29 en 30 september logen dagen. programma & abstracts. Nederlandse Vereniging voor Radiologie. Radiological Society of the Netherlands

Agfa HealthCare Alliance Medical Bard Benelux Bayer Schering Pharma Biomedic Bracco Imaging Europe Covidien Nederland Esaote Pie Medical GE Healthcare Guerbet Nederland Haga Medical Helsebemanning Medtronic Nederland Melius Pro Oldelft Benelux Radiomatix Toshiba Medical Systems Nederland Tromp Medical Vrest Medical

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programma & abstracts

sponsoren en exposanten

programma & abstracts - 16E nederlandse radiologendagen - 29 en 30 september 2011

Hoofdsponsoren radiologendagen 2011

16

29 en 30 september 2011

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Veel plezier op de radiologendagen 2011!

Bert-Jan de Bondt, voorzitter Vincent Cappendijk Marion Smits Bart Wiarda Henk-Jan van der Woude

Kwaliteit

Dames en heren, geachte leden van de Nederlandse Vereniging voor Radiologie,

Welkom in Maastricht op de Radiologendagen 2011! Het thema dit lustrumjaar is Kwaliteit. Kwaliteitseisen in de gezondheidszorg worden steeds meer opgelegd en zijn belangrijk voor een goede praktijkvoering. Dit geldt uiteraard ook voor de radiologie, dan bij voorkeur door ons als vereniging zelf de eisen opgesteld en in goede samenwerking met onze klinische collega’s. Voor de hand liggend is het om kwalitatief beter te worden door te leren van eigen fouten. Het programma begint donderdagochtend daarom met ‘Deze misser maak je maar 1 keer’. In de tweede plenaire sessie op donderdag ‘Setting standards in healthcare – many ways, no return’ zal het onderwerp kwaliteit belicht worden door gastsprekers Dr. M-J Vrancken Peeters (chirurg, NKI-AvL) en Prof. Dr. D. Rubin (radioloog, Stanford University, USA). Op vrijdag zal er door een drietal pro-con koppels worden gedebatteerd over het hanteren van kwaliteitsnormen: ‘Pro-con: setting standards in healthcare – which way to go?’.

Nieuw onderwerp bij de parallelsessies is de Educatieve Voordracht. Dit is bedoeld om onderwerpen welke direct toepasbaar zijn in uw praktijk, maar (nog) niet zijn verworden tot een wetenschappelijk artikel. Bij alle wetenschappelijke abstract sessies zijn hierbij passende keynote lectures gezocht. De ‘Research Corner’ uit 2009 is gestoken in een nieuw jasje. Acht UMC’s presenteren niet alleen hun spraakmakende wetenschappelijke onderzoeken, maar steken ook de hand naar elkaar uit, om samen beter te worden. De Refresher Courses op beide dagen worden deels verzorgd door toonaangevende gastsprekers uit het buitenland. Aan de hand van de verstrekte leerdoelen kunt u beter schatten of een onderwerp uw belangstelling heeft. Wij zijn buitengewoon verheugd een aantal van u ook een workshop te kunnen aanbieden. De geluksvogels onder u gaan statistisch gezien herboren naar huis en met bouwstenen voor een robuuste teachingfile (millennium proof). Lees voor details het volledige programma.

Dit jaar is er een andere formule gekozen voor de verschillende prijzen. Naast de bekende Philipsprijs en Radiologendagen prijs zal er een toelichting op en uitreiking van de NVvR Travel Grant plaatsvinden.

Bent u dit jaar niet in de prijzen gevallen dan bent u niet minder welkom in feestelijke kleding op het Diner & Galafeest met als thema ‘Dress to impress’. Op een prachtige locatie in Maastricht wordt u op zuidelijke wijze verwend.

De radiologendagen kunnen mede mogelijk worden gemaakt door sponsoring van de industrie, u wordt dan ook van harte uitgenodigd om met de industrie in contact te komen op de expositie.

Onze dank gaat uit naar de inzet van velen, zichtbaar in het programma boekje. Namen noemen is ontoereikend, enthousiaste deelnemers is uw verdienste.

Parallelsessie: Abdominale radiologie 1

Zaal 2.1 Colorado

Het uitgebreide programma en de leerdoelen vindt u vooraan in dit programma- en abstractboek: Donderdag 29 september 2011: bladzijde 2 t/m 5 Vrijdag 30 september 2011: bladzijde 5 t/m 7

Expofoyer Auditorium 2 Zaal 0.1 London Zaal 0.2 Berlin Zaal 0.4 Brussels Zaal 0.5 Paris Zaal 0.8 Rome Zaal 0.9 Athens Zaal 2.1 Colorado 08.30 - 09.00 Ontvangst 09.00 - 10.15 Workshop/hands-on: Workshop: Refresher course: Refresher course: Refresher course: Refresher course: Refresher course: To make Radlex more familiar. “Interpretatie van Buiktrauma, waar gaat Acute pijn op de borst: De knie: Niet standaard Opleiden anno 2011 Veneuze Using IHE TCE for radiologisch het nou eigenlijk om Stand van zaken MRI bevindingen en interventies export of PACS data to wetenschappelijk de postoperatieve knie an MIRC teaching file onderzoek” 10.15 - 10.45 Koffiepauze 10.45 - 12.15 Parallelsessie: Parallelsessie: Parallelsessie: Parallelsessie: Parallelsessie: Parallelsessie: De educatieve Abdominale Mammadiagnostiek 2 Kinderradiologie / MSK / Thorax / Neuro-Hoofdhals voordracht radiologie 2 & Uitreiking Diversen Diversen radiologie Jan Hendriksprijs 12.15 - 13.15 Lunch 12.30 - 13.00 Postersessie 13.15 - 13.30 Wetenschappelijk beleid NVvR voor academische en niet academische centra 13.30 - 14.30 Plenaire sessie: Pro-con: Setting standards in healthcare - which way to go? 14.30 - 15.15 Richtlijnen sessie 15.15 - 15.45 Theepauze 15.45 - 16.25 Prijsuitreiking: Philipsprijs, Posterprijs, Radiologendagenprijs, NVvR Travel Grant en Fellowshipdiploma’s 16.25 - 17.15 Quiz Vanaf 20.00 Diner & galafeest in Amrâth Grand Hotel De L’Empereur, Maastricht

Vrijdag 30 september 2011

Expofoyer Auditorium 2 Zaal 0.2 Berlin Zaal 0.3 Copenhagen Zaal 0.4 Brussels Zaal 0.5 Paris Zaal 0.8 Rome Zaal 0.9 Athens 10.00 - 10.45 Ontvangst 10.45 - 12.00 Plenaire sessie: Emeritus programma Deze misser maak je (start vanaf 11.20 uur) maar één keer 12.00 - 13.00 Lunch 12.15 - 12.45 Postersessie 13.00 - 14.00 Plenaire sessie: Setting standards in healthcare many ways, no return 14.05 - 15.35 Research corner Vervolg Parallelsessie: Parallelsessie: Parallelsessie: Parallelsessie: Emeritus programma Interventieradiologie / Cardiovasculaire Abdominale radiologie / Mammadiagnostiek 1 Cardiovasculaire radiologie radiologie Acute radiologie / Diversen 15.35 - 16.00 Theepauze 16.00 - 17.15 Refresher course: Workshop: Vervolg Refresher course: Refresher course: Refresher course: Refresher course: Respons monitoring “Interpretatie van radiologisch Emeritus programma Chronische thrombo- Neuranatomie Beeldvorming bij groei- What is the best imaging made sexy wetenschappelijk onderzoek” embolische pulmonale voor dummies en puberteitsstoornissen modality for “aseptic/low hypertensie grade infection/infectious loosening of joint prostheses?” 17.15 - 17.30 Uitreiking WSS penning 17.30 - 18.45 ALV NVvR & Juniorsectie 18.15 Industrieborrel: excl. aangeboden door

Donderdag 29 september 2011

programma & abstracts voorwoord

16E RADIOLOGENDAGEN 2011

Organisatie Organisatie Comité

Bert-Jan de Bondt, voorzitter Vincent Cappendijk Marion Smits Bart Wiarda Henk-Jan van der Woude WETENSCHAPPELIJK COMITÉ

Henk Jan Baarslag Ludo Beenen Marc Engelbrecht Nanko de Graaf Jan-Cees de Groot Ieneke Hartmann Mechli Imhof-Tas Simone Jap-a-Joe Viola Koen Martin Kraai Krijn van Lienden Ruud Pijnappel Stefan Steens Joachim Wilberger CONGRESSECRETARIAAT

Postbus 2428 5202 CK ‘s-Hertogenbosch Tel 073 700 3500 Fax 073 700 3505 [email protected] www.congresscompany.com 1 6 E

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programma & abstracts programma Donderdag 29 september 2011 Tijdstip Onderwerp TRAJECTUM Ontvangst & registratie 10.00 - 10.40 10.40 - 10.45

AUDITORIUM 2 Opening door voorzitter Dr. R.B.J. de Bondt, Isala klinieken, Zwolle

AUDITORIUM 2 10.45 - 12.00 Plenaire sessie: Deze misser maak je maar één keer Voorzitter: Mw. Drs. V.H. Koen, Kennemer Gasthuis, Haarlem Dr. K.P. van Lienden, AMC, Amsterdam Mw. Dr. C.S.P. van Rijswijk, LUMC, Leiden Dr. M.W. de Haan, MUMC, Maastricht EXPOFOYER Lunch 12.00 - 13.00 EXPOFOYER Postersessie 12.15 - 12.45 AUDITORIUM 2 13.00 - 14.00 Plenaire sessie: Setting standards in healthcare - many ways, no return Kwaliteitseisen opgelegd door de zorgverzekeraar, maar ook die van de heelkundige beroepsvereniging zijn opmerkelijk in het nieuws geweest. Onvermijdelijk dat de radiologie hiermee te maken krijgt. Van buitenaf opgelegd dan wel zelf opgesteld. In deze sessie schetst dr. M-J. Vrancken Peeters, chirurg en woordvoerster van de NVvH, de aanloop tot -en achtergrond van de recent gepubliceerde kwaliteits eisen voor oncologische chirurgie. Vervolgens stelt dr. D. Rubin een ambitieuze maar praktische manier voor om de kwaliteit van het radiologisch werk te verbeteren. Inleiding door: Prof. dr. J.S. Laméris, AMC, Amsterdam Gastsprekers: Dr. M-J. Vrancken Peeters, chirurg, NKI-AvL, Amsterdam Prof. D. Rubin, Stanford University, USA 14.05 - 15.35

Parallelsessies vrije voordrachten Voorafgaand aan de wetenschappelijke voordrachten zal iedere sessie aanvangen met een keynote lecture. ZAAL 2.1 COLORADO Sessie 1: Abdominale radiologie 1 Voorzitters: Dr. R.F.A. Vliegen, Atrium MC, Heerlen & Drs. J.E. van den Bergh, AMC, Amsterdam PET-MRI: tool or toy Dr. J. Buscombe, Addenbrooke’s Hospital, Cambridge, UK Learning objectives: Understand technical issues of PET/MR Look at possible indications for PET/MR Understand some of the issues for nuclear medicine staff The first PET/MR machines are now on the market for €2 million. However there are significant technical issues including just trying to acquire images. What compromises are made in terms of image quality for both PET and MR. How can attenuation correction be applied? Once these technical issues have been resolved is PET/MR just a technique looking for an indication? ZAAL 0.8 ROME Sessie 2: Abdominale radiologie / Acute radiologie / Diversen Voorzitters: Mw. M.A. Stam, Medisch Centrum Alkmaar & L.F.M. Beenen, AMC, Amsterdam Alternatieve diagnoses bij MRI appendicitis Mw. M.A. Stam, Medisch Centrum Alkmaar, Alkmaar ZAAL 0.5 PARIS Sessie 3: Cardiovasculaire radiologie Voorzitters: Dr. H.J. Lamb, LUMC, Leiden & H.C.M. van den Bosch, Catharina Ziekenhuis, Eindhoven MRI bij diabetes en metabool syndroom Dr. H.J. Lamb, LUMC, Leiden ZAAL 0.9 ATHENS Sessie 4: Mammadiagnostiek 1 & Uitreiking Jan Hendriksprijs Voorzitters: Dr. M.J.C.M. Rutten, Jeroen Bosch Ziekenhuis & Mw. K.M. Duvivier, UMC Utrecht, Utrecht 3D echografie van de mamma; een poor mans MRI? Dr. M.J.C.M. Rutten, Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch ZAAL 0.4 BRUSSELS Sessie 5: Interventieradiologie / Cardiovasculaire radiologie Voorzitters: Dr. M.W. de Haan, MUMC, Maastricht & L.W. Kaufmann, Spaarne Ziekenhuis, Hoofddorp Update abdominale endoprothesen Dr. M.W. de Haan, MUMC, Maastricht

AUDITORIUM 2 Research Corner Voorzitters: Mw. Prof. dr. R.G.H. Beets-Tan, MUMC, Maastricht & Prof. dr. J.S. Laméris, AMC, Amsterdam Tijdens deze parallelsessie zullen de 8 UMC’s de gelegenheid hebben een presentatie te geven van een hoogstaand en origineel onderzoeksproject. Van het project wordt een kort overzicht gegeven. Duidelijk zal worden wat de positie van het onderzoek is ten opzichte van andere groepen in Nederland en daarbuiten, en wat het perspectief van het onderzoek is in 5 a 10 jaar van nu. Tot slot wordt aangegeven met welke additionele (externe?) kennis, men dit perspectief verwacht eerder te kunnen halen.

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16E RADIOLOGENDAGEN 2011 Tijdstip Onderwerp LUMC: Toepassingen van ultrahoogveld MRI bij patientenpopulaties Prof. dr. M.A. van Buchem Erasmus MC: Population Imaging Prof. dr. A. van der Lugt UMC Groningen: Screening for Coronary Artery Disease by Non-invasive Imaging in Patients with known Extra-cardiac Atherosclerotic Disease: the GROUND-2 study Mw. Dr. R. Vliegenthart VUMC: Pseudo-continuous arterial spin-labeling at 3T in Alzheimer’s disease Drs. M.A.A. Binnewijzend UMC St Radboud: MR gestuurde prostaat interventies; klaar voor de praktijk? Dr. J.J. Fütterer MUMC: Wait and See in rectal cancer patients: selection by imaging and outcome Mw. Drs. M. Maas & Mw. Prof. dr. R.G.H. Beets-Tan AMC: Neurotransmitters in de MRI Mw. Dr. L. Reneman, neuroradioloog UMC Utrecht: MRI-guided High Intensity Focused Ultrasound: The future of tumor ablation? Dr. M.A.A.J. van den Bosch EXPOFOYER 15.35 - 16.00 Theepauze 16.00 - 17.15 Refresher courses ZAAL 0.4 BRUSSELS Chronische thrombo-embolische pulmonale hypertensie Voorzitter: Dr. H.W. van Es, St. Antonius Ziekenhuis, Nieuwegein Het klinisch gezichtspunt L. van den Toorn, Erasmus MC, Rotterdam Leerdoelen: * De patient met pulmonale hypertensie bestaat (niet)? * Work-up van patiënten met (vermoeden) pulmonale hypertensie * Wat zijn de verschillende behandelingen (medicamenteus en chirurgisch). CT beeldvorming Mw. Dr. W. van Lankeren, Erasmus MC, Rotterdam Leerdoelen: * Welk protocol bij analyse pulmonale hypertensie? * Wat zijn de direct en indirecte kenmerken CTEPH op CT? * Wat zijn de pitfalls? MRI beeldvorming Prof. dr. A. Vonk-Noordegraaf, VUMC, Amsterdam Leerdoelen: * Welk protocol bij analyse pulmonale hypertensie? * Wat zijn de direct en indirecte kenmerken CTEPH op CT? * Toegevoegde waarde van functionele informatie? Chirurgie Dr. W.J. Morshuis, St. Antonius Ziekenhuis, Nieuwegein Leerdoelen: * Wat zijn de operatie-indicaties * Wat houdt CTEPH chirurgie in? * Post-operatief beloop: succes gegarandeerd? Paneldiscussie Leerdoel: Kunnen MRI en CT angiografie vervangen? ZAAL 0.8 ROME Beeldvorming bij groei- en puberteitsstoornissen Voorzitter: Drs. N. de Graaf, Erasmus MC, Rotterdam Beeldvorming Mw. A.M.J.B. Smets, AMC, Amsterdam What the clinician wants to know! Drs. N. Zwaveling-Soonawala, kinderarts-endocrinoloog, EKZ-AMC, Amsterdam Leerdoelen: Beeldvorming bij groei- en puberteitsstoornissen Beeldvorming is een essentieel onderdeel in de work-up van een slecht of juist te snel groeiend kind, van een puberteit die te lang op zich laat wachten of juist te vroeg begint. Beeldvormers beschikken over een palet aan technieken om de kinderarts te ondersteunen in de diagnostiek van deze problemen. Na deze refresher course, weet u meer over de achtergrond van groei- en puberteitsstoornissen, beheerst u welke radiologische onderzoeken sleutels kunnen zijn in het oplossen van een endocrinologisch probleem bij kinderen en hoe u deze modaliteiten optimaal kunt inzetten. ZAAL 2.1 COLORADO What is the best imaging modality for ‘aseptic/low grade infection/infectious loosening of joint prostheses?’ Chairman: Dr. A. Ginai, AMC, Amsterdam & Erasmus MC, Rotterdam Imaging of Total Hip Replacement and Complications Dr. A. Ginai, AMC, Amsterdam & Erasmus MC, Rotterdam Learning objectives: * Various types of hip prostheses and their radiological appearances. * Recognition of postoperative complications. * Role of imaging in diagnosis of prosthetic loosening. * Recommendations and an algorithm for imaging in ‘a patient with painful total hip arthroplasty or THP’

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programma & abstracts programma Tijdstip Onderwerp Radionuclide imaging of the problematical prosthetic hip Dr. J. Buscombe, Addenbrooke’s Hospital, Cambridge, UK Learning objectives: Understand the role of multiphase scintigraphy in the painful hip prosthesis Understand advantages and problems of labelled leucocyte imaging in the painful hip prosthesis Understand the interaction of nuclear medicine and other investigations. Whilst many areas of clinical practice has been lost to nuclear medicine the assessment of the painful hip prosthesis remains a common indication. The incidence of infected hip prosthesis is less than that for the knee (1% vs4%) but hip replacements remain more common. In many cases pain in a hip prosthesis is not due to infection or loosening but the advantage of nuclear medicine techniques is their high negative predictive value. However care must be taken when using various scintigraphic techniques to ensure an accurate final diagnosis is established. AUDITORIUM 2 Respons monitoring made sexy Chairman: Dr. B. Brans, nucleair geneeskundige, MUMC, Maastricht Accurate respons monitoring is crucial for the patient Prof. dr. H.C. Schouten, hemato-oncologist, MUMC, Maastricht Learning objectives: Refresh knowledge about respons workhorses RECIST and HOVON Advantages and disadvantages of these workhorses What does the oncologist do with the (standardized) radiology report? Learn about the impact of respons monitoring on survival, management, and complications Respons monitoring, State of the art Prof. Dr. V. Vandecaveye, UZ Leuven, Belgium Learning objectives: Overview of methods of respons monitoring of the near future (automatic volume measurements, DWI, dynamic postcontrast imaging, PETCT/PETMRI, other?) Work out of 1 or 2 of these techniques; how do I, interpretation, reporting (with emphasize on daily practice) Information technology solutions for practical implementation of these new techniques Prof. D. Rubin, Stanford University, USA Learning objectives: * Learn about IT developments which can accelerate introduction of new techniques in daily practice * Learn about IT developments which can accelerate introduction of quantitative imaging in daily practice * Learn about basic IT concepts to achieve your optimal workflow -learn about who can do this for you ZAAL 0.5 PARIS Neuroanatomie voor dummies Voorzitter: Prof. dr. F.A. Barkhof, VUMC, Amsterdam Oppervlakte en diepte anatomie - chirurgische landmarks Prof. dr. F.A. Barkhof, VUMC, Amsterdam Functionele anatomie - toepassingen fMRI en tractografie Prof. dr. S. Sunaert, UZ Leuven, België Vasculaire anatomie - arteriële en veneuze territoirs Dr. G.J. Lycklama à Nijeholt, MCH Westeinde, Den Haag Leerdoelen: Kennis van anatomie vormt de basis van elke radiologische interpretatie. Gezien de complexiteit van de hersenanatomie geldt dat zeker ook voor de Neuroradiologie. Toenemende scankwaliteit en geavan ceerde beeldvormingstechnieken zoals fMRI en DTI maken het mogelijk steeds meer descriptieve en functionele anatomie af te beelden van zowel cortex als subcorticale structuren. Kennis hiervan is van belang voor goede diagnostiek en planning van therapie. Deze ‘refresher course’ behandelt aan de hand van state-of-the-art MRI beelden de descriptieve en functionele anatomie van de cortex, diepe kernen, vezelbanen en vasculaire territoria en reikt praktische tips aan voor een klinisch relevante beschrijving van afwijkingen van deze structuren. Het volgen van deze cursus zal hopelijk leiden tot een verbetering van uw neuroradiologische verslagen. Verder kan de verworven kennis uw inzicht in ziekteprocessen vergroten, en zullen uw diagnostisch arsenaal en didactische vaardigheden toenemen. ZAAL 0.2 BERLIN Workshop “Interpretatie van radiologisch wetenschappelijk onderzoek” Mw. Dr. S. Spronk, klinisch epidemioloog, Erasmus MC, Rotterdam Leerdoelen: * Het toepassen van risicomaten zoals incidentiecijfer en cumulatieve incidentie, en de effectmaten zoals relatief risico, (populatie-)attributief risico * Het beoordelen van een studie op validiteit en precisie en daarbij de volgende begrippen leren gebruiken: selectiebias, informatiebias, confounding bias, effectmodificatie, verification bias, regressie naar het gemiddelde * Berekenen van sensitiviteit en specificiteit op basis van onderzoeksgegevens en werken met de regel van Bayes * Onderzoeksdesign kunnen herkennen: follow-up onderzoek (retrospectief, prospectief); patient controle onderzoek; experimenteel onderzoek; non-expirimentele evaluatie van therapie; meta-analyse. 11.20 - 12.00

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ZAAL 0.3 COPENHAGEN Emeritus programma (parallel aan het algemene programma) Voorzitters: Prof. dr. G. Rosenbusch en J.F.M. Panhuysen Een bijzondere tentoonstelling in 1929: Invloed van de Russische kunst op de kinderboek illustratie in het westen vóór de 2e wereldoorlog Dr. A. Lemmens

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Opwekking van röntgenstraling m.b.v. het teruggevonden toestel van Hoffmans uit januari 1896 te Maastricht Prof. dr. J. van Engelshoven en Dr. G. Kemerink De eerste Wereldoorlog in België, Radiologie in ‘Trench Coat’ Dr. R. van Tiggelen “Koorts en Honger” ofwel geneeskunde op het platteland in de afgelopen eeuwen J.A.C. van den Broek De gang van J.S. Bach naar Nederland Prof. dr. M. Oudkerk, UMC Groningen, Groningen AUDITORIUM 2 Uitreiking prestigieuze WSS penning aan Prof. dr. J.O. Barentsz met aansluitend de ALV NVvR & Juniorsectie

EXPOFOYER 18.15 Industrieborrel: exclusief aangeboden door

Vrijdag 30 september 2011 Tijdstip Onderwerp 8.30 - 9.00

Ontvangst & registratie

9.00 - 10.15 Refresher courses ZAAL 0.4 BRUSSELS Buiktrauma, waar gaat het nou eigenlijk om Voorzitter: L.F.M. Beenen, AMC, Amsterdam Classificaties van orgaanletsels, lever en milt L.F.M. Beenen, AMC, Amsterdam Classificaties van orgaanletsels, overige organen Mw. D.R. Kool, Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch Interventieradiologie bij buiktrauma Dr. O.M. van Delden, AMC, Amsterdam Leerdoelen: * Inzicht in wat wel en wat niet van belang is bij buiktrauma’s * Inzicht achter de ratio van de verschillende chirurgische en radiologische classificaties * Rol van de interventieradiologie in de behandeling van buiktrauma’s ZAAL 0.5 PARIS Acute pijn op de borst: Stand van zaken Voorzitter: Prof. dr. M. Oudkerk, UMC Groningen, Groningen Acute Chest Pain: The clinical perspective Dr. S.C.A.M. Bekkers, MUMC, Maastricht * To understand the challenges for the clinical assessment of pulmonary embolism, acute aortic pathologies and coronary artery disease * To define the in- and exclusion criteria for imaging in patients with acute chest pain Acute Chest Pain: The imaging perspective Prof. dr. J.E. Wildberger, MUMC, Maastricht * To summarize the technical prerequisites for advanced cross-sectional imaging * To define the role of CT and MR in the assessment of pulmonary embolism, acute aortic pathologies and coronary artery disease * To understand the potential clinical impact of imaging in the emergency setting, also in the perspective of logistics and cost-effectiveness Acute Chest Pain: Statement of the European Society of Cardiac Radiology Prof. dr. M. Oudkerk, UMC Groningen, Groningen * To summarize current clinical concepts and guidelines for acute chest pain * To learn about the specific role of different imaging modalities (CT, MR, Ultrasound, QCA) in this context Differentiated examination protocols even for the emergency setting have become technically feasible due to ongoing advances especially in non-invasive imaging techniques. The aim of this refresher course is to provide an overview on the rationale, the opportunities and current concepts for the work-up in patients with acute chest pain. ZAAL 0.8 ROME De knie: Niet standaard MRI bevindingen en de postoperatieve knie Voorzitter: Mw. Dr. M.P. Terra, AMC, Amsterdam De postoperatieve knie (MRI) Dr. P. Van Dyck, UZ Antwerpen, België De postoperatieve knie Mw. Dr. G.A. Meins, orthopedisch chirurg, ZGT, Almelo-Hengelo / clubarts FC Twente Niet standaard MRI bevindingen in en rond de knie Dr. P. Van Dyck, UZ Antwerpen, België ZAAL 0.9 ATHENS Opleiden anno 2011 Voorzitter: Dr. H.J. Baarslag, Meander MC, Amersfoort AIOS als “active learner” Mw. Drs. J.A. Baane, AMC, Amsterdam

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programma & abstracts programma Tijdstip Onderwerp Intervisie voor opleiders Prof. dr. O.R.C. Busch, chirurg, AMC, Amsterdam Optimalisatie radiologie bespreking Dr. M. Maas, AMC, Amsterdam & Drs. B.M. Wiarda, MCA, Alkmaar Leerdoelen: De HORA heeft veel veranderd en verbeterd in opleidingsland. Maar daarmee zijn we er nog niet. Met betrekking tot het opleiden anno 2011 is een nog actievere instelling mogelijk, die zowel de AIOS, de opleider als ook de gehele opleidingsstaf stimuleert. Alle 3 genoemde groepen komen zowel individueel als interactief aan bod bij deze refreshercourse onderwijs. ZAAL 2.1 COLORADO Veneuze interventies Voorzitters: Dr. K.P. van Lienden, AMC, Amsterdam & Mw. Dr. C.S.P. van Rijswijk, LUMC, Leiden Pelvic congestion syndroom Dr. J.H.B. Boomsma Behandeling veneuze trombose Dr. J.A. Vos, St. Antonius Ziekenhuis, Nieuwegein Rol van cava filters Prof. dr. J.A. Reekers, AMC, Amsterdam Veneuze toegang; PICCs, Dialyse catheters en andere CVCs Dr. H. van Overhagen, HagaZiekenhuis, Den Haag

ZAAL 0.1 LONDON Workshop / hands-on: To make Radlex more familiar. Using IHE TCE for export of PACS data to an MIRC teaching file E. Sanders, Amphia Ziekenhuis, Breda P. van Ooijen, UMC Groningen, Groningen

EXPOFOYER 10.15 - 10.45 Koffiepauze 10.45 - 12.15 Parallelsessies vrije voordrachten Voorafgaand aan de wetenschappelijke voordrachten zal iedere sessie aanvangen met een keynote lecture. ZAAL 0.4 BRUSSELS Sessie 6: Abdominale radiologie 2 Voorzitters: Prof. dr. A.A.M. Masclee, MUMC, Maastricht & Dr. R.E. van Gelder, AMC, Amsterdam Endoscopie vs CTC Prof. dr. A.A.M. Masclee, MUMC, Maastricht ZAAL 0.8 ROME Sessie 7: Kinderradiologie / Diversen Voorzitters: Dr. R.A.J. Nievelstein, UMC Utrecht, Utrecht & N. de Graaf, Erasmus MC, Rotterdam Huidige status en toekomstperspectief Dr. R.A.J. Nievelstein, UMC Utrecht, Utrecht ZAAL 0.5 PARIS Sessie 8: Mammadiagnostiek 2 Voorzitters: Drs. R.D.M. Mus, UMC St Radboud, Nijmegen & Mw. M.W. Imhof-Tas, UMC St Radboud, Nijmegen MRI van de mamma in 2 minuten? Drs. R.D.M. Mus, UMC St Radboud, Nijmegen ZAAL 2.1 COLORADO Sessie 9: Neuro-Hoofdhals radiologie Voorzitters: Dr. J.C. de Groot, UMC Groningen, Groningen & Dr. S.C.A. Steens, UMC St Radboud, Nijmegen Vasculaire evaluatie van het brein in stroomversnelling Dr. J.C. de Groot, UMC Groningen, Groningen ZAAL 0.9 ATHENS Sessie 10: MSK / Thorax / Diversen Voorzitters: Mw. Dr. M. Reijnierse, LUMC, Leiden & Dr. P.J.W. Wensing, ZGT Almelo/Hengelo Postop infection around metals: CT/Mri techniques Mw. Dr. M. Reijnierse, LUMC, Leiden

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AUDITORIUM 2 De educatieve voordracht Voorzitters: Dr. C.J. van Rooden, HagaZiekenhuis & Dr. R. Ouwendijk, Erasmus MC, Rotterdam In deze gloednieuwe sessie tijdens de Radiologendagen komt een groot scala aan klinisch georiënteerde onderwerpen voorbij, van echogeleide bijnierpunctie tot beeldvorming van atherosclerose. Voor het eerst konden dit jaar, naast wetenschappelijke, ook educatieve abstracts ingestuurd worden. De kwaliteit van de inzendingen was hoog, dus deze primeur belooft een erg interessante, gevarieerde en vooral ook leuke sessie te worden, voorgezeten door twee top-radiologen! Future clinical applications of high resolution anatomical imaging of the brain at 7.0 Tesla MRI A.G. van der Kolk, UMC Utrecht, Utrecht Is beeldvorming van atherosclerose klaar voor de dagelijkse praktijk? Mw. S. Gerretsen, MUMC, Maastricht Lung perfusion defects on dual-energy Computed Tomography (DECT): review of morphology and differential diagnosis Mw. Dr. A.E. Odink, Erasmus MC, Rotterdam Value of computed tomography coronary angiography in failed conventional coronary angiography A.S. Thijssen, Erasmus MC, Rotterdam Pseudotumoren bij metaal op metaal totale heup artroplastiek M.F. Boomsma, Isala klinieken, Zwolle

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16E RADIOLOGENDAGEN 2011 Tijdstip Onderwerp

