Syrgiamiotis; Athens/GR A. Mizzi; Msida/MT A-044 08:30 RC 114 MRI technology and techniques A. Recent developments in structural and quantitative spinal cord imaging at 3T M.C. Yiannakas; London/UK In this presentation I would be discussing new developments in acquisition and analysis protocols for spinal cord imaging using a clinical 3T MR system, which are suitable for use in a number of neurological diseases, such as multiple sclerosis (MS), spinal cord injury (SCI), amyotrophic lateral sclerosis (ALS), neuromyelitis optica (NMO) and multiple system atrophy (MSA). In terms of acquisition, protocols which allow depiction of grey matter (GM) and white matter (WM) within the cord will be presented along with examples on how these may facilitate further tissue-specific (i.e. GM/WM) quantitative investigations such as the estimation of tissue volume, diffusion tensor imaging (DTI) metrics and magnetisation transfer ratio (MTR). In terms of analysis methods, recent advances in semi- and fully-automated image segmentation will be presented and discussed. Learning Objectives: 1. To understand the technical challenges associated with spinal cord imaging. 2. To learn about new structural and quantitative spinal cord acquisition and analysis protocols. 3. To discuss some of the clinical applications in neurological disease. A-045 08:55 B. RF-related heating in clinical MRI T. Owman; Lund/SE () Magnetic resonance is a frequently used diagnostic tool and considered a fairly safe modality. It is well known that MR is not only exclusively used for diagnostic purposes but also used in interventional care, research and functional studies of various kinds. Clinical demands for faster examinations and higher resolution, and in combination with advanced research has resulted in a development toward stronger magnetic fields and a more powerful and complex technology. This with the consequence that clinical MR of today uses higher frequencies and increased energy deposition in patients and volunteers. There are several known risks in MR and the radiofrequency (rf)-induced heating problem in patients has increased significantly parallel to the fast technological development. Several efforts are made to improve the situation since MR-related rf-burns occur more and more frequent in clinical practice. The rf-heating problem is relatively difficult to predict and may even cause various degrees of burns during regular clinical MR scanning. Improved knowledge and better understanding of this hazard is necessary to minimize risks and avoid unnecessary damage. Heat-related accidents (rf) can be reduced and the situation considerably improved by careful patient preparations and good safety routines prior to MR examinations. Learning Objectives: 1. To learn about b1-related problems in clinical MRI. 2. To understand RF-related heating and current efforts to improve the situation. 3. To discuss how to avoid RF-burns in clinical practice. A-046 09:20 C. The benefits of diffusion imaging J. Castillo; Msida/MT () Diffusion-weighted magnetic resonance imaging (DWI) derives its image contrast from differences in the motion of water molecules between tissues. Such imaging can be performed very quickly without the need for exogenous contrast medium administration. A series of technological advances have made it feasible to translate DWI measurements to extra-cranial sites, such as the abdomen and pelvis. The application of DWI in oncology has been widely explored. DWI for tumour detection has been shown for a variety of tumour types in adult and paediatric oncology. Used together with other MR imaging techniques, DWI can aid tumour characterization and in distinguishing tumour from non-tumour tissues. DWI is usually performed using an echo-planar imaging technique, in breath-hold, free-breathing or with the use of respiratory and/or cardiac gating. Meticulous attention to technique is important to ensure high-quality images can be consistently obtained. This is one of the key competence of MR radiographers. There is now considerable interest in using DWI for the monitoring of treatment response. Several studies have already shown that the apparent diffusion coefficient (ADC) of tumour in response to successful chemotherapy, radiotherapy and other minimally invasive interventional procedures. Diffusion-weighted MRI is being increasingly used in paediatric body imaging. Its role is still emerging. It holds great promise in the assessment of therapy response in body tumours, with ADC value as a potential biomarker. Body DWI is a technique that can be quickly performed on clinical MR systems, and can be incorporated into existing clinical protocols. Learning Objectives: 1. To appreciate the role of diffusion imaging in oncology imaging. 2. To discuss the responsibility of radiographers in the application of DWI. 3. To discuss the clinical application of diffusion imaging in MR enterography and paediatric imaging. 09:45 Discussion and questions: How is patient care affected by MRI technology and techniques? 08:30 - 10:00 Room M 1 RC 115 Peripheral vascular malformations: light after darkness A-047 08:30 Chairman's introduction J.A. Reekers; Amsterdam/NL () Treatment of peripheral vascular malformations is a combination of diagnostics, skills and experience. This treatment is done by specialised interventional radiologists in dedicated centres. Treatment is always a team effort. There is a wide variety of diagnostic pathways used to establish the final diagnosis and to plan treatment. These pathways will be discussed. Based on the clinical diagnosis specific imaging algorithms can be used. In the workshop this will be discussed. Treatment of peripheral vascular malformations is often not a medical necessity but mainly closely related to the wishes and expectations of the patients. Every procedure is tailored by this “shared dissection making” and, therefore, planning of a treatment procedure should also be patient tailored. How to define success is, therefore, sometimes difficult. This planning of treatment will also be discussed. Children are a specific entity within the spectrum of vascular malformations and special knowledge is needed not only to treat but also to support these patients and their family. Also in children interventional techniques are tailored and this will be discussed in the session. Session Objectives: 1. To review classification and description. 2. To identify the role of imaging modalities. 3. To understand the role of interventional radiologist in management and treatment. A-048 08:35 A. The diagnostic assessment M. Köcher; Olomouc/CZ () Vascular malformations are categorized into the low-flow malformations and high-flow malformations. From imaging methods it is expected to distinguish between the low-flow lesions and high-flow lesions, localisation, volume and range of lesion and relationship to the surrounding tissues and organs. Colour Doppler ultrasonography (DUS) can offer good differentiation between highflow and low-flow lesions. Magnetic resonance (MR) offers good differentiation between high-flow and low-flow lesions also and, moreover, good evaluation of volume and extent of lesion, good interpretation of anatomical relationship to the surrounding tissues and organs. On DUS the low-flow malformations are demonstrated as hypoechogenic or heterogenous lesions with minimal flow inside, flow during augmentation and normal arterial flow volumes and normal high arterial resistance flow. The high-flow malformations are heterogeneous lesions with tortuous feeding arteries, high-velocity and low-resistance flow in feeding arteries, multiple arteriovenous shunts and pulsatile flow in draining veins. On MR, the low-flow malformations typically have low signal intensity in T1-weighted images in abnormal vascular structures and high signal intensity in T2-weighted images whereas the high-flow lesions usually demonstrate signal voids in abnormal vascular structures on most sequences. At follow-up, DUS demonstrates thrombosis and fibrosis of the low-flow lesion. In the highflow lesion, the waveform will normalised and the resistive indexes and the flow volumes will become normalized as well. MR demonstrates thrombosis and fibrosis of low-flow malformation by the loss of high signal in T2-weighted images and loss of signal voids in high-flow lesions. Learning Objectives: 1. To learn about classification and terminology. 2. To understand the role of US, CT and MRA in diagnostic assessment. 