De vergrote bijnier: Endosonografische FNA van de linker-bijnier R. de Ridder, MDL-arts, MUMC, Maastricht Long-term follow-up features on rectal MRI during a wait-and-see approach after a clinical complete response in rectal cancer patients treated with chemoradiotherapy D.M.J. Lambregts, MUMC, Maastricht Implementatie van virtuele colonoscopie in de dagelijkse radiologische praktijk M.T. de Witte, VieCuri Medisch Centrum, Venlo / UMC St Radboud, Nijmegen Mw. Dr. P.C.G. Simons, VieCuri Medisch Centrum, Venlo

ZAAL 0.2 BERLIN Workshop “Interpretatie van radiologisch wetenschappelijk onderzoek” Mw. Dr. S. Spronk, klinisch epidemioloog, Erasmus MC, Rotterdam Leerdoelen: * Het toepassen van risicomaten zoals incidentiecijfer en cumulatieve incidentie, en de effectmaten zoals relatief risico, (populatie-)attributief risico * Het beoordelen van een studie op validiteit en precisie en daarbij de volgende begrippen leren gebruiken: selectiebias, informatiebias, confounding bias, effectmodificatie, verification bias, regressie naar het gemiddelde * Berekenen van sensitiviteit en specificiteit op basis van onderzoeksgegevens en werken met de regel van Bayes * Onderzoeksdesign kunnen herkennen: follow-up onderzoek (retrospectief, prospectief); patient-controle onderzoek; experimenteel onderzoek; non-expirimentele evaluatie van therapie; meta-analyse. EXPOFOYER 12.15 - 13.15 Lunch EXPOFOYER 12.30 - 13.00 Postersessie AUDITORIUM 2 13.15 - 13.30 Wetenschappelijk beleid NvvR voor academische -en niet academische centra Mw. Prof. dr. R.G.H. Beets-Tan, MUMC, Maastricht AUDITORIUM 2 Plenaire sessie 13.30 - 14.30 Pro-con: Setting standards in healthcare - Which way to go? Ook voor de radiologie zullen kwaliteitsnormen steeds belangrijker worden. Wat vinden de debaters, maar ook: Wat vindt U! Drie onderwerpen zullen U raken. Drie pro-con koppels testen uw dekking. Fair play is de regel, maar neem uw bokshandschoenen mee. Voorzitter: Dr. J.A. Vos, St. Antonius Ziekenhuis, Nieuwegein De kwaliteitseisen voor de radiologie zijn autonoom op te stellen Pro: Dr. C. Holt, Isala klinieken, Zwolle Con: J.W.A.P. van Hoogstraten, Deventer Ziekenhuis, Deventer Hoog complex, (laag volume) diagnostiek moet alleen door experts worden uitgevoerd Pro: Prof. dr. J. Stoker, AMC, Amsterdam Con: Mw. L.F.I.J. Oudenhoven, ZGT Almelo, Almelo Information technology in radiology - Yes, it helps! Pro: Prof. D. Rubin, Stanford University, USA Con: R.H.M. Smithuis, Rijnland Ziekenhuis, Leiderdorp 14.30 - 15.15 Richtlijnen sessie Voorzitter: Drs. B.M. Wiarda, Medisch Centrum Alkmaar, Alkmaar Licht traumatisch hoofd/hersenletsel Mw. D.R. Kool, Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch Distale Radius Fracturen Mw. S. Kolkman, AMC, Amsterdam Acuut lateraal enkelletsel en Interne indicatoren Acuut lateraal enkelbandletsel J.W.A.P. van Hoogstraten, Deventer Ziekenhuis, Deventer Oesofaguscarcinoom Prof. dr. E.J. van der Jagt, UMC Groningen, Groningen EXPOFOYER 15.15 - 15.45 Theepauze 15.45 - 16.25

AUDITORIUM 2 Uitreiking Philipsprijs, gevolgd door bekendmaking en presentatie van achtereenvolgens de Posterprijs, Radiologendagen prijs, NVvR Travel Grant en Fellowshipdiploma’s

16.25 - 17.15

AUDITORIUM 2 Quiz Door de maatschap radiologie van het Albert Schweitzer ziekenhuis

17.15 - 17.20

AUDITORIUM 2 Afsluiting door voorzitter Dr. R.B.J. de Bondt, Isala klinieken, Zwolle

Vanaf 20.00

Diner & Galafeest Amrâth Grand Hotel De L’Empereur Maastricht

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Genomineerde abstracts voor de Radiologendagenprijs 2011

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O1.7

ASSESSMENT OF A COMPLETE RESPONSE OF RECTAL CANCER TO PREOPERATIVE CHEMORADIATION THERAPY: A COMPARISON BETWEEN MR VOLUMETRY AND DIFFUSION-WEIGHTED MRI D.M.J. Lambregts1, L. Curvo-Semedo2, M. Maas1, T. Thywissen1, G. Lammering1, G.L. Beets1, F. Caseiro-Alves2, R.G.H. Beets-Tan1 1 Maastricht Universitair Medisch Centrum, Maastricht 2 Radiology University Clinic, Coimbra University Hospital, Coimbra, Portugal

O4.3

LESION DETECTION AND BI-RADS CLASSIFICATION IN 3D-US AUTOMATED BREAST VOLUME SCANS (ABVS): CORRELATION WITH BREAST MRI T.A. Fassaert, I.J.M. Dubelaar, M.D.F. de Jong, M.C.J.M. Rutten Jeroen Bosch Ziekenhuis, Den Bosch

O5.8

1 JAAR NA EVAR BESTAAT NOG ONGEVEER EENDERDE DEEL VAn de ANEURYSMAZAK UIT ONGEORGANISEERDE THROMBUS BIJ PATIENTEN MET EN ZONDER AANTOONBAAR ENDOLEAK S.A.P. Cornelissen1, E.P.A. Vonken1, H.J. Verhagen2, F.L. Moll1, L.W. Bartels3 1 Universitair Medisch Centrum Utrecht, Utrecht 2 Erasmus Medisch Centrum, Rotterdam 3 Image Sciences Institute, Universitair Medisch Centrum Utrecht, Utrecht

O9.1

ARTERIAL CALCIFICATION IN RELATION TO COGNITION AND STRUCTURAL BRAIN CHANGES D. Bos, M.W. Vernooij, S.E. Elias-Smale, G.P. Krestin, A. Hofman, W.J. Niessen, J.C.M. Witteman, A. van der Lugt, M.A. Ikram Erasmus Medisch Centrum, Rotterdam

O10.5

IMPACT ON DIAGNOSTIC PERFORMANCE AND READING TIME OF A COMPUTER AIDED DETECTION ALGORITHM FOR THE DETECTION OF ACUTE PE: SECOND READING VERSUS CONCURRENT READING R. Wittenberg1, J.F. Peters2, I.A.H. Van den Berk3, N.J.M. Freling3, R.J. Lely4, B. de Hoop5, K. Horsthuis3, C.J. Ravesloot5, M. Prokop6, C.M. Schaefer-Prokop7 1 Universitair Medisch Centrum Utrecht, Utrecht 2 Philips Healthcare, Best 3 Academisch Medisch Centrum, Amsterdam 4 VU Medisch Centrum, Amsterdam 5 Universitair Medisch Centrum Utrecht, Utrecht 6 Universitair Medisch Centrum St Radboud, Nijmegen 7 Meander Medisch Centrum, Amersfoort

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Genomineerde abstracts voor de NVvR Travel Grant 2011 O2.3

MRI FEATURES ASSOCIATED WITH ACUTE APPENDICITIS M.M.N. Leeuwenburgh1, B.M. Wiarda2, A. Spilt3, P.M.M. Bossuyt1, M.A. Boermeester1, J. Stoker1, OPTIMAP Studiegroep 1 Academisch Medisch Centrum, Amsterdam 2 Medisch Centrum Alkmaar, Alkmaar 3 Kennemer Gasthuis, Haarlem

O2.4

OPTIMAL STRATEGY IN PATIENTS WITH SUSPECTED ACUTE APPENDICITIS, CAN MRI REPLACE CT? M.M.N. Leeuwenburgh1, H.W. van Es2, J.W.C. Gratama3, P.M.M. Bossuyt1, M.A. Boermeester1, J. Stoker1, OPTIMAP Studiegroep 1 Academisch Medisch Centrum, Amsterdam 2 St. Antonius Ziekenhuis, Nieuwegein 3 Gelre ziekenhuizen, Apeldoorn

O2.7

MR EVALUATION OF URETHRAL DIVERTICULA AND DIFFERENTIAL DIAGNOSIS IN SYMPTOMATIC FEMALE PATIENTS S.I. Verschuuren, R.S. Dwarkasing, W. Dinkelaar, W.C.J. Hop, G.R. Dohle, G.P. Krestin Erasmus Medisch Centrum, Rotterdam

O5.7

CAROTID ATHEROSCLEROTIC PLAQUE PROGRESSION AND CHANGE IN PLAQUE COMPOSITION OVER TIME; A PROSPECTIVE IN VIVO SERIAL CT ANGIOGRAPHY STUDY M.J. van Gils, D. Vukadinovic, D.W.J. Dippel, W.J. Niessen, A. van der Lugt Erasmus Medisch Centrum, Rotterdam

O6.4

PERCEIVED BURDEN OF SCREENING BY COLONOSCOPY OR CT-COLONOGRAPHY IN THE DETECTION OF ADVANCED NEOPLASIA: A RANDOMIZED CONTROLLED TRIAL M.C. de Haan1, T.R. de Wijkerslooth1, E. Stoop2, P.M. Bossuyt1, M. Thomeer2, M.L. Essink-Bot1, M.E. van Leerdam2, P. Fockens1, E.J. Kuipers2, E. Dekker1, J. Stoker1 1 Academisch Medisch Centrum, Amsterdam 2 Erasmus Medisch Centrum, Rotterdam

O7.2

MINIMALLY INVASIVE MRI BY OMITTING INTRAVENOUS CONTRAST INJECTION; DOES IT CHANGE THE RADIOLOGIC ASSESSMENT OF KNEE JOINT PATHOLOGIES IN JIA? R. Hemke, M.A.J. van Rossum, M. van Veenendaal, T.W. Kuijpers, M. Maas Academisch Medisch Centrum, Amsterdam

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Vervolg

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O7.3

ULTRASOUND TO PREDICT SIGNIFICANT HEPATIC STEATOSIS IN OBESE ADOLESCENTS: POOR POST-TEST PROBABILITY DESPITE ACCEPTABLE SENSITIVITY AND SPECIFICITY A.E. Bohte1, B.G. Koot1, A.J. Nederveen1, O.H. van der Baan-Slootweg2, S. Bipat1, T.H. Pels Rijcken3, P.L.M. Jansen1, M.A. Benninga1, J. Stoker1 1 Academisch Medisch Centrum, Amsterdam 2 Heideheuvel Kliniek, Hilversum 3 Tergooiziekenhuizen, Hilversum

O9.1

ARTERIAL CALCIFICATION IN RELATION TO COGNITION AND STRUCTURAL BRAIN CHANGES D. Bos, M.W. Vernooij, S.E. Elias-Smale, G.P. Krestin, A. Hofman, W.J. Niessen, J.C.M. Witteman, A. van der Lugt, M.A. Ikram Erasmus Medisch Centrum, Rotterdam

O9.2

TIA AND STROKE PATIENTS WITH CAROTID STENOSIS: PRESENCE OF COMPLICATED PLAQUE FEATURES AT MRI IS ASSOCIATED WITH RECURRENT EVENTS R.M. Kwee1, R.J. van Oostenbrugge1, W.H. Mess1, M.H. Prins1, R.J. van der Geest2, J.W.M. ter Berg3, C.L. Franke4, A.G.G.C. Korten5, B.J. Meems6, J.M.A. van Engelshoven1, J.E. Wildberger1, M.E. Kooi1 1 Maastricht Universitair Medisch Centrum, Maastricht 2 Leids Universitair Medisch Centrum, Leiden 3 Orbis Medisch Centrum, Sittard 4 Atrium Medisch Centrum Parkstad, Heerlen 5 Laurentius Ziekenhuis, Roermond 6 VieCuri Medisch Centrum, Venlo

O10.6

DEVELOPMENT AND VALIDATION OF A DIAGNOSTIC MODEL FOR AIRFLOW LIMITATION IN HEAVY SMOKERS BY USING QUANTITATIVE COMPUTED TOMOGRAPHY O.M. Mets1, C.M.F. Buckens1, P. Zanen1, I. Isgum1, M. Prokop2, P.A. de Jong1 1 Universitair Medisch Centrum Utrecht, Utrecht 2 Universitair Medisch Centrum St Radboud, Nijmegen

P02

AUTOMATED BREAST VOLUME SCANNER: 3D-ULTRASOUND OF BREAST LESIONS T.A. Fassaert, M.D.F. de Jong, I.J.M. Dubelaar, M.C.J.M. Rutten Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch

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Auteursindex AUTEUR

abstract

Aalten, S.M. van O6.7 Adam, J. O1.8 Adams, A. O8.7 O9.6 Adriaanse, S.M. Akkerman, E.M. O1.8 Amstel, J.D. van O8.10 Aquarius, R. O5.2 Baan-Slootweg, O.H. van der O7.3 O1.3 Backes, W.H. Backx, F.J.G. O3.7 E02, O1.3 Bakers, F.C.H. Bakker, C.J. O5.4 Ballegooijen, M. van O6.3 Barkhof, F.A. O9.5, O9.6 Bartels, L.W. O3.2, O5.8 P03 Bechan, M.A.H. Beek, F.J.A. O1.8, O7.4 Beek, H. van O10.8 O2.5 Beenen, L.F.M. Beerman, H. O10.8 Beets, G.L. E02, O1.1, O1.2, O1.3, O1.6, O1.7, P14 Beets-Tan, R.G.H. E02, O1.1, O1.2, O1.3, O1.6, O1.7, O2.2, O4.1, O6.8, P14 Benedictus, M.R. O9.5 Benninga, M.A. O7.3 O7.5 Bentohami, A. Berckel, B.N.M. van O9.6 Berg, A.S. van den O5.1 Berg, R. van den O9.5, P09, P12, P13 Berk, I.A.H. van den O10.5 O1.1 Berkhof, M. Bernsen, M.R. O7.7, O7.8 O9.5 Beumer, D. Beute, G.N. O9.8 Bierings, M.B. O1.8 Biermann, K. O6.3 Biessels, G.J. O3.8 Bijlsma, T.S. O7.5 Binnewijzend, M.A.A. O9.6 Bipat, S. O2.1, O5.3, O5.5, O6.1, O6.5, O7.1, O7.3 Bisschops, R.H.C. O8.6 Bluekens, A.M.J. O8.4 Boelens, J.J. O7.4 Boellaard, T.N. O6.2, O6.5 Boer, E. de O6.6

Boer, R. de O9.4 Boermeester, M.A. O2.3, O2.4 Boersma, E.H. O3.1 Boetes, C.† O4.1 Bohté, A.E. O7.3 Boiten, J. O5.6, O9.5 P05, P06 Bokkers, R.P.H. Bonenkamp, J. P04 Booij, R. E06 Boomsma, M.F. E08 Borst, G.J. de P05 Bos, D. O9.1 O4.4, Bosch, M.A.A.J. van den O5.4, O8.5, O8.10 Bosker, B.H. E08 Bosker, R.J.I. O1.4 P10 Bosscha, K. O2.3, O2.4, O6.1, Bossuyt, P.M.M. O6.2, O6.3, O6.4 Bot, J. O9.5 Bouwhuijsen, Q.J.A. van den O9.3 O4.3 Breest Smallenburg, V. van Brink, R.B.A. van den O3.6 O10.4 Broeder, A.A. den Broeders, M.J.M. O8.4 Bron, E. O10.1 O4.5 Bruijnes, V. Brundel, M. O3.8 Buckens, C.M.F. O10.6 Budde, R.P.J. O3.2, O3.4, O3.5, O3.6 O1.2 Buijsen, J. Buitenhuis, E.M. O2.6 O2.1, O7.1 Caan, M.W.A. Cappendijk, V.C. E01, E02, E05, O1.3, O2.2 Carli, D.F.M. O9.8 Caseiro-Alves, F. O1.7 O3.6 Chamuleau, S.A.J. Cleutjens, J. O4.1 Cornelissen, S.A.P. O5.8 Cramer, M.J.M. O3.7 O1.5 Cremers, P.T.J. Cremers, S.E.H. O1.5 Curvo-Semedo, L. O1.7 Dalen, T. van O4.4 Damoiseaux, J.S. O9.6 Das, M. E05 Dekker, E. O6.3, O6.4 Dekker, H.M. O2.6 Dharampal, A.S. O3.1, O3.3 1 6 E


Diepstraten, S.C.E. O4.4 Diest, P.J. van O4.4, O8.10 Dijk, R.A.J.M. van O1.4, O4.6, O8.3 Dijkman, B.A. van O7.5 Dinkelaar, W. O2.7 O5.7, O9.5, P08 Dippel, D.W.J. Doeswijk, G. O7.7, O7.8 Dohle, G.R. O2.7 O2.5, O9.5 Doorn, M.M.A.C. van Douwes, D.C.E. O2.2 Dubelaar, I.J.M. O4.2, O8.1, P02 P04, P07 O4.3, O8.2, 08.9 Duijm, L.E.M. O4.4 Duvivier, K.M. Dwarkasing, R.S. O2.7, O6.1, O6.7 Eddes, E.H. O1.4 Eeftinck Schattenkerk, M. O1.4 O8.7 Elias, S.G. Elias-Smale, S.E. O9.1 Elschot, M. O5.4 Engelen, S.M.E. O1.2 Engelshoven, J.M.A. van E05, O9.2 Ernst, M. P10 O2.4 Es, H.W. van Essink-Bot, M.L. O6.4 Ettema, H.B. E08 Fassaert, T.A. O4.2, O8.1, P02 Fernandez-Gallardo, M.A. O4.4 O3.1, O3.3 Feyter, P.J. de Fijnheer, R. O1.8 Flier, W.M. van der O9.5, O9.6 Flucke, U. P04 O6.3, O6.4 Fockens, P. Folbert, E.C. O10.3 O9.2 Franke, C.L. Frans, F.A. O5.3, O5.5 Fransen, P.S. O9.5 Freling, N.J.M. O10.5 Frotscher, C. O4.1 Geelen, L.M.H. O9.7 Geerdes, M. O5.2 Geest, R.J. van der O9.2 Gerretsen, S.C. E05 Gilhuijs, K.G.A. O4.5 Gillissen, F. O1.2 Gils, M.J. van O5.7, P08 Gorp, T. van O6.8 Goslings, J.C. O7.5 Gratama, J.W.C. O2.4 Gryspeerdt, S. O1.5 -

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programma & abstracts index Guenoun, J. O7.7, O7.8 Haan, M.C. de O6.1, O6.3, O6.4 Habets, J. O3.4, O3.5, O3.6 Hartkamp, N.S. P05, P06 Hartmann, I.J.C. E06, O10.7 Hauptmann, M. O7.6 O5.2 Havinga, M.E. Heer, L.M. de O3.2 O8.4 Heeten, G.J. den Hegeman, J.H. O10.3 Heijde, D.M.F.M. van der O10.4, P12, P13 Helle, M. P06 O3.7 Hellemondt, F.J. van O7.2 Hemke, R. Hendrikse, J. E04, O3.8, P05, P06 Hendriks-Roelofs, F. O10.4 Hensen, J.J. O8.8, O10.8 O7.6 Herk, M. van Herwerden, L.A. van O3.2 Hobbelink, M. O8.10 Hoeberigs, M.C. O9.7 Hofman, A. O9.1 Hofman, P.A.M. O9.7 O8.4 Holland, R. Homburg, P.J. P08 Hoop, B. de O10.5 Hop, W.C.J. O2.7 O10.5 Horsthuis, K. Houterman, S. O1.5 Huizinga, T.W.J. P12, P13 Hummel, T.Z. O7.1 IJzermans, J.N.M. O6.7 Ikram, M.A. O9.1, O9.3, O9.4 O4.6, O8.3 Imholz, A.L.T. Isgum, I. O10.6 Jager, G.J. O8.1, P10 Jansen, F.H. O4.3, 08.9 Jansen, P.L.M. O7.3 O6.1 Jansen, R.J. Jasperse, B. O9.4 Jens, S. O5.5 Jeukens, C.R.L.P.N O1.6 Jong, H.W. de O5.4 Jong, M.D.F. de O4.3, O8.1, P02, P10 Jong, P.A. de O7.4, O10.6 Kallen, B.F.W. van der O5.6, O9.5 Karssemeijer, N. O8.4 Kate, F.J.W. ten O6.6 Kauffman, D. O6.1 12

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Kersten, M.J. O1.8 Kessel, C.S. van O6.6 Keymeulen, K. O4.1 Kindermann, A. O7.1 Klein, S. O10.1 Klein, W.M. P01 O1.8 Klerk, J.M.H. de Klieverik, S.J. P14 O8.5 Klomp, D.W. Kluin, J. O3.2 Kluza, E. O1.6, P14 Koek, M. O9.4 Koelemay, M.J.W. O5.3, O5.5 E04, O3.8 Kolk, A.G. van der E08 Kollen, B.J. Koning, G.A. O7.7, O7.8 Kooi, M.E. E05, O9.2 Koot, B.G. O7.3 O9.2 Korten, A.G.G.C. Korteweg, M.A. O8.5, O8.10 Koster, K. O1.4 Kotek, G. O10.1 Kraai, M. O10.3 Kraal, K.J. O8.8 P10 Kreb, D. Krestin, G.P. E07, O2.7, O3.1, O3.3 O7.7, O7.8, O9.1, O9.3 O10.1, O10.2 O6.8 Kruitwagen, R. Kruse, A. O6.8 Kuijer, J.P.A. O9.5 Kuijpers, T.W. O7.2 Kuipers, E.J. O6.3, O6.4 Kwee, R.M. E05, O9.2 O1.8 Kwee, T.C. Lahaye, J. O1.2, O4.1 Lalisang, R. O6.8 Lalji, U.C. O2.8 Lam, M.G.E.H. O5.4 E02, O1.1, Lambregts, D. O1.2, O1.3, O1.6, O1.7, O6.8, P14 Laméris, J.S. O7.6 Lammering, G. E02, O1.7 Langenhuijsen, J.F. O2.6 Lavini, C. O2.1, O7.1 Ledeboer, M. O1.4 Leerdam, M.E. van O6.3, O6.4 Leeuwen, M.S. van O1.8, O6.6 Leeuwenburgh, M.M.N. O2.3, O2.4 Lefere, P. O1.5


Legemate, D.A. O5.3 Leij, C. van der O6.1 Leiner, T. E05, O3.4 Lely, R.J. O10.5 Liedenbaum, M.H. O6.1 Lijn, F. van der O9.4 O6.1 Lijster, M.S. de Lima Passos, V. O4.1 P10 Linden, H. van der Linden, E. van der O5.6 Lobbes, M.B.I. E05, O4.1 Loeffen, D.V. O2.2 Loo, C. O4.5 P10 Looij, B.G. O1.8 Ludwig, I. Lugt, A. van der O5.7, O9.1, O9.3, O9.4, O9.5, P08 Luijkx, T. O3.7 E04, O3.8, O8.5 Luijten, P.R. Lute, C.C. O6.1 Lutgens, L. O6.8 Lycklama à Nijeholt, G.J. O5.6, O9.5 Maas, M. E02, O1.1, O1.2, O1.3, O1.6, O1.7, P14 E08, O7.2, O7.5 Maas, M. Maat, G.H. van de O5.4 Majoie, C.B.L.M. O9.5, P09 Mali, W.P.Th.M. O3.2, O3.4, O3.6, O3.7, O4.4, O8.5, O8.7, O8.10 Man, R.A. de O6.7 Marcelis, C. P01 Meems, B.J. O9.2 Meijer, F.A. P07 P03 Mendez, C.P. Mess, W.H. O9.2 Met, R. O5.3 Mets, O.M. O10.6 Mol, B.A.J.M. de O3.4, O3.5 O5.8 Moll, F.L. Mollet, N.R.A. E07, O3.1, O3.3 Mongula, J.E. O6.8 Mourik, J.E.M. O8.7 Nederend, J. O8.9 Nederkoorn, P.J. O9.5 Nederveen, A.J. O2.1, O6.5, O7.1, O7.3 Neefjes, L. O3.1, O3.3 Nieman, K. O3.1, O3.3 Niessen, W.J. O5.7, O9.1, O9.3, O9.4 Nievelstein, R.A.J. O1.8, O7.6 Niezen, R.A. O8.8, O10.8


Nijman, J. O8.8 Nijsen, J.F.W. O5.4 Nio, C.Y. O6.2, O6.3 Nunspeet, L. van O1.4 Odink, A.E. E06, O10.7 Odink, H. O5.1 O10.1, O10.2 Oei, E.H.G. Oostenbrugge, R.J. van O9.2, O9.5 P06 Osch, M.J.P. van Paardt, M.P. van der O6.1, O6.5 Pels Rijcken, T.H. O7.3 Pengel, K. O4.5 Pennings, J.P. O8.6 O10.5 Peters, J.F. P08 Plas, G.J.J. Ponsioen, C.Y. O2.1 Prakken, N.H.J. O3.7 Prehn, J. van O3.2 O9.2 Prins, M.H. Prokop, M. O3.5, O10.5, O10.6, P04 Quarles van Ufford, H.M.E. O1.8 Ravesloot, C.J. O10.5 Reekers, J.A. O5.3, O5.5 Reijnierse, M. O10.4, P12, P13 O1.3 Riedl, R.G. Ridder, R. de E01 Ronckers, C.M. O7.6 Rooij, W.J.J. van O9.8 O9.5 Roos, Y.B. Rooy, J.W.J. de P04 Rooy, T.D. de O5.6 Rossi, A. O3.1, O3.3 Rossius, M. E06, O10.7 Rossum, M.A.J. van O7.2 O8.6 Rozendaal, R. Ruggiero, A.R. O7.8 Rutten, I.J.G. O1.3 Rutten, M.J.C.M. O4.2, O8.1 P02, P10 Sandt-Koenderman, W.M.E. van de P03 Sanz-Arigita, E. O9.6 Schaefer-Prokop, C.M. E06, O10.5, O10.7 Scheltens, P. O9.5, O9.6 Schep, N.W.L O7.5 Schepers-Bok, R. O5.2 Schip, A.D. van het O5.4 Schoonheim, M.M. O9.6 Seevinck, P.R. O5.4 Senden, P.J. O3.7

Setz-Pels, W. O4.3, O8.2 Siebelt, M. O10.2 Sijbrandij, L. E08 Sikkenk, A.C. O8.8 Simons, P.C.G. E03 Slaar, A. O7.5 O6.8 Slangen, B.F. Slooter, G. O1.5 O9.8 Sluzewski, M.S. Smets, A.M. O7.1, O7.6 Smit, H. O10.1 Smit, R.S. O10.3 Smits, M. O9.4, P03 O5.4 Smits, M.L.J. O2.1, O3.6 Spijkerboer, A.M. Spilt, A. O2.3 Sprengers, M.E. O9.5 Stehouwer, B.L. O8.5, O8.10 O1.8, O2.1, O2.3, O2.4 Stoker, J. O6.1, O6.2, O6.3, O6.4 O6.5, O7.1, O7.3 Stokkers, P. O2.1 Stoop, E. O6.3, O6.4 Storm, R. O8.6 O10.2 Straten, M. van Symersky, P. O3.4, O3.5 Tanghe, H.L.J. P08 Ter Berg, J.W.M. O9.2 O6.7 Terkivatan, T. Thijssen, A.S. E07 Thomeer, M.G.J. O6.1, O6.3, O6.4, O6.7 Thywissen, T. O1.7 Tiel, J. van O10.1, O10.2 E07 Tilborg, G.F.A.J.B. van Tolboom, N. O9.6 Tran, V.H.P. O8.3 Uijlings, R. O3.6 Uiterwaal, C.S.P. O1.8 P01 Vandenbussche, F. Veenendaal, M. van O7.2 Velde, D. van der O10.3 Veldhuis, W.B. O8.5, O8.10 Velthuis, B.K. O3.7 Vente, M.A.D. O5.4 Verhagen, H.J. O5.8 Verheij, J. O6.7 Verhulst, M.L. O1.5 Verkooijen, H.M. O4.4 Vermeule, W. O10.7 Vermoolen, M.A. O1.8 1 6 E


Vernooij, M.W. Verreyen, C.C.C.M. Verschuuren, S.I. Versluys, A.B. Vijver, M.J. van de Vincken, K.L. Visch-Brink, E.G. Visser, R.N. de Visser, F. Visser, P.J. Vliegen, R. Vlies, M. van der Volmerink, M.H.M. Vonken, E.P.A. Voogd, A.C. Voort, M. van der Vossen, M.H.E. Vroegindeweij, D. Vrooman, H.A. Vukadinovic, D. Waarsing, J.H. Walenkamp, M.W. Wattjes, M.P. Weerink, L.B.M. Weinans, H. Wensing, P.J.W. dr. Wetzels, J.F.M. Weustink, A.C. Wiarda, B.M. Wielopolski, P.A. Wiersma, H.W. Wijkerslooth, T.R. de Wildberger, J.E. Wilde, J.C.H. Wink, A.M. Winkens, B. Witkamp, A.J. Witte, M.T. de Witteman, J.C.M. Wittenberg, R. Worp, H.B. van der Ypma, Y.F.R. Zagers, M.B. Zanen, P. Ziech, M.L.W. Zijlstra, I.J.A. Zijta, F.M. Zonnenberg, B.A. Zsiros, J. Zwam, W. van Zwanenburg, J.J.M. -

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O9.1, O9.3, O9.4 E08 O2.7 O7.4 O6.3 O3.2 P03 E07 E04, O3.8 O9.5 O6.8 P09 O4.6, O8.3 O5.8 O8.2 O8.7 O10.4, P12, P13 O8.8, O10.8 O9.4 O5.7 O10.2 O7.5 O9.5 O10.3 O10.1, O10.2 O5.2 O2.6 E07, O3.1, O3.3 O2.3 O7.7 O1.4 O6.3, O6.4 E05, O4.1, O9.2 O7.5 O9.6 O5.1 O4.4, O8.10 E03 O9.1, O9.3 O10.5 P05 O10.8 O5.5 O10.6 O2.1, O7.1 O6.1 O6.5 O5.4 O1.8 O9.5 E04, O3.8

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Donderdag 29 september, 14.05 - 15.35 uur LUMC TOEPASSINGEN VAN ULTRAHOOGVELD MRI BIJ PATIENTENPOPULATIES M.A. van Buchem Enkele jaren geleden zijn MRI-systemen ontwikkeld met een zeer hoge veldsterkte die geschikt zijn voor onderzoek bij

Erasmus MC POPULATION IMAGING A. van der Lugt, M. Vernooij, M. Smits, W. Niessen, G.P. Krestin Introductie: Beeldvormende technieken worden in toenemende mate gebruikt in epidemiologische studies. Het gaat hier niet meer alleen om de relatief goedkopere technieken zoals conventionele Röntgenonderzoeken of echografie, maar ook om state-of-the-art CT en MRI. In grote populatiestudies met langdurige follow-up wordt onderzoek gedaan naar 1) determinanten van ziekten, gericht op 1a) inzicht in de pathofysiologie van ziekte en 1b) de mogelijkheid tot preventie door middel van interventie; 2) vroegtijdige detectie van ziekte; 3) vaststellen van hoog risico groepen. Gezien het jarenlange subklinische beloop van ziekten zoals aderverkalking en neurodegeneratieve afwijkingen (dementie) waarvan de afwijkingen (mogelijk) al vroeg in het ziekte proces zichtbaar te maken zijn, kan beeldvorming een belangrijke rol spelen in deze onderzoeksprogramma’s. Beeldvorming en met name seriële beeldvorming kan surrogaat eindpunten leveren voor ziekte waardoor het onderzoek naar determinanten kan verbeteren en meer inzicht kan worden verkregen in de pathofysiologie van ziekte. Beeldvorming kan bijdrage aan vroege detectie van ziekte waardoor een tijdige interventie ook binnen handbereik komt. Project: De afdeling Radiologie van het Erasmus MC is partner in twee grote lopende populatie studies: de Rotterdam Studie en Generation R. In beide studies wordt (seriële) MRI verricht bij alle deelnemers in de studie

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mensen. Recent zijn twee van zulke systemen, functionerend bij een veldsterkte van het magnetisch veld van 7Tesla, in Nederland geplaatst, respectievelijk in het LUMC en het UMCU. Inmiddels zijn een groot aantal patiënten op deze systemen onderzocht. In deze presentatie zal een indruk geschetst worden van de eerste ervaringen die daarbij opgedaan zijn.

(>1000). Het onderzoek richt zich op hersenen, bloedvaten, hart en skelet. In de presentatie wordt aangegeven wat de meerwaarde is van de radiologische bijdrage in het beantwoorden van de studie vraagstellingen. Tevens wordt ingegaan op de specifieke radiologische problemen zoals kwaliteitscontrole, dataopslag, data analyse en toevalsbevindingen. Bijzonder: Beeldvorming in populatie studies heeft een andere oogpunt dan de klinische radiologie waarbij men gericht is op het oplossen van een specifiek klinisch probleem en de radioloog met een differentiaal diagnose een bijdrage levert aan de zorg van de individuele patiënt. In populaties studies gaat het om grote aantallen deelnemers waarbij voornamelijk wordt gekeken naar “normale afwijkingen” die geleidelijk optreden bij veroudering en waarbij afwijking van de norm relevant is. Grote datasets zijn nodig voor het vaststellen van determinanten (waaronder genetische variaties) en het voorspellen van ziekte. (Semi)automatische kwantitatieve evaluatie van afwijkingen is noodzakelijk gezien de omvang van de datasets en de subtiliteit van de afwijkingen. Perspectief: Door de inbreng van de radiologie worden de nieuwste technieken direct toegepast in wetenschappelijk onderzoek. Andersom kan de klinische radiologie leren van de manier waarop consistente data acquisitie plaats vindt, wat het belang is van standaardisatie en kwantificatie van data. Ontwikkelde kwantificatiesoftware kan gebruikt worden in de kliniek. Tot slot verschaffen deze studies normaal waarden waartegen klinische pathologie kan worden uitgezet.

research naam corner sessie UMC Groningen SCREENING FOR CORONARY ARTERY DISEASE BY NON-INVASIVE IMAGING IN PATIENTS WITH KNOWN EXTRACARDIAC ATHEROSCLEROTIC DISEASE: THE GROUND-2 STUDY R. Vliegenthart1, M. Oudkerk1, M.A.M. Dekker1, J.J.A.M. van den Dungen2, R.A. Tio3, W.P.Th.M. Mali4, M.M.J.J.R. Jaspers5 1 Center for Medical Imaging – North East Netherlands (CMINEN), Dept of Radiology, University Medical Center Groningen/University of Groningen, Groningen 2 Dept of Surgery, University Medical Center Groningen/ University of Groningen, Groningen 3 Dept of Cardiology, University Medical Center Groningen/ University of Groningen, Groningen 4 Dept of Radiology, University Medical Center Utrecht, Utrecht 5 Dept of Radiology, Deventer Hospital, Deventer Patients with extra-cardiac atherosclerosis, like claudication, carotid stenosis or aortic aneurysm, have an increased risk of coronary heart disease. The purpose of the GROUND-2 study is to non-invasively evaluate the presence of asymptomatic coronary artery disease (CAD) by CT calcium scoring, coronary CT angiography (CTA) and adenosine perfusion cardiac magnetic resonance imaging (APMR) in case of known extra-cardiac atherosclerosis.

VUMC PSEUDO-CONTINUOUS ARTERIAL SPIN LABELING AT 3T IN ALZHEIMER’S DISEASE INITIAL EXPERIENCE IN A MEMORY CLINIC M.A.A. Binnewijzend, J.P.A. Kuijer, M.R. Benedictus, P.J. Visser, W.M. van der Flier, M.P. Wattjes, P. Scheltens, F.A. Barkhof 3D pseudo-continuous arterial spin labeling (PCASL) is a non-invasive scan technique that measures cerebral blood flow (CBF). We aimed to compare CBF of subjects with Alzheimer’s disease (AD), mild cognitive impairment (MCI) and subjective memory complaints (SMC). MRI scans, including MPRAGE and 3D-PCASL (post-label delay 2.0s, 3D-FSE, TR=4.8s, TE=4.7ms, spiral readout 8 arms x 512 samples; 36x5.0mm axial slices; total scan time 4min) were acquired on a 3T GE HDxt scanner in 76 consecutive subjects (33 AD, 15 MCI, 28 SMC) that visited our memory clinic. Partial volume estimates were obtained from MPRAGE images (using the FAST algorithm, part of FSL) to create CBF maps corrected for partial volume effects. Gray matter (GM) CBF-values were compared using analyses-ofvariance. Correlations with cognition (MMSE-scores) and vascular white matter lesions (WML) were investigated 1 6 E

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This study is designed as a prospective multicenter study. Patients aged 50 and over, diagnosed with extra-coronary atherosclerosis, either stenotic or aneurysmatic, are eligible to participate. Exclusion criteria are a history of symptomatic cardiac disease, severe arterial hypertension and contraindications to the used imaging modalities. All patients will non-contrast CT scanning to evaluate the coronary calcium score. In case of a zero calcium score, patients will be followed. In all other cases, CTA will be performed to evaluate the coronary arteries for significant stenoses. In case of a calcium score above 1000, the CTA is bypassed. Next, APMR will be used to assess perfusion defects of the myocardium. If there is a left main stenosis or equivalent on CTA or a perfusion defect on APMR, the patient will be referred to a cardiologist for further evaluation and treatment. All patients will be followed for 5 years for the occurrence of events. In this multicenter study, at least 1030 patients will be included. Inclusion has started in December 2009. This study will provide insight into the prevalence of silent severe CAD, detected by non-invasive cardiac imaging, in patients with known extra-cardiac atherosclerosis. Radiological screening for asymptomatic CAD may improve survival in these patients. Preliminary results indicate that significant coronary atherosclerosis is prevalent in patient with known extracoronary atherosclerosis.

using linear regression analyses, correcting for age and gender. Four subjects (1 AD, 2 MCI, 1 SMC) were excluded from further analyses because of poor scan quality. Compared to SMC subjects, GM-CBF was decreased in both MCI (43±7 vs. 50±8 ml/100g/min; p<0.04) and AD patients (39±7 ml/100g/min; p<0.001). GM-CBF correlated with WMLscores across diagnostic groups (stβ=-0.28), and within MCI (stβ=-0.59) and AD (stβ=-0.52) patient groups. MMSE correlated with GM-CBF across diagnostic groups only (stβ=0.44), but not within patient groups. In conclusion, GM-CBF was decreased in MCI and AD patients compared to SMC subjects. PCASL is a promising technique that could contribute to the early diagnosis of AD. The observed effect of vascular WML on CBF in AD needs further research.


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Figure 1: Whole brain CBF map.

Figure 2: Partial volume corrected gray matter CBF map.

Figure 3: Boxplot of gray matter CBF in SMC, MCI and AD.

UMC St Radboud MR GESTUURDE PROSTAAT INTERVENTIES; KLAAR VOOR DE PRAKTIJK? J.J. Fütterer

MR scanners can be used for the prebiopsy scan as well as for the biopsy procedure. Because operating room is limited within the closed MR scanner, manipulators are used to perform the biopsy. The MR detection rates after one negative biopsy round using MR-guided biopsy ranges between 38% and 55.5%. The clinical value of MR-guided prostate biopsy lies in the fact that a high percentage of prostate cancers can be depicted using an targeted biopsy technique, eliminating unnecessary systematic prostate biopsies for patients with elevated PSA levels and repeated tumor-negative TRUSBx. Extensive clinical studies are still essential to review the value of MR-guided biopsy. One of the largest challenges in taking biopsiesof the prostate is the correction for movements of the prostate tissue during the biopsy procedure. In conclusion the combination of a diagnostic MR examination and MR-guided biopsy is a promising tool and may be used in patients with previous negative TRUSBx.

Next to digital rectal examination and PSA level, biopsy of the prostate is an essential procedure for determining optimal treatment. Systematic TRUSBx is the gold standard, but it fails to detect numerous tumors. This systematic approach is characterized by low sensitivity (39–52%) and high specificity (81–82%). Using diagnostic MRimages during an MR-directed biopsy procedure improves quality of the biopsy. In open MR scanners, the prebiopsy MR images often must be registered to the real-time biopsy images because open MR scanners do not provide optimal tissue contrast; thus, the patient must first be examined in a closed MR scanner and then biopsied in an open scanner. The advantage of open MR over closed MR is that the physician has easy patient access. Closed

MUMC WAIT AND SEE IN RECTAL CANCER PATIENTS: SELECTION BY IMAGING AND OUTCOME M. Maas, R.G.H. Beets-Tan Locally advanced rectal cancer is treated with neoadjuvant chemoradiation. In approximately 20% of the patients the tumor and the involved lymph nodes disappear or become sterilized due to this chemoradiation: a complete response.

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With a combination of T2-weighted MRI, diffusion-weighted MRI, gadofosveset-enhanced MRI and endoscopy these patients can be selected for a ‘wait-and-see policy’, in which surgery is omitted and patients undergo intensive follow-up. Maastricht University Medical Centre is the only Dutch centre that currently performs a study to evaluate this waitand-see policy with MRI-based selection and follow-up. The preliminary results are very encouraging and for the future we expect to be able to offer this wait-and-see policy safely to complete responders after neoadjuvant chemoradiation.

research naam corner sessie AMC NEUROTRANSMITTERS IN DE MRI L. Reneman Kinderen krijgen steeds vaker medicijnen voorgeschreven, terwijl niet duidelijk is òf en hoe dit hun hersenontwikkeling beïnvloedt. Onderzoek is er nauwelijks. Niet naar de bijwerkingen en zelfs niet naar de effectiviteit. Toch stijgt het gebruik fors, want ze kunnen er baat bij hebben. Er is weinig bekend over bijwerkingen bij kinderen omdat deze medicijnen altijd zijn getest in volwassen dieren en mensen. Het meerendeel van de medicijnen dat wordt voorgeschreven is zelfs niet geregistreerd voor gebruik in kinderen. Ze worden off label en off license voorgeschreven. Uit proefdieronderzoek weten we dat medicijnen de ontwikkeling van het brein langdurig kunnen beïnvloeden en daardoor een tegenovergesteld effect kunnen hebben van wat je zou verwachten. Onderzoek naar eventuele bijwerkingen van medicijnen bij kinderen is vooral belangrijk voor geneesmiddelen die hun invloed uitoefenen op de hersenen, zoals middelen tegen depressie en ADHD. Want niet alleen wijkt de stofwisseling van kinderen af van dan die van volwassenen, hun brein is nog in ontwikkeling tot aan de jong volwassenheid. Medicijnen zouden die ontwikkeling kunnen verstoren. In Nederland hebben 8.500 kinderen in de leeftijd van 0 t/m 20 jaar in de eerste helft van 2008 een antidepressivum via de apotheek gekregen. Echter, de sterkste stijging de afgelopen tien jaar zijn medicijnen voor attention deficit hyperactivity disorder (ADHD). Werden in 2008 ongeveer 500.00 recepten uitgeschreven, was dit in 1999 nog maar 132.000 keer. De oorzaak van de forse stijging zijn de verbeterde diagnostiek en de steeds sterkere behoefte van ouders en artsen aan verlichting van klachten.

UMC Utrecht MRI-GUIDED HIGH INTENSITY FOCUSED ULTRASOUND: THE FUTURE OF TUMOR ABLATION? M.A.A.J. van den Bosch

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De afdeling Radiologie van het AMC heeft door de jaren heen een sterke reputatie opgebouwd in het bestuderen van effecten van middelen (misbruik) op de hersenen. Zowel nationaal als internationaal vervult het AMC hierin een pioniersfunctie en wordt baanbrekend onderzoek verricht. In een groot multidisciplinair project onderzoeken we nu de zogeheten neurologische imprinting van geneesmiddelen. Bijvoorbeeld, rond 2004 kwamen aanwijzingen dat bij jongvolwassenen het percentage zelfmoordgevallen juist toenam onder invloed van serotonine heropname remmers (SSRIs), waardoor dit medicijn een tijdje gecontraindiceerd is geweest in deze populatie. Wij onderzoeken hoe dat komt en wat de werking is van andere geneesmiddelen op de hersenontwikkeling. Kleven er risico’s aan het gebruik op jonge leeftijd, of misschien juist onverwachte voordelen? We visualiseren de veranderingen die medicijnen kunnen aanbrengen in de hersenontwikkeling met behulp van farmacologsiche magnetic resonance imaging (phMRI). Hierbij kijken we vooral naar hersensystemen die werken op basis van de neurotransmitters serotonine - waarop medicijnen tegen depressie aangrijpen - en dopamine - voor medicijnen tegen ADHD. Ook kijken we naar het functioneren van de hersenen met behulp van neuropsychologisch onderzoek. Wij denken dat hoe jonger kinderen medicijnen krijgen, hoe meer ze ingrijpen op de normale uitrijping van de hersenen. Alle artsen willen het beste voor kinderen, maar dan moet wel duidelijk zijn of je meer goed dan kwaad doet. Ons onderzoek stelt artsen en ouders in staat de eventuele risico’s van bijwerkingen af te wegen tegen de voordelen van een medicamenteuze behandeling.

The first step for treatment of malignant tumors with MR-HIFU has been made in patients with painful bone metastases. Palliative treatment of painful bone metastases is applied in clinical practice since the beginning of this year. It is expected that besides bone, the first breast cancer patients will be treated in the beginning of 2012.

MR-HIFU is an innovative, noninvasive tumor ablation technique. MR-imaging and focused ultrasound is combined allowing real-time anatomic guidance and temperature mapping during treatment. Recently, the volumetric ablation approach has been introduced in order to reduce treatment length and more homogenous tumor ablation. A MR-HIFU system has been installed at the department of Radiology UMC Utrecht in 2009. From the beginning a successful program for MR-HIFU treatment of uterine fibroids has been started. Currently one patient a week is treated in clinical practice, and a phase2 efficacy study is running.

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Several issues need to be further investigated for successful cancer treatment with MR-HIFU, including patient selection criteria, definition of treatment margins and optimal transducer technology. For this we have a multidisciplinary MR-HIFU team in UMC Utrecht consisting of interventional radiologists, radiotherapists, physicists, postdocs and PhDstudents.


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Abdominale radiologie 1 Donderdag 29 september, 14.05 - 15.35 uur O1.1 RESTAGING NODAL STATUS AFTER CHEMORADIATION FOR LOCALLY ADVANCED RECTAL CANCER: PREDICTIVE FACTORS M. Maas, D.M.J. Lambregts, M. Berkhof, G.L. Beets, R.G.H. Beets-Tan Maastricht Universitair Medisch Centrum, Maastricht Purpose: Restaging N-stage after CRT for rectal cancer is more accurate than N-stage prediction at primary staging of rectal cancer. The aim was to identify predictive factors which can help a radiologist in predicting the yN-stage. Methods: 39 patients with locally advanced rectal cancer underwent MRI before and after CRT. All visible nodes in the mesorectum were measured and recorded before and after CRT on a 3DT1W GRE-sequence with 1mm3 voxels. Baseline characteristics were collected and compared between patients with and without nodal involvement at pathology with t-tests and χ2. With regression analyses predictive factors for nodal involvement after CRT were identified.

O1.2 MRI-BASED SELECTION OF PATIENTS WITH INVOLVED EXTRAMESORECTAL LYMPH NODES IN THE OBTURATOR AREA FOR CHEMORADIATION PROVIDES GOOD LOCAL CONTROLN M. Maas, F. Gillissen, D.M.J. Lambregts, S.M.E. Engelen, M.J. Lahaye, J. Buijsen, G.L. Beets, R.G.H. Beets-Tan Maastricht Universitair Medisch Centrum, Maastricht Purpose: 20% of rectal cancer patients have involved lymph nodes outside the mesorectum (obturator areas). These involved extramesorectal nodes (EMRs) are associated with poor prognosis. Accurate selection would help tailor treatment and improve prognosis for these patients. Methods: Rectal cancer patients participated in a study in which treatment was based on (contrast-enhanced)MRI. EMR-status was predicted by an expert radiologist. Based on this prediction patients underwent chemoradiation(CRT) 18

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Based on the regression analyses a predictive model for yNstage was constructed and ROC curves were constructed for this predictive model. Results: 895 nodes were identified, of which 392 (44%) disappeared after CRT. Patients with ypN+ had larger nodes than ypN0-patients: mean 6.3 vs 3.6mm before CRT and 4.5 vs 2.3mm after CRT, respectively (both p<0.0001). Regression analyses identified pre- and post-CRT nodal size, presence of T-downstaging and higher age as predictive factors for ypN0. The AUC under the ROC curve constructed with the predictive model including size, age and T-downstaging was 0.86, with a sensitivity of 95%. For pre-CRT and post-CRT size AUCs were 0.78&0.77, respectively Conclusion: Larger nodal size (both pre-&post-CRT), T-downstaging and higher age are predictors of ypN0-stage. With this knowledge and by use of these criteria a radiologist could select yN0-patients with higher sensitivity than when size is used as a single criterion.

of the EMRs. 6-8 weeks after CRT EMRs were restaged. If still involved, the EMRs were resected. When the EMRs were sterilised by the CRT they were not resected. Patients were followed 3 to 6-monthly after surgery by a combination of modalities. 3-year outcome was estimated with Kaplan Meier curves. Results: 50 patients with suspected EMRs were included. Median follow-up was 26(0-50) months. In 13 patients EMRs were resected after CRT and in only 2/13 positive nodes were found. Of the remaining 37 patients 5 had a local recurrence (LR). In total 32+11=43 patients had no involved EMRs after CRT. Five patients had metastasis and 2 of these 5 patients also had a LR. 3-year LR was 2.3%, 3-year DFS was 86% and 3-year OS was 90%. Conclusion: MRI-based selection of patients with EMRs for CRT provides adequate local control. Distant metastasis is the main cause of poor prognosis in these patients. When

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Abdominale radiologie 1 MRI is used for EMR identification and thus for identification of patients who need CRT on the obturator areas, patients

can be spared an extensive resection with associated morbidity.

O1.3 GADOFOSVESET-ENHANCED MRI FOR NODAL STAGING IN RECTAL CANCER: PREDICTIVE CRITERIA D.M.J. Lambregts, M. Maas, I.J.G. Rutten, W.H. Backes, R.G. Riedl, F.C.H. Bakers, V.C. Cappendijk, G.L. Beets, R.G.H. Beets-Tan Maastricht Universitair Medisch Centrum, Maastricht

On gadofosveset-MRI, SI was significantly higher in the benign nodes (p<0.0001), which resulted in an area under the ROC-curve (AUC) of 0.77 for prediction of metastatic nodes. The combination of SI and nodal relief rendered an AUC of 0.88. When analysed visually, AUC for discrimination of metastatic nodes was 0.92 Conclusion: Only benign nodes show uptake of gadofosveset-contrast. Criteria to identify metastatic nodes are nodal signal intensity and nodal relief. When analysed visually, these criteria provide high accuracy for discrimination of metastatic nodes.

Purpose: Recently, we showed that MRI using a new lymph-node contrast (gadofosveset) can significantly improve accuracy for staging of rectal cancer nodes. Aim of the present study was to determine the most accurate predictive imaging criteria for lymph node assessment using gadofosveset-MRI. Methods: 33 patients underwent a 3D T1-weighted GRE sequence (1 mm isotropic voxels) at 1.5T, before and after administration of gadofosveset-contrast. For each node the signal intensity (SI) was measured on pre- and post-contrast MRI. Furthermore, the nodal border characteristics (“relief effect”) were scored. Finally, nodes were scored (using a 5-point confidence score) by an MR-rectum expert, based on visual evaluation of these criteria (SI and nodal relief). Nodes were drawn on an anatomical template for lesion-bylesion histologic validation. Results: 289 nodes (55 malignant) were analysed. On pre-contrast MRI, the SI did not differ between benign and malignant nodes. After administration of gadofosveset there was a significant increase in SI of 58% (p<0.001) for the benign nodes versus 25% (p=0.12) for the metastatic nodes.

Figure 1: Signal intensities on pre- & post-gadofosveset MRI

O1.4 PROSPECTIEF ONDERZOEK NAAR DE LOKALISATIE VAN RECTUM- EN SIGMOÏDCARCINOMEN T.O.V. DE OMSLAGPLOOI. VERGELIJKING TUSSEN DE LIJN PROMONTORIUM-SYMFYSE EN DE OMSLAGPLOOI OP MRI H.W. Wiersma, L. van Nunspeet, K. Koster, M. Ledeboer, R.J.I. Bosker, E.H. Eddes, M. Eeftinck Schattenkerk, R.A.J.M. van Dijk Deventer Ziekenhuis, Deventer De indicatie voor preoperatieve radiotherapie voor het rectumcarcinoom maakt het onderscheid met sigmoïdcarcinoom (boven de omslagplooi) van groot belang. Endoscopisch wordt de grens 15cm proximaal van de linea dentata 1 6 E

gebruikt. Op MRI wordt ligging caudodorsaal van de lijn promontorium-symfyse (PS-lijn) als rectum aangeduid. Deze prospectieve studie onderzoekt de waarde van MRIrectum voor het bepalen van de omslagplooi en daarmee het onderscheid tussen sigmoïd- en rectumcarcinoom bij endoscopisch vastgestelde colonmaligniteit tot 30cm proximaal van de linea dentata (sept 2009-juli 2010). MRI criteria (zichtbaarheid omslagplooi, ligging tumor t.o.v. omslagplooi, tumor t.o.v. PS-lijn, ligging omslagplooi t.o.v.anus) werden vergeleken met peroperatieve bevindingen (gouden standaard). Alle tumoren (13 rectum en 10 sigmoïd) liggen caudodorsaal t.o.v. PS-lijn. Zichtbaarheid omslagplooi: goed (n=10), matig (n=9), niet (n=4). Gemiddelde afstand van omslagplooi tot anus 13,5cm (n=19; range 8,5-16,9cm). Op MRI 11 rectumen 9 sigmoïdtumoren, correlatie met gouden standaard


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1 programma & abstracts Abstracts in 10 en respectievelijk 8 tumoren. Op MRI 3 tumoren op niveau omslagplooi: peroperatief 2 rectumtumoren en 1 sigmoïdtumor. De PS-lijn heeft geen onderscheidend vermogen tussen rec-

tum- en sigmoïdtumor. Ondanks de matige zichtbaarheid van de omslagplooi correleert MRI in 18 van de 23 tumoren met peroperatieve bevindingen. De afstand omslagplooi tot anus (MRI) benadert het 15cm-criterium (endoscopie).

O1.5 CHRONIC DIVERTICULITIS VERSUS COLORECTAL CANCER: FINDINGS ON CT COLONOGRAPHY S.E.H. Cremers1, S. Gryspeerdt2, P. Lefere2, S. Houterman3, G. Slooter3, M.L. Verhulst3, P.T.J. Cremers3 1 Albert Schweitzer ziekenhuis, Dordrecht 2 Virtual Colonoscopy Teaching Centre (VCTC), Hooglede 3 Máxima Medisch Centrum, Veldhoven

the mass, growth pattern, luminal narrowing, presence of perilesional lymph nodes and mesenteric fat stranding were evaluated. Statistical analysis was performed using MannWhitney and Chi-Square tests.

Purpose: In CT colonography chronic diverticulitis (CD) can mimic colorectal cancer (CRC) masses. In order to distinguish these two entities several findings were analysed. Methods: 525 symptomatic patients consecutively underwent CT colonography between June 2008 and February 2011. All patients with pathologic confirmation of CD (13) and CRC (30) on surgical specimens were included. The images were analysed in retrospect by a consensus of two reviewers. Length of the mass, diverticula included in

O1.6 DYNAMIC CONTRAST-ENHANCED MRI WITH A BLOOD POOL CONTRAST AGENT TO IMPROVE THE DIAGNOSTICS OF PATIENTS WITH RECTAL CANCER E. Kluza, M. Maas, C.R.L.P.N Jeukens, D.M. Lambregts, G.L. Beets, R.G.H. Beets-Tan Maastricht Universitair Medisch Centrum, Maastricht Aim: The application of minimally-invasive treatments in patients with rectal cancer requires accurate imaging strategies. To this aim, we propose a unique method of dynamic contrast-enhanced MRI (DCE-MRI) with a blood pool contrast agent to characterize the vascular function in cancer-affected rectum. Methods: Three patients underwent examination during the primary cancer staging. DCE-MRI was performed on a 1.5 T MRI scanner using a sense cardiac coil (Philips Medical Systems). The acquisition consisted of a dynamic series of 3D T1-weighted gradient-echo images (TE/TR=4.6/7.9ms, α=30°, time resolution=8s or 30s, matrix=256[GREEKX]256). The blood pool contrast agent gadofosveset trisodium was administered at the dose of 0.03mmol/kg. ROIs in tumors were drawn on T2-weighted images. DCE-MRI data were analyzed semiquantitatively. 20

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Results: There was a significant difference in median length of the mass between CD and CRC, 100 and 49 mm respectively ( p<0.001 ). Diverticula included in the mass were visible in all patients with CD, but in none of the patients with CRC ( p < 0.001 ). A curved growth pattern of the mass was noted in all but one patient with CD versus three out of 30 patients with CRC ( p < 0.001 ). There were no significant differences between the groups with respect to median luminal narrowing ( 86 vs 83%, p=0.3 ), presence of perilesional lymph nodes ( p=0.2 ) and presence of perilesional mesenteric fat stranding ( p=0.4 ). Conclusion: To differentiate CD and CRC masses the length of the mass, inclusion of diverticula and growth pattern are important discriminating factors.

Results: In one patient with locally-advanced tumor, two distinct tumor regions were distinguishable, i.e. the fastand slow-enhancing region, indicating a heterogeneous vascular function (Figure 1A). In two patients with smaller tumors, the enhancement pattern was relatively homogeneous throughout the tumor area. Early after administration, gadofosveset produced a superb contrast between different tissue types in the rectum. Importantly, in all examined patients, both the initial slope and amplitude of contrast enhancement in the tumor were larger compared to relevant normal tissues (Figure 1B). Discussion: The tumor vascular heterogeneity, which was readable from DCE-MRI images, can be of important prognostic and predictive value. The signal enhancement curve was found to be a good criterion for differentiation between the tumor and normal rectum. We show therefore a great potential of DCE-MRI with gadofosveset for detection of rectal cancer.

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Abdominale radiologie 1

Figure 1: A) T1-weighted images (T1W) acquired before, 30 s and 60 s after contrast agent (CA) administration, obtained for a patient with rectal cancer during primary staging. Red line indicates the tumor boundaries. White arrows indicate different tissue components of the rectum. T2W tumor image is shown as an image inset (upper left). B) Average signal enhancement-time curves obtained for the tumor (black line), rectal muscle (red line), mucosa (green line) and mesorectal fat (blue line) in three patients. In patient 3, the delineation of ROIs in rectal muscle and mucosa was not possible.

O1.7 ASSESSMENT OF A COMPLETE RESPONSE OF RECTAL CANCER TO PREOPERATIVE CHEMORADIATION THERAPY: A COMPARISON BETWEEN MR VOLUMETRY AND DIFFUSION-WEIGHTED MRI D.M.J. Lambregts1, L. Curvo-Semedo2, M. Maas1, T. Thywissen1, G. Lammering1, G.L. Beets1, F. Caseiro-Alves2, R.G.H. Beets-Tan1 1 Maastricht Universitair Medisch Centrum, Maastricht 2 Radiology University Clinic, Coimbra University Hospital, Coimbra, Portugal Purpose: To determine the performance of diffusion-weighted MRI (DWI) in assessing a complete tumor response (CR) after chemoradiation (CRT) in patients with locally advanced rectal cancer (LARC) by means of [1] volumetric signal intensity and [2] apparent diffusion coefficient (ADC) measurements, and to compare its performance with volumetry on T2W-MRI.

curves were generated to compare the performance of T2Wvolumetry, DWI-volumetry and ADC in assessing a CR. The intraclass correlation coefficient (ICC) was used to evaluate interobserver variability and the correlation between T2Wvolumetry and DWI-volumetry. Results: Areas under the ROC-curve (AUC) for identification of a CR based on pre-volume / post-volume / ∆volume were 0.57 / 0.70 / 0.84 for T2W-volumetry versus 0.63 / 0.93 / 0.92 for DWI-volumetry (p=0.15 / 0.02 / 0.42). For ADC, AUCs were 0.55, 0.54 and 0.51. Interobserver agreement was excellent for all pre-CRT measurements (ICC 0.91-0.96) versus good (0.610.79) post-CRT. The ICC between T2W- and DWI-volumetry was excellent (0.97) pre-CRT versus fair (0.25) post-CRT. Conclusion: Post-CRT DWI-volumetry provided a high diagnostic performance is assessing a CR and was significantly more accurate than T2W-volumetry. Post-CRT DWI was equally accurate as ∆volume of both T2W-MRI and DWI. Pretreatment volumetry and ADC were not reliable.

Methods: Fifty LARC patients underwent standard T2W-FSE and DWI (b0,500,1000) pre- and post-CRT. Two independent readers retrospectively placed free-hand ROIs in each tumorslice on both datasets to determine pre-CRT and post-CRT tumor volumes and the tumor volume reduction (∆volume). ROIs were copied to an ADC-map to calculate mean tumor ADCs. Histology (ypT0) was the standard reference. ROC1 6 E


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Figure 1: ROC-curves for assessment of a CR.

O1.8 WHOLE-BODY MRI, INCLUDING DIFFUSIONWEIGHTED IMAGING, FOR STAGING NEWLY DIAGNOSED LYMPHOMA: COMPARISON TO COMPUTED TOMOGRAPHY IN 101 PATIENTS T.C. Kwee1, M.A. Vermoolen1, E.M. Akkerman2, M.J. Kersten2, R. Fijnheer3, I. Ludwig1, F.J. Beek1, M.S. van Leeuwen1, M.B. Bierings1, J. Zsiros2, H.M.E. Quarles van Ufford1, J.M.H. de Klerk3, J. Adam2, J. Stoker2, C.S.P. Uiterwaal1, R.A.J. Nievelstein1 1 Universitair Medisch Centrum Utrecht, Utrecht 2 Academisch Medisch Centrum, Amsterdam 3 Meander Medisch Centrum, Amersfoort Purpose: To compare whole-body magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI), to computed tomography (CT) for staging newly diagnosed lymphoma. Materials and methods: One hundred and one consecutive patients with newly diagnosed lymphoma prospectively underwent whole-body MRI (T1-weighted and T2-weighted short inversion time inversion recovery [n=101], and DWI [n=96]) and CT. Ann Arbor stages were assigned according to whole-body MRI and CT findings. Disagreements in staging between whole-body MRI (without and with DWI) and CT were resolved using bone marrow biopsy, 18F-fluoro2-deoxyglucose positron emission tomography (FDG-PET), and follow-up FDG-PET, CT, and whole-body MRI studies as reference standard. Results: Staging results of whole-body MRI without DWI were equal to those of CT in 65.4% (66/101), higher in 22

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30.7% (31/101), and lower in 4.0% (4/101) of patients, with correct/incorrect/unresolved overstaging and incorrect/ unresolved understaging relative to CT in 13/12/6 and 3/1 patient(s), respectively. Staging results of whole-body MRI with DWI were equal to those of CT in 62.5% (60/96), higher in 32.3% (31/96), and lower in 5.2% (5/96) of patients, with correct/incorrect/unresolved overstaging and incorrect/unresolved understaging relative to CT in 18/10/3 and 4/1 patient(s), respectively. Conclusion: Staging of newly diagnosed lymphoma using whole-body MRI (without and with DWI) equals staging using CT in the majority of patients. Disagreements between whole-body MRI and CT are mostly caused by overstaging of the former relative to the latter, with the number of correctly and incorrectly overstaged cases being approximately equal. The potential advantage of DWI is still unproven.