3. To learn the optimal imaging algorithm for diagnosis and follow-up. A-049 08:58 B. Percutaneous or endovascular treatment: when and how? B. Peynircioglu; Ankara/TR () Vascular anomalies are divided into two different categories which carry different prognosis and management: "vascular tumours" and "vascular malformations" (VM). Their precise identification is crucial and involves a good knowledge of the biological classification published by Mulliken and Glowacki and that has recently been updated by the International Society for the Study of Vascular Anomalies (ISSVA). Vascular malformations are always congenital and growth with the child. They can involve type of vessels solely or combined with others. A rheologic differentiation between low and high flow malformations is essential to characterize the seriousness of the lesion. Interventional radiology (IR) plays major role in both curative and palliative treatments of these VM. Transcatheter/endovascular (transarterial or transvenous) or direct percutaneous puncture under imaging guidance are the 2 main techniques for treating these lesions. Depending on the type, nature, location and surroundings of the VM, one should decide the best strategy for treatment. Another key point is to decide whether to use embolization or sclerotherapy. Again, the type, location of the VM is vital and the patient-based decision is to be made carefully by a multidisciplinary team. Operator’s experience is of most importance in determining all of the above variables, together with the local circumstances. There are many different types of embolic and sclerotherapy agents available around the world. Learning Objectives: 1. To recognise the indications and the real need for treatment. 2. To learn about technical approach - how to plan the intervention? 3. To understand possible limitations and the final result prediction. A-050 09:21 C. Paediatric vascular malformations: diagnosis and treatment S. Stuart, D. Roebuck; London/UK () The current accepted method for classification of vascular malformations is straightforward and clinically relevant. Vascular malformations can be divided into high flow lesions such as arteriovenous malformation (AVM) or low flow lesions such as venous or lymphatic malformations. In children, 90% of vascular anomalies can be diagnosed by clinical history and examination alone. Imaging predominantly with US or MRI can confirm the diagnosis, evaluate extent of a lesion or flow within it. In children ultrasound is particularly useful for aiding the diagnosis. Many vascular malformations require no treatment, if they are not causing symptoms. A multidisciplinary team approach to the management of these conditions is vital. Non-interventional treatments such as physiotherapy and occupational therapy are vital. The use of compression garments can help symptomatically in venous malformations. Interventional radiology plays a role in treatment principally with injection sclerotherapy of low flow lesions and embolization of the much rarer AVM. Many sclerotherapy agents are available with sodium tetradecyl sulphate the most commonly used for venous malformations and doxycycline commonly used for lymphatic malformations. Different sclerotherapy agents have different characteristics and uses which will be covered. Symptomatic relief is often achieved with treatment but multiple treatment episode may be needed to achieve the wanted outcome. Ensuring the child and family understand this is vital to ensure they are satisfied with the management of the condition. Learning Objectives: 1. To understand the specifics of vascular malformations in children. 2. To recognise when to observe and when to intervene? 3. To learn about interventional techniques used and results of treatment. 09:44 Panel discussion: How could we improve diagnosis and optimise the results of our interventions? 08:30 - 10:00 Interventional Radiology Room M 3 Moderator: A. Gangi; Strasbourg/FR A-051 08:30 A. Musculoskeletal ablation and embolisation A. Basile; Catania/IT () In a modern era of interventional strategies, ablation and embolization use is not anymore limited to usual target organs but these techniques are finding new rooms, remarkably in MSK tumours. In the literature, the most encountered benign tumours treated via ablation and/or embolization are osteoid osteoma, osteoblastoma, chondroblastoma and osteochondroma, giant cell tumour, aneurysmal bone cyst, eosinophilic granuloma, vertebral haemangioma and fibrous dysplasia. In turn, malignancies of the soft tissue and bones (primary sarcomas) are rare, likely spinal metastases are the most common (derived by carcinomas of the breast, lung, prostate, kidney and uterus). Shall be underlined that in most cases palliative measures are related to malignant cancer and patient's quality of life and motility are the priority. Among first weapon such as thermal ablation (both MW, RF and Laser) cryotherapy is raising the interest of the IR's community due to the powerful pain management feature and the possibility of an instant check of the ice ball, preserving nervous tissues, specially for vertebral metastases use. Nevertheless, ablation may be applied both for curative and palliative strategies when combined with cement injection, allowing a precise patient's selection to be made. Embolization has a strong importance applied to hypervascular lesions, may also reduce recurrence rate and potentially extend survival one. New heroes of oncologic interventions and probably future fashion are MR-guided HIFU and irreversible electroporation (IRE), even though bringing higher cost. Improved research of the field is strongly needed to assess a proper cost-benefit analysis and limits of these approaches. Learning Objectives: 1. To appreciate the indications for ablations and embolisation. 2. To learn about different techniques and combination of them. 3. To discuss the results and literature data of interventional radiology procedures. A-052 09:00 B. Vertebral augmentation and discectomy techniques: can we challenge surgery? D. Filippiadis; Athens/GR () Vertebral augmentation techniques include standard vertebroplasty, balloon kyphoplasty and percutaneous implant insertion combined to PMMA injection. Indications include osteoporotic, traumatic, pathologic and cancer-related fractures as well as benign (e.g. symptomatic atypical aggressive haemangiomas) or malignant (e.g. metastatic) lesions. Under proper patient selection, these techniques provide pain relief and functional improvement along with spine alignment height restoration and endplate reduction. Additionally, kyphotic angle restoration or maintenance seems to prevent future vertebral fracture in the adjacent levels and improved sagittal balance. Studies in the literature report that load distribution in patients with vertebral fractures post-vertebroplasty returns to values of normal population. Variety in the morphology, location, and aetiology of vertebral fractures demands a tailored patient-centred approach. Percutaneous technique for intervertebral disc herniation and discogenic pain can be either decompression or biomaterial implantation techniques. The former can be classified into mechanical (discectomy), thermal (RF, laser, coblation, IDET) or chemical (Discogel, ozone) methods whilst the latter includes hydrogel, PRP and stem cell therapies. Decompression techniques are indicated for small- to medium-sized symptomatic contained hernias. Percutaneous techniques are performed as outpatient, low-cost procedures and are governed by good patient compliance, high success (75-85%) and low complication rates (<1-2%). In case of treatment failure, percutaneous techniques can be repeated without interfering with surgery at a later stage. Percutaneous vertebral augmentation and discectomy techniques compared to surgical approaches are favoured in terms of reduced blood loss and operating time, shorter hospital stay, fewer complications and less postoperative pain. Learning Objectives: 1. To appreciate the rationale for the using of interventional radiology procedures. 2. To learn about different techniques and treatment strategy. 3. To discuss results and literature data in comparison with other treatments. A-053 09:30 C. Bone biopsy and pain treatment using cone-beam CT (CBCT) L. Tselikas; Villejuif/FR () Cone beam-CT imaging (CB-CT) is actually widely available and allows, because of high-quality multiplanar reconstructions and using dedicated guiding software, to perform various bone interventions. Bone biopsies are feasible using CB-CT guidance with the same accuracy as CT-scan guidance and requiring less radiation exposure for patients and operators. Furthermore, pain palliation procedures such as cementoplasty and percutaneous osteosynthesis are actually possible with very high accuracy and technical success rates. New techniques and software are under development to decrease radiation dose, improve guidance for in case where CB-CT acquisition can be complicated and be easily integrated in an everyday workflow. Learning Objectives: 1. To appreciate the high imaging quality and guidance accuracy using CBCT for biopsy and pain treatment. 2. To learn about the advantages of CBCT guided interventions, reconstruction algorithms, image enhancement and dose reduction. 3. To discuss about techniques, limitations of CBCT and future applications. Author Disclosure: L. Tselikas: Consultant; General Electric. 08:30 - 10:00 E³ - ECR Academies: Tips and Tricks in Liver, Bile Ducts and Pancreas Imaging E³ 118 Liver, bile ducts and pancreas: improving your technique with advanced tools Room M 4 A-054 08:30 Chairman's introduction Y. Menu; Paris/FR () Optimal imaging technique is absolutely critical in abdominal studies, as many parameters may interfere in the production of final images. Despite technical advances, or may be as a consequence, settings and fine-tuning of machines is the only way to reach clinical relevance of images. The radiologist has to be familiar with the most important parameters that may influence image quality and relevance. In this session, the purpose is to learn the best and the most simple way to obtain optimized results with recent and advanced imaging technique, with a special interest on how to integrate it while driving these machines for clinical practice. A-055 08:35 A. Liver specific contrast: how, why, when? E. Neri; Pisa/IT The so-called liver-specific (or hepatobiliary) contrast agents (gadobenate dimeglumine, Gd-BOPTA, and gadoxetic acid, Gd-EOB-DTPA), are characterised by a dual behaviour by exhibiting elimination through both renal and hepatic excretion pathways and thereby possessing both early perfusion information (renal elimination pathway) and, later, hepatocyte-selective information (hepatic excretion pathway) mediated through protein transporters, located in the canalicular or sinusoidal pole of the hepatocytes. As a basic rule of MR technique all non-blood pool gadolinium chelate-based contrast agents are suitable for dynamic liver MRI, but the use of liver-specific contrast agents is mandatory to obtain the hepatobiliary phase in addition to the dynamic phase. The workup of solid focal liver lesions should include: axial breath-hold heavily T2-weighted half-Fourier single-shot turbo spin-echo sequences; navigator triggered intermediate T2-weighted turbo spin-echo sequences, breath-hold T1-weighted two-dimensional dual gradient-echo in-phase and opposed-phase sequences, and dynamic contrast enhanced fat-suppressed three-dimensional spoiled gradient-echo breath-hold sequence, acquired before and during the late arterial, portal venous and late dynamic phase. Hepatocyte phase can be considered adequate when Gd-EOB is detected in the intrahepatic bile ducts and the vessels are definitely hypointense in comparison to the background parenchyma. Liver specific contrast agents improves the characterisation of benign liver lesions, malignant liver lesions in non-cirrhotic, focal lesions in cirrhotic patients; they are also helpful to to depict the degree of fibrotic changes in liver fibrosis. Learning Objectives: 1. To learn about physiology of liver specific contrast media physiology, and to be able to optimise liver MRI protocols. 2. To understand why they are useful for the detection and characterisation of liver masses. 3. To learn and understand the limitations. A-056 09:03 B. Diffusion-weighted imaging (DWI): how, why, when? D.-M. Koh; Sutton/UK Diffusion-weighted MRI (DWI) is now routinely applied for the evaluation of abdominal diseases. The principles of optimising DWI are similar on both 1.5T and 3.0T, which includes maximising image signal to noise and minimising artefacts. In this regard, free-breathing DWI acquisition is most widely used to achieve the best image quality. DWI can be used to improve disease detection in the liver, hepatobiliary tract and the pancreas. It can be applied to support disease characterisation, but potential pitfalls should be appreciated. There is an increasing role for its deployment for the early evaluation of tumour response to treatment. Monoexponential DWI model to derive the apparent diffusion coefficient (ADC) of tissue is still the most widely used approach in the clinical setting. However, there is interest in applying non-monoexponential approaches including IVIM (intravoxel incoherent motion) and DKI (diffusion kurtosis imaging). These approaches should be utilised with full knowledge of their measurement repeatability so that it allows for meaningful data interpretation. Learning Objectives: 1. To become familiar with the different acquisition techniques and to be able to adapt to a specific machine, including field strength. 2. To understand the role of DWI in the detection and characterisation of hepatobiliary and pancreatic diseases. 3. To learn about the potential technical future developments. A-057 09:31 C. Advances in hybrid imaging: new tracers and MR/PET E.J. Rummeny; Munich/DE () In both PET/CT and MR/PET, radioactive tracers are used to detect primary tumours and metastases. During the lecture, we will discuss those tracers which are used for PET imaging of the abdomen and pelvis. By far the most commonly applied tracer is 18F-FDG which is used to study glucose metabolism in tumours and metastases. Increasingly, other more specific tracers, primarily marked with 68 Ga, are used for abdominal tumours such as DOTA-TATE and DOTA TOC. These tracers exhibit high affinity to somatostatin receptors and can be used to detect endocrine tumours (NET) with low or moderate proliferation rate (G1 and G2). To quantify tumour response to therapy, standard uptake values (SUV) can be calculated. Newer tracers like 68 Ga-PSMA-ligand are primarily used to diagnose prostate cancer (PCa) and its metastases to lymph nodes and bones. Furthermore, this tracer may be also useful to diagnose other tumours of the urinary tract. Bound to 90 Yttrium or 177 Lutetium, these carriers, i.e. DOTA-NOC and PSMA-ligand, can be used as so-called theranostics which are employed successfully to treat tumour metastases of certain cancers. All those markers can be used for PET/CT and MR/PET. While PET/CT is in clinical use already, MR/PET systems are still under evaluation. MR has better soft tissue contrast and radiation dose from MR/PET is substantially less than PET/CT. However, MR/PET takes longer than PET/CT and is only feasible in certain patients. Therefore, MR/PET is currently available for patients with selected indications and primarily used for clinical research studies. Learning Objectives: 1. To understand why alternative tracers to FDG may be useful in exploring liver and pancreatic diseases. 2. To learn about the role of PET in the follow-up of tumours and quantification of tumour response. 3. To become familiar with the specific advantages of MR/PET over PET/CT in abdominal diseases. 08:30 - 10:00 E³ - ECR Master Class (Genitourinary) E³ 126b Functional MRI of the kidneys: ready for prime time? Room M 5 Moderator: H.C. Thoeny; Berne/CH A-058 08:30 A. Diffusion-weighted MRI N. Grenier; Bordeaux/FR () Diffusion-weighted MRI of the kidney has multiple applications in morphological renal imaging. Its applications in the functional field of parenchymal renal diseases are still to be defined. For morphological applications such as renal tumours or infections, 3 b-values are enough with calculation of an ADC-map based on a mono-exponential fit. For functional applications, the tendency goes toward more sophisticated approaches such as the IVIM technique with more b-values and a bi-exponential fit or characterisation of the diffusion tensor, based on acquisition of at least 6 directions, of diffusion encoding. All functional and tissue changes decreasing water movements or increasing the cell density in renal parenchyma can decrease diffusion coefficients. Renal ADC decrease is correlated with the degree of renal dysfunction in parenchymal diseases. Urinary obstruction and parenchymal processes such as inflammation or fibrosis also decrease the diffusion coefficients. In chronic diseases, tissue changes and fibrosis induce changes of the microarchitecture responsible for a decrease of renal anisotropy shown by diffusion tensor imaging. Learning Objectives: 1. To learn about the technical issues of DWI. 2. To understand the physiological determinants of diffusion measurements. 3. To assess the role of DWI in clinical practice. Author Disclosure: N. Grenier: Advisory Board; Supersonic Imagine. A-059 09:00 B. Perfusion MRI M. Claudon; Vandoeuvre-les-Nancy/FR () Because of its high spatial resolution, magnetic resonance urography has demonstrated high accuracy in the morphologic assessment of urinary tract. More recently, functional MRU (fMRU) has shown feasibility in adults and children, using dynamic pulse sequences performed after injection of an intravenous bolus of gadolinium chelates (DCE-MRU), which allow calculating the split renal function (SRF) from time-intensity curves, where the Patlak method should be preferred to the area under the curve method. Using MRU to obtain both anatomical and functional information in a single examination without radiation would be beneficial, especially for follow-up in young patients. Complementary medico-economic analysis confirms the interest of a potential substitution of nuclear renal scintigraphy by fMRU as an adjunct to morphological MRU. Learning Objectives: 1. To learn about the clinical indications for kidney perfusion imaging. 2. To become familiar with perfusion protocols for kidney perfusion imaging. 