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Abdominale radiologie/ Acute radiologie/Diversen

Sessie 2 Abdominale radiologie/ Acute radiologie/Diversen Donderdag 29 september, 14.05 - 15.35 uur O2.1 DYNAMIC CONTRAST ENHANCED MRI FOR THE EVALUATION OF PERIANAL FISTULAS IN PATIENTS WITH CROHN’S DISEASE M.L.W. Ziech, C. Lavini, C.Y. Ponsioen, M.W.A. Caan, S. Bipat, A.M. Spijkerboer, P. Stokkers, A.J. Nederveen, J. Stoker Academisch Medisch Centrum, Amsterdam

The qualitative parameters Maximum Enhancement (ME), slope of the enhancement curve (SoE) and curve shape type (as by Lavini et al), as well as the quantitative parameters Ktrans, Vep, Kep as in the Tofts model were calculated (using a measured arterial input function) on a pixel by pixel basis, and then averaged of over an ROI drawn around the fistula. Spearman correlations between DCE-MRI parameters and PDAI and MRI-based score were calculated.

Purpose: To determine if dynamic contrast enhanced MRI (DCE-MRI) can evaluate disease activity in patients with perianal fistulizing Crohn’s disease.

Results: Sixteen patients (7 males) were included, mean age 37 (range 18-63). PDAI correlated with ME (r=0.669, p=0.005), SoE (r=0.582, p=0.018), ROI volume (r=0.786, p<0.001) and MRI-based score (r=0.574, p=0.020), but not with Ktrans, Vep and Kep. ME correlated with Ktrans (r=0.701, p=0.002) and Kep (r=0.626, p=0.009).

Methods and materials: Patients with perianal fistulizing Crohn’s disease, underwent DCE-MRI. The van Assche MRI-based score and perianal disease activity index (PDAI) were determined. Transversal DCE-MRI was performed at 3T during intravenous contrast injection (TE 2.3, TR 5.1, FA 30, 15 slices, total duration of dynamic scan 5.05 min, 70 scans per slice, temporal resolution 4.2 sec per volume).

O2.2 INFLUENCE OF PREPARATION PROTOCOL ON URINARY TRACT FILLING IN CTU D.C.E. Douwes, V.C. Cappendijk, F.C.H. Bakers, D.V. Loeffen, R.G.H. Beets - Tan Maastricht Universitair Medisch Centrum, Maastricht Purpose: CT Urography(CTU) has rapidly become the most frequently requested examination in the evaluation of the urinary system because of its ability to image anatomical and physiological aspects of the urinary tract. However, preparation protocols may vary significantly amongst different institutions from oral fluid intake to the use of diuretics. Our purpose was to evaluate the influence of different preparation protocols on urinary tract filling. Methods and materials: 80 patients were prospectively randomized into four groups. Group A received no preparation, group B drank 1000cc of water, group C was injected 140cc of saline and group D received 10mg Furosemide iv. Pre-heated (37˚C) contrast material (110 ml Iopromide, 1 6 E

Conclusion: ME, SoE and MRI-based score seem to be the best choice to evaluate perianal disease activity. None of the quantitative model based parameters showed a direct significant correlation with disease activity.

Ultravist, Bayer) was injected using split bolus technique. The urinary tract was divided into six segments: left(L1) and right(R1) pyelum, proximal (L2,R2) and distal (L3,R3) ureter. Three radiologists, blinded for the preparation protocol and each others results, scored the filling of each segment on a three point scale. (1=no filling;2=partial filling;3=total filling) All data were compared in group analysis using KruskalWallis, ANOVA, Tukey. Results: Highest means (range 2.68-2.98 + 0.7-0.2) per segment were registered for group D(L1,L2,L3,R1 and R3) followed by R2 for group B. Significant differences in mean scores were seen in group D for ureter filling (p<0.002), not for pyelum (p>0.05). Conclusion: Administration of 10mg Furosemide iv just prior to CTU results in optimal filling of the ureters compared to other preparation protocols.


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O2.3 MRI FEATURES ASSOCIATED WITH ACUTE APPENDICITIS M.M.N. Leeuwenburgh1, B.M. Wiarda2, A. Spilt3, P.M.M. Bossuyt1, M.A. Boermeester1, J. Stoker1, OPTIMAP Studiegroep 1 Academisch Medisch Centrum, Amsterdam 2 Medisch Centrum Alkmaar, Alkmaar 3 Kennemer Gasthuis, Haarlem Purpose: To identify MRI features associated with appendicitis.

(3) Peri-appendiceal fat infiltration; (4) Peri-appendiceal fluid; (5) Absence of gas in the appendix; (6) Destruction of the appendiceal wall structure; (7) Restricted diffusion of the appendiceal wall; (8) Restricted diffusion of the appendiceal lumen; (9) Restricted diffusion of focal fluid collections An expert panel assigned acute appendicitis as final diagnosis in 117 of 223 patients based on histopathology and follow-up after 3 months. Associations between imaging features and appendicitis were evaluated with multivariable logistic regression analysis.

Methods: Signs expected to be associated with appendicitis were recorded by two expert radiologists in 223 abdominal MRI scans of patients with suspected appendicitis (HASTE, HASTE SPAIR, DWI). The investigated features were: (1) Diameter >6mm; (2) Appendicolith;

Results: In 210 of 223 scans the appendix could be visualised. All 9 investigated MRI features were significantly associated with appendicitis in univariate analysis. Presence of two of these features had a probability of appendicitis between 85%(95%CI: 78-91%) and 100%(95%CI: 86-100%). If no features were identified in the MRI appendicitis was present in 0%(95%CI: 0%-8%) of patients. In multivariable

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Abdominale radiologie/ Acute radiologie/Diversen analysis only peri-appendiceal fat infiltration and restricted diffusion of the appendiceal wall had a significant association with appendicitis. The probability of appendicitis was 96%(95%CI: 90-98%) in presence of both features, and 5%(95%CI: 2-11%) in their absence.

Conclusion: In MRI, peri-appendiceal fat infiltration and restricted diffusion of the appendiceal wall are strongly associated with appendicitis. Presence of both features in a MRI examination leads to a high probability of appendicitis, whereas their absence almost rules appendicitis out.

O2.4 OPTIMAL STRATEGY IN PATIENTS WITH SUSPECTED ACUTE APPENDICITIS, CAN MRI REPLACE CT? M.M.N. Leeuwenburgh1, H.W. van Es2, J.W.C. Gratama3, P.M.M. Bossuyt1, M.A. Boermeester1, J. Stoker1, OPTIMAP Studiegroep 1 Academisch Medisch Centrum, Amsterdam 2 St. Antonius Ziekenhuis, Nieuwegein 3 Gelre ziekenhuizen, Apeldoorn

of the following scenarios: (1) US only;(2) US in all patients followed by CT after a non-diagnostic US;(3) US followed by MRI after a non-diagnostic US;(4) MRI only.

Purpose: To identify the optimal imaging strategy in adult patients with suspected appendicitis. Methods: We included consecutive patients with suspected appendicitis in six hospitals. Patients underwent initial US, followed by CT in case of non-diagnostic US results. Additionally, all patients underwent MRI (HASTE, HASTE SPAIR, DWI), with the MRI reader blinded for the results of the other imaging methods. An expert panel assigned a final diagnosis based on histopathology and clinical follow up after 3 months. We evaluated the sensitivity and specificity

Results: We performed 229 US, 126 CT and 223 MRI examinations in 230 patients (mean age 38 years, 41% male). Acute appendicitis was assigned as final diagnosis in 118 patients (51%). Sensitivity of US only was 0.76(95%CI: 0.68-0.83); specificity 0.94(95%CI: 0.88-0.97). Conditional imaging strategies with CT or MR after a non-diagnostic US resulted in a significantly increased sensitivity (p<0.001) of 0.97(95%CI: 0.93-0.99) and 0.99(95%CI: 0.95-1.00) and a specificity of 0.91(95%CI 0.84-0.95) and 0.88(95%CI 0.81-0.93) respectively. Conditional strategies with CT and MRI had comparable results for sensitivity and specificity (p=0.500, p =0.453). The MRI only strategy had a high sensitivity (0.97, 95%CI: 0.92-0.99) and specificity (0.93, 95%CI: 0.87-0.97). Conclusion: Using US only would miss too many patients with acute appendicitis. Additional CT or MRI after a nondiagnostic US improves accuracy. An MRI only strategy could be an alternative approach.

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2 programma & abstracts abstracts O2.5 IS TRAUMA SIMULATIE NUTTIG BIJ TRAINING VAN RADIOLOGEN IN OPLEIDING? M.M.A.C. van Doorn, L.F.M. Beenen Academisch Medisch Centrum, Amsterdam Doelstelling: Evalueren van het effect van simulatie van polytrauma Total Body CT scans.

levensbedreigende letsels op te sporen. De dataset betrof alleen axiale coupes, reconstructies konden naar eigen inzicht worden uitgevoerd op het PACS-station. De simulatie is 3 maal herhaald, met enkele maanden tussenpoos. Bij de eerste simulatie werd een blanco invulformulier gebruikt, bij de tweede en derde simulatie een checklist. Een Likert-scale van 5 werd gebruikt als confidence-score. Een webbased-enquête werd opgesteld om achteraf de ervaringen te evalueren.

Achtergrond: In grote traumacentra kan het voorkomen dat er meerdere traumata tegelijk moeten worden opgevangen. Van al deze patiënten wordt beeldvorming verricht, waarbij er steeds vaker een Total Body CT scan (TBCT) wordt uitgevoerd. Dit genereert een grote druk bij arts-assistenten, die in korte tijd uit >1000 beelden per patiënt, allereerst de klinisch meest relevante afwijkingen moeten vaststellen.

Resultaten: 19 van de 31 arts-assistenten hebben minimaal 2 simulaties meegedaan. Het merendeel van de arts-assistenten vindt de simulatie reëel met betrekking tot tijdsdruk (20/23) en pathologie (23/23), en goede voorbereiding op een ramp(21/22). Bij 8/19 van de arts-assistenten is er een toename van de confidence-score.

Beschrijving: In een prospectieve setting zijn 3 simulaties uitgevoerd. Per simulatie werd een groot ongeval aangekondigd met betrokkenheid van 5 slachtoffers, waarbij om de 10 minuten een TBCT scan werd vervaardigd. Elke arts-assistent kreeg de uitdrukkelijke opdracht binnen 10 minuten de

Conclusie: Simulatie is een eenvoudige methode, die het vertrouwen van arts-assistenten zowel objectief als subjectief vergroot. Met behulp van een checklist verloopt de beoordeling meer gestructureerd.

O2.6 SIMULTANE INTRODUCTIE VAN EEN NIEUWE PREVENTIE RICHTLIJN VOOR CONTRASTNEFROPATHIE IN COMBINATIE MET EEN AANGEPAST RADIOLOGISCH AANVRAAGFORMULIER: 1 JAAR ERVARING H.M. Dekker, E.M. Buitenhuis, J.F. Langenhuijsen, J.F.M. Wetzels Universitair Medisch Centrum St Radboud, Nijmegen

CN-polikliniek. Gedurende 1 jaar werden gegevens verzameld van alle poliklinisch geplande urologische patiënten van ≥18 jaar, gepland voor CT met iv contrast.

Doel: De evaluatie van de toepassing van een aangepast radiologisch aanvraagformulier. Methoden: Ziekenhuisbreed is een nieuwe richtlijn geïntroduceerd om contrastnefropathie(CN) te voorkomen. Deze richtlijn adviseert om bij alle patiënten de serumcreatinineconcentratie te bepalen en de eGFR te schatten met de MDRD formule en om patiënten met hoog risico te identificeren en voorzorgsmaatregelen te nemen. Hoog-risicopatiënten zijn gedefinieerd als eGFR<45 ml/ min/1.73m2; of eGFR45-60 en diabetes mellitus; of eGFR4560 en >1 risicofactor (risicofactoren: hartfalen, perifeer vaatlijden, dehydratie, >75 jaar, anemie, symptomatische hypotensie, >150 ml contrastmiddel, nefrotoxische medicatie) of ziekte van Kahler/Waldenström met lichte ketens in de urine. Op het aangepaste aanvraagformulier dienen de MDRD en risicofactoren verplicht te worden aangegeven. Hoog-risicopatiënten werden verwezen naar een

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Resultaten: Er waren 622 patiënten, met een gemiddelde leeftijd van 56 jaar. Bij 99% was een serumcreatinineconcentratie bekend. In 23% was de eGFR<60 ml/min/1.73m2. 82 patiënten werden geclassificeerd als hoogrisico en verwezen naar de CN-polikliniek. Uiteindelijk kregen 68 patiënten pre- en posthydratie in combinatie met een CT met iv contrast. De gemiddelde leeftijd was 69 jaar (41-86 jaar). De meerderheid had een maligniteit. Discussie: De introductie van een aangepast radiologisch aanvraagformulier met verplichte vermelding van MDRD en risicofactoren geeft een goede signalering van patiënten met verhoogd risico op CN. Op de CN-polikliniek werden adequate voorzorgsmaatregelen genomen, dit verbetert de patientveiligheid.

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Abdominale radiologie/ Acute radiologie/Diversen O2.7 MR EVALUATION OF URETHRAL DIVERTICULA AND DIFFERENTIAL DIAGNOSIS IN SYMPTOMATIC FEMALE PATIENTS S.I. Verschuuren, R.S. Dwarkasing, W. Dinkelaar, W.C.J. Hop, G.R. Dohle, G.P. Krestin Erasmus Medisch Centrum, Rotterdam Objective: The purpose of this study was to evaluate the role of MRI in the diagnosis and differential diagnosis of urethral diverticula (UD) in symptomatic female patients. Materials and methods: Female patients referred for MRI at a single institution with suspicion of UD were included retrospectively. All MRI examinations were independently evaluated by two radiologists and compared with patients’ follow-up data. Sensitivity and specificity of MRI for UD was calculated using surgery and clinical confirmation as the reference standard. Image quality of the urethra and

periurethral region performed with the endoluminal coil was compared with the pelvic phased array coil. Results: From a study group of 60 patients (mean age, 44 years), 20 patients (33 %) had UD, 28 (47 %) had an alternative diagnosis, of which 13 (46 %) were demonstrated with MRI. In the remaining 12 patients (20 %) no abnormalities were found. For UD, MRI had a sensitivity and specificity of both 100 %. Twenty patients had a total of 27 diverticula; these were mostly locally round (n=12) with sharp margins (n=25) and high (n=19), homogeneous (n=16) signal intensity on T2- weighted sequences. The ostium of UD was identified in 23 (85 %) diverticula by both readers. Agreement was 93 % with a kappa value of 0.72. Endoluminal coil in the vagina demonstrated the best image quality of the urethra and periurethral region. Conclusion: Dedicated MRI is an excellent imaging modality for UD, furthermore, MRI will show the alternative diagnosis in almost half of the remaining patients.

O2.8 WAARDE VAN METOCLOPRAMIDE BIJ MRI ENTEROGRAFIE U.C. Lalji Maastricht Universitair Medisch Centrum, Maastricht

maag of beoordeelbaarheid van het onderzoek. Metoclopramide interfereerde niet met de acquisitie van de beelden na toediening van buscopan. Discussie: Metoclopramide lijkt geen toegevoegde waarde te hebben bij MR-enterografie.

Vraagstelling: Is metoclopramide nuttig bij MR-enterografie voor het diagnostiseren van Crohn met betrekking tot darmdistentie. Methode: In de periode van 1 mei 2010 tot 30 juni 2010 werden 24 patienten geincludeerd met de vraagstelling Crohn. Hiervoor ondergingen ze een MRI van de dunne darm volgens ons MR-enterografie protocol waarbij er 1 liter water met hierin opgelost metamucil 1 uur voor het onderzoek moest worden gedronken. Van deze 24 patienten kregen 10 patiënten 3 uur voor aanvang van het onderzoek 10 mg metoclopramide per os. Ook moesten zij een vragenlijst invullen m.b.t. bijwerkingen en vragen over het onderzoek zelf. De overige 14 patiënten kregen geen metoclopramide maar volgden wel de rest van het protocol. 2 abdominale radiologen scoorden de onderzoeken op de volgende punten: Distentie proximale dunne darm, distentie distale dunne darm, distensie terminale ilium, maagresidu en beoordeelbaarheid onderzoek. De radiologen waren hierbij niet op de hoogte welke patiënten metoclopramide hadden gekregen. Resultaten: De onderzoeken waren over het algemeen goed te beoordelen. Vergeleken met de groep zonder metoclopramide liet de groep met metoclopramide geen significante verschillen zien in mate van distentie van de delen van de dunne darm, residu in de 1 6 E


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Cardiovasculaire radiologie Donderdag 29 september, 14.05 - 15.35 uur O3.1 DIAGNOSTIC ACCURACY OF COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY (CTCA) IN WOMEN WITH LOW, INTERMEDIATE AND HIGH RISK FOR CORONARY ARTERY DISEASE (CAD) A.S. Dharampal, A. Rossi, A.C. Weustink, L. Neefjes, K. Nieman, N.R.A. Mollet, E.H. Boersma, G.P. Krestin, P.J. de Feyter Erasmus Medisch Centrum, Rotterdam Purpose: To determine the diagnostic accuracy of CTCA in women with low, intermediate and high risk of having significant CAD. Materials and methods: Retrospective study including symptomatic women without prior history of coronary revascularization who underwent both CTCA and invasive coronary angiography between 2004 and 2009. The pre-test probability for significant CAD was estimated using the Duke Clinical Score and were grouped in low (≤20%), intermediate (21-80%), and high risk (≥81% probability) groups. The diagnostic accuracy of CTCA to detect significant CAD

O3.2 ANALYSIS OF AORTIC VALVE ANNULUS PULSATILE DISTENSION IN PATIENTS WITHOUT AORTIC VALVE DISEASE BY ECG-GATED MULTISLICE COMPUTED TOMOGRAPHY (MSCT) L.M. de Heer, L.W. Bartels, L.A. van Herwerden, W.P.Th.M. Mali, K.L. Vincken, J. van Prehn, J. Kluin, R.P.J. Budde Universitair Medisch Centrum Utrecht, Utrecht Objective: A key element of successful transcatheter aortic valve (AV) implantation is adequate prosthesis sizing. Cardiac output and aortic compliance result in aortic shape changes throughout the cardiac cycle. This may result in inadequate prosthesis sizing. To understand the dynamic changes in stenotic AV, the healthy aorta has to be studied 28

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(≥50% lumen diameter narrowing) was assessed in the dif ferent risk groups on a per patient level. Results: Two-hundred-and-seventy-five women were included and stratified in low (n=50), intermediate (n=183) and high (n=42) risk group. The pre-test probability in the low, intermediate and high risk groups were 12%, 49% and 89% with a prevalence of 38%, 66%, and 83%, respectively. In the low risk group the sensitivity, specificity, PPV and NPV were 100%(95%CI: 83-100%), 74%(57-86%), 70%(52-84%) and 100%(85-100%). In the intermediate risk group the sensitivity, specificity, PPV and NPV were 98%(94-100%), 78%(66-86%), 89%(83-94%) and 96%(87-99%). In the high risk group the sensitivity, specificity, PPV and NPV were 100%(90-100%), 57%(25-84%), 92%(81-97%) and 100%(51-100%). Conclusion: The prevalence of CAD in women is underestimated in low and intermediate risk groups. CTCA can accurately rule out significant CAD in women with all risk groups. The post-test probability for detecting significant CAD is not depended on the pre-test probability of disease.

first. We assessed the dynamic changes of the AV annulus using ECG-gated MSCT. Methods: Fifteen patients without AV disease who had undergone cardiac MSCT were identified. 3D datasets were reconstructed at each 10% of the ECG-interval. Per phase a cross-section in-plane with the AV annulus was reconstructed. The annulus area was segmented and analysed using in-home developed software (Dynamix, ISI) (figure). Radius changes were measured over 360 degrees from the center of mass per phase and plotted. The complete annulus shape change in all directions was depicted by fitting an ellipse over the data obtained in 360 degrees and described by radius changes over the major and minor axis. The asymmetry ratio was calculated by dividing the major by the minor axis. In addition area change was determined.

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Cardiovasculaire radiologie Results: In all patients distension of the AV annulus was asymmetric (ratio 1.3±0.2). Diameter and area changes were significant in all patients. Mean diameter change was 20±4%. Mean area change was 28±7%.

Conclusions: The healthy AV annulus diameter and area show over 20% change during the cardiac cycle and these changes are asymmetrical. Quantification of dynamic morphological changes may aid prosthesis sizing and it may have implications for ultimate clinical success.

Figure 1: Aortic segmentation (pink) by thresholding

O3.3 DIAGNOSTIC PERFORMANCE OF 128SLICE DUAL SOURCE CT CORONARY ANGIOGRAPHY IN PATIENTS WITH VARIOUS HEART RATES USING 3 DIFFERENT SCAN PROTOCOLS: A RANDOMIZED STUDY L.A. Neefjes, A. Rossi, A.S. Dharampal, K. Nieman, A.C. Weustink, P.J. de Feyter, G.P. Krestin, N.R. Mollet Erasmus Medisch Centrum, Rotterdam

to have a SAS (scan window 31-75%) or RS scan (pulsing window 31-75%). The presence of a significant stenosis was assessed (segment-level) and compared with quantitative coronary angiography. Estimated radiation exposure was calculated.

Purpose: To compare radiation dose and diagnostic performance of 3 CT coronary angiography (CTCA) protocols using a 128-slice Dual Source CT scanner (Siemens): a prospective high pitch spiral (HPS), a prospective step-and-shoot (SAS), and a retrospective (RS) scan protocol. Materials and methods: We prospectively included 459 symptomatic patients with a regular heart rate (HR). Patients with a pre-scan HR <65 bpm (group A: 231 patients, 146 men, mean HR 58±7bpm) were randomized to have a HPS or SAS (scan window 62-74% of the RR-interval) scan. Patients with a pre-scan HR ≥65 bpm (group B: 228 patients, 132 men, mean HR 75±11bpm) were randomized

O3.4 A NOVEL ITERATIVE RECONSTRUCTION ALGORITHM ALLOWS REDUCED DOSE MULTIDETECTOR-ROW CT IMAGING OF MECHANICAL PROSTHETIC HEART VALVES J. Habets1, P. Symersky2, B.A.J.M. De Mol2, W.P.Th.M. Mali1, T. Leiner1, R.P.J. Budde1 1 Universitair Medisch Centrum Utrecht, Utrecht 2 Academisch Medisch Centrum, Amsterdam Purpose: Retrospectively ECG-gated prosthetic heart valve (PHV) multislice CT imaging is associated with a 1 6 E

Results: Group A: Sensitivity and negative predictive value (NPV) using HPS were significantly lower than by using the SAS protocol (89% vs. 97%, p<0.05, and 99% vs. 100%, p<0.05). Specificity and positive predictive value (PPV) were similar. The estimated radiation dose was significantly lower with the HPS than with the SAS protocol (0.74±0.15 vs. 2.65±1.0mSv, p<0.001). Group B: Sensitivity, specificity, PPV and NPV were not significantly different using a SAS or RS protocol. The estimated radiation dose was significantly lower with the SAS than with the RS protocol (4.05±1.46 vs. 5.66±2.30mSv, p<0.001). Conclusion: A step-and-shoot CTCA scan protocol is the preferred protocol in patients with regular heart rates using 128-slice Dual Source CT, providing optimal diagnostic accuracy with an “as-low-as-reasonably-achievable”radiation dose.

considerable radiation dose. Novel iterative reconstruction (IR) algorithms may enable radiation dose reduction with retained image quality. We compared image noise and artifact volumes in scans of mechanical PHVs reconstructed with conventional filtered back projection (FBP) to lower dose scans reconstructed with IR. Methods: Four different PHVs (St. Jude, Carbomedics, ON-X and Medtronic Hall) were scanned in a pulsatile in vitro model. Ten retrospectively ECG-gated CT scans were performed of each PHV at 120 KV, 600 mAs (high-dose CTDIvol 35.3mGy) and 120 KV, 300 mAs (low-dose CTDIvol 17.7mGy) R A D I O L O G E N D A G E N

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3 programma & abstracts abstracts on a 64 detector-row scanner. Diastolic and systolic images were reconstructed with FBP (high and low-dose) and the IR algorithm (low-dose only). Hypo- and hyperdense artifact volumes were determined using two threshold filters (≤-50 HU and ≥175 HU, respectively). Image noise was measured. Results: Mean image noise was 16.3±1.6 HU (high-dose FBP), 23.2±2.3 HU (low-dose FBP) and 16.5±1.7 (low-dose IR). Low-dose IR reconstructions had similar image noise compared to high-dose FBP (16.5±1.7 vs. 16.3±1.6, mean

± SD). Mean hypo- and hyperdense artifact volumes (mm3) were 1235/5346 (high-dose FBP); 2405/6877 (low-dose FBP) and 1218/5333 (low-dose IR). For all PHV types, hypodense and hyperdense artifact volumes were similar for the highdose scans reconstructed with FBP when compared to lowdose scans reconstructed with IR. Conclusion: Iterative reconstruction allows ECG-gated PHV imaging with similar image noise and PHV artifacts at 50% less dose compared to FBP in an in vitro pulsatile model.

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O3.5 RADIATION DOSE AND ARTIFACTS ARE REDUCED BY PROSPECTIVE ECGTRIGGERING RELATIVE TO RETROSPECTIVE ECG-GATING FOR IMAGING OF PROSTHETIC HEART VALVES WITH 256-SLICE CTS P. Symersky1, J. Habets2, B.A.J.M. de Mol1, M. Prokop3, R.P.J. Budde2 1 Academisch Medisch Centrum, Amsterdam 2 Universitair Medisch Centrum, Utrecht 3 Radboud University Nijmegen Medical Center, Nijmegen Introduction: Multislice CT imaging has complementary diagnostic value in the evaluation of prosthetic heart valve (PHV) dysfunction. For PHV imaging, modified coronary protocols with retrospective ECG-gating have been used at 30

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considerable radiation exposure. We compared image noise, radiation dose and artifacts with prospective triggering to retrospective gating for PHV evaluation. Methods: Two mechanical PHVs (St Jude bileaflet and Medtronic Hall tilting disc) were scanned using a pulsatile in vitro model. Image acquisition was performed with a 256-slice scanner with either a retrospectively gated helical scan (120kV, 600mAs, CTDIvol 39.8mGy) or a prospectively triggered axial scan (120kV, 200mAs, CTDIvol 13.3mGy), rotation time 0.27sec. Hypo- and hyperdense artifact volumes were quantified using thresholds of -45 and 175HU. Image noise and artifacts were compared between protocols. Additionally, mean image noise and radiation dose were compared between 6 patients with mechanical PHVs scanned with a prospectively triggered protocol and 20

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triggering (p<0.05). Mean dose for prospective triggering was 5.7 mSv compared 12.2 mSv for retrospective gating.

Results: In vitro, prospective triggering reduced valve-induced hypo- and hyperdense artifacts by 35 and 26%, respectively (p<0.001 both values). Median image noise was 11.3HU (10.9-12.2 interquartile) for prospective triggering compared to 16.6HU (14.8-17.8) for retrospective gating (p<0.001). For patients, image noise was significantly lower for prospective

Conclusion: Compared to retrospective gating, prospective triggering reduces image noise despite a lower radiation exposure for the evaluation of PHV. In vitro results demonstrate a significant reduction in artifacts as well.

Figure 1: In vitro images of a St Jude bileaflet valve.

Figure 2: Diastolic (A) and systolic (B) images each 1.7 mSv.

O3.6 CORONARY ARTERY ASSESSMENT WITH MULTISLICE COMPUTED TOMOGRAPHY IN PATIENTS WITH A PROSTHETIC HEART VALVE: IS CORONARY ASSESSMENT HAMPERED BY VALVE RELATED ARTIFACTS J. Habets1, R.B.A. Van den Brink2, R. Uijlings3, A.M. Spijkerboer2, W.P.Th.M. Mali1, S.A.J. Chamuleau1, R.P.J. Budde1 1 Universitair Medisch Centrum Utrecht, Utrecht 2 Academisch Medisch Centrum, Amsterdam 3 Deventer Ziekenhuis, Deventer

Purpose: Patients with a prosthetic heart valve (PHV) may require assessment for the presence of coronary artery disease. We evaluated whether PHV artifacts prohibit coronary artery assessment by multislice computed tomography (MSCT). Methods: Seventy ECG-gated CTAs performed on a 64-slice (n=25) or 256-slice (n=45) scanner were retrospectively scored for the presence of PHV artifacts prohibiting coronary artery assessment on the axial CT images by a single observer. Results: Mean heart rate was 73±17 bpm. We investigated 61 mechanical and 17 biological PHVs, positioned in the

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3 programma & abstracts abstracts aortic (n=59), mitral (n=17), pulmonary (n=1) and tricuspid (n=1) position. In addition, seven annuloplasty rings were present. PHV artifacts prohibiting assessment of at least one coronary segment were present in 12/70 patients (17%). Artifacts were located in the RCA, LCX and LAD: in 9/70 patients (13%) (mainly from PHVs in the aortic position), in 7/70 patients (10%) and in 3/70 patients (4%) (both mainly from PHVs in mitral position), respectively, and never in the left main coronary artery. Biological PHVs (0/17), annuloplasty rings (0/7), Carbomedics bileaflet (0/20), ON-X bileaflet (0/7) and Medtronic Hall tilting disc (1/11) PHVs caused no artifacts precluding coronary artery assessment. However, coronary artery assessment was hampered by PHV artifacts in the Bileaflet Saint Jude (3/11) and Duromedics (1/1) PHVs as well as Sorin (5/7) and Björk Shiley (4/4) tilting disc PHVs.

assess coronary artery segments in most patients with PHVs. Björk-Shiley and Sorin tilting disc PHVs prohibit diagnostic assessment due to PHV artifacts.

Conclusions: MSCT imaging is a suitable technique to

Figure 1: PHV artifact in the RCA.

O3.7 MORE NON-COMPACTED MYOCARDIUM IN BLACK FOOTBALLERS ON CARDIAC MRI T. Luijkx1, B.K. Velthuis1, F.J. van Hellemondt2, P.J. Senden2, N.H.J. Prakken1, F.J.G. Backx1, W.P.T.M. Mali1, M.J.M. Cramer1 1 Universitair Medisch Centrum Utrecht, Utrecht 2 Meander Medisch Centrum, Amersfoort

ratio of non-compacted to compacted (NC/C ratio) myocardium was determined on a standardized apical-to-mid-ventricular CMR short axis slice at six positions recommended by the American Heart Association.