3. To learn about difficulties in kidney perfusion imaging. A-060 09:30 C. BOLD and ASL A. Boss; Zurich/CH () In functional renal magnetic resonance imaging (MRI) advanced techniques are used to obtain functional and molecular information from the state of the kidney. In blood oxygenation level-dependent (BOLD) MRI, the susceptibility difference between oxyhaemoglobin (diamagnetic) and deoxyhaemoglobin (paramagnetic) is used to extract information on tissue oxygenation, which is interesting because of the physiological hypoxia in the renal medulla. BOLD MRI, therefore, may be applied to non-invasively assess renal oxygenation and the oxygen metabolism of the kidneys. Arterial spin labelling (ASL) is a noninvasive technique, which uses radiofrequency-labelled blood water as endogenous tracer to visualize and quantify renal perfusion. Using the extended Bloch equations, quantitative perfusion values in ml/100 g/min can be calculated. Learning Objectives: 1. To understand the physiological and technical basis of blood oxygen leveldependent (BOLD) imaging of the kidneys. 2. To learn typical findings of BOLD-MRI in patients with kidney disease. 3. To review the physics and technique of arterial spin labelling (ASL) perfusion measurements of the kidneys. 4. To see typical findings of ASL measurements in patients with kidney diseases. 10:30 - 12:00 E³ - ECR Academies: Interactive Teaching Sessions for Young (and not so Young) Radiologists E³ 221 MR imaging in sports medicine I A-061 10:30 A. Muscle injury in sports M.G. Mack; Munich/DE () According to the UEFA injury study 2014, almost 50% of all injuries in professional soccer players are related to muscles, tendon and the musculotendinous junction. During this lecture, you will learn how normal and injured muscle will look like. The standard imaging protocol is including axial T1- and fsPD sequences, angulated coronal and sagittal fsPD sequences with a slice thickness between 1 and 6 mm. You will learn to differentiate between functional muscle disorders without structural injuries (like fatigue-induced muscle disorder (Type 1a), delayed-onset muscle soreness (Type 1b) and spine (Type 2a) or muscle-related neuromuscular disorder (Type 2b)) and structural injuries (minor partial tear (Type 3a), moderate partial tear (Type 3b) and total/subtotal tear (Type 4) of the muscle, the musculotendinous junction and tendinous avulsion). Most structural injuries are stretch-induced injuries and have to be differentiated from contusion injury and distraction injury. In soccer, 92% of all muscle injuries affect the four major muscle groups of the lower limbs (hamstrings, adductors, quadriceps and calf muscles) and occur mainly in non-contact situations. Learning Objectives: 1. To understand the anatomy of the most common injured muscles. 2. To learn the evaluation of muscle injuries and the impact regarding recover. A-062 11:15 B. Knee trauma M. Shahabpour; Brussels/BE "no abstract submitted" Learning Objectives: 1. To learn the anatomy of the most common injured structures. 2. To recognise typical combinations of injuries. E³ - Rising Stars Programme: Basic Session 10:30 - 12:00 BS 2 Lungs Moderator: T. Franquet; Barcelona/ES A-063 10:30 Congenital anomalies J. Ley-Zaporozhan; Munich/DE Imaging in lung anomalies is usually started off by plain film radiography. This projection technique gives a first overview of the anatomical situs and allows for a first assessment of expected anomaly. Depending on the individual setting an ultrasound of the chest can be added for further assessment of the vascular structures or cystic components. A more sophisticated imaging technique like computed tomography or magnetic resonance imaging will allow for definite classification of the anomaly. The different imaging techniques and especially CT and MRI protocols used will be covered. Anatomical variants are most often detected within the tracheobronchial tree, namely with anomalous branching pattern of the upper lobe bronchi. Congenital lung anomalies are a heterogeneous group of developmental disorders with a wide distribution in imaging appearance and clinical manifestations. The most frequent ones are: congenital pulmonary airway malformation (CPAM), congenital lobar hyperinflation, bronchial atresia, bronchiogenic cyst and pulmonary sequestration. For these anomalies, the embryologic background, clinical presentation and imaging findings will be demonstrated. Learning Objectives: 1. To discuss current imaging techniques for evaluation of normal lung anatomy. 2. To learn and understand possible anatomical variants. 3. To describe the typical imaging features of the most common anatomical anomalies. A-064 11:00 Infection T. Franquet; Barcelona/ES () Inflammation is a response of vascularised tissues to infections to eliminate the offending agents. Pneumonia occurs when the host mounts an inflammatory response, centred on the lung parenchyma, usually against a microorganism which has reached this normally sterile site. Bacteria are the most common causative microorganisms. Pneumococci usually spare alveolar walls and cause lobar pneumonia that resolves completely, whereas Staphylococci and Klebsiella species destroy alveolar walls and form abscesses that heal with scar formation. Combination of pattern recognition with knowledge of the clinical setting is the best approach to pulmonary infectious processes. When pulmonary infection is suspected, knowledge of the varied radiographic manifestations will narrow the differential diagnosis, helping to direct additional diagnostic measures, and serving as an ideal tool for follow-up examinations. Management of immunocompromised patients is challenging and difficult because of the diversity of causative organisms. Although diagnostic information may also be obtained by means of bronchoalveolar lavage and transbronchial needle aspiration, the radiologist plays an important role in the diagnosis and management of patients with suspected pneumonia. Learning Objectives: 1. To recognise the most common imaging patterns of lung infections. 2. To understand the temporal relationship between the immune status and diverse lung infections. 3. To have a basic knowledge of CT-path correlation of some pulmonary infectious diseases. A-065 11:30 Tumours I. Hartmann; Rotterdam/NL () Non-small cell lung carcinoma (NSCLC) comprises the largest group of which the imaging appearance can be variable. It can present as centrally or peripherally located nodule or mass that may invade mediastinal structures or the chest wall. Tumour margins may be smooth, lobulated, ill defined, irregular or spiculated. Other findings include cavitation, consolidation and ground glass opacity (GGO). Accompanying post-obstructive pneumonia and/or lung collapse can be seen in central tumours. Small cell lung carcinoma (SCLC) is the most common primary pulmonary neuroendocrine tumour. Most SCLCs are a centrally located large mass invading or metastasising to regional lymph nodes. 5-10% of SCLCs present as a peripherally located spiculated nodule without associated lymphadenopathy. Pulmonary metastasis: the lung is frequently involved in metastatic disease. Typical radiological features include multiple round nodules with variable size, peripherally located (haematogenous metastasis) and diffuse thickening of the interstitium (lymphangitic carcinomatosis). Atypical features such as cavitation, calcification, air bronchogram and GGO are often encountered. Pulmonary lymphoma imaging findings of parenchymal disease in both primary (rare entity) and more frequently occurring secondary pulmonary lymphoma are variable and nonspecific. They include single or multiple nodules, masses or consolidations, cavitation and air bronchogram. Ancillary findings include lymphadenopathy, bronchial wall thickening, interlobular septal thickening and pleural effusion. CT is the workhorse of imaging in bronchogenic carcinoma, metastasis and lymphoma, and plays together with PET/CT a crucial role in staging bronchogenic carcinoma and lymphoma. Due to the variety in CT imaging appearances, tissue confirmation is usually warranted to confirm the diagnosis. Learning Objectives: 1. To describe the typical imaging appearance of bronchogenic carcinoma. 2. To describe the typical imaging features of pulmonary metastases. 3. To describe the manifestations and the role of imaging in pulmonary lymphoma. 10:30 - 12:00 E³ - ECR Academies: Tips and Tricks in Liver, Bile Ducts and Pancreas Imaging E³ 218 Benign liver tumours: daily questions Room M 4 A-066 10:30 Chairman's introduction S.M. Ertürk; Istanbul/TR () The session will focus on the imaging features of the cystic and solid liver lesions. The new classification system of the hepatic adenomas will be discussed in detail. Sample cases of haemangiomas and FNHs will be another focus of the session since these lesions are very frequently encountered in imaging studies of the liver. Imaging strategies to increase accuracy regarding the detection and characterisation of focal hepatic lesions will be summarised. Author Disclosure: S.M. Ertürk: Speaker; General Electric, Siemens, Bayer, Guerbet. A-067 10:35 A. Cystic lesions: always biliary cysts? O. Benjaminov; Petach Tikva/IL () Liver cysts are increasingly found on abdominal imaging studies. They cause a diagnostic challenge. There are no current management guidelines that help in their management. In most cases they are asymptomatic and follow a benign course. However, it is essential to differentiate between benign and malignant liver cysts. The majority are of a biliary origin. Others are non-biliary and include hydatid and other infectious cystic lesions, cystic neuroendocrine lesions and cystic metastases. Other lesions which contain a fluid attenuation component may mimic liver cysts such as necrotic changes within lesions following chemotherapeutic treatment. Clinical history, laboratory findings and previous imaging may help in reaching an accurate diagnosis. An important step in narrowing the differential diagnosis is in determining the presence of complex structures within the lesions. Learning Objectives: 1. To be able to list the different conditions that may present as cystic liver masses. 2. To understand the diagnostic multimodality strategy. 3. To become familiar with assessment challenges. A-068 11:03 B. Solid benign lesions: how to solve the conundrum? F. Caseiro-Alves; Coimbra/PT () Benign hepatocellular neoplasms are being recognized with increased frequency using cross-sectional imaging. One of the main goals is to be able to make a clear-cut differential diagnosis between focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA) since patient management is substantially different. Despite the sound knowledge acquired in the last few years about the morphological features of FNH using various cross-sectional imaging techniques, new players in the field have arisen such as diffusionweighted MR imaging (DWI) and use of hepatobiliary contrast agents. These new biomarkers offer a different view over FNH and allow a more accurate characterization even in more atypical cases. Concerning HCA, current knowledge implies that the sub-types of this neoplasm should be known since, again, patient management differs and these patients are no longer seen as compulsory surgical candidates. These sub-types will be further discussed and the role of imaging for risk stratification (haemorrhage and malignant transformation) will be addressed. Further, illustrative cases of combined FNH/HCA cases will be demonstrated along with the main imaging clues for a successful differential diagnosis. Learning Objectives: 1. To become familiar with the recent classification of liver cell adenoma and its justification. 2. To learn about the typical and atypical appearance of focal nodular hyperplasia. 3. To understand the treatment strategy and the modalities of follow-up when appropriate. A-069 11:31 C. From images to strategy: tough cases of benign liver tumours M. Nadrljanski; Belgrade/RS () Benign liver tumours are often diagnosed incidentally. The most common lesions include haemangioma, focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA). Liver nodule(s), often detected on the initial abdominal ultrasound (US), are characterized by contrast-enhanced imaging studies: contrast-enhanced US (CEUS), computed tomography (CT) and magnetic resonance imaging (MRI). Clinical context determines the association with the development of liver disease. Lesions with atypical features (“tough cases”) require additional attention. The most common atypical findings in haemangioma - rapidly filling and giant haemangiomas - may be diagnosed on MRI. In case of the slow-filling and calcified lesions - sclerosing haemangiomas - the diagnostic imaging is less reliable. In case of the growing lesions, the lesion management is made according to multidisciplinary team (MDT). The diagnosis of FNH is based on the combined radiological features, not considered as lesion specific. Atypical forms (FNH without a central scar, FNH with significant steatosis) require particular attention, as the sensitivity of MRI is lower, especially in the absence of the central scar. The use of the specific hepatobiliary contrast agents may contribute to the increase of MRI sensitivity. HCA, not considered the unique entity, reflects the subtype radiological features. The presence of fat and telangiectatic features requires the appropriate imaging technique(s) - MRI for fat and dilated vascular spaces visualization. MRI lesion subtyping is important, as MRI is considered superior to other modalities. In case of atypical benign lesions, MDT will decide on the patient management, including the indication for biopsy/resection. Learning Objectives: 1. To be able to define a diagnostic strategy when facing an unknown case of solid liver lesion, likely to be benign. 2. To become familiar with the unusual appearance of common lesions like focal nodular hyperplasia or haemangioma. 12:15 - 12:45 Headline Session Presiding: P.M. Parizel; Antwerp/BE A-070 12:15 Guest Lecture Breaking News from Latin America Imaging findings in Zika virus infection M. Vasco Aragao; Recife/BR () Zika virus (ZIKV) was discovered in 1947 in monkeys (Zika forest) and human infection was identified in 1952. The first epidemic happened in 2007, at Micronesia and Yap Islands and the second in 2013, at French Polynesia. In Brazil (March 2015) begun the third epidemic and, surprisingly, in the second half of 2015, a microcephaly epidemic was identified. The relationship between the two epidemics is established. The diagnosis is based on clinical and radiological findings, associated with laboratory exclusion of other congenital infections or hereditary conditions. The imaging abnormalities are subcortical calcifications and malformations of cortical development (frontal predominance), ventriculomegaly, decreased brain volume, enlarged cisterna magna, corpus callosum abnormalities and delayed myelination. In patients with arthrogryposis, the abnormalities are reduced spinal cord thickness and anterior nerve roots. Immunologic tests specific for the ZIKV are in development and not available for clinical routine. Thus, the role of radiologists is extremely important in recognizing the radiological pattern of presumed cases of the congenital Zika syndrome, mainly in mild cases, when the disease is not suspected by the paediatrician. There is a possibility that we have been seeing just the most severe extreme of the disease spectrum. Guillain-Barre syndrome, myelitis and encephalitis have been found in adults. Prevention remains the only way to control the disease. The disease has already spread across the world. Up to October 19th, 2016, 73 countries had reported ZIKV transmission, while 23 countries had reported ZIKV-related microcephaly (WHO). In Brazil, there are 2,033 confirmed cases of microcephaly. Learning Objective: 1. To describe the neuroimaging findings of the Zika virus (ZIKV) syndrome, the new emerging epidemic that is writing a new chapter in the history of medicine. 12:30 - 13:30 E³ - The Beauty of Basic Knowledge: Chest Imaging E³ 25A Useful signs in chest radiology Moderator: N. Howarth; Chêne-Bougeries/CH A-071 12:30 A. Lung parenchyma G.R. Ferretti; Grenoble/FR () CXR remains the keystone for the diagnosis of pulmonary diseases, as it is performed in the vast majority of patients complaining of chest symptoms, because is it largely available, simple to realize, low cost and delivers low radiation dose. However, indications of CXR for imaging the lung parenchyma are challenged by ultra-low-dose HRCT. In this presentation, we will focus on useful signs to detect lung parenchymal abnormalities such as airspace opacities, air bronchogram, silhouette sign, atelectasis and interstitial pattern. Pulmonary distribution of abnormalities such as butterfly-wing distribution, antibutterfly-wing distribution and migratory consolidations may increase the value of CXR. Difficulties in the interpretation and limitations of CXR will be discussed along with correlations with HRCT results. Learning Objectives: 1. To review the most useful signs on the chest x-ray. 2. To learn how to interpret the chest x-ray more accurately. 3. To know the appropriate indications of the chest x-ray. A-072 13:00 B. Mediastinum and chest wall N. Howarth; Chêne-Bougeries/CH () The presentation will explain useful signs in chest radiology using side-by-side plain film and CT imaging to help understand the imaging features of common pathologies of the mediastinum and chest wall. Although the clinical value of the chest x-ray remains undiminished, errors of interpretation of the chest x-ray remain one of the most frequent causes of malpractice issues. The skills required for accurate interpretation of imaging of the mediastinum and chest wall will be explored. The objective is to help you improve your performance in plain film interpretation and CT imaging of the chest. Learning Objectives: 1. To review the most useful signs on the chest x-ray. 2. To learn how to interpret the chest x-ray more accurately. 