Purpose: Electro- and echocardiographic (e.g. septal wall thickness, SWT) characteristics are known to differ between athletes of black and white ethnic descent. We used cardiac MRI (CMR) to study differences between elite black and white football (soccer) players. Methods: 38 healthy elite male football players aged 19-34 years (mean age 23±4 years) underwent CMR: 28 of white and 10 of black ethnic descent. Blinded observers used a reproducible contour tracing protocol to assess ventricular volumes, function and wall mass. Maximum SWT and the

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Results: Black athletes showed slightly lower end-diastolic volumes and higher end-systolic volumes in both ventricles, resulting in lower ejection fractions. SWT was larger in black athletes. Myocardial NC was more widely present and more pronounced in black athletes with both a higher peak (white/black mean 1.81/2.30, range 1.13-2.42/1.14-3.66) and average (white/black mean 1.02/1.40, range 0.42-1.66/0.692.08) NC/C ratio. Conclusions: In this small sample footballers of black ethnicity show decreased ventricular systolic function at rest, which may be related to more pronounced myocardial noncompaction. The NC/C ratio frequently exceeds the clinically used CMR cut-off value of 2.3.

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Cardiovasculaire radiologie O3.8 INTRACRANIAL VESSEL WALL IMAGING AT 7.0 TESLA MRI IN ISCHEMIC STROKE AND TIA PATIENTS A.G. van der Kolk, J.J.M. Zwanenburg, M. Brundel, G.J. Biessels, F. Visser, P.R. Luijten, J. Hendrikse Universitair Medisch Centrum Utrecht, Utrecht Background & purpose: Conventional imaging methods cannot depict the vessel wall of intracranial arteries at sufficient resolution. This hampers the evaluation of intracranial arterial disease. The aim of the present study was to develop a high-resolution MRI method to image intracranial vessel wall. Methods: We developed a volumetric (3D) turbo spin echo (TSE) sequence for intracranial vessel wall imaging at 7.0 Tesla MRI. Inversion Recovery (IR) was used to null cerebrospinal fluid to increase contrast with the vessel wall. Magnetization preparation (MP) was applied prior to inversion to improve signal-to-noise ratio (SNR). 35 patients

with ischemic stroke or TIA (Transient Ischemic Attack) of various causes were imaged to test the MPIR-TSE sequence. Gadolinium-based contrast agent (Gadobutrol, 0.1mL/kg) was administered to assess possible lesion enhancement in the patients. Results: The walls of intracranial arterial vessels could be visualized in all volunteers and patients with good contrast between wall, blood and cerebrospinal fluid. The quality of the vessel wall depiction was independent of the vessel orientation relative to the plane of acquisition. In 21 of the 35 patients a total number of 52 intracranial vessel wall lesions were identified. Eleven of the 52 lesions showed enhancement after contrast administration. Only 14 of the 52 lesions resulted in a stenosis of the arterial lumen. Conclusions: Intracranial vessel wall and its pathology can be depicted with the MPIR-TSE sequence at 7.0 Tesla. The MPIR-TSE sequence will make it possible to study the role of intracranial arterial wall pathology in ischemic stroke.

Figure 1: Example of wall lesion on 7T MPIR-TSE & TOF-MRA

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Mammadiagnostiek 1 Donderdag 29 september, 14.05 - 15.35 uur O4.1 VISUELE VERSUS SEMI-AUTOMATISCHE BEOORDELING VAN MAMMADENSITEIT IN STANDAARD MAMMOGRAFISCH ONDERZOEK M.B.I. Lobbes1, J. Cleutjens1, V. Lima Passos2, K. Keymeulen1, R.G. Beets-Tan1, C. Frotscher1, M.J. Lahaye1, J. Wildberger1, C. Boetes † 1 Maastricht Universitair Medisch Centrum, Maastricht 2 Universiteit Maastricht, Maastricht Doel: BI-RADS richtlijnen adviseren analyse van de klierweefseldensiteit op mammografisch onderzoek als deel van de mammografische evaluatie. Over het algemeen wordt visuele inspectie gebruikt om de densiteit van het klierweefsel in te schatten. Vergelijking tussen visuele en semi-automatische beoordeling van de klierdensiteit nog niet eerder onderzocht met een zogenaamde ‘threshold techniek’. Methoden: Klierdensiteit werd beoordeeld door een ervaren en onervaren radioloog in 200 mammografieën. Klierdensiteit werd ook gemeten met een softwareprogramma dat gebruik maakt van een zogenaamde ‘threshold

O4.2 LESION DETECTION AND BI-RADS CLASSIFICATION IN 3D-US AUTOMATED BREAST VOLUME SCANS (ABVS): CORRELATION WITH BREAST MRI T.A. Fassaert, I.J.M. Dubelaar, M.D.F. de Jong, M.C.J.M. Rutten Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch Purpose: To determine the diagnostic accuracy of 3D-US Automated Breast Volume Scanning (ABVS) related to MR breast imaging, using the BI-RADS classification as discriminator. Method and materials: During a 5-month period, all patients who underwent breast MRI, were requested to have additional ABVS conducted of their breasts. Patients under 34

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technique’ (figuur 1). Klierdensiteit werd gescoord volgens de richtlijnen van het BI-RADS classificatiesysteem. De correlatie tussen klierdensiteit van beide radiologen, alsook de correlatie tussen hun beoordeling versus de semi-automatische methode, werd uitgedrukt in de gewogen Kappa-waarde. Resultaten: Klierdensiteitmetingen van beide mammae en in beide projectierichtingen waren uitstekend en hoog significant (intraclass correlation coefficients >0.9, alle p<0.001). Er was frequent discrepantie tussen BI-RADS classificaties van de ervaren en de onervaren radioloog (42%). De ervaren radioloog classificeerde in 58.5% van de gevallen de klierdensiteit juist (volgens de semi-automatische aanpak). De klierdensiteit werd in 35.5% van de gevallen overschat. De correlatie tussen de classificatie van beide radiologen versus de semi-automatische methode werd beschouwd als onvoldoende: gewogen Kappa-waarden van 0.367 (ervaren radioloog) en 0.232 (onervaren radioloog). Conclusie: Visuele beoordeling van klierweefseldensiteit op mammografisch onderzoek is inaccuraat en observerafhankelijk. Semi-automatische analyse van de klierdensiteit kan helpen in het verbeteren van de inter-observer variatie bij het classificeren van klierweefseldensiteit.

18 years of age, males, patients unable to undergo MRI, or give informed consent were excluded. Time between breast MRI and ABVS was <7 days. The number of datasets obtained was related to breast size: In cup-size A to C 3 scans and in size D and D+ 5 scans per breast were obtained. Resulting 3D-US data is evaluated on a dedicated workstation by an experienced radiologist, who is blinded for MRI findings. The 3D-US findings are evaluated using the BI-RADS classification for ultrasound. MR findings are used as gold standard and, when available, also histopathologic correlation was performed. Results: Out of 281 consecutive scanned patients with MR imaging of the breasts (for various indications), 201 patients participated in our study. In nearly all patients, ABVS was technically successful and breast tissue was visible from skin to thoracic wall. The axillary region could not sufficien-

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Mammadiagnostiek 1 tly be visualized for evaluation in most patients. To date, 50 patients are evaluated: 3D-US evaluation of the breast shows a sensitivity of 88% and specificity of 97%, compared to MR imaging findings (and histology). In coming months all 201 patients will be evaluated.

Conclusion: In our study so far, 3D-US shows high sensitivity and specificity in the detection of suspicious lesions compared to MRI. Automated breast volume scanning seems a promising new ultrasound technique in breast evaluation.

O4.3 MEDICOLEGAL CLAIMS FOLLOWING SCREENING MAMMOGRAPHY IN THE NETHERLANDS V. van Breest Smallenburg, W. Setz-Pels, F.H. Jansen, L.E.M. Duijm Catharina Ziekenhuis, Eindhoven

of all screen detected cancers (SDC) and interval cancers (IC) and determined whether the cancer had been missed at the previous screen (in case of SDC) or latest screen (in case of IC). The radiologists were blinded to each others review; discrepant readings were followed by consensus reading.

Purpose: To determine the type and frequency of medicolegal claims at a Dutch breast cancer screening programme. Materials and methods: The study population consisted of all 80019 women who underwent screening mammography at a southern breast screening region of the Netherlands between January 1997 and July 2007 (301139 screens). We included all medicolegal claims that had been recorded at the central screening department within 3 years following screening mammography. During 2-year follow-up, we collected the biopsy results and surgery reports of all referred women. Two screening radiologists reviewed the screening mammograms

O4.4 RADIOFREQUENCY-ASSISTED INTACT SPECIMEN BIOPSY OF BREAST TUMORS: AN EVALUATION ACCORDING TO THE IDEAL GUIDELINES S.C.E. Diepstraten1, H.M. Verkooijen1, P.J. van Diest1, M.A. Fernandez-Gallardo1, K.M. Duvivier1, A.J. Witkamp1, T. van Dalen2, W.P.Th.M. Mali1, M.A.A.J. van den Bosch1 1 Universitair Medisch Centrum Utrecht, Utrecht 2 Diakonessenhuis, Utrecht Purpose: Radiofrequency-assisted intact specimen biopsy (RFIB) has been introduced for percutaneous biopsy or removal of breast tumors. Using radiofrequency cutting, the system enables the interventional radiologist to obtain an intact sample of the target lesion. According to IDEAL guidelines, we performed a critical evaluation of our initial experience with RFIB. Methods: Between June and November of 2010, X-ray guided RFIB was performed in 19 female patients. All patients presented with suspicious microcalcifications (BI-RADS III-V) on mammography. Biopsy specimen integrity, thermal damage and histological diagnosis were assessed by an expert breast pathologist. Data on technical success, 1 6 E

Results: Just 3 medicolegal claims had been reported, all of them related to financial compensation following a diagnosis of IC. The verdicts of these cases still have to be finalized. Excisional biopsy had been performed in 10.7% (234/2183) of false positive referrals. Review showed that 20.8% (261/1254) of SDC had been missed at the previous screen and 23.6% (139/588) of IC should have been detected at the latest screen. Conclusions: Medicolegal claims were very rare, although a substantial proportion of false positive referred women had been confronted with excision biopsy and over 20% of cancers had been missed at the previous screen or latest screen, respectively.

diagnostic and therapeutic accuracy and peri-procedural complications were collected and analyzed according to the IDEAL guidelines. Results: Median age was 59 years. Median lesion diameter on mammography was 8 mm (range 2-76 mm). The procedure was successful in 17/19 (89%) patients and unsuccessful in 2/19 (11%) patients (1 nonrepresentative sample, 1 sample with extensive thermal damage). Histological analysis of the RFIB specimen revealed 12/19 (63%) benign lesions and 7/19 (37%) malignancies (4 DCIS lesions and 3 invasive ductal carcinomas). In 1 patient a DCIS lesion was completely removed with RFIB. Overall, 3 peri-procedural complications occurred (1 wound leakage, 1 arterial hemorrhage and 1 infection requiring oral antibiotics). Conclusion: Tissue sampling of suspicious breast lesions can be performed successfully with RFIB. In 1 patient DCIS was radically excised with RFIB, which illustrates its potential as a minimally invasive therapeutic procedure for removal of small breast tumors. This is an interesting focus for further research when larger probe sizes become available.


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4 programma & abstracts abstracts O4.5 CAN COMPUTER-AIDED ANALYSIS OF BREAST MRI PREDICT THE NOTTINGHAM PROGNOSTIC INDEX OF PATIENT SURVIVAL? K.G.A. Gilhuijs1, K. Pengel2, V. Bruijnes2, C. Loo2 1 Universitair Medisch Centrum Utrecht, Utrecht 2 NKI-AvL, Amsterdam Purpose: The aim of this study is to identify imaging biomarkers from contrast-enhanced breast MRI that predict the Nottingham prognostic index (NPI) prior to surgery. Methods: Patients with invasive breast cancer and eligible for breast-conserving therapy on the basis of conventional breast imaging and clinical examination received additional preoperative breast MRI in a prospective study. Temporal and morphological features of contrast uptake were automatically analyzed by a custom-build workstation. The size and grade of the tumor as well as the number of positive lymph nodes were assessed at histopathology. From their combination, the NPI was calculated. Based on NPI, patients were stratified in subgroups with expected 5-year survival rates larger or equal

O4.6 MRI RESPONSE MONITORING IN NEOADJUVANTLY TREATED MAMMACARCINOMA: ADVANTAGE OF TWO- AND THREE-DIMENSIONAL OVER ONE DIMENSIONAL MEASUREMENTS? M.H.M. Volmerink, A.L.T. Imholz, R.A.J.M. van Dijk Deventer Ziekenhuis, Deventer Aim: to investigate the associations of (changes in) MRI tumoursize in one, two and three dimensions with specimen pathology of neoadjuvantly treated mammacarcinoma. Methods: In this retrospective study, in 35 patients dynamic contrast-enhanced MRI was performed before, during and after chemotherapy. Tumoursize was measured by RECIST,

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to 93% and subgroups with lower survival rates. Multivariate analyses were performed to identify correlations between computer-extracted MRI features and NPI. Bonferroni correction and receiver-operating characteristics were employed. Results: Five-hundred-and-forty-nine patients were included between 2000 and 2007. The mean patient age was 57 years, the mean tumor size was 1.6 cm. A total of 224/549 patients had one or more positive lymph nodes. The mean NPI was 3.1 (range 1.2 - 36.2), 304 patients were at or above the expected 93% 5-year survival threshold, 245 were below. From 20 computer-extracted features, the largest diameter of the washout in the enhancing lesion was most predictive to discriminate between the two groups, yielding an area under the curve of 0.74. Discussion and conclusion: Computer-aided analysis of breast MRI shows potential to estimate the NPI prior to surgery, and may thus ultimately provide complementary information to select neoadjuvant or minimally invasive treatment strategies.

cross-section area (2D), volume (3D; all at early (70s) and late (450s) enhancement) and by RECISTwashout. Change in tumoursize from MRI 1 to 2, and tumoursize at MRI3 were correlated with pathology by logistic regression. Results: decrease in tumoursize measured by 2Dlate (ß=4,1 p=0,03), RECISTearly (ß=2,5 p=0,01) and RECISTwashout (ß=3,4 p<0,01) was associated with absence of residual tumour. Positive predictive value of washout and negative predictive value of late enhancement at MRI3 for residual malignancy both were 100%. Conclusions: 2Dlate decrease in tumoursize showed the strongest association with pathology. Absence of late enhancement at MRI3 was strongly associated with absence of tumor, presence of washout with residual tumour.

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Interventieradiologie/ Cardiovasculaire radiologie

Sessie 5 Interventieradiologie/ Cardiovasculaire radiologie Donderdag 29 september, 14.05 - 15.35 uur O5.1 CRURAL PTA FOR CRITICAL LIMB ISCHEMIA; TECHNICAL AND CLINICAL LONG-TERM RESULTS A.S. van den Berg1, H. Odink1, B. Winkens2 1 Atrium Medisch Centrum, Heerlen 2 Universiteit Maastricht, Maastricht

in time (limb salvage rate = LSR), was performed using the Kaplan-Meier life-table analysis.

Purpose: To evaluate the technical and clinical long-term effectiveness of angioplasty of the crural arteries to preserve the leg. Materials and methods: In a 5½ year period a retrospective study was performed with 109 crural PTA’s of consecutive patients (47 men and 62 women; median age 79 years; SD = 9) with critical limb ischemia. Analysis of the clinical longterm effectiveness of angioplasty of the lower leg arteries

Results: PTA included 29 stenoses (mean grade of stenosis = 90%; SD = 6%, mean length = 5 cm; SD = 12 cm) and 80 occlusions (mean length = 15 cm; SD = 10 cm). Total technical failures were 16 (TF = 15%) and 93 procedures were successful (TS = 85%). The procedure-related mortality rate was 4%. Of 109 limbs 90 procedures were a PTA of a de novo lesion (83%). In the group of de novo lesions the LSR after 3 years was 78% (SD = 4.8). For the 80 technically successful procedures only the LSR after 3 years was 87% (SD = 4.1). Conclusion: PTA of the crural arteries appears to be an effective treatment for patients suffering from critical limb ischemia.

Figure 1: Kaplan-Meier survival curves of PTA .

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5 programma & abstracts abstracts O5.2 CLINICAL PERFORMANCE OF A NOVEL BIOACTIVE COMPOSITE IN THE TREATMENT OF VERTEBRAL COMPRESSION FRACTURES R. Schepers-Bok1, M. Geerdes1, M.E. Havinga1, R. Aquarius2, P.J.W. Wensing1 1 Ziekenhuisgroep Twente, Hengelo 2 Radboud University Nijmegen Medical Centre, Nijmegen Objective: To analyse the outcome of percutaneous vertebroplasty with CortossTM in patients with vertebral compression fractures.

score. This increased to 86,8% after six weeks. 34 new fractures occurred in 22 patients (17,4%).No embolisms occurred. Mean injected volume of Cortoss was 1,54 mL. Conclusion: In a group of patients with vertebral compression fractures percutaneous vertebroplasty with Cortoss is an effective and safe treatment option. PVP leads to a significant, rapid decrease in pain. Our results are comparable to results of other studies which used PMMA. These good clinical results, together with advantages of Cortoss, such as the low cement volume needed, and the mix-on-demand delivery system, make it a strong candidate to be a standard material in vertebral augmentation.

Methods: Between 2005 and 2010, 221 vertebral compression fractures were treated with percutaneous vertebroplasty in 132 patients. Inclusion criteria were: compression fractures due to osteoporosis, trauma or malignancy, invalidating back pain due to compression fracture, no improvement to standard conservative therapy for minimal 6 weeks, Numerical Rating Scale (NRS) score of at least 7 and bone marrow edema on MRI scan. NRS score was obtained before, and two and six weeks after vertebroplasty. Primary outcome was pain reduction measured by NRS score. Clinically significant pain relief was defined as a decrease in NRS score of at least 3 points. Secondary outcome were new vertebral fractures, injected volume and complications. Results: Two weeks after vertebroplasty, 84,7% of the patients showed a decrease of at least three points on NRS

Table 1: Patient characteristics. 38

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Figure 1: Distribution of Cortoss: trabecular pattern.

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Interventieradiologie/ Cardiovasculaire radiologie

Table 2: Mean NRS before and after vertebroplasty.

O5.3 INTERVENTIES BIJ PATIËNTEN MET KRITIEKE ISCHEMIE EN KWALITEIT VAN LEVEN F.A. Frans, R. Met, S. Bipat, M.J.W. Koelemay, D.A. Legemate, J.A. Reekers Academisch Medisch Centrum, Amsterdam De keuze van de behandeling bij patiënten met kritieke ischemie (CLI) van het onderbeen is maatwerk. Behoud van het been en Kwaliteit van Leven (Qol) zijn belangrijke uitkomstmaten bij de behandeling. Doel van dit onderzoek was het inventariseren van de behandelingen en het vervolgen van de Qol bij patiënten met CLI. In deze prospectieve cohort studie werden alle opeenvolgende patiënten met CLI die zich presenteerden in ons ziekenhuis geïncludeerd. De ziektespecifieke VascuQol vragenlijst werd ingevuld bij presentatie (baseline) en na 6 maanden. Verschillen in scores werden getoetst met de Wilcoxon-Signed Ranks test. Van mei 2007 t/m mei 2010 presenteerden zich 218 patiënten met CLI. Hiervan konden 150 patiënten worden geïncludeerd in de studie. De uiteindelijke studiepopulatie bestond na 6 maanden uit 127 patiënten. Primaire behandeling was een PTA (79;62%), chirurgisch (32;25%), conservatief (12;10%) of een amputatie (4;3%). Bij 43 patiënten (34%) was binnen 6 maanden opnieuw een interventie nodig. De hele groep liet een toename zien in Qol na 6 maanden in de somscore en op

O5.4 INTRAHEPATIC BIODISTRIBUTION ASSESSMENT OF 166-HOLMIUM MICROSPHERES IN PATIENTS WITH LIVER METASTASES USING MRI AND SPECT M.L.J. Smits, M. Elschot, G.H. van de Maat, M.A.D. Vente, M.G.E.H. Lam, P.R. Seevinck, A.D. van het Schip, B.A. Zonnenberg, C.J. Bakker, H.W. de Jong, J.F.W. Nijsen, M.A.A.J. van den Bosch Universitair Medisch Centrum Utrecht, Utrecht 1 6 E

alle individuele domeinen van de VascuQol (p <0,001). Na PTA en chirurgische revascularisatie verbeterden de VascuQol scores op alle domeinen (p<0,05). Na amputatie was er een verbetering in de somscore en het domein pijn ( p<0,05), het domein activiteiten bleef onveranderd laag. Interventies gericht op verbetering van de perfusie van het been, maar ook amputaties hebben een positieve invloed op de Qol van patiënten met CLI na 6 maanden. Bij patiënten met een laag activiteitenniveau is een primaire amputatie een effectieve behandeling.

Figuur 1: Gemiddelde score VascuQol op baseline en na 6 maanden.

Purpose: Holmium-166 poly(L-lactic acid) microspheres (166Ho-MS) were developed as an alternative to yttrium-90 microspheres radioembolization (RE) of liver tumors. 166HoRE is currently under investigation in a phase I trial (HEPAR trial, NCT01031784). The main advantage of 166Ho-MS is that 166Ho provides the possibility for in vivo biodistribution assessment post therapy by means of MRI and SPECT. We investigated the ability of MRI and SPECT to assess the intrahepatic biodistribution of 166Ho-MS.


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5 programma & abstracts abstracts Methods: five patients with liver metastases were treated with 166Ho-radioembolization. In order to assess microsphere biodistribution, pre and post treatment multi-gradient echo T2*-weighted MR images and post treatment SPECT images were acquired. R2* (R2*=1/ T2*) maps were constructed, since increases in R2* are known to linearly relate to the 166 Ho-MS concentration. R2*-maps were compared with SPECT images. Couinaud’s liver segments and up to 5 index lesions per patient were selected in volumes of interest (VOI) using anatomical MR images. VOIs were projected over the SPECT images and R2*-maps and the intensity per VOI was expressed in percentage of total liver intensity. From the 5 patients a total of 61 VOIs from R2*-maps and SPECT were compared.

Results: Presence of 166Ho-MS in the human liver was clearly visible with both modalities. In certain cases, the higher resolution of MR-acquired R2*-maps provided additional information to the SPECT images with regard to the microsphere biodistribution within a tumor. Biodistribution measurements showed a high correlation between SPECT and MRI for liver segments (r2 0.92) and index lesions (r2 0.83). Conclusion: The intrahepatic biodistribution of 166HoMS can be clearly visualized with both SPECT and MRI. Biodistribution measurements based on MRI and based on SPECT show a very good correlation.

Figure 2: Percentage of total liver intensity in each VOI.

Figure 1: 166Ho microspheres visualised on R2*-map and SPECT.

O5.5 COMPARISON OF SELF REPORTED WALKING DISTANCE, TREADMILL TEST PERFORMANCE AND WALKING ABILITY IN PATIENTS WITH INTERMITTENT CLAUDICATION M.B. Zagers, F.A. Frans, S. Bipat, J.A. Reekers, S. Jens, M.J.W. Koelemay Academisch Medisch Centrum, Amsterdam Objectives: Decisions regarding treatment of patients with intermittent claudication (IC) are guided by the patient’s perceived disability due to limited pain free (PWD) and 40

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maximum walking distance (MWD), and objective assessment of PWD and MWD on a treadmill. There are few data on the relationship between treadmill test, daily life and patient reporting regarding the outcomes, PWD and MWD. Our objective was to determine correlations between these assessments. Methods: All consecutive outpatients with IC who gave informed consent were included in this prospective study. Assessments included PWD and MWD during a standardized treadmill test (3,0 km/h, 8% incline), and on a walking track on the corridor at the patient’s own pace. All patients

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Interventieradiologie/ Cardiovasculaire radiologie also estimated their Subjective (S)PWD and (S)MWD. Differences and correlations between the assessments were determined with the Wilcoxon-Signed Ranks test and Spearman’s rank test, respectively.

meters, however on an individual level MWD and SMWD were moderately correlated (r = 0.601). The same accounts for PWD on the corridor and SPWD (r=0,487).

Results: 35 patients (71% men, mean age 64 years) were included. Mean PWD and MWD at corridor were significantly higher (115 and 265 meters) compared to the distances on the treadmill (62 and 128 meters) (P<0.05). Mean MWD on the corridor was 265 meters and mean SMWD was 286

O5.6 MECHANISCHE THROMBECTOMIE BIJ ACUUT HERSENINFARCT: MINDER THROMBOLYTICA EN BETERE UITKOMSTEN? G.J. Lycklama à Nijeholt, B.F.W. van der Kallen, E. van der Linden, T.D. de Rooy, J. Boiten Medisch Centrum Haaglanden, Den Haag

Conclusion: Treadmill testing and subjective estimated distances do not reflect actual walking distance in patients with IC. Walking distances determined with a treadmill test for decision making regarding treatment for IC is therefore questionable.

Doel: Retrospectieve ‘single center’ evaluatie van de ervaringen met intracraniële thrombolyse/thrombectomie bij 75 patienten in een periode van 27 maanden

gebruikt. Klinische verbetering trad op bij 30% van deze patienten en er waren 6 bloedingen. 10 van de 31 patiënten overleed. In de tweede periode (14 maanden, n=44) werd bij alle patiënten mechanische thrombectomie verricht met Merci device (n = 6), Solitaire stent (n= 24), Trevo stent (n= 14) of een combinatie van devices. Gemiddelde urokinase dosis was lager (2750000 IE), er was vaker klinisch succes (50%) en er waren 3 slechts bloedingen. 8 van 44 patiënten overleed in de tweede periode. Bij de laatste 14 gevallen (2011, allen Trevo stent) werd bij slechts 4 patienten urokinase toegediend en trad klinisch herstel op bij 9 patienten.

Resultaten: In de eerste periode (13 maanden, n=31) werd naast thrombolyse (gemiddeld 450000 IE urokinase) bij 17 patienten (55%) ook een Merci device en/of Solitaire stent

Conclusie: Sinds de introductie van mechanische thrombectomie devices is er mogelijk een trend tot minder thrombolytica gebruik, minder bloedingen en betere uitkomsten.

Figure 1: ACM afsluiting rechts (A). Trevo stent in situ (B).

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Figure 2: Opname na thrombectomie (C) zonder thrombolytica.

O5.7 CAROTID ATHEROSCLEROTIC PLAQUE PROGRESSION AND CHANGE IN PLAQUE COMPOSITION OVER TIME; A PROSPECTIVE IN VIVO SERIAL CT ANGIOGRAPHY STUDY M.J. van Gils, D. Vukadinovic, D.W.J. Dippel, W.J. Niessen, A. van der Lugt Erasmus Medisch Centrum, Rotterdam Purpose: Serial in vivo imaging would improve our understanding of atherosclerotic plaque progression and would be useful in assessing cardiovascular risk and monitoring treatment efficacy. Purpose of this prospective study is to quantify changes in atherosclerotic carotid plaque volume and plaque composition over time with CT angiography (CTA).

way t-test). Plaque composition changed significantly from baseline (fibrous 66.3%, lipid 29.0%, calcifications 4.7%): fibrous tissue decreased with 1.1% (p<0.05), lipid with 2.1% (p<0.001); calcified tissue increased with 3.2% (p<0.001, paired-t-test). No correlations were found between baseline plaque characteristics and serial changes. Conclusion: Changes in carotid plaque burden and plaque composition can be quantified in serial CTA using a semiautomated segmentation-tool. Plaque burden development is a heterogeneous and slow process.

Method: 111 patients with carotid plaque underwent a serial CTA of the carotid arteries after 4-6 years. Vessel range of interest was semi-automatically matched for paired baseline-follow-up datasets. Outer vessel wall boundaries and lumen boundaries were defined using a semi-automated segmentation-tool. Annual changes in lumen and vessel wall volumes were calculated. Wall component volumes were measured using HU-thresholds. Results: Thirty out of 222 arteries were excluded (local treatment, occlusion or poor image quality). Mean follow-up was 63±8 months. Intra-observer reproducibility of all volume measurements was good (ICC=0.90-1.00), except for lipid (ICC=0.79). Wall volume decreased in 30% and increased in 70% of vessels (range -6.8-10.9%/year). Baseline lumen volume was 1479±632 mm3, wall volume was 1089±461 mm3. On average, volumes of vessel, lumen and wall increased 0.6%, 0.5% and 1.2% per year (p≤0.001, one42

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Figure 1: Serial carotid CTA with segmentation of plaque.

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Interventieradiologie/ Cardiovasculaire radiologie O5.8 1 JAAR NA EVAR BESTAAT NOG ONGEVEER EENDERDE DEEL VAN DE ANEURYSMAZAK UIT ONGEORGANISEERDE THROMBUS BIJ PATIENTEN MET EN ZONDER AANTOONBAAR ENDOLEAK S.A.P. Cornelissen1, E.P.A. Vonken1, H.J. Verhagen2, F.L. Moll1, L.W. Bartels3 1 Universitair Medisch Centrum Utrecht, Utrecht 2 Erasmus Medisch Centrum, Rotterdam 3 Image Sciences Institute, Universitair Medisch Centrum Utrecht, Utrecht Doel: Doel van dit onderzoek was om de veranderende organisatiegraad van de aneurysmazak gedurende het eerste jaar na EVAR af te beelden met MRI. Methoden: In deze METC-goedgekeurde studie ondergingen 30 patiënten MRI-onderzoeken pre-operatief, < 6 weken postoperatief, 6 maanden en 1 jaar na EVAR. Er werden pre-contrast T1- en T2- en postcontrast T1-gewogen beelden gemaakt. De aneurysmazak werd met speciaal hiervoor ontwikkelde software door een ervaren radioloog uitgesplitst in gebieden met endoleak, ongeorganiseerde en georganiseerde thrombus aan de hand van de signaalintensiteit op de verschillende beelden.

Resultaten: Het gemiddelde ongeorganiseerde thrombusvolume pre-operatief was 23 ml(95%CI 16-30ml), postoperatief 51 ml(95%CI 41-61 ml), na 6 maanden 39 ml(95%CI 29-48ml), na 1 jaar 32 ml(23-41ml), zie figuur 1. Er was een significante toename in ongeorganiseerde thrombusvolume postoperatief t.o.v. pre-operatief (gepaarde t-test, p <0.05) gevolgd door een significante afname na 1 jaar t.o.v. postoperatief (gepaarde t-test, p < 0.05). 10 patienten hadden een type II endoleak op het postoperatieve CT-onderzoek. Bij patienten met een type II endoleak op de postoperatieve CT scan was het volumepercentage ongeorganiseerde thrombus na 6 maanden significant hoger dan bij patienten zonder type II endoleak (gemiddeld 48%, 95%CI 38-58% vs. gemiddeld 33%,95%CI 25-41%, student’s t-test p<0.05). Conclusies: Het is mogelijk de organisatiegraad van de thrombus na EVAR te meten met MRI. Na EVAR neemt het ongeorganiseerde thrombus volume af in de tijd, echter zowel bij patienten met als zonder endoleak bestaat na 1 jaar nog ongeveer eenderde deel van de aneurysmazak uit ongeorganiseerde thrombus waarvan de oorzaak onduidelijk is.

Figure 1: T2w MRI beelden pre(A)post(B)6mnd(C)1jr(D) na EVAR.