3. To know the appropriate indications of the chest x-ray. 12:30 - 13:30 E³ - The Beauty of Basic Knowledge: A Survival Guide to Musculoskeletal Imaging E³ 24A Degenerative disorders Moderator: V.N. Cassar-Pullicino; Oswestry/UK A-073 12:30 Degenerative disorders A. Cotten; Lille/FR () Osteoarthritis is the most common joint disease worldwide. It is a major source of pain, disability, and socioeconomic cost. The epidemiology of the disorder is complex and multifactorial, with genetic, biological and biomechanical components. Conventional x-ray is the standard diagnostic method to confirm the clinical diagnosis, to evaluate the degree of severity of osteoarthritis and to look for predisposing conditions. CT can be performed for the assessment of bone stock, anatomic conditions and bone deformation. MRI can be used to confirm early forms and to clarify possible damage and/or wear and tear, which cannot be seen on x-rays. Finally, intraarticular administration of contrast will be performed in selected cases, when a precise assessment of the cartilage or fibrocartilage is required. This lecture will focus on: the role of imaging in clinical practice, the typical and atypical imaging features of OA, the radiological features which should not be read as OA, the main predisposing factors that have to be known and searched. Learning Objectives: 1. To appreciate the musculoskeletal imaging manifestations of degenerative disorders. 2. To understand the underlying pathomechanisms involved in these imaging abnormalities. 3. To appreciate the strengths and weaknesses of imaging modalities in assessing these disorders. 14:00 - 15:30 E³ - Rising Stars Programme: Basic Session BS 3 Gastrointestinal diseases Moderator: N. Papanikolaou; Lisbon/PT A-074 14:00 Oesophagus F.-T. Fork; Malmö/SE () Double-contrast barium fluoroscopy is today almost substituted for endoscopy, because the oesophageal mucosa is better evaluated and locally treated by therapeutic endoscopy. Single-contrast studies are used for diagnosing swallowing disorders, sometimes in combination with oesophageal manometry, for food impaction, stent function and achalasia. Computed tomography of thorax and abdomen is done for staging malignant diseases. Combined with FDG-PET the number of metastases increases. Magnetic resonance imaging of thorax with diffusion techniques may improve detectability of metastatic deposits. Local tumour spread, TNM-stage 1 to 4, is imaged by endoscopic ultrasound. The majority of benign oesophageal lesions emanate from the mucosal lining, i.e. adenoma, all kinds of inflammatory conditions, be it gastric reflux, overgrowth in immunosuppressive patients, or noxious contact lesions. As with varices these superficial lesions are diagnosed and biopsied and, when appropriate treated endoscopically. However, diverticular disease is best evaluated radiographically. Small neoplastic lesions are vague in symptoms and incidentally found on routine examination for other reasons and seldom diagnosed by radiological means. Local wall thickening and dislocation are suspicious signs, whereas local lymph nodes grown in size and number are ominous. Oesophageal cancer is endemic in Asia and with us seen in individuals with an overconsumption of tobacco and alcohol. Due to anatomy of the lymphatic system with lymph vessels reaching into the mucous membrane, early tumour spread is mostly encountered. Radiology plays an important role in detecting peripheral disease prior to a MDT-meeting but also after surgical resection to document any post-operative complication or recurrent tumour. Learning Objectives: 1. To discuss current imaging techniques for evaluation of normal anatomy. 2. To describe the imaging features in most common benign pathologies. 3. To review and illustrate the imaging features of malignant pathologies. A-075 14:22 Stomach M. Laniado; Dresden/DE () Today, the stomach is well accessible for endoscopic evaluation. Therefore, double-contrast barium studies of the stomach have almost completely disappeared from the armamentarium of imaging studies in radiology. However, abdominal computed tomography (CT) - not so much magnetic resonance imaging (MRI) - has become the number one procedure in many scenarios if ultrasonography fails to provide a conclusive diagnosis. As the stomach is always imaged when abdominal CT is performed knowledge of normal anatomy, incidental findings, and the most often benign and malignant gastric pathologies is mandatory. Depending on the clinical request, imaging techniques are slightly different. If the main focus is on a lesion of the stomach, maximum wall distention should be achieved by oral administration of up to 2 L of water shortly before the study and i.v. administration of a hypotonic agent. In addition, i.v. administration of iodinated contrast material is mandatory. The presentation will cover normal anatomy of the stomach including vascular supply/drainage and loco-regional lymph nodes. Examples of common and uncommon gastric lesions (e.g. carcinoma, lymphoma, GIST, NET, metastases, ulcer, portal gastropathy, pneumatosis, ischaemia) will be shown and discussed. Also examples of postoperative anatomy and potential complications will be part of the presentation. Learning Objectives: 1. To discuss current imaging techniques for evaluation of normal anatomy. 2. To describe the imaging features in most common benign pathologies. 3. To review and illustrate the imaging features of malignant pathologies. A-076 14:45 Small bowel N. Papanikolaou; Lisbon/PT () Magnetic resonance imaging (MRI) provides excellent soft tissue contrast without radiation exposure and three-dimensional imaging capabilities, which are important when studying the small intestine. Various sequences and contrast agents have been proposed for MRI examination of the small bowel. The development of high-performance gradient systems improved the performance of ultra-fast sequences and allowed comfortable breath-hold acquisition times. For a more detailed evaluation of small bowel diseases, MRI examination should be performed in conjunction with duodenal intubation and administration of a suitable contrast agent, i.e. iso-osmotic water solution (PEG) for homogeneous lumen opacification and adequate distention. A comprehensive MR enteroclysis imaging protocol should comprise single shot turbo spin echo (SSTSE), diffusion weighted imaging, true FISP, HASTE and fat suppressed T1 FLASH sequences. SSTSE is utilized for monitoring the infusion process and performing MR fluoroscopy while true FISP and HASTE, classified as sequential ultrafast techniques insensitive to motion, are mainly used for anatomic demonstration and detection of the pathology. T1 FLASH sequences after intravenous gadolinium injection may aid tissue characterization. For the assessment of Crohn’s disease activity other alternative techniques may be used including perfusion and calculation of the magnetization transfer ratio of the bowel wall. These techniques may be useful for differentiating oedematous or inflammatory bowel thickening from fibrotic thickening but a more extensive evaluation is required to determine the clinical utility of these methods. Learning Objectives: 1. To discuss current imaging techniques for evaluation of normal anatomy. 2. To describe the imaging features in most common benign pathologies. 3. To review and illustrate the imaging features of malignant pathologies. A-077 15:07 CT, US and colonoscopy are the main diagnostic tools for detection of benign and malignant diseases involving the colon. Bowel ischaemia, infectious enterocolitis, diverticulitis and appendicitis are causes of the acute abdomen that often needs prompt diagnosis. This lecture will deal with the typical features on imaging that will lead to the correct diagnosis. CT is part of the staging work up of patients with colonic cancer. It does not only provide information on distant disease but also on the local status. The latter information will help surgeons in choosing the right surgical approach. In this lecture attendees will learn about the current role for CT and potential new role for MRI in the management of colon cancer. Learning Objectives: 1. To discuss current imaging techniques for evaluation of normal anatomy. 2. To describe the imaging features in most common benign pathologies. 