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Abdominale radiologie 2 Vrijdag 30 september, 10.45 - 12.15 uur

O6.1 EVALUATION OF A STANDARDIZED CT COLONOGRAPHY TRAINING PROGRAM IN NOVICE READER M.H. Liedenbaum1, S. Bipat1, P.M.M. Bossuyt1, R.S. Dwarkasing2, M.C. de Haan1, R.J. Jansen1, D. Kauffman1, C. van der Leij1, M.S. de Lijster1, C.C. Lute1, M.P. van der Paardt1, M.G. Thomeer2, I.J.A. Zijlstra1, J. Stoker1 1 Academisch Medisch Centrum, Amsterdam 2 Erasmus Medisch Centrum, Rotterdam Purpose: To determine how many CT colonography (CTC) training examinations have to be evaluated by novice readers to obtain an adequate level of competence in polyp detection. Methods: Informed consent was obtained from all participants. Six physicians (one radiologist, three radiology residents, two researchers) and three technicians completed a CTC training program. 200 CTC’s with colonoscopic verification were selected from a research database, with 100 CTC’s with at least one polyp ≥6mm. After a lecture session

O6.2 THE FEASIBILITY OF TRAINING RADIOLOGIC TECHNOLOGISTS IN TRIAGING CT-COLONOGRAPHY FOR EXTRACOLONIC FINDINGS T.N. Boellaard, C.Y. Nio, P.M. Bossuyt, J. Stoker Academisch Medisch Centrum, Amsterdam Purpose: Cost-effectiveness is important for the implementation of CT-colonography as a screening tool for colorectal cancer. Radiologists’ reading time contributes substantially to CT-colonography costs. Therefore we evaluate the feasibility of radiologic technologists in triaging screening CT-colonography for extracolonic findings. Method and materials: Eight technologists participated in a training program and subsequently reported extracolonic findings in 280 CT-colonography exams. The dataset contained 86 possibly (E3) and 30 probably important (E4) 44

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and an individual hands-on training, CTC reading was done individually with immediate feedback of the colonoscopy outcome. The increase in per-polyp sensitivity was calculated for four sets of 50 CTC’s for lesions ≥6mm. Using logistic regression analyses, the number of CTC’s to reach 90% sensitivity for lesions ≥6mm was estimated. Reading times were registered. Results: The average per-polyp sensitivity for lesions ≥6mm was 76% (207/270) in the first set of 50 CTC’s, 77% (262/342) in the second set (p=0.96 vs. first set), 80% (310/387) in the third set (p=0.67 vs. first set) and 91% (261/288) in the fourth set (p=0.018). The estimated number of CTC’s to be evaluated to reach a sufficient sensitivity for lesions ≥6mm was 164. Six of the nine readers reached this level of competence within 175 CTC’s. Reading times decreased significantly from the first 50 CTC’s to the second 50 CTC’s for 6 readers. Conclusions: Novice CT colonography readers obtained a sensitivity equal to that of experienced readers after practicing on average 164 CTC studies.

findings (C-RADS). The first and last 40 cases were identical examination cases. Feedback was given after each case from reference standard (the consensus read by two radiologists), except for the examination cases. Technologists reported lesion location and characteristics, C-RADS classification, need for a radiologist’s read and reading time. We constructed learning curves for correct scan and lesion triaging using a moving average technique. Results: For the final exam 70% of scans with E3 or E4 findings were correctly triaged, while 30.5% of scans without E3 or E4 findings were incorrectly triaged. For the final exam technologists correctly identified and classified 64.4%(67/104) of E3 and 67.5%(27/40) of E4 findings. This is an improvement, compared to the first exam, of 33.6%(p<0.0001) and 2.5%(p>0.05). The learning curve for E3 and E4 findings combined did not reach a plateau after 280 cases. The technologists’ average reading time decreased from 11:51 to 4:13 minutes(p<0.0001).

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Abdominale radiologie 2 Conclusion: A training program for radiologic technologists leads to an increased capability of triaging extracolonic fin-

dings at CT-colonography. The number of cases was too low to reach a sufficient competence.

O6.3 A RANDOMIZED CONTROLLED TRIAL COMPARING PARTICIPATION AND DIAGNOSTIC YIELD IN COLONOSCOPY AND CT-COLONOGRAPHY FOR POPULATION BASED COLORECTAL CANCER SCREENING (COCOS TRIAL) M.C. de Haan1, E. Stoop2, T.R. de Wijkerslooth1, P.M. Bossuyt1, M. van Ballegooijen2, Y. Nio1, M.J. van de Vijver1, K. Biermann2, M. Thomeer2, M.E. van Leerdam2, P. Fockens1, J. Stoker1, E.J. Kuipers2, E. Dekker1 1 Academisch Medisch Centrum, Amsterdam 2 Erasmus Medisch Centrum, Rotterdam

CRC) was detected; CTC when a lesion >5mm was found. Individuals with ≥1 lesions 6-9mm at CTC were offered surveillance CTC and colonoscopy was offered for lesions ≥10mm. Diagnostic yield was calculated as number of advanced neoplasia per 100 invitees.

Purpose: To compare participation rate and diagnostic yield of colonoscopy and CT-colonography screening in a RCT trial. Methods: A random selection of the Dutch population, aged 50-75 years, was 2:1 randomized to colonoscopy or CTC for primary CRC screening. Participation rate was defined as number of invitees undergoing the examination divided by the total number of invitees. Colonoscopy was positive when advanced neoplasia (adenomas with a diameter ≥10 mm, a ≥25% villous component, or high grade dysplasia or

O6.4 PERCEIVED BURDEN OF SCREENING BY COLONOSCOPY OR CT-COLONOGRAPHY IN THE DETECTION OF ADVANCED NEOPLASIA: A RANDOMIZED CONTROLLED TRIAL M.C. de Haan1, T.R. de Wijkerslooth1, E. Stoop2, P.M. Bossuyt1, M. Thomeer2, M.L. Essink-Bot1, M.E. van Leerdam2, P. Fockens1, E.J. Kuipers2, E. Dekker1, J. Stoker1 1 Academisch Medisch Centrum, Amsterdam 2 Erasmus Medisch Centrum, Rotterdam

Conclusion: This randomized population-based CRCscreening trial demonstrated superior participation for CTC compared to colonoscopy, but colonoscopy identified significantly more advanced neoplasia per participant. The diagnostic yield for advanced neoplasia per 100 invitees was comparable for both strategies.

using a validated questionnaire, and analyzed using MannWhitney test.

Purpose: To compare the perceived burden of colonoscopy and CTC used for primary CRC screening in a RCT. Methods: 8,842 Dutch citizens aged 50-74 were randomly invited for CRC screening by colonoscopy (n=5,923) or CTC (n=2,919). 1,276 (22%) of colonoscopy invitees participated compared to 982 (34%) of CTC invitees. Colonoscopy was performed with 2L Moviprep and 2L clear fluid, CTC with 3x50mL Telebrix. Midazolam and fentanyl were administered during colonoscopy. Perceived burden was measured two weeks after the procedure on a five-point Likert scale, 1 6 E

Results: 1,276 of 5,923 colonoscopy invitees participated (22%) compared to 982 of 2,919 CTC invitees (34%) (p<0.001). Yield colonoscopy participants: 113 (9%) had advanced neoplasia, 7 (0.5%) had a carcinoma. Yield CTC participants: 80/982 (8%) were offered surveillance, 84/982 (9%) were offered colonoscopy of which 60 (6%) had advanced neoplasia, 5 (0.5%) had a carcinoma. The diagnostic yield of advanced neoplasia was 8.9 per 100 participants for colonoscopy versus 6.1 for CTC (p=0.02); relative to the number of invitees, these numbers were 1.9 and 2.1 per 100 invitees respectively (p=0.56).

Results: 1.012 (79%) of colonoscopy and 812 (83%) of CTC participants completed the questionnaire. Drinking the preparation was more burdensome in colonoscopy (mean rank colonoscopy 3.0, versus 1.7 in the CTC group, p<0.001), related bowel movements were more burdensome in CTC (2.0 versus 2.2, p<0.001). 24% of colonoscopy and 48% of CTC participants experienced abdominal complaints after the examination (p<0.001). The whole screening procedure was more burdensome in CTC (1.8 versus 2.0, p<0.001). Most burdensome aspect colonoscopy: bowel preparation (73%). Most burdensome aspects CTC: the examination itself (37%) and bowel preparation (32%). 96% of colonoscopy and 93% of CTC participants would probably or definitely participate in a next screening round (p for mean rank = 0.98). Conclusion: Overall CTC was experienced as more burdensome than colonoscopy with conscious sedation, but differences were small. There was no difference in number of participants who intent to participate in a next screening round with the same technique.


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6 programma & abstracts abstracts O6.5 MR-COLONOGRAPHY WITH IODINETAGGED LIMITED BOWEL PREPARATION AND AUTOMATED CARBON DIOXIDE INSUFFLATION FOR COLONIC DISTENSION M.P. van der Paardt, F.M. Zijta, T.N. Boellaard, S. Bipat, A.J. Nederveen, J. Stoker Academisch Medisch Centrum, Amsterdam Introduction: To prospectively evaluate image quality and diagnostic accuracy of 3.0Tesla MR-colonography using iodine-tagged preparation and CO2 for bowel distension. Methods: 40 patients at increased risk for colorectal carcinoma underwent 3.0Tesla MR-colonography using iodinetagged bowel preparation and automated CO2 insufflation. Coronal FS 3D-T1-weighted SPGR were acquired in supine and prone position, 2D-T2-weighted SSFSE in supine position. Five parameters (Table) were assessed by two observers for 6 colon segments (240 segments/observer, 480 segments/sequence). Wilcoxon-signed-rank test was used for comparison. MR-colonography results were compared with colonoscopy and sensitivity/specificity were assessed.

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Results: The amount of fecal residue was rated ‘0-25% of lumen filled’ in 66.9%(321/480) of the images. Overall, the consistency of the residue was scored ‘liquid’; 93.3%(448/480). Supine distension was ‘adequate’ to ‘optimal’ in 89.2%(428/480) segments on T1-weighted images and 90.4%(427/472; 8 missing values) on T2-weighted series. In the T1-weighted series distension was better in supine compared to prone position: 89.2%(428/480) versus 74.1%(347/468; 12 missing values), p<0.0001. In the T1-weighted series 8.5%(41/480) of the segments were scored as ‘not diagnostic’ versus 12.7% in T2-weighted series (60/474; 6 missing values). More artifacts were present in T1-weighted series 70.2%(337/480) versus T2-weighted 13.5%(64/471; 9 missing values), p<0.0001. However, only 22 (2.3%) artifacts hampered image readability (21 artifacts on T1-weighted images, 1 artifact on T2-weighted). Per-polyp sensitivity was 66.7%(4 of 6), specificity 100%(34 of 34) for polyps>10mm. Conclusion: 3.0T MR-colonography with automated CO2 insufflation and iodine-tagged preparation results in adequate to optimal distension of segments and homogeneous tagging. Per-polyp specificity was high, sensitivity was modest.

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Figure 1: Dark lumen MR-colonography

O6.6 GD-EOB-DTPA HEPATOBILIARY PHASE ENHANCEMENT PATTERNS OF FNH; LIMITED VARIABILITY WITH DISTINCT PATHOLOGICAL CORRELATION E. de Boer, C.S. van Kessel, F.J.W. ten Kate, M.S. van Leeuwen Universitair Medisch Centrum Utrecht, Utrecht

Objective: To recognize various enhancement patterns of focal nodular hyperplasia (FNH) after Gd-EOB-DTPA.

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Background: Differentiation between FNH, which does not require treatment or follow-up, and adenoma, HCC or hypervascular metastases, which do require medical attention, is a clinical challenge which often can be met with tri-phasic CT or Gd-DTPA enhanced MRI. In inconclusive

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Abdominale radiologie 2 cases, Gd-EOB-DTPA (Primovist®) can be used, which is taken up by hepatocytes, if they are connected to biliary ducts, leading to hyperintensity in the hepatobiliary phase. However, thus far specific enhancement patterns of FNH have not been reported. Material and Methods: Retrospective evaluation was performed of 29 FNH lesions, imaged with MRI precontrast and after Gd-EOB-DTPA. MR examination consisted of precontrast T1 sequences, in and out of phase T1 sequences, T1-weighted dynamic sequences after Gd-EOB-DTPA injection, T2-weighted sequences, Diffusion weighted imaging and T1 hepatobiliary phase after 10 and 20 minutes.

Results: Evaluation of 29 FNH lesions during the hepatobiliary phase yielded four types of enhancement: homogenous hyperintense 12/29 (41,4%), heterogeneous 3/29 (10,3%), hypointense with peripheral rim enhancement 5/29 (17,3%) and isointens to liver parenchyma 9/29 (31,0%). In all cases, enhancement patterns observed at 5 minutes persisted during 10 and 20 minutes post injection. Pathological examination demonstrated correlation of observed enhancement patterns with specific vascular and biliary duct distribution. Conclusion: In the hepatobiliary phase of the Gd-EOB-DTPA four different enhancement patterns were recognized in FNH. Pathological correlation suggests specific subtypes of FNH lesions.

Figure 1: Four different enhancement patterns FNH.

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6 programma & abstracts abstracts O6.7 MAGNETIC RESONANCE IMAGING FINDINGS CORRELATES WITH PATHOLOGICAL SUBTYPE CLASSIFICATION OF HEPATOCELLULAR ADENOMAS S.M. van Aalten, M.G.J. Thomeer, T. Terkivatan, R.S. Dwarkasing, J. Verheij, R.A. de Man, J.N.M. IJzermans Erasmus Medisch Centrum, Rotterdam Purpose: To investigate the correlation between magnetic resonance imaging (MRI) findings and pathological subtype classification of hepatocellular adenoma (HCA) and to propose guidelines for follow-up and management. Methods: This retrospective study was approved by the institutional review board and the requirement for informed consent was waived. Seventy-one resected tumours previously diagnosed as HCA were classified based on pathological findings and immunohistochemical analysis: liver-fatty acid binding protein (L-FABP) negative HCA, inflammatory HCA, β-catenin positive HCA and unclassified HCA. The available MRI scans of 61 lesions (48 patients, median age

O6.8 MAGNETIC RESONACE IMAGING FOR PREDICTING RESIDUAL DISEASE AFTER RADIOTHERAPY IN LOCALLY ADVANCED CERVICAL CANCER J.E. Mongula1, D. Lambregts1, R. Kruitwagen2, T. van Gorp2, A .Kruse2, L. Lutgens3, R. Lalisang2, R. Vliegen4, B.F. Slangen2, R. Beets-Tan1 1 Maastricht Universitair Medisch Centrum, Maastricht 2 GROW, School for Oncology and Developmental Biology, Maastricht 3 Maastro clinic, Maastricht 4 Atrium Medisch Centrum, Heerlen Objective: To assess whether MRI is valuable for evaluating the presence of residual tumor after RT and which imaging criteria are the best predictors of response. Methods: 40 patients with histologically proven primary cervical cancer FIGO ≥1b were retrospective included, to date 20 out of 40 have been analyzed. Patients underwent MRI (standard T2-weighted FSE in 3 planes at 1.5T) before and 2-3 months after RT. An experienced gynaecologic radiologist scored the likelihood of residual tumor on post-RT MRI using a 5-point confidence level score based on assessment

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36 years) were independently reviewed by two radiologists, thereafter consensus was obtained. Chi-square and Fishers’ exact tests were performed for statistical analysis. Results: MRI signs of diffuse intratumoral fat deposition were present in 7 of 9 L-FABP-negative HCA compared to 5 of 29 inflammatory HCA (P = 0.001). Steatosis within the non-tumoral liver was present in 11 of 29 inflammatory HCA compared to none L-FABP-negative HCA (P = 0.038). A characteristic ‘atoll’ sign was only seen in the inflammatory group (P = 0.027). Presence of a typical vaguely defined type of scar was seen in 5 of 7 β-catenin positive HCA (P = 0.003). No specific MRI features were identified for the unclassified cases. Conclusions: L-FABP-negative HCA, inflammatory HCA and β-catenin positive HCA were related to MRI signs of diffuse intratumoral fat deposition, an ‘atoll’ sign, and a typical vagely defined scar, respectively. Since β-catenin positive HCA are considered premalignant, closer follow-up with MRI or resection may be preferred.

of isointens residual mass, hypointens fibrotic mass, border irregularity and nodular shape. The standard reference consisted of gynecological examination with biopsy and/or clinical follow-up. ROC curve analyses were performed to determine the performance for assessing residual tumor. The value of each imaging criterion was assessed. Results: 3/20 patients had residual disease. AUC for identification of residual tumor based on visual interpretation was 0,94; sensitivity 100%, specificity 88%. The individual imaging criteria resulted in AUCs of 0,94 (isointense mass), 0,50 (hypointense mass), 0,67 (irregular border) and 0,70 (nodular shape). The combination of an isointens nodular mass resulted in a AUC of 0,98, sensitivity 100%, specificity 88%. Adding an irregular border in AUC of 1,00, sensitivity 100%, specificity 100% Discussion: MRI can provide high accuracy for the assessment of residual tumor after RT in patients with locally advanced cervical carcinoma. The best imaging criteria to predict residual disease are the presence of an isointense residual mass with nodular shape and irregular borders. Use of these criteria could benefit the MR assessment of residual disease in daily clinical practice.

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Kinderradiologie/Diversen

Sessie 7 Kinderradiologie/Diversen Vrijdag 30 september, 10.45 - 12.15 uur O7.1 THE ROLE OF DYNAMIC CONTRAST ENHANCED MR ENTEROGRAPHY AS COMPARED TO ABDOMINAL ULTRASOUND IN DIAGNOSING INFLAMMATORY BOWEL DISEASE IN CHILDREN M.L.W. Ziech, T.Z. Hummel, A.M. Smets, C. Lavini, A. Kindermann, S. Bipat, A.J. Nederveen, M.W.A. Caan, J. Stoker Academisch Medisch Centrum, Amsterdam Purpose: Our purpose was to assess if dynamic contrast enhanced magnetic resonance imaging is useful as compared to ultrasound in diagnosing inflammatory bowel disease (IBD) in children. Method and materials: Consecutive consenting pediatric patients with suspected IBD were included. All patients underwent diagnostic work-up including ileo-colonoscopy and esophagogastroduodenoscopy under general anesthesia, MR enterography (800 ml sorbitol ingested in 3 hours as an small bowel and colonic intraluminal contrast agent, 3T coronal dynamic contrast enhanced 3D T1-weighted sequence, temporal resolution 0.8 seconds) and

O7.2 MINIMALLY INVASIVE MRI BY OMITTING INTRAVENOUS CONTRAST INJECTION; DOES IT CHANGE THE RADIOLOGIC ASSESSMENT OF KNEE JOINT PATHOLOGIES IN JIA? R. Hemke, M.A.J. van Rossum, M. van Veenendaal, T.W. Kuijpers, M. Maas Academisch Medisch Centrum, Amsterdam Purpose: MRI is the most preferred imaging modality in detecting joint pathologies in Juvenile Idiopathic Arthritis (JIA), despite practical limitations. Gadolinium (Gd) contrast use prolongs examination time, increases invasiveness and patient discomfort, and thereby reduces feasibility of MRI in JIA patients. Therefore, our objective is to evaluate if JIA joint pathologies can be reliably assessed by MRI 1 6 E

abdominal ultrasound (including Doppler measurements of the superior and inferior mesenteric artery). At MRI maximum enhancement (ME) was calculated in a region of interest representing the terminal ileum, ascending, transverse and descending colon. Statistical analysis was performed with the Kruskall-Wallis test. Results: Eighteen paediatric patients were included (9 males, 50%; mean age 14, range 10-18 years). Seven were diagnosed with ulcerative colitis (39%) and eight with Crohn’s disease (44%). Three patients had no IBD (17%). Fifteen patients underwent all modalities, three did not undergo ultrasound. Patients with Crohn’s disease had significantly larger wall thickness of the terminal ileum (p=0.037) measured with abdominal ultrasound. There were no differences between groups for all other segments and flow velocities. Mean ME at DCE-MRI did not differ significantly between the three groups (p=0.202). Conclusion: Wall thickness of the terminal ileum on abdominal ultrasound can be used for the diagnosing Crohn’s disease, but not for ulcerative colitis. There seems to be no role for DCE-MRI in children with suspected IBD.

without Gd injection compared with Gd-enhanced MRI as the reference. Methods: Data-sets (open-bore, 1.0T) of 46 JIA patients (mean age 12 years [range 4-18]) were prospectively scored twice by two experienced readers for the presence of knee joint pathologies. MRI features were evaluated using a literature-based assessment score, comprising synovial hypertrophy, bone marrow edema (BME), cartilage lesions and bone erosions. The first reading included unenhanced images (-Gd), whereas complete image sets were available for the second reading (+Gd). Results: Using +Gd MRI as the reference, sensitivity and specificity of -Gd MRI in the detection of BME (89%, 99%), cartilage lesions (73%, 100%) and erosions (100%, 99%) were high. Good -Gd and +Gd interreader agreements (ICC) R A D I O L O G E N D A G E N

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7 programma & abstracts abstracts were found regarding BME (0.87, 0.88), cartilage lesion (1.00, 0.97) and bone erosion scores (0.90, 0.93). Regarding synovial hypertrophy scores, the specificity of -Gd MRI was 98%, though the sensitivity was 60%. ICC for +Gd MRI was 0.88, however omitting post-Gd acquisitions increased interreader variation (ICC=0.76).

Conclusion: Omitting intravenous contrast is unimportant in the assessment of bone marrow edema, cartilage lesion and bone erosion scores in knees of JIA patients, but decreases the reliability of synovial hypertrophy scores.

O7.3 ULTRASOUND TO PREDICT SIGNIFICANT HEPATIC STEATOSIS IN OBESE ADOLESCENTS: POOR POST-TEST PROBABILITY DESPITE ACCEPTABLE SENSITIVITY AND SPECIFICITY A.E. Bohté1, B.G. Koot1, A.J. Nederveen1, O.H. van der Baan-Slootweg2, S. Bipat1, T.H. Pels Rijcken3, P.L.M. Jansen1, M.A. Benninga1, J. Stoker1 1 Academisch Medisch Centrum, Amsterdam 2 Heideheuvel Kliniek, Hilversum 3 Tergooiziekenhuizen, Hilversum

severe HS as a FF>7.7% and US score ≥2. Sensitivity and specificity for both thresholds were calculated. Based on these values the negative and positive post-test probabilities were determined and plotted against the prevalence of HS.

Purpose: to evaluate the post-test probability of ultrasound (US) for the prediction of hepatic steatosis (HS) in a severely obese adolescent population with 1H-MRS as reference standard. Methods: HS was prospectively evaluated in 113 obese adolescents with US and 1H-MRS. For US, HS was graded semi-quantitatively as 0:none, 1:mild, 2:moderate, 3:severe).1H-MR spectra were acquired with a PRESS sequence in a voxel of 8cm3 at 3T. The fat fraction (FF) was calculated as: total fat peak area/reference water peak area. HS was defined as a FF>1.8% and US score ≥1. Moderate/

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Results: Mean age was 14.1y; mean BMI was 38.3 kg/m2. The overall prevalence of HS was 0.45 (95%CI:0.36-0.54) with a sensitivity of 0.84 (0.78-0.91) and a specificity of 0.55 (0.46-0.64) for US grade ≥1. The prevalence of moderate/ severe HS was 0.14 (0.08-0.21) with a sensitivity of 0.75 (0.67-0.83) and a specificity of 0.87(0.80-0.93) for US grade ≥2. The positive and negative post-test probabilities are plotted in fig.1 for both threshold values. The positive posttest probabilities were low: 0.61 for US grade ≥1 and 0.48 for grade ≥2. Negative post-test probabilities (1-NPV) were adequate: 0.19 and 0.05 respectively. Discussion: The positive post-test probability of US for HS was poor. This implies that the applicability of US to predict HS in the individual obese adolescent is limited.

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Kinderradiologie/Diversen O7.4 RESPIRATORY DISEASE IN PAEDIATRIC ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANT (HSCT) RECIPIENTS: COULD A HIGH-RESOLUTION COMPUTED TOMOGRAPHY (HRCT) SCORE AID IN DIAGNOSIS? P.A. de Jong, A.B. Versluys, J.J. Boelens, F.J.A. Beek Universitair Medisch Centrum Utrecht, Utrecht

severity per lobe (maximum score 18) by two blinded independent radiologists for various airway and parenchyma/ interstitial abnormalities. Clinical diagnosis was established by an expert HSCT-physician based on all available information including follow-up. Possible diagnoses were; pulmonary infection, early alloimmune lung disease (<100 days post- HSCT), late alloimmune lung disease, or other.

Aims: To assess observer agreement of a HRCT-score for typical post-HSCT abnormalities and to determine whether this HRCT-score can differentiate between infectious and non-infectious diseases.

Results: Between observer agreement was good (intraclass-correlation>0.80) for consolidation and composite HRCT-score and moderate (intraclass-correlation 0.60-0.79) for bronchiectasis, tree-in-bud, nodules, ground glass and expiratory air trapping. The prevalence of abnormalities largely overlapped between infectious and non-infectious complications, but alloimmune lung disease was associated with significantly higher composite HRCT-score (both early and late), ground glass HRCT-score (early) and air trapping HRCT-score (late, Figure 1) when compared to infectious disease.

Methods: Following protocol paediatric HSCT-recipients undergo HRCT when respiratory symptoms occur or when infection is suspected for which chest radiography demonstrates no obvious cause. Forty-five consecutive disease episodes in 45 children were studied. HRCT were scored for

Conclusion: Our data suggest that the severity of certain HRCT abnormalities aids in the differentiation between infectious and non-infectious complications in pediatric HSCT recipients. The role of the HRCT-score in HSCTrecipients needs confirmation in an independent study.

Background: HSCT can be complicated by a variety of live-threatening infectious and non-infectious pulmonary complications, but much overlap appears to be present in HRCT features of these complications.

Figure 1: Two patients with alloimmune lung disease.

O7.5 OVERCONSUMPTIE VAN RÖNTGENDIAGNOSTIEK BIJ KINDEREN NA POLSTRAUMA; DE NOODZAAK VAN EEN KLINISCHE BESLISREGEL A. Slaar1, A. Bentohami1, M.W. Walenkamp1, B.A. van Dijkman2, T.S. Bijlsma3, M. Maas1, J.C.H. Wilde1, N.W.L. Schep1, J.C. Goslings1 1 Academisch Medisch Centrum, Amsterdam 2 Flevoziekenhuis, Almere 3 Spaarne Ziekenhuis, Hoofddorp Acuut polsletsel bij kinderen is een van de meest voorkomende redenen van een bezoek aan de spoedeisende hulp. In de meeste ziekenhuizen wordt routinematig een 1 6 E

Röntgenfoto gemaakt van de pols. Echter, een groot aantal van de Röntgenfoto’s laat geen afwijkingen zien. Doel: onderzoeken welk percentage van de aangevraagde röntgenfoto’s met de vraagstelling fractuur ook daadwerkelijk een fractuur liet zien bij kinderen met polsletsel. Gegevens van de kinderen (3 tot en met 16 jaar oud) die zich van 1 september 2009 tot 1 september 2010 presenteerden op de spoedeisende hulp van een ziekenhuis, waarvan een röntgenfoto van de pols werd gemaakt met de vraagstelling polsfractuur, werden geanalyseerd. Van deze patiënten werden de demografische gegevens, het traumamechanisme, aanwezigheid van een fractuur en fractuurtype verzameld. 309 patiënten konden worden geanalyseerd. De gemiddelde leeftijd bedroeg 11.20 (SD=3.1); 153 waren jongens. 77% R A D I O L O G E N D A G E N

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7 programma & abstracts abstracts van de patiënten was gevallen, 33% van de kinderen waren gevallen tijdens spelen. Slechts 50 % van de röntgenfoto’s liet een polsfractuur zien. Bij 34% van deze patiënten bedroeg het een torus fractuur, 17% een radius fractuur, 13% een greenstick fractuur, 15% een antebrachii fractuur, bij 19% een Salter Harris type 2 fractuur, resterende fracturen 2%.

Conclusie: De helft van de röntgenfoto’s van kinderen na een polstrauma liet geen fractuur gezien. Deze overconsumptie van röntgendiagnostiek leidt tot onnodige wachttijden, onnodige stralenbelasting bij kinderen, en onnodige kosten. Derhalve is er behoefte aan een klinische beslisregel analoog aan de Ottowa Ankle rules. Deze Amsterdam Wrist Rules zijn op dit moment in ontwikkeling.

O7.6 STRALING DOOR CT SCANS BIJ KINDEREN EN HET RISICO OP KANKER: EEN EPIDEMIOLOGISCHE STUDIE M. Hauptmann1, A.M. Smets2, M. van Herk1, R.A.J. Nievelstein3, J.S. Laméris2, C.M. Ronckers2,4 1 Nederlands Kanker Instituut, Amsterdam 2 Academisch Medisch Centrum, Amsterdam 3 Universitair Medisch Centrum Utrecht, Utrecht 4 Stichting Kinderoncologie Nederland, Den Haag

direct empirisch bewijs voor een verband tussen CT scans en kanker. Wij beschrijven de opzet van een Nederlands retrospectief cohortonderzoek als onderdeel van een groot multinationaal samenwerkingsverband. Het onderzoek heeft als doel om (1) het gebruik van CT scans bij kinderen in Nederland te beschrijven en (2) het verband tussen CTgerelateerde stralingsdosis en het risico op kanker (voornamelijk leukemie) te kwantificeren. De methoden van dataverzameling zijn getest in een pilot-studie en geoptimaliseerd. De beoogde studie betreft circa 100.000 mensen die in de periode 1999-2010 op kinderleeftijd (0-17 jaar) één of meerdere CT scans hebben gehad in Nederland. De cohortleden worden geïdentificeerd en de dosis zal worden geschat op basis van elektronische archieven (RIS, PACS) van de afdelingen (kinder) radiologie van deelnemende ziekenhuizen. Follow-up voor incidente gevallen van kanker zal via de Nederlandse Kanker Registratie (NKR) gaan. Voorbereidingen voor de dataverzameling zijn dit voorjaar van start gegaan, in nauwe samenwerking met de Nederlandse Vereniging voor Radiologie en de radiologie afdelingen van Nederlandse ziekenhuizen.

Computer tomografie (CT) scans gaan gepaard met hogere stralingsdoses dan conventionele beeldvormende technieken. Omdat het gebruik van CT gestaag stijgt is het van belang ongewenste neveneffecten goed in kaart te brengen, in het bijzonder het ontstaan van kanker. Kinderen vormen een extra kwetsbare groep omdat zij gevoeliger zijn dan volwassenen voor de schadelijke gevolgen van ioniserende straling en omdat zij een lange levensverwachting hebben waardoor er een grotere kans is dat negatieve bijwerkingen tot uiting kunnen komen. Er is op dit moment echter geen

O7.7 LONGITUDINAL IN VIVO IMAGING OF GD-LABELED MSCS AND OPTIMIZATION OF LABELING STRATEGY J. Guenoun, G.A. Koning, P.A. Wielopolski, G. Doeswijk, G.P. Krestin, M.R. Bernsen Erasmus Medisch Centrum, Rotterdam Purpose: Optimizing the labeling of mesenchymal stem cells with Gd-liposomes for sensitive, longitudinal cell tracking in vivo. Materials and methods: Gd-DTPA was incorporated in liposomes. Rat mesenchymal stem cells were labeled with liposomes containing various Gd-dosages, for various labeling times. Cellular Gd load, cellular toxicity, cell proliferation rate and cell differentiation were then determined for the different conditions. Intracellular retention of Gd was assessed (20d). Intracellular fate of Gd-liposomes was imaged with confocal microscopy, using intraliposomal fluorescent dyes. MRI of MSCs was performed on a 1.5T 52

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and 3.0T clinical scanner. Cells were transplanted in rat skeletal muscle and imaged for 3 weeks in vivo. At several time-points histology was performed to correlate to MRI findings. Statistical tests: one-way ANOVA, with Bonferroni post-hoc test. Results: Labeling for 4h with 125 µM lipid is most preferred, combining time-efficiency with sufficient cellular Gd uptake (30±2.5 pg Gd cell-1), lacking significant effects on cell viability, proliferation and differentiation. Gd-liposomes were well retained intracellularly in endosomes. Gd-liposome labeled MSCs were visualized at 1.5T and 3.0T both in vitro and in vivo. At least 10.000 Gd-MSCs were detected. Histology showed cellular incorporated liposomes at the site of injection. Prolonged in vivo imaging of 500,000 Gd-labeled cells was possible for at least two weeks (3.0T). Conclusion: Gd-loaded liposomes are suitable for cell labeling, without detrimental effects on cell viability, proliferation and differentiation allowing sensitive and longitudinal visualization by MRI.