3. To review and illustrate the imaging features of malignant pathologies. Room M 1 14:00 - 15:30 Professional Challenges Session PC 3 Excellence and innovation in undergraduate teaching of radiology A-078 14:00 Chairman's introduction: Innovative approaches to undergraduate teaching, impact on student learning V. Válek; Brno/CZ () Over the past several decades, the practice of radiology has undergone substantial change primarily related to advances in imaging technology, changes in the infrastructure of healthcare delivery, and evolution of reimbursement systems. Rapid technological innovation in radiology has led to continual advances in importance of radiology in clinical praxis. This trend is, however, unfortunately without significant implications for radiology teaching and the educational system has not substantially changed. Radiology training programs around the world face a challenging task in both teaching a common knowledge base across all the imaging modalities and in imparting deep knowledge within each imaging domain. Today medical school teaching of radiology includes anatomy, imaging, interventions and new technology. Cross-sectional and virtual anatomy is extremely important. Clinical procedures performed without such a relevant anatomical knowledge could result in serious harm to patients. Important part of the training programs are radiological e-learning activities. E-learning has been used recently in dental and general medicine curricula to support traditional learning methods. Effectiveness of e-learning in radiology education when compared with traditional classroom learning methods is very good and the students had positive attitude when using e-learning. Second example is incorporation of ultrasound education into medical school curricula. Even if the ultrasound imaging is incorporated into the curricula of most of medical schools, actual hands-on training is less widespread. It is time for the changes. 80 hours, which is a common duration of medical school teaching of radiology, is insufficient. Radiology must be incorporated into clinical teaching programmes. Session Objectives: 1. To learn about innovation of didactic and learning strategies in radiology. 2. To evaluate the impact of technology for developing and transforming undergraduates teaching. 3. To analyse student organisation experiences. A-079 14:05 How to keep students engaged C. Nyhsen; Sunderland/UK () When teaching medical students, PowerPoint presentations are often chosen as the preferred lecture format as they can be reliably shown year after year. Although presented material may be of excellent quality, published surveys have shown that students prefer interactive sessions, in particular when realcase scenarios are discussed with close relation to daily medical practice. The objective of this talk is to inspire attendees to try implementing different teaching methods, thus breaking down teaching sessions into smaller elements, engaging students to a higher degree (thereby hopefully improving learning outcomes and retention of information) as well as making it more enjoyable for teachers. The focus will be on "low tech" teaching methods which do not require sophisticated software or hardware facilities. Possibilities of how to integrate quizzes and assessments in a positive way will also be included. Learning Objectives: 1. To learn about tips and tricks to connect with students. 2. To analyse the learning outcomes of students and specify what they expect as a result of a learning activity. 3. To define the methods to achieve excellence in undergraduate training and usefulness of teaching evidence-based radiology. A-080 14:23 Excellence in undergraduate teaching B. Ertl-Wagner; Munich/DE () To attract the best and the brightest medical students into a carrier in radiology, it is important that they become acquainted with the principles of radiology early on in their medical studies, preferentially already during preclinical studies. Cross-sectional and radiographic anatomy, radiation biology, radiation protection and imaging physics can already form an integral part of preclinical training and can be integrated into other teaching modules, e.g. in anatomy. During the clinical part of undergraduate medical education, radiology is a crucial part in almost all clinical aspects - the diagnostic workup and/or image-guided therapeutic principles are highly pertinent for almost all disease entities. In addition, radiology is an integral and important part of many oral and/or written examinations throughout undergraduate medical education. To ascertain that radiology is well represented during undergraduate medical education, it is very important that radiologists become and remain involved in curricular planning. The U-level curriculum of the ESR provides a basis for undergraduate curricular planning. In addition, mentoring programmes can be an important part in undergraduate medical education. Learning Objectives: 1. To learn about the usefulness of curricula. 2. To discuss how to introduce to the students during the undergraduates teaching programmes radiology as an attractive specialisation. 3. To analyse the importance of mentoring undergraduates. A-081 14:41 Teaching with technology: a challenging experience P. Pokieser; Vienna/AT () Direct communication with the students remains the basis of medical education. The big difference to the past before information technology is the great advantage that the students' self-directed learning process is supported by online information and their new ability to navigate within the free available resources and the journals and other contents, by university access. For radiology training, for example, they can even use eurorad, epos or radiopaedia and other valuable data bases. This paradigmatic change does not mean more or less, that the modern student has most interest to hear, what is not accessible online. First, direct contact and interaction with experienced doctors (teachers, tutors), best near the daily work is and will stay as the most appreciated contribution we can give to our students. Second, doctors' experience, ideally combined with own original case studies; nowadays more and more interdisciplinary (e.g. board cases) represents a good starting point of training. Other new challenges in education are the international new undergraduate curricula, with focus on problem orientation, interdisciplinary perspectives of clinical decisions and dedication to organ systems more than clinical disciplines. Sessions in undergraduate’s education are enriched by new tools to allow the students to interact with teachers, communication platforms and webinar applications open the space to include online live and remote blended learning. Learning Objectives: 1. To emphasise on how to communicate with the students. 2. To evaluate new challenges in education, informatics tools available to encourage education. 3. To analyse the advantages of interactive sessions in undergraduate’s education. A-082 14:59 Evidence-based radiology for diagnostic imaging: do we need to teach the undergraduates? R. Iezzi; Rome/IT () Evidence-based practice (EBP) has been defined as the ‘interpretation of the best research evidence with clinical expertise and the patient’s unique values and circumstances’. EBP teaching to future healthcare professionals has mainly been documented in medical students. Many different educational interventions of varying duration, frequency, and forma to teach EBP in a variety of settings exist. It showed that educational strategies adopted were found to improve students’ overall EBP competence and their EBP knowledge and skills. Students felt more confident to accurately interpret the literature, could better assess the reliability/validity of information on the web and felt more comfortable with the concepts of EBP. It indicated that EBP is a learnable skill and the question is not whether EBP can or should be taught, but how to best teach. The use of technology to promote EBP through mobile devices, simulation, and the web is on the rise and web-based educational platforms have been demonstrated as an effective and desirable mechanism to deliver educational content to health professionals. Learning Objectives: 1. To analyse the key concepts of teaching evidence-based radiology. 2. To learn about new approaches in teaching and learning radiology. 3. To discuss the importance of teaching evidence-based radiology among students. 