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Kinderradiologie/Diversen

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O7.8 CELLULAR IMAGING: IN VIVO ASSESSMENT OF GD- OR SPIO-LABELED CELL GRAFT VIABILITY, COMBINING MRI AND BIOLUMINESCENCE IMAGING J. Guenoun, A.R. Ruggiero, G. Doeswijk, G.A. Koning, G.P. Krestin, M.R. Bernsen Erasmus Medisch Centrum, Rotterdam Purpose: Using MRI mapping techniques to determine possible differences in R1, R2 or R2* relaxation rate of viable and non-viable transplanted rMSCs, labeled with Gd or SPIO . Using bioluminescence imaging to link changes in R1, R2 or R2* to cell viability. Materials and methods: Study type: experimental longitudinal follow up. Gd-DTPA was intraliposomal incorporated. Rat mesenchymal stem cells (rMSCs), expressing firefly luciferase, were labeled with SPIO or Gd-liposomes. Cells were divided in a viable and non-viable fraction (non-viable cells were acquired by repeated freeze-thawing). For in vivo studies, 5x105 viable or non viable rMSCs were injected intramuscular and imaged with MRI and BLI at days 2, 5, 10, 15. T1, T2 and 1 6 E

T2* mapping was performed on 3T. At end-point animals were sacrificed for immunofluorescent staining. Results: Irrelevant MRI signal from non-viable Gd-MSCs disappeared quickly (<1 day post-injection), while signal void from non-viable SPIO-MSCs persisted for at least 2 weeks. The low specificity of SPIO signal was due to macrophage uptake, shown by histology. Viable Gd-MSCs were easily distinguished from non-viable Gd-MSCs, based on both visible contrast changes and quantitative data. Differences in viability of SPIO-MSCs however, could not be detected visually or by r2 measurements. Conclusion: Gd-liposomes can be used as a cell labeling tool to distinguish between viable and dead transplanted MSCs. Gd-liposomes are favored over SPIO nanoparticles, due to the low specificity of the latter.


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Mammadiagnostiek 2

Sessie 8 Mammadiagnostiek 2 Vrijdag 30 september, 10.45 - 12.15 uur

Materiaal & methode: Van 50 ABVS scans werden eerst de coronale reconstructies beoordeeld volgens de BI-RADS criteria. Ieder onderzoek betrof 3 a 5 scans per borst. Aantal en locatie van elke laesie en beoordelingstijd werd genoteerd. Daarna werden de drie richting scans beoordeeld en vergeleken met de coronale.

O8.1 EVALUATIE IN TIJD EN ACCURATESSE VAN CORONALE BEOORDELING VERSUS CORONALE, SAGITTALE EN AXIALE VLAKKEN BIJ AUTOMATED BREAST VOLUME SCANNING M.D.F. de Jong, G.J. Jager, I.J.M. Dubelaar, T.A. Fassaert, M.J.C.M. Rutten Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch Doel: Borstkankerscreening middels mammografie is een effectieve manier van screenen om de sterfte aan boorstkanker te verlagen. Echter de sensitiviteit wordt lager naarmate densiteit van het borstweefsel toeneemt. Automated breast volume scanning (ABVS) kan worden ingezet als toegevoegde screeningsmodaliteit. Voorafgaand hieraan zullen de testeigenschappen (hoge sensitiviteit en laag aantal fout negatieven) geëvalueerd moeten worden. Voordat implementatie in een screeningsprogramma mogelijk is, zal ook het gebruiksgemak en beoordelingstijd geëvalueerd moeten worden.

O8.2 OPBRENGST VAN HERHAALDE VERWIJZING NA EEN EERDERE FOUT POSITIEVE SCREENINGSMAMMOGRAFIE W. Setz-Pels1, L.E. Duijm1, A.C. Voogd2 1 Catharina Ziekenhuis, Eindhoven 2 Universiteit Maastricht, Maastricht

Conclusie: Voorlopige resultaten tonen een goede overeenkomst tussen de twee manieren van beoordelen, waarbij er aanzienlijke tijdwinst te behalen valt met de coronale scan beoordeling. Dit kan belangrijk zijn als ABVS als screeningsmodaliteit ingezet gaat worden.

reden voor herhaalde verwijzing dezelfde laesie betrof.

Doel: Bepaling van de screeningsuitkomsten van vrouwen die opnieuw zijn verwezen voor een laesie welke na een eerdere verwijzing als fout positief is afgegeven. Methoden: We includeerden alle 424703 screeningsonderzoeken, welke van 1995 t/m 2009 bij 2 screeningseenheden waren gemaakt. Van alle 5676 verwijzingen werd na 1 jaar, middels de verslagen van radiologische, chirurgische en PA-bevindingen in het natraject, vastgesteld of er al dan niet sprake was van borstkanker. Bij 61 van de 147 vrouwen, die na een eerdere fout-positieve verwijzing voor een tweede keer waren verwezen, werd middels de screeningsfoto’s en notities van de screeningsradiologen vastgesteld dat de 1 6 E

Resultaten: Als proof of principal werden 9 patiënten beoordeeld tot nu, resulterend in 59 scans van 17 borsten. Er was geen verschil in BI-RADS classificatie en de drie vlakken beoordeling detecteerde vier extra cysten. Beoordelingstijd bedroeg bij de coronale evaluatie 28,1 seconden in vergelijking met 96,0 seconden met drie vlakken, hetgeen een factor 3,4 bedraagt.

Resultaten: Bij 2180 verwezen vrouwen was sprake van borstkanker (5,1 borstkankers per 1000 screens, positief voorspellende waarde van verwijzing (PVW): 38,4%, 95% betrouwbaarheids-interval 37,1%-39,7%). Bij 22 van de 61 vrouwen, opnieuw verwezen voor dezelfde laesie na een eerdere fout positieve screen, werd borstkanker vastgesteld (PVW 36,1%, 95% betrouwbaarheids-interval 23,7%-48,5%). Bij 4 van deze 22 borstkankers betrof het een advanced cancer (invasief carcinoom >20 mm en/of lymfkliermetastasen). De vertraging in borstkanker diagnose varieerde van 21 tot 92 maanden (gemiddeld 42,5 maanden) en 9 vrouwen (40.9%) waren tenminste 1 keer gescreend (en niet verwezen) tussen de eerste, ten onrechte fout positieve verwijzing, en de tweede verwijzing. Discussie: Bij een belangrijk percentage vrouwen die opnieuw wordt verwezen voor dezelfde laesie, is sprake van borstkanker. Verder onderzoek is vereist om te bepalen welke factoren in het natraject en in de screening leiden tot een vertraging in de diagnose borstkanker.


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8 programma & abstracts abstracts O8.3 RESPONSE EVALUATION OF NEOADJUVANT CHEMOTHERAPY IN MAMMACARCINOMA: ASSOCIATION OF CHANGES IN MRI DYNAMIC GADOLINEUM ENHANCEMENT AND DIFFUSION WEIGHTED IMAGING (DWI) V.H.P. Tran, M.H.M. Volmerink, A.L.T. Imholz, R.A.J.M. van Dijk Deventer Ziekenhuis, Deventer Background: Monitoring tumour response in neoadjuvant chemotherapy in mammacarcinoma is based on MRI dynamic gadolineum enhancement. However, the role of DWI in tumour response monitoring remains to be established. Methods: In this retrospective study, (changes in) apparent diffusion coefficient (ADC) after three cycles of neoadjuvant chemotherapy in 29 consecutive patients treated in our hospital between 2006 and 2010 were compared to changes

O8.4 FFDM SUPERIOR TO SFM IN THE EARLY DETECTION OF BREAST CANCER A.M.J. Bluekens1, N. Karssemeijer2, R. Holland3, M.J.M. Broeders3, G.J. den Heeten3 1 St. Elisabeth Ziekenhuis, Tilburg 2 Universitair Medisch Centrum St Radboud, Nijmegen 3 LRCB, Nijmegen Purpose: To study the performance of full-field digital mammography (FFDM) in breast cancer service screening compared with screen-film mammography (SFM). Methods: Preceding the nation-wide transition to FFDM in the Dutch screening programme, the feasibility of FFDM was studied in 3 screening regions. Both FFDM and SFM images were double read by qualified screening radiologists. Screening outcomes obtained with both modalities were compared (Chi-square test), as well as grade, size, TNMstage and surgical outcomes of detected cancers.

in tumour size measured by RECIST, cross sectional area of tumour (both early enhancement), and diameter of gadolineum washout. Results: Following chemotherapy, ADC increased from 1,44*10-3mm2/sec (SD0,37*10-3) to 1,69*10-3mm2/sec (SD0,40*10-3; Student’s t-test p<0,01). Baseline high ADC was associated with less posttreatment decrease in RECIST (Pearson correlation R=0,45,p=0,04). Posttreatment increase in ADC was associated with decrease in tumour size measured by tumour cross sectional area (R=0,42,p=0,04) and washout (R=0,53,p=0,02), but not by RECIST (R=0,41,p=0,09). Discussion: Our study indicates that both pretreatment ADC and changes in ADC after chemotherapy are associated with changes in gadolineum enhanced MRI tumour size. Therefore, there is a potential role for ADC in monitoring tumour response in neoadjuvantly treated mammacarcinoma.

Subsequently, 18896 women were referred (SFM 1.5%; FFDM 2.4%). Breast cancer was diagnosed in 6410 women with a detection rate of 6.2” with FFDM and 5.2” with SFM (p<.00). More ductal carcinoma in situ (DCIS) (p<.00) and invasive carcinoma (p=.01) was found with FFDM with a significant increase in the detection of high grade DCIS. Digitally detected cancers tended to be smaller (p=.05) and more often fell to the T1N0 category (p<.00), resulting in significantly more breast-conserving surgery and sentinel node procedures. Conclusion: With FFDM in population-based breast cancer screening detection performance is significantly better than with SFM. While referral increased, detection improved disproportionately, largely due to detection of clinically relevant cancers, such as high grade DCIS and invasive carcinoma. With FFDM cancers tend to be smaller at the time of detection and have a better prognosis according to TNM-stage. Therefore FFDM might be able to achieve less morbidity and mortality than reported for SFM in service screening.

Results: Nearly 1.2 million screens were performed (152515 digital; 1045978 conventional) between 2003 and 2007.

O8.5 FEASIBILITY OF ULTRA HIGH FIELD 7T CONTRAST-ENHANCED MAGNETIC RESONANCE IMAGING OF INVASIVE BREAST CANCER B.L. Stehouwer, D.W. Klomp, M.A. Korteweg, P.R. Luijten, W.P.Th.M. Mali, M.A.A.J. van den Bosch, W.B. Veldhuis Universitair Medisch Centrum Utrecht, Utrecht 56

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Purpose: Feasibility of 7 Tesla (T) contrast enhanced (CE) Breast MRI and its amenability to BI-RADS-MRI conform analysis. Materials & methods: We prospectively included 5 female patients with breast lesions suspicious of malignancy, BI-RADS IV (n=1) or V (n=4), detected by mammography or ultrasound.

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Mammadiagnostiek 2 MRI was performed on a 7T whole-body scanner (Philips Health Care, Cleveland, USA) using a two-channel doubletuned unilateral RF breast coil. The protocol included a dynamic series consisting of 7 consecutive 3D T1-weighted Turbo Field Echo scans with fat suppression by means of selective water excitation [TR/TE 5.0/2.0ms, binominal FA 20˚, FOV 160x160x160mm3, acquired resolution 1mm isotropic, temporal resolution of 63seconds]; and a high resolution T1-weighted 3D Fast Field Echo Spectral Selection Attenuated Inversion Recovery sequence [acquired resolution 0.45x0.57x0.45mm3]. After the 1st dynamic scan 0.1mmol/kg Gadobutrol was injected. Lesions were assessed according to ACR BI-RADS-MRI criteria. Results were compared to histopathology. Results: The exams were technically successful. Lipid suppressed sequences showed good lesion-and-fibroglandulartissue to fat contrast. All lesions were masses of irregular shape. Margins were spiculated in 4 and irregular in 1. Enhancement was heterogeneous in 3, homogeneous in 1 and rim type in 1. In 4 lesions the kinetic curve showed rapid-rise, followed by wash-out: type-3 curve. 1 lesion showed rapid-rise followed by a plateau-phase: type-2 curve. All lesions were categorized BI-RADS V. Histopathology showed 3 ductulolobular and 2 ductal carcinomas.

Figure 1: X-ray mammography and 7T CE-MRI results obtained from a 62 year old patient.

Conclusion: CE Breast MRI at 7T is technically feasible.

a) X-ray mammography (Cranio-Caudal view, rotated to correspond to the MRI orientation), showed a BI-RADS V lesion (circle).

The exams were amenable to BI-RADS-MRI conform analysis, allowing for future intra-individual comparison between 7T and 3T.

b) Pre-contract T1 weighted MRI (voxel size 1x1x2mm3) showed a irregular mass. c) After administration of contrast agent the mass showed heterogeneous enhancement (T1w imaging, voxel size 1x1x2mm3) d) High resolution T1w SPAIR (voxel size 0.45x0.45x0.57mm3) showed good fat suppression and fine morphological details. e) The most malignant curve (squares) shoed a rapid initial rise, followed by a plateau in the delayed phase. The average curve showed a similar “tpe-2” pattern (triangles).

O8.6 DE INVLOED VAN MRI OP HET BELEID EN DE UITKOMST VAN PATIËNTEN MET EEN INVASIEF LOBULAIR MAMMACARCINOOM J.P. Pennings, R. Storm, R. Rozendaal, R.H.C. Bisschops Albert Schweitzer ziekenhuis, Dordrecht Doel: Preoperatieve MRI is een onderdeel van de EU-richtlijnen bij het beleid van het invasieve lobulaire carcinoom (ILC), vanwege de permeatieve groei, frequent gerapporteerd multifocaal en multicentrisch voorkomen (32%) en contralaterale laesies (7%). In deze retrospectieve studie is gekeken of er verschil is in de chirurgische behandeling sinds het invoeren van een preoperatieve MRI. 1 6 E

Methode: Tussen januari 2007 en maart 2011 werden 117 patiënten met een histologisch bewezen ILC geïncludeerd. 49 (42%) patiënten onderging sinds het invoeren van de richtlijn in 2008 een MRI, van wie 5 postoperatief. Alle patiënten werden behandeld conform de geldende richtlijnen. De volgende primaire uitkomstmaten werden vergeleken: contralaterale bevindingen, chirurgische behandeling, irradicaliteit en heroperaties. Resultaten: Tussen de patiënten met (n= 49) en zonder (n=68) een MR mammografie zijn geen significant verschillen in patiëntkarakteristieken, bevindingen op X-mammagram of echografie. In beide groepen werd één contralaterale tumor gevonden, echter geen ILC maar een ductaal adeno-


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8 programma & abstracts abstracts carcinoom. In de MRI groep toonde 14 (28%) patiënten een multifocale of een multicentrische laesie. Bij acht patiënten werd een additionele benigne contralaterale laesie gevonden met de MRI. Er is geen significant verschil in chirurgische behandeling tussen de twee groepen, 19 (39%) patiënten met MRI en 18 (27%) patiënten zonder MRI ondergingen een lumpectomie. Er zijn ook geen significante verschillen

tussen de MRI groep en de niet-MRI groep in irradicaliteit (18% vs. 12%) en het aantal heroperaties (14% vs. 4%).

O8.7 MOLECULAR OPTICAL IMAGING USING AN ORGANIC FLUOROPHORE AND A CLINICAL FLUORESCENCE DIFFUSE OPTICAL TOMOGRAPHY SYSTEM - EXTENSIVE PHANTOM EXPERIMENTS A. Adams1, J.E.M. Mourik2, M. van der Voort3, W.P.Th.M. Mali1, S.G. Elias1 1 Universitair Medisch Centrum Utrecht, Utrecht 2 Leids Universitair Medisch Centrum, Leiden 3 Philips Research, Eindhoven

blanks to reach a type-1 error of 1%)). Pearson’s correlationcoefficients and between-day reproducibility were calculated.

Purpose: Fluorescence Diffuse Optical Tomography (FDOT) is an emerging clinical breast imaging modality. To estimate Limits of Detection (LOD) of a clinical FDOT breast system (Philips, The Netherlands), phantoms filled with the clinical grade available near-infrared organic fluorophore IRDye800CW (Licor, Lincoln, NE) were scanned in various situations. Methods: Phantoms (0.9cm3, 2.1cm3) were filled with IRDye800CW and suspended in optical matching fluid (with optical properties of average breast tissue) at a center and an edge position in a medium sized breast cup (±500cm3). Relative (1-120:0, 1-6:1) and absolute (2-20nM) phantom-tobackground concentration differences were assessed. Threedimensional fluorescence images (excitation: 730nm; filters: >750nm) were obtained twice on different days. Average signal intensities were determined on reconstructed images for volumes matching the sizes and locations of the phantoms. Regression lines were fitted and LOD were estimated (LOD=(sB/β)*kn; sB: standard deviation of measurements of blanks; β: slope of regression line; kn: coverage factor (3.13 for duplicate measurements and five measurements of

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Discussie: Er werd geen contralaterale ILC gevonden. Preoperatieve MRI liet geen significant verschil zien in chirurgische behandeling in de door ons onderzochte populatie.

Results: The LOD ranged from 0.1nM to 2.3nM for the different situations. The fluorescent signal was very well linearly correlated with concentration differences (R2: 0.95-1.00); between-day reproducibility was excellent (intraclass-correlation: 0.93-0.99). Differences in regression line slopes were observed for the two phantoms and locations but did not affect the LOD. Conclusion: Limits of Detection of the Fluorescence Diffuse Optical Tomography system for IRDye800CW are in the lownanomolar range for relevant situations. Upcoming clinical studies with this system and this fluorophore are feasible. This research was supported by the Center for Translational Molecular Medicine (MAMMOTH).

Figure 1: The clinical Fluorescence Diffuse Optical Tomography (FDOT) breast imaging system. (Philips, The Netherlands)

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Mammadiagnostiek 2

Figure 2

O8.8 CORRELATIE VAN GEBIOPTEERDE MICROCALCIFICATIES IN DE MAMMAE MET DE INITIËLE BI-RADS CODERING; ANALYSE EN HERBEOORDELING VAN BI-RADS 3 CALCIFICATIES K.J. Kraal, J.J. Hensen, A.C. Sikkenk, J. Nijman, R.A. Niezen, D. Vroegindeweij Maasstad Ziekenhuis, Rotterdam Doel: evaluatie en justificatie van stereotactisch gebiopteerde microcalcificaties in de mammae en vergelijking van de initiële en gereviseerde BI-RADS codering. Methode: retrospectieve analyse van de in de periode 2007-2009 stereotactisch gebiopteerde microcalcificaties. Per mammabiopt werd de oorspronkelijke BI-RADS codering vergeleken met de PA-uitslag. De BI-RADS 3 groep (42 biopten) werd voor herbeoordeling voorgelegd aan een ervaren mammaradioloog (A) en een ouderejaars assistent (B), zonder kennis van de oorspronkelijke codering maar met kennis van de oorspronkelijke klinische informatie en ondergane stereotaxie. Maligne werd gedefinieerd als BIRADS 4 en 5.

Bij herevaluatie van de oorspronkelijke BI-RADS 3 codering, ivm te hoog percentage maligniteit, ontstond een spreiding naar andere coderingen waarbij 44% een BI-RADS code 2 of 3 en 56% code 4 of 5 kregen. Beoordelaar A en B bereikten een sensitiviteit van 86%, resp. 57 % en een positief voorspellende waarde van 25%, resp. 17 % voor de maligne microcalcificaties. Conclusie: van de stereotactische biopten in verband met microcalcificaties bleek 26% maligne. De oorspronkelijke codering laat een te hoog percentage maligne microcalcificaties met oorspronkelijke BI-RADS 3 codering zien. Bij herbeoordeling ontstaat een significante verschuiving van code 3 naar een hogere codering en een betere correlatie met de PA. De meest ervaren beoordelaar haalt bij herbeoordeling de hoogste sensitiviteit en PVW voor maligne microcalcificaties.

Resultaten: van 236 biopten bleek 74% benigne en 26% maligne. Respectievelijk 0% van de BI-RADS 2-, 16% van de BI-RADS 3-, 26% van de BI-RADS 4- en 88% van de BIRADS 5 gecodeerde microcalcificaties waren maligne. 1 6 E


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8 programma & abstracts abstracts O8.9 TRENDS IN INCIDENCE AND DETECTION OF ADVANCED BREAST CANCERS AT BIENNIAL SCREENING MAMMOGRAPHY: A POPULATION BASED COHORT STUDY J. Nederend, F.H. Jansen, L.E.M. Duijm Catharina Ziekenhuis, Eindhoven Purpose: To determine trends in incidence of advanced breast cancer (ABC) at screening mammography and determine the potential of reducing ABC at screening. Methods and Materials: We included all 351,009 biennial screening mammograms obtained in a Dutch breast cancer screening region between 1997-2009. Two screening radiologists reviewed screening mammograms of all advanced screen detected cancers (SDCs) and advanced interval cancers (ICs) and determined whether the ABC (defined as >T2-tumour and/or axillary lymph node positive tumour) had been visible at the previous screen (SDC) or latest screen (IC). Outcome measures were the proportions of ABCs

O8.10 THE VALUE OF BLUE DYE FOR DETECTING THE SENTINEL LYMPH NODE IN BREAST CANCER PATIENTS IN ADDITION TO LYMPHOSCINTIGRAPHY M.A. Korteweg, J.D. van Amstel, M. Hobbelink, B.L. Stehouwer, M.A.A.J. van den Bosch, A.J. Witkamp, P.J. van Diest, W.P.Th.M. Mali, W.B. Veldhuis Universitair Medisch Centrum Utrecht, Utrecht Background: Sentinel lymph node biopsy (SLNB) is performed for axillary staging of breast cancer patients by blue dye injection, lymphoscintigraphy or combining both techniques. This study assesses the added value of blue dye for sentinel lymph node (SLN) detection in comparison to lymphoscintigraphy. Materials & methods: Patients with invasive breast cancer who underwent a SLNB following both lymphoscintigraphy (figure1) and blue dye injection between January 2007 and August 2010, were included. The outcome was recorded. Sensitivity, specificity, positive and negative predictive value (PPV, NPV) were determined.

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among SDCs and ICs through the years and the potential of detecting SDCs and ICs at an earlier stage. Results: The incidence of ABC did not decline through the years and fluctuated annually from 28.7% to 35.4% (mean 32.2%, 571/1773 among SDCs and from 52.0% to 68.1 % (mean 63.4%, 424/669) among ICs. Of the 571 screen detected ABCs, 106 (18.6%) were detected at the initial screen, respectively 266 (46.6%) and 88 (15.4%) were either not visible or showed a minimal sign at the previous screen and 111 (19.4%) had been missed at the previous screen. Advanced ICs were either not visible at the latest screen or showed a minimal sign in respectively 50.9% (216/424) and 24.3% (103/424) of cases, whereas 25.1% (105/394) had been missed at screening. Conclusions: No decline in ABC was observed during 12 years of biennial screening mammography. A majority of ABCs cannot be prevented through earlier breast cancer detection at screening.

Results: 256 SLNs were harvested of 151 patients who received 153 SLNB procedures. 68 (26%) nodes contained metastases. Lymphoscintigraphy was unsuccessful in 5 procedures (3%), of which in 1 case (1/5; 20%) blue dye detected the SLN (table1). The added overall value of blue dye is 0.7% (1/153). Blue dye was unsuccessful in 55 procedures (36%), of which lymphoscintigraphy was successful in 51 procedures (51/55; 93%). Of the 4 procedures both techniques failed, an axillary nodal dissection was performed in 3 cases and in 1 case the SLN was found by palpability. Sensitivity, specificity, PPV and NPV for blue dye and for lymphoscintigraphy were respectively 68%, 50%, 33%, 81% and 97%, 12%, 40%, 92%. Combining both techniques resulted in values of 99%, 5%, 27% and 90%. Conclusion: Blue dye injection, as adjunct to lymphoscintigraphy resulted in 0.7% additional SLN detection. Blue dye detected the SLN in 20% of failed lymphoscintigraphy procedures. This implies that blue dye should only be used when lymphoscintigraphy is unsuccessful.

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Mammadiagnostiek 2

Figure 1: Anterior(A) and lateral(B) scintigraphic imaging in a 59-year old female patient with breast cancer, two hours after injection of technetium-99 nanocolloid. The largest spot is the injection site of technetium-99-nanocolloid. The nannocolloid was injected peri-tumorally in the breast. The lateral image also depicts two axillary lymph nodes (arrows) which have taken up the nanocolloid. These nodes are sentinel lymph nodes as they are assumed to also be the first nodes to accumulate metastases.

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Age

Breast Cancer Type

Metastatic Node

Blue Node

1 69 Ductal None No 2 83 Lobular None No 3 64 Mixed ductal-lobular Macro No 4 73 Mixed ductal-lobular Macro No 5 79 Ductal Macro Yes Table 1: Patient characteristics of the patients with an unsuccessful lymphoscintigraphy procedure: Patients 1-3 received an axillary lymph node dissection. Patient number 4 and 5 received a sentinel lymph node biopsy as in patient 4 the node was palpable and in patient 5 the sentinel node dyed blue.

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Neuro- en Hoofdhals radiologie Vrijdag 30 september, 10.45 - 12.15 uur

O9.1 ARTERIAL CALCIFICATION IN RELATION TO COGNITION AND STRUCTURAL BRAIN CHANGES D. Bos, M.W. Vernooij, S.E. Elias-Smale, G.P. Krestin, A. Hofman, W.J. Niessen, J.C.M. Witteman, A. van der Lugt, M.A. Ikram Erasmus Medisch Centrum, Rotterdam Purpose: Atherosclerosis plays an important role in the pathogenesis of cognitive decline and dementia. Calcified plaque measured with CT is a marker of atherosclerosis. This study investigates associations between CT-measured arterial calcifications measured at four locations, with cognition and macro- and microstructural brain changes. Method and materials: From the general population, 2437 participants underwent CT of the coronary arteries, aortic arch, extracranial and intracranial carotid arteries to quantify calcification volume. Cognitive function was assessed in the following domains: memory, executive function, information processing speed and motor speed. In a random subgroup of 844 participants brain MRI was performed to obtain measures of brain atrophy. Automated quantification of brain MRI

O9.2 TIA AND STROKE PATIENTS WITH CAROTID STENOSIS: PRESENCE OF COMPLICATED PLAQUE FEATURES AT MRI IS ASSOCIATED WITH RECURRENT EVENTS R.M. Kwee1, R.J. van Oostenbrugge1, W.H. Mess1, M.H. Prins1, R.J. van der Geest2, J.W.M. ter Berg3, C.L. Franke4, A.G.G.C. Korten5, B.J. Meems6, J.M.A. van Engelshoven1, J.E. Wildberger1, M.E. Kooi1 1 Maastricht Universitair Medisch Centrum, Maastricht 2 Leids Universitair Medisch Centrum, Leiden 3 Orbis Medisch Centrum, Sittard 4 Atrium Medisch Centrum Parkstad, Heerlen 5 Laurentius Ziekenhuis, Roermond 6 VieCuri Medisch Centrum, Venlo

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scans yielded tissue-specific brain volumes. Furthermore, microstructural integrity of white matter was quantified using diffusion tensor imaging (DTI). Associations between arterial calcification and cognition, brain tissue volumes and DTI-measures were assessed with linear regression, adjusted for relevant confounders. Results: Larger calcification load was associated with worse cognitive scores in all domains. Calcification in all vessel beds was also associated with smaller total brain volume. Specifically, coronary calcification was associated with smaller grey matter volume, whilst both extra- and intracranial carotid artery calcification was associated with smaller white matter volume. Calcification in all vessel beds was associated with worse microstructural integrity of white matter. Conclusion: Arterial calcification load is associated with worse cognitive performance. Moreover, larger calcification load is associated with smaller brain tissue volumes and with worse white matter microstructural quality, elucidating possible mechanisms through which atherosclerosis leads to poorer cognition.

Purpose: There is a need for improved risk stratification of TIA and stroke patients with carotid atherosclerosis. The purpose of the present study was to prospectively investigate whether certain MRI-based carotid plaque characteristics are associated with recurrent ischemic events. Materials and Methods: One hundred TIA/stroke patients with ipsilateral 30-69% carotid stenosis underwent multisequence MRI, including contrast-enhanced images, of the carotid plaque within 32.7±19.9 days after the initial event. For each plaque, vessel wall volume and volumes of lipidrich necrotic core (LRNC), calcifications, and fibrous tissue were assessed. Maximum vessel wall thickness, minimum lumen area, fibrous cap status, and intraplaque hemorrhage (IPH) were also assessed. Patients were followed by structured interviews and chart review to determine the recurrence of ipsilateral TIA and/or ischemic stroke within one year.

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Neuro- en Hoofdhals radiologie Results: Ten of hundred included patients suffered from recurrent ipsilateral clinical ischemic events (9 TIAs and 1 ischemic stroke). The presence of IPH was associated with recurrence (Pearson Chi-Square= 7.373, P=0.007). Patients with recurrent events also had plaques with larger LRNC volume and larger maximum vessel wall thickness, although these findings were borderline significant (P=0.032 and P=0.055, respectively). Other MRI-based parameters were not related to recurrent ischemic events.

Conclusion: The results of this study indicate that the presence of IPH, larger LRNC volume, and larger maximum vessel wall thickness of carotid plaques are associated with recurrent TIA and ischemic stroke. Assessment of carotid plaque characteristics by MRI may help identifying high-risk patients, which could improve patient selection for carotid endarterectomy or stenting.

O9.3 CAROTID PLAQUE MORPHOLOGY AND ISCHEMIC VASCULAR BRAIN DISEASE ON MRI Q.J.A. van den Bouwhuijsen, M.W. Vernooij, W.J. Niessen, G.P. Krestin, M.A. Ikram, J.C.M. Witteman, A. van der Lugt Erasmus Medisch Centrum, Rotterdam

participant and additionally per carotid artery. Analysis were adjusted for cardiovascular risk factors. Results: Carotid stenosis (OR per 10% stenosis increase 1.2 95% confidence interval (1.0-1.4), maximum carotid wall thickness (per mm increase 1.3,1.1-1.6) en presence of intraplaque hemorrhage (1.9,1.1-3.3), were all found to be significantly associated with presence of cortical infarcts, both in the participant based analysis and in the carotid artery based analysis. There were no associations between any plaque characteristics and presence of lacunar infarcts. In the subject based analysis maximum plaque thickness, presence of intraplaque hemorrhage and calcification were associated with WML-volume. In the artery based analysis only the association for calcifications remained.