15:17 Panel discussion: How do new approaches contribute to excellence in undergraduate teaching? Room M 4 14:00 - 15:30 E³ - ECR Academies: Tips and Tricks in Liver, Bile Ducts and Pancreas Imaging E³ 318 Chronic liver disease: guidelines for the radiologist A-083 14:00 Chairman's introduction B.J. Op de Beeck; Antwerp/BE () Chronic liver disease is a substantial worldwide problem. Its major consequence is increasing deposition of fat, iron and fibrous tissue within the liver, leading to the development of cirrhosis with its consequences, portal hypertension, hepatic insufficiency and HCC. During this session, the question “how accurate are we in measuring fat and iron with MRI” will be answered. The goal is to become familiar with the different acquisition techniques, to understand the correspondence between MRI evaluation and histological scores and to learn about the limitations of the method. A second problem will be discussed concerning the question “can we reliably identify and quantify liver fibrosis and cirrhosis”. It is important to understand the basic principles of fibrosis evaluation with US and MRI, how these methods could be implemented in daily practice, and how to make a radiological report. Fibrosis is independently associated with the viscoelastic parameters and is less associated with the diffusion parameters than is steatosis. There is a need for non-invasive detection and follow-up of these chronic liver diseases. Elastographic techniques are rapidly becoming the method of choice for the assessment of liver fibrosis, replacing liver biopsy for diagnosis, evaluation of disease progression and treatment monitoring. Finally, the problem of a small liver nodule in a patient with chronic liver disease will be discussed with the focus on characterisation and the international guidelines presenting diagnostic Gutteridge C.: B-0065 Güven Z.: B-0503 Guyler P.: B-0275, B-0828 Guyon P.: B-1023 Guzmán L.: B-1161 Gvozdev A.: B-1033 Gysin V.: B-1201 Puylaert J.B.C.M.: A-524, A-690 Pyatigorskaya N.: B-1396 Pyfferoen L.: B-0487, B-0657 Rathod N.: B-0103 Ratib O.: A-258, A-260, A-348, A-639 Rattansingh A.: B-1241 Ratti F.: B-0553 Rauchmann B.: B-0352 Raupach R.: B-0126, B-0314 Rausch I.: A-866 Rausch V.H.: B-0185 Rauscher I.: B-0796 Ravanelli M.: B-0053, B-0168, B-0251 Ravelli S.: B-1013 Rawlings D.: B-0312 Raza S.A.: B-0445 Razansky D.: B-0506 Re T.: B-0025, B-0026 Re T.J.: B-0264, B-0265 Reboredo A.R.: B-0868 Reckenfelderbäumer A.: B-0352 Reddy P.T.: B-0103 Reekers J.A.: A-047 Refait J.: B-1087 Reffat M.M.: B-0010 Regge D.: A-369, A-723, A-808, B-0575, B-0633, B-1131, B-1199 Regier M.: B-1034, B-1356 Regnard N.E.: B-0301 Regnard N.-E.: B-1155 Reh C.: B-0608 Rehn J.: SY 6 Reijman M.: B-1352 Reijnierse M.: A-333, B-0295 Reimer R.: B-0308 Reiner C.S.: B-0205, B-0206, B-1246 Reis C.: B-0668 Reis C.S.D.: B-0664, B-0666, B-1183 Reis Lima M.: B-0853 Reiser M.F.: A-500, B-0094, B-0210, B-0216, B-0272, B-0273, B-0306, B-0405, B-0587, B-0611, B-0618, B-0797, B-0909, B-0964, B-0965, B-0969, B-1079, B-1110 Reiter C.: B-0333, B-0989 Reiter G.: B-0333, B-0989 Reiter U.: B-0333, B-0989 Rella L.: B-0634 Rembak-Szynkiewicz J.: B-0584 Reményi P.: B-0038 Remy J.: B-0154, B-0155, B-0571 Rémy-Jardin M.: A-091, A-504, B-0154, B-0155, B-0571 Rengier F.: B-0570, B-1136, B-1252 Rengo M.: A-166, A-291, B-0418, B-0419, B-0704, B-1283 Renne G.: B-0698 Renovanz M.: B-0619 Renton M.: B-0874 Renz M.: B-0450, B-0960 Repo P.: B-0310 Resinger C.: B-0117 Restivo A.: B-0423 Retico A.: B-1315 Reu S.: B-0306 Reutener M.: B-0292 Revel M.-P.: A-584 Rey Y.R.: B-0495 Reymond E.: B-0734 Rezaei Motamed S.: B-0099 Rezk M.: B-0912 Rezk M.M.A.: B-0927 Riascos R.: B-1134 Ribas M.: B-0652 Ribeiro A.: B-0498 Ribeiro A.M.: A-419, B-0824, B-0827, B-0830, B-0981 Ribeiro L.P.V.: A-419, B-0140, B-0324, B-0498, B-0822, B-0823, B-0824, B-0827, B-0830, B-0981, B-1181, B-1364 Ribeiro M.M.C.P.: B-0132, B-1363, B-1365 Ribelles M.J.: B-0776 Ribó Jacobí M.: B-0446, B-0995, B-1254 Riccabona M.: A-011, A-645 Ricci P.: A-108, A-110 Van Camp L.: B-0913 van de Leemput S.: B-0523 Van De Moortele K.: B-0487, B-0657 van den Hauwe L.: A-325, A-528 van der Geest R.J.: B-0508 van der Harst P.: B-0505, B-0838 van der Heide U.A.: B-0415 van der Hoorn A.: B-0778 Van der Lugt A.: A-378, B-0091, B-0676, B-0931 van der Molen A.: B-0108 van der Poel H.: B-0741 van der Sande M.: B-0021, B-0416, B-0417 van der Zijden T.: A-028, A-648, B-0451 van Dijk R.: B-0505, B-0838 van Dijkman P.: B-0505, B-0838 van Driel W.: B-0340 Van Dyck P.: B-1357 van Engen R.E.: B-0483 Van Gils C.: SY 3b van Gils M.: A-174 van Ginneken B.: B-0392, B-0401, B-1211, B-1212 Van Goethem J.: A-455, A-794 van Griethuysen J.: B-0016 Van Griethuysen J.J.M.: B-0020, B-0022, B-0271, B-0414 van Hamersvelt R.W.: B-0072, B-0142, B-0836, B-0988 van Hecke W.: A-612 Van Herck P.: B-0844 Van Hoof T.: B-0651 van Koeverden S.: B-0364 van Laar P.J.: B-0778 Van Laer P.: A-469 Van Maanen A.G.: B-0786 van Nijnatten T.: B-0920, B-1327 Van Ongeval C.: B-0940, SY 3c van Ooijen P.M.A.: A-560 van Oostenbrugge R.J.: B-0091, B-0676 van Rijn R.R.: A-340, A-702 van Rijswijck C.: B-0372 van Roozendaal L.: B-0920 Van Tiggelen R.: A-445 van Triest B.: B-0415 van Tuijl S.: B-0839 van Vliet L.J.: B-0374 van Westen D.: B-0936 van Zelst J.C.M.: B-0949 van Zwam W.: A-027, B-0091 van Zwam W.H.: B-0219 Vande Berg B.: A-861 Vande Vyvere T.: A-852 Vandecaveye V.: A-860 Vanhevel F.: B-0325 Vanhoenacker F.M.H.M.: A-726, A-887 Vanhooymissen I.J.S.M.: B-0364 Vanninen R.L.: A-711 Vaño E.: A-144 van't Sant-Jansen I.: B-0340 Vantorre A.: B-0813 Vanwetswinkel S.: B-0457 Vanzulli A.: B-0167 Varallyay C.G.: B-1399 Vardhanabhuti V.: B-0065, B-0398 Varga A.: B-0212 Varga Szemes A.: B-0031, B-0674 Varga-Szemes A.: B-0508, B-0685, B-0834, B-0840, B-1026, B-1061 Varma S.: A-175 Varoquaux A.: B-0250 Varotto A.: B-0907 Varrassi M.: B-0182 Vasco Aragao M.D.F.: A-070 Vasil'eva Y.: B-0757 Vasilevska Nikodinovska V.: B-1140 Vaskuri A.: B-0310 Vassallo L.: B-0575, B-1131 Vazquez J.: B-0849 Vazquez Mendez É.: B-0995 Vedolin L.: B-0853 Vegar Zubovic S.: B-0160 Wawroschek F.: B-1303 Wawrzyniak P.: B-0620 Wazira A.: B-1361 Webb J.-A.: B-1366 Weber M.: B-0117, B-0302, B-0752, B-1001, B-1036, B-1125 Weber M.-A.: A-435, A-539, B-0105, B-0476 Weckbach S.: A-712 Ween B.: B-1179 Wegierska M.: B-0298 Wei X.B.: B-1323 Weibrecht M.: B-0016 Weidemann F.: B-1010 Weiguo M.: B-1024 Weijers G.: B-0949, B-1244 Weininger M.: B-1010 Weinreb J.: B-1198 Weinrich J.: B-0696, B-1237 Weinrich J.M.: B-1232 Weir-McCall J.: B-0030, B-0237, B-0993, B-1372 Weir-McCall J.R.: B-0682, B-1342 Weishaupt D.: A-758, B-0205, B-0206, B-1118 Weiß C.: B-0559 Weiss J.: B-0188, B-0190, B-0541, B-0542, B-0546, B-0705, B-0710 Welbourn R.: B-0489 Well L.: B-0185 Wells A.U.: A-267 Wells M.L.: B-0240 Welsch G.H.: B-1356 Wen J.B.: B-0781 Weng A.: B-1084 Weng A.M.: B-1085 Wenger N.K.: B-0680 Wengert G.: B-0736 Wengert G.J.: B-0439 Wenkel E.: SY 3a, SY 3d Wenz H.: B-1202, B-1203 Werlen S.F.: B-1165 Werncke T.: B-0720 Wester H.J.: B-0792 Wester H.-J.: B-0700, B-0790 Westerlaan H.E.: B-0778 Westerland O.A.: B-1288 Weston M.: A-150, A-437 Wetter A.: B-0482, B-0748, B-0755, B-0795 White R.D.: B-1342 Whittle C.: B-1313 Wichmann J.L.: B-0089, B-0215, B-0508, B-0565, B-0680, B-0684, B-0717, B-1061, B-1102, B-1338 Wick M.C.: B-0099 Widmann C.: B-1391, B-1395 Widmann G.: B-0146 Widmer M.: B-1183 Wiech D.: B-1107 Wiederer J.: B-0077 Wiedermann F.-J.: B-0146 Wielpütz M.O.: A-700, A-838, B-1086 Wienbeck S.: B-0462 Wieners G.: B-0888 Wiersma S.: B-0072 Wiese M.: B-1083 Wiesmann M.: B-0854 Wiesmueller M.: B-0071 Wiestler B.: B-0616 Wiggermann P.: B-0980 Wilczek B.: SY 6 Wildauer M.: B-0673 Wildberger J.: B-0920 Wildberger J.E.: B-0142, B-0143, B-0217, B-0219, B-0457, B-0564, B-0716, B-1005, B-1063, B-1255, SY 20 Wildberger J.W.: B-0676 Wilde R.: B-0488 Wildgruber M.: B-0427, B-0506 Wildiers H.: B-0940 Wilén J.: B-0315 Wilkinson L.: B-0442, B-1146 Willemink M.J.: A-510, B-0072, B-0142, B-0836, B-0988 Yabuuchi H.: B-0070 Yadav K.: B-0380 Yadav P.: B-0254, B-1089 Yagami K.: B-0493 Yaghmai V.: B-0028, B-0730 Yagi T.: B-0136 Yaguchi A.: B-0230 Yakabe M.: B-0436 List of Moderators (G) Connor S.: SS 1008 Cook G.: SS 1016b Cosson P.: SS 1414 Costagli M.: SS 1413 Coulon P.: SY 30 Cuenod C.A.: SS 1916 Cyteval C.: RC 510 Czerny C.: SS 1810b Calli C.: SS 311b Cambronero Gómez J.M.: SS 1810a Campbell R.: SS 310 Camps Herrero J.: SS 1802a Cantisani V.: WG 4 Cassar-Pullicino V.N.: E³ 24A, E³ 24B, E³ 24C, E³ 24D, E³ 24E, ESR/EANM Cevasco L.: SS 201b Chodorowska A.: RC 1204 Choi B.I.: SS 1401 Chouhan M.: SS 1416 Ciet P.: SS 1804 Clément O.: RC 406 Ebdon-Jackson S.: EU 5 Ehman R.L.: EM 2 Esen G.: SS 202 Esposito A.: SS 203 Grunwald I.Q.: SS 1011b Guerrero Gil J.L.: EM 3 Guerrini S.: SS 316 Iliadis K.: SS 612 Ippolito D.: SS 201a Jackson S.A.: SS 1901a Jargiello T.: RC 815 Jefic S.: SS 311a Maas M.: SS 217 Macri F.: SS 1017 Magnano G.M.: E³ 1526b Maher M.: SS 1901b Maj E.: RC 1311 Maksimović R.: SS 1403a Mann R.M.: SS 1802a Maric D.: SS 1811a Marincek B.: SS 1901b Marti-Bonmati L.: SS 301a Matin T.N.H.: SS 704 Matos C.: SS 1801 Mayerhöfer M.E.: SS 605 Mechl M.: SS 614 Mendichovszky I.: SS 1006 Mentzel H.-J.: SS 1412 Merlino B.: SS 1815 Mershina E.: SS 704 Mizzi A.: RC 114 Montet X.: SS 1804 Morozov S.: PI 1 Muscat K.: SS 214 Natale L.: SS 314 Negaard A.: SS 1411 Nievelstein R.A.J.: SS 1512 Nikolaou K.: ESHI Njagulj V.: RC 1210 Torresin A.: EF 1 Tóth A.: SS 603 Traykova N.I.: SS 308 Trimboli R.M.: SS 1902a Tsalafoutas I.A.: SS 613 Tscholakoff D.: SS 1914 Tsetis D.K.: E³ 526b Tshering Vogel D.W.: RC 108 Tyurin I.E.: SY 25 Ulbrich E.J.: SS 1910b Ulzheimer S.: SY 31 Vaidya S.: SS 217 Van Beers B.E.: SS 1901c van Buchem M.A.: SS 611 van den Hauwe L.: RC 414 Van Hoyweghen A.: SS 1402b Van Ongeval C.: SY 3d van Randen A.: SS 317 Varian C.: SY 6 Vassileva J.N.: SS 1413 Velonakis G.: SS 1909 Verbist B.: SS 708 Verstraete K.: SS 710 Vilanova J.C.: SS 1407 Vilela P.: RC 111 Villeirs G.M.: EM 1 Vliegenthart R.: SS 1803 Walter T.C.: SS 703a Weishaupt D.: SS 701a Wildberger J.E.: SY 20 Wildner S.: SS 713 Wirth S.: SS 317 Wolf F.: SS 703a Zackrisson S.: SS 714, SS 1802b Zahel T.: SS 610

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ECR 2017 – BOOK OF ABSTRACTS, Insights into Imaging, 2017, 1-583, DOI: 10.1007/s13244-017-0546-5