Purpose: Vulnerable plaque components in carotid arteries can be detected non-invasively with magnetic resonance imaging (MRI). In asymptomatic persons, the relation between carotid plaque composition and vascular brain disease is not well studied. We studied the association between carotid atherosclerotic plaque characteristics and ischemic brain disease on MRI. Methods: From the population-based Rotterdam Study, 952 participants with carotid wall thickening on ultrasound >2.5 mm underwent both carotid MRI and brain MRI. Maximum carotid wall thickening, degree of stenosis and presence of intraplaque hemorrhage, lipid core and calcification were assessed in both carotid arteries. Associations between plaque characteristics and white matter lesions (WMLs), lacunar and cortical infarcts were investigated per

Conclusion: Presence of carotid intraplaque hemorrhage and measures of carotid plaque size are independently associated with cortical infarcts, but not with lacunar infarcts. Plaque calcification, but not vulnerable plaque components, is related to WML volume.

O9.4 A COMPUTER BASED DIAGNOSTIC SYSTEM TO FACILITATE THE EARLY AND DIFFERENTIAL DIAGNOSIS OF DEMENTIA B. Jasperse, H.A. Vrooman, M. Koek, M.W. Vernooij, R. de Boer, F. van der Lijn, M.A. Ikram, M. Smits, W. Niessen, A. van der Lugt Erasmus Medisch Centrum, Rotterdam

developed an automated system that provides individualspecific lobar brain volumes, hippocampal volumes and white matter lesion volume taking into account age- and sex-specific reference data from a ‘healthy’ aging population.

Clinical relevance: This MRI study gives insight into the importance of atherosclerotic plaque composition, also in small plaques, for development of ischemic brain disease.

Purpose: Patterns of brain atrophy, hippocampal atrophy and vascular changes, as visualized on brain-MRI, play an important role in determining the underlying cause of dementia syndromes. The visual interpretation of these pathological changes can be very challenging due to intercurrent agerelated brain changes.To facilitate the distinction between abnormal and ‘normal age-related’ brain changes, we 1 6 E

Methods and Materials: Automated brain tissue segmentation and atlas-based registration is performed on T1, T2 and FLAIR MR-images, generating lobar brain volumes, hippocampal volumes and white matter lesion volume. For each resulting volume, reference curves are used to generate age- and sex-specific percentile values. The results are then presented in an on-line viewer to interpret the quality of tissue and structure segmentation and the quantitative results. Reference curves are generated from 867 healthy aging individuals (age-range (years): 61-91, Male/female-ratio (N): 425/422).


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9 programma & abstracts abstracts Results/conclusion: An example of segmentation results and percentile plots (colored lines represent percentile-lines) for a 69 year old male patient with suspected dementia is provided in figure 1. Visual inspection suggests parietal atrophy, which might be attributed to global cortical atrophy. The automated analysis results show that overall brain volume is appropriate for age (75th to 95th percentile), with

a strikingly low parietal lobe volume (37th percentile), confirming the initially suspected parietal lobe atrophy. A system prototype is currently under evaluation at our radiology department. Future work aims to incorporate automated analysis of microbleeds, shape of individual brain structures and microstructural integrity using diffusionweighted MRI sequences.

Figure 1: Results for a patient with suspected dementia.

O9.5 MECHANICAL THROMBECTOMY WITH THE TREVO STENT DEVICE IN PROXIMAL INTRACRANIAL ARTERIAL OCCLUSIONS M.M.A.C. van Doorn1, R. van den Berg1, B. van der Kallen2, G.J. Lycklama à Nijeholt2, W. van Zwam3, Y.B. Roos1, P.J. Nederkoorn1, M.E. Sprengers1, J. Bot1, J. Boiten3, R. van Oostenbrugge3, A. van der Lugt4, D. Beumer4, P.S. Fransen4, D.W.J. Dippel4, C.B.L.M. Majoie1 1 Academisch Medisch Centrum, Amsterdam 2 Medisch Centrum Haaglanden, Den Haag 3 Maastricht Universitair Medisch Centrum, Maastricht 4 Erasmus Medisch Centrum, Rotterdam

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within the first 8 hours from symptom onset (median NIHSS 21 [range 13-28]). Thrombectomy was used as rescue therapy in patients who were refractory to, had contraindications for or were to late for IV rtPA. The occlusion site was the middle cerebral artery in 7, terminus internal carotid artery in 2, cervical internal carotid artery/middle cerebral artery in 4 and basilar artery in 9 patients. Complications related to the procedure and outcome at 3-6 months were assessed.

Background and Purpose: To evaluate the safety and effectiveness of a self-expanding and fully retrievable stent (Trevo; Concentric Medical Inc, Mountain View, CA, USA) in revascularization of patients with acute ischemic stroke.

Results: Stent placement was feasible in all procedures and successful recanalization defined as thrombosis in cerebral ischemia (TICI) grade 2b or 3 was achieved in 18 of 22 treated vessels (82%). The mean number of passes for maximal recanalization was 2 (range 1-5). The median time from groin puncture to recanalization was 110 minutes (range 26 – 199). One significant procedural event occurred (carotid artery occlusion after stent removal). 33% of all patients had a good outcome (mRS 0-2), 0% moderate outcome (mRS 3), 67% poor outcome (mRS 4-6).

Methods: Prospective multicenter case series of 22 patients with an acute ischemic stroke caused by a proximal intracranial arterial occlusion treated with a fully retrievable stent

Conclusions: These results suggest that with the Trevo device, clots can be safely and effectively removed from intracranial large vessel occlusions in acute ischemic stroke.

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Neuro- en Hoofdhals radiologie O9.6 RESTING-STATE FUNCTIONAL MRI CHANGES IN ALZHEIMER’S DISEASE AND MILD COGNITIVE IMPAIRMENT M.A.A. Binnewijzend1, M.M. Schoonheim1, E. Sanz-Arigita2, A.M. Wink1, W.M. van der Flier1, N. Tolboom1, J.S. Damoiseaux3, S.M. Adriaanse1, P. Scheltens1, B.N.M. van Berckel1, F.A. Barkhof1 1 VU medisch centrum, Amsterdam 2 Foundation CITA-AD, San Sebastian, Spain 3 Stanford University School of Medicine, Palo Alto, Cal, USA Alzheimer’s disease (AD) features distinct structural and functional brain changes. With the prospect of disease-modifying therapies it is desirable to detect signs of neurodegeneration before it is detectable on structural MRI as atrophy. In this study we used resting-state functional MRI (rs-fMRI) to compare regional functional connectivity of patients with AD, mild cognitive impairment (MCI) and healthy elderly controls (HC). MRI scans and neuropsychological assessments were acquired of 39 AD patients, 23 MCI patients and 43 HC. After a mean follow-up of 2.8±1.9 years seven MCI patients

converted to AD, while 14 patients remained cognitively stable. Rs-fMRI scans were non-linearly registered to standard space and analyzed using independent component analysis (ICA), followed by a “dual-regression”technique to create and compare subject-specific maps of each spatio-temporal independent component, correcting for age, gender and additionally for gray matter atrophy. AD patients displayed decreased functional connectivity within the default-mode network (DMN) in the precuneus and posterior cingulate cortex compared to HC, which survived correction for gray matter atrophy. Within these regions, decreased functional connectivity was found in converting MCI as well, while no differences were found between stable MCI patients and HC. Correlation with cognitive dysfunctions demonstrated the clinical relevance of functional connectivity changes within the DMN. In conclusion, a clinically relevant decrease in functional connectivity was observed within the DMN in AD, independent of cortical atrophy. Similar decreases were present in MCI patients before conversion to AD. Rs-fMRI is a promising technique that can identify functional impairment in early AD.

Figure 1: Differences in DMN FC between HC and AD patients.

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Figure 2: Boxplots of regional FC mean z-values.

O9.7 COMPUTER-AIDED DIAGNOSIS OF CORTICAL LESIONS IN EPILEPSY PATIENTS M.C. Hoeberigs1, L.M.H. Geelen1, P.A.M. Hofman2 1 Maastricht Universitair Medisch Centrum, Maastricht 2 Kempenhaeghe Epilepsiecentrum, Heeze About 30% of epilepsy patients with partial seizures have intractable epilepsy. MRI detection of an epileptogenic lesion is of clinical importance because focal resection may be the only viable therapeutic option. In up to 74% of patients with partial seizures, MRI shows no abnormalities, although it is assumed that the majority of these patients have a small cortical dysplasia. In some of these cases the lesion is visible on the MRI study, but not detected by the neuroradiologist. We investigated the additional value of a computer-aided diagnostic technique, by retrospectively analyzing all scans from patients with partial seizures acquired between December 2008 and December 2009. The scan protocol on

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a 3T scanner included a 3D-T1 weighted scan, which was used for the post-processing. The other sequences were axial TSE-T2, FFE-T2 and FLAIR, coronal FLAIR and IR. MRI post-processing was a fully-automated voxel-based 3D MRI analysis within SPM5 (normalization, segmentation, results compared to normal database): feature maps of cortical thickness, gray-white junction and gray matter extension were generated. These maps were visually evaluated and correlated with the full exam. Only when the detected cortical lesion was also visible on the original scans it was considered a true cortical lesion. A total of 289 MRIs were evaluated. Based on visual assessment, a cortical lesion was described in 45/289. In 28/45 positive scans and in 5 out of the initially negative 244 patients a cortical lesion was detected by computeraided technique. Computer-aided postprocessing can increase the diagnostic yield, but not replace visual assessment.

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Neuro- en Hoofdhals radiologie O9.8 COMPLICATIONS OF PARTICLE EMBOLIZATION OF MENINGIOMAS: FREQUENCY, RISK FACTORS, AND OUTCOME D.F.M. Carli, M.S. Sluzewski, G.N. Beute, W.J.J. van Rooij St. Elisabeth Ziekenhuis, Tilburg Purpose: We assessed the frequency and outcome of complications of embolization of meningiomas and tried to identify risk factors. Methods: Between 1994 and 2009, a total of 198 patients with 201 meningiomas underwent embolization. Indication for embolization was preoperative in 165 meningiomas and adjunctive to radiosurgery in 8. In the remaining 28 meningiomas, embolization was initially offered as a sole therapy. There were 128 women and 70 men with a mean age of 54.4 years (median age, 54 years; range, 15-90 years). Complications were defined as any neurologic deficit or death that occurred during or after embolization. Logistic regression was used to identify the following possible risk

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factors: age above median, female sex, tumor size above median, meningioma location in 5 categories, use of small particle size (45-150 microm), the presence of major peritumoral edema, and arterial supply in 3 categories. Results: Complications occurred in 11 patients (5.6%; 95% confidence interval [CI], 3.0%-9.8%). Ten complications were hemorrhagic, and 1 was ischemic. Six of 10 patients with hemorrhagic complications underwent emergency surgery with removal of the hematoma and meningioma. Complications of embolization resulted in death in 2 and dependency in 5 patients (7/198, 3.5%; 95% CI, 1.6%-2.0%). The use of small particles (45-150 mum) was the only risk factor for complications (odds ratio [OR], 10.21; CI, 1.3-80.7; P = .028). Conclusions: In this series, particle embolization of meningiomas had a complication rate of 5.6%. We believe that the use of small polyvinyl alcohol (PVA) particles (45-150 microm) should be discouraged.


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MSK/Thorax/Diversen Vrijdag 30 september, 10.45 - 12.15 uur O10.1 REPRODUCIBILITY OF 3D DELAYED GADOLINIUM ENHANCED MRI OF CARTILAGE OF THE KNEE AT 3.0 TESLA IN PATIENTS WITH EARLY-STAGE OSTEOARTHRITIS J. van Tiel, G. Kotek, H. Smit, E. Bron, S. Klein, G.P. Krestin, H. Weinans, E.H.G. Oei Erasmus Medisch Centrum, Rotterdam Purpose: To assess the reproducibility of 3D delayed Gadolinium Enhanced MRI of Cartilage (dGEMRIC) of the knee at 3.0Tesla in patients with early-stage osteoarthritis (OA). Methods: In three early-stage knee OA patients (Kellgren and Lawrence grade I or II) dGEMRIC was performed twice with an interval of seven days using a 3.0Tesla MRI-scanner and a custom-made open design knee coil. This coil was specifically developed to enable imaging of OA patients who would not fit in the commercially available knee coil. The new coil has a higher signal-to-noise ratio in the weightbearing cartilage compared to the regular knee

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coil. The dGEMRIC consisted of an Inversion Recovery Fast Spoiled Gradient Echo sequence with five different inversion times. Using Matlab, three regions of interest (ROIs) in the medial and lateral cartilage (weight-bearing condyle and plateau and non weight-bearing condyle) were drawn on three consecutive slices. Mean T1GD relaxation time per ROI per slice was calculated and compared between the two dGEMRIC scans using a paired t-test and an intraclass correlation coefficient (ICC) to assess reproducibility of the measurements. Results: In all ROIs of all slices mean T1GD relaxation time was not significantly different between the two examinations (p=0.1-0.5). The ICCs of mean T1GD relaxation times of all ROIs were good to excellent (ICC:0.640.99;p=0.004-0.0001). Conclusions: These preliminary results suggest that 3D dGEMRIC of the knee at 3.0Tesla is a reproducible measure of cartilage quality in early-stage OA patients. Therefore, it is a valuable tool to assess cartilage quality over time in longitudinal studies.

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MSK/Thorax/Diversen O10.2 CT-ARTHROGRAPHY TO MEASURE CARTILAGE QUALITY: INFLUENCE OF SULPHATED GLYCOSAMINOGLYCAN CONTENT AND STRUCTURAL COMPOSITION OF EXTRACELLULAR MATRIX ON CONTRAST AGENT DIFFUSION INTO CARTILAGE J. van Tiel, M. Siebelt, J.H. Waarsing, M. van Straten, G.P. Krestin, H. Weinans, E.H.G. Oei Erasmus Medisch Centrum, Rotterdam Purpose: To assess the potential of CT-arthrography to evaluate cartilage quality in terms of sulphated glycosaminoglycan content (sGAG) and structural composition of the extra-cellular matrix (ECM). Methods: Eleven human cadaveric knee joints were scanned on a second generation dual source spiral CT scanner before and after intra-articular injection of a negatively charged contrast agent. Mean X-ray attenuation values of both scans were calculated in seven regions of interest (ROIs) of the cartilage (weight-bearing condyles and plateaus, non weight-bearing condyles and patella). Next, all ROIs were rescanned with contrast-enhanced

micro-CT (μCT), which served as reference standard because it accurately measures sGAG content and hence quality of cartilage. Correlation between mean X-ray attenuation values of CT-arthrography and μCT was analyzed with linear regression. Additionally, residual values from the linear fit between unenhanced CT and μCT were used as a covariate measure to identify the influence of structural composition of cartilage ECM, i.e. without influence of sGAG, on contrast diffusion into cartilage. Results: Mean X-ray attenuation of cartilage was significantly higher for CT-arthrography compared to unenhanced CT in all ROIs. Furthermore, CT-arthrography attenuation values correlated excellently with reference μCT values representing sGAG content of cartilage (R=0.86;R2=0.73;p<0.0001). When taking into account structural composition of cartilage EMC, this correlation improved substantially (R=0.95;R2= 0.90;p<0.0001). Conclusion: Contrast diffusion into articular cartilage detected with CT-arthrography correlates excellently with sulphated glycosaminoglycan content and to a lesser extent with structural composition of cartilage ECM. Therefore, CT-arthrography may be clinically applicable to quantitatively measure the quality of articular cartilage.

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10 programma & abstracts abstracts O10.3 FRACTUREN VAN DE THORACALE EN LUMBALE WERVELKOLOM IN HET CENTRUM VOOR GERIATRISCHE TRAUMATOLOGIE: VASTSTELLEN VAN SCHADE AAN DE MIDDELSTE PIJLER NIET VAN BELANG VOOR BELEID L.B.M. Weerink, M. Kraai, E.C. Folbert, R.S. Smit, J.H Hegeman, D. van der Velde Ziekenhuisgroep Twente, Almelo Over de behandeling van ouderen met een wervelfractuur door de middelste pijler is geen consensus. De relevantie van de CT-scan in de diagnostiek staat hiermee ook ter discussie. Doel van dit onderzoek is de meerwaarde van de CT-scan bij ouderen met een wervelfractuur te bepalen. Voor dit onderzoek werden 106 patiënten in het Centrum voor Geriatrische Traumatologie met een fractuur ter hoogte van de thocacolumbale wervelkolom geïncludeerd. Er werden retrospectief gegevens verzameld over radiologische parameters zoals betrokkenheid van de middelste pijler en diameter van het spinale kanaal. Algemene patiënten-

O10.4 IMPROVING DEPLOYMENT OF MR-SI IN PATIENTS SUSPECTED FOR SPONDYLOARTHRITIS IN A LARGE CLINICAL PRACTICE, USING A TARGETED INTERVENTION M.H.E. Vossen1, A.A. den Broeder2, F. Hendriks-Roelofs2, D.M.F.M. van der Heijde1, M. Reijnierse1 1 Leiden Universitair Medisch Centrum, Leiden 2 Sint Maartenskliniek, Nijmegen Background: Diagnosing axial spondyloarthritis (SpA) can be difficult: sacroiliac (SI) joint radiographs are often normal. Magnetic Resonance (MR) exam of SI joints (MR-SI) may reduce diagnostic uncertainty. Optimal deployment requires pretest chance of approximately 50%. Otherwise, increased numbers of MR-SI requests, false positives, excessive patient burden and costs will result. Objective: To examine characteristics of deployment of MR-SI in patients with suspected SpA before and after targeted intervention. Methods: MR-SI from April 1st, 2004 to December 31st, 2010 were retrospectively collected. Inclusion criteria: MR-SI ordered by rheumatologist, suspicion of axial SpA, complete patient data. MR-SI reports were graded ‘normal’, ‘suspected sacroiliitis’ and ‘sacroiliitis’. Descriptive statistics were mean ± standard deviation (SD) or median (25-p75). In April 2007, an intervention was done to improve deployment. Review data on requesting behavior, patient characteristics, outcomes were presented to rheumatologists. 70

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gegevens en gegevens over het functioneren na 6 weken en 3 maanden werden geregistreerd. In onze populatie is er geen relatie is tussen betrokkenheid van de middelste pijler, compressie van het spinale kanaal en andere radiologische parameters met het functioneel eindresultaat. In tegenstelling tot de literatuur werd bij patiënten met een fractuur door voorste en middelste pijler het beleid in 83,3% (45 patiënten) gewijzigd naar snelle mobilisatie. Het functioneel eindresultaat in beide groepen is vergelijkbaar. Conclusie: In onze studie hebben radiologische kenmerken van een wervelfractuur geen relatie met het functioneringsniveau na 6 weken en 3 maanden. De toepassing van snelle mobilisatie in plaats van strikte bedrust bij een fractuur met betrokkenheid van de middelste pijler is een veilige optie. Het vaststellen van de betrokkenheid van de middelste pijler door middel van een CT-scan lijkt met deze conclusies minder relevant voor het te volgen beleid. De rol van de CT-scan bij de diagnostiek van ouderen met een wervelfractuur staat hiermee ter discussie.

An introduction on effect of pretest chance on predictive value, patient burden, costs was given. Alternative behavioral strategy was offered through a simple diagnostic algorithm. Results: 198 MR-SI (148 females / 50 males; mean age 36 ± 9.8yrs) were performed between April 1st, 2004 and April 17th, 2007. 166 MR-SI (84%) were normal, 5 (2.5%) suspicious and 27 (13.5%) positive. After intervention, MR-SI number dropped to 58 (41 females / 17 males; mean age 35. ± 9.8 years). Corrected for total number of patients seen (mean increase 12%), this is decrease of 79% with almost doubling of positive MR-SI: 44 normal (76%), 0 suspicious and 14 (24%) positive. Conclusion: A simple, three stage feedback intervention resulted in 79% reduction of MR-SI requests with increase in number of positive MR-SI. This approach may benefit future research in areas with diagnostic uncertainty.

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MSK/Thorax/Diversen

Figure 1: Diagnostic algorithm by Rudwaleit, M. et al.

Methods and materials: In this retrospective study, six observers of varying experience evaluated 157 negative and 39 positive 64-slice consecutively acquired CTPA. With a time interval of 6 weeks, all cases were read twice in different order using CAD as second and as concurrent reader, respectively. Per patient, observers were asked to determine the presence of PE using a 5 point confidence scale and to document their reading time with and without CAD. Sensitivity and specificity were calculated by comparing the reader data with an independent consensus standard.

O10.5 IMPACT ON DIAGNOSTIC PERFORMANCE AND READING TIME OF A COMPUTER AIDED DETECTION ALGORITHM FOR THE DETECTION OF ACUTE PE: SECOND READING VERSUS CONCURRENT READING R. Wittenberg1, J.F. Peters2, I.A.H. Van den Berk3, N.J.M. Freling3, R.J. Lely4, B. de Hoop5, K. Horsthuis3, C.J. Ravesloot5, M. Prokop6, C.M. Schaefer-Prokop7 1 Universitair Medisch Centrum Utrecht, Utrecht 2 Philips Healthcare, Best 3 Academisch Medisch Centrum, Amsterdam 4 VU Medisch Centrum, Amsterdam 5 Universitair Medisch Centrum Utrecht, Utrecht 6 Universitair Medisch Centrum St Radboud, Nijmegen 7 Meander Medisch Centrum, Amersfoort Purpose: Evaluation of a CTPA study for the detection of pulmonary embolism (PE) represents a time consuming and tiring reading process. Computer-aided detection (CAD), when used as second reader, was found to improve reader performance for the detection of small emboli but inevitably at the expense of a substantial increase of reading time. We hypothesised that CAD may be used more advantageously when used as concurrent reading tool.

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Results: Baseline performance without CAD was high with a mean sensitivity of 91 % and increased further to 95 % with CAD as second reader and 94 % with CAD as concurrent reader. Mean specificity decreased with CAD as second reader (96%, 94 % and 96 %, respectively). The mean reading time with CAD as concurrent reader significantly decreased (108 s, 136 s and 91s, respectively). Conclusions: CAD used as concurrent reader has the potential to achieve the same high sensitivities without loss of specificity at the advantage of a significantly shorter reading time.


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10 programma & abstracts abstracts O10.6 DEVELOPMENT AND VALIDATION OF A DIAGNOSTIC MODEL FOR AIRFLOW LIMITATION IN HEAVY SMOKERS BY USING QUANTITATIVE COMPUTED TOMOGRAPHY O.M. Mets1, C.M.F. Buckens1, P. Zanen1, I. Isgum1, M. Prokop2, P.A. de Jong1 1 Universitair Medisch Centrum Utrecht, Utrecht 2 Universitair Medisch Centrum St Radboud, Nijmegen Purpose: To develop a CT based diagnostic model for the presence of airflow limitation in smokers participating in a lung cancer screening study. Materials and methods: In 1173 screening participants, we analyzed inspiratory and expiratory chest computed tomography (CT) scans, patient characteristics, smoking history and prebronchodilator spirometry obtained at the same day as the CT scan. Scan parameters were: 120kVp (≤80kg) or 140kVp (>80kg) at 30mAs for inspiratory scans, and 90kVp (≤80kg) or 120kVp (>80kg) at 20mAs for expiratory scans. Axial slices of 1mm at 0.7mm increment were reconstructed.

O10.7 FREQUENCY AND ORIGIN OF LUNG PERFUSION DEFECTS ON DUAL-ENERGY COMPUTED TOMOGRAPHY (DECT) IN AN UNSELECTED PATIENT GROUP A.E. Odink1, M. Rossius1, W. Vermeule1, C.M. Schaefer-Prokop2, I.J.C. Hartmann1 1 Erasmus Medisch Centrum, Rotterdam 2 Meander Medisch Centrum, Amersfoort Background and purpose: Lung perfusion defects seen on DECT are not necessarily caused by acute pulmonary embolism (PE) and therefore may cause interpretation difficulties. Purpose of the study was to assess frequency and underlying cause of perfusion defects on DECT in an unselected patient group. Methods: The study group consisted of 200 consecutive patients who underwent DECT for suspected acute PE between May 2009 and February 2011. State of the art protocols were used with a second generation DECT scanner. All scans were retrospectively revised by two radiologists with respect to the presence, morphology and location of perfusion defects and to the presence and type of artefacts. Findings were correlated with the findings at lung window settings and the CTA findings. Results: In 189 (94%) of the included 200 patients perfusion maps were available for evaluation. Twenty three patients (12%) were positive for PE, of whom 14 had wedge shaped 72

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CT emphysema was defined as percentage of voxels <-950 Hounsfield Unit (HU). CT air trapping was defined as the expiratory to inspiratory ratio of mean lung density. Airflow limitation was defined as FEV1/FVC< 0.70 (forced expiratory volume in one second over forced vital capacity ratio). Logistic regression was used to fit a prediction model; internal validation was performed by bootstrapping. Results: Thirty-eight percent (450/1173) of the subjects had airflow limitation. The final model included CT emphysema, CT air trapping, body mass index (BMI), packyears and smoking status. After internal validation the model yielded an area under the ROC curve of 0.84. The optimal point at the ROC curve was at sensitivity 0.62 and specificity 0.88; this corresponds to 62% (280/450) of the subjects with airflow limitation being identified, at the cost of 24% (90/370) falsepositives. Conclusion: Fully automatic quantitative assessment of emphysema and air trapping in CT, combined with simple patient characteristics, can identify the majority of subjects with airflow limitation.

perfusion. In 140 of the 175 patients (80%) underlying lung diseases were identified causing perfusion defects. These included emphysema (18%), pleural fluid with compression atelectasis and/or pneumonic consolidations (62%). 162 DECT perfusion maps (93%) showed some type of perfusion defects caused by artefacts such as beam hardening or pulsation artefacts, none of them were found to interfere with diagnosis. Conclusion: In an unselected study group, the majority of patients show perfusion defects on DECT which are not caused by PE and correct interpretation requires close correlation with lung parenchymal findings and CTA findings.

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MSK/Thorax/Diversen O10.8 ANALYSE RESULTATEN CYTOLOGISCH EN HISTOLOGISCHE PUNCTIES;CORRELATIE AAN PA-DIAGNOSE EN UITVOERDER Y.F.R. Ypma, J.J. Hensen, D. Vroegindeweij, H. van Beek, R.A Niezen, H. Beerman Maasstad Ziekenhuis, Rotterdam Doel: Evaluatie hoe frequent een CT, echografisch of stereotactisch geleide cytologische en histologische punctie resulteerde in een PA diagnose. Tevens werd het verschil in materiaal opbrengst tussen radioloog en arts-assistent geanalyseerd. Methode: Retrospectief werden alle cytologische en histologische puncties van 2009 en 2010 geincludeerd geanalyseerd. Het verschil tussen cytologische en histologische punctie werd geanalyseerd alsmede de methode hoe het PA materiaal werd verkregen en door wie de punctie werd verricht (radioloog versus assistent). Daarnaast werden alle puncties gecorreleerd aan de PA diagnose.

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Resultaten: In 2009 en 2010 werden 814 histologische biopten en 1260 cytologische puncties verricht. Radiologen verrichtten in deze periode 1056 puncties, waarvan 407 histologisch en 649 cytologisch. Assistenten verrichtten 1018 puncties, waarvan 407 histologisch en 611 cytologisch. Van alle puncties (cytologisch en histologisch) waren er 67 CT geleid, 1820 echogeleid en 175 stereotactisch. Cytologische puncties gaven in 88,5% (1116/1260) een PA diagnose en histologie in 95,3% (776/814). Van deze histologische biopten resulteerde het stereotactische biopt in de hoogste opbrengst, 96% (168/175), gevolgd door het echogeleide biopt, 95% (554/581). De laagste opbrengst gaf het CT geleide biopt, 93 % (62/67). Radiologen verkregen in 91,1% (962/1056) van de puncties representatief materiaal, assistenten in 91,3% (930/1018). Conclusie: Het stereotactisch geleide histologische biopt resulteerde in de hoogste PA score. Zowel cytologische puncties als histologische biopten resulteerden in vrijwel alle gevallen in een juiste PA diagnose. Er was geen significant verschil tussen de verschillende uitvoerders van de puncties.


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E programma & abstracts abstracts Samenvattingen ‘De educatieve voordracht’ Vrijdag 30 september, 10.45 - 12.15 uur E01 DE VERGROTE BIJNIER: ENDOSONOGRAFISCHE FNA VAN DE INKER BIJNIER R.J.J. de Ridder1, V.C. Cappendijk2 1 Maag-, darm-, leverziekten, Maastricht Universitair Medisch Centrum, Maastricht 2 Radiologie, Maastricht Universitair Medisch Centrum, Maastricht

Referenties:

Incidentalomen van de bijnier worden door toenemend gebruik van beeldvormende technieken vaker gevonden. Driekwart van deze afwijkingen wordt gevonden bij personen welke beeldvorming ondergaan voor de stadiering van een maligniteit. Vaak kan door beeldvorming, eventueel aangevuld met endocrinologisch onderzoek, vastgesteld worden dat het om een (niet-functioneel) bijnieradenoom gaat. Bij twijfel over een primaire dan wel secundaire maligniteit, en indien relevant in de klinische context, is nader onderzoek aangewezen.

4. Welch TJ, Sheedy PF, Stephens DH et al. Pecutaneous adrenal

1. Harisinghani MG, Maher MM, Pinkney PF et al. Predictive value of benign percutaneous adrenal biopsies in oncology patients. Clin Radiol 2002;57: 898-901 2. Gilliams A, Roberts CM, Shaw P. et al. The value of CT scanning and percutaneous fine needle aspiration of adrenal masses in biopsy-proven lung cancer. Clin Radiol 1992;46: 18-22 3. Mody MK, Kazerooni EA, Korobkin M et al. Pecutaneous CT-guided biopsy of adrenal masses: immediate and delayed complications. J Comput Assist Tomogr 1995;19:434-439 biopsy: review of 10-year experience. Radiology 1994;193:341-4 5. Dietrich CF, WehrmannT, Hoffmann C et al, Detection of the adrenal gland by endoscopic or transabdominal ultrasound. Endoscopy 1997;29:859-864 6. Schuurbiers OCJ, Tournoy KG, Schoppers et al. EUS-FNA for the detection of left adrenal metastasis in patients with lung cancer; Lung Cancer, in press 7. DeWitt J, Alsatie M, LeBlanc J et al, Endoscopic ultrasound- guided fine-needle aspiration of left adrenal gland masses,

Percutane CT- of echo geleide FNA van de bijnier heeft een sensitiviteit voor het aantonen van een maligniteit van 93%. In studies bedraagt het aantal niet diagnostische puncties echter 19-24% [1,2] Belangrijke complicaties ontstaan in 3-8% van de patiënten aansluitend aan een percutane punctie.[3,4] De belangrijkste complicaties zijn pneumothorax, bloeding, hematoom en het risico op entmetastase. Transgastrische endosonografie (onder sedatie middels midazolam) is een beproefde methode voor afbeelding van met name de linker bijnier. De linker bijnier kan in 98% van de patiënten middels EUS in beeld worden gebracht, de rechter in 30% van de gevallen. Transabdomiale echo kan in 69% van de gevallen de linker bijnier visualiseren.[5] De sensitiviteit voor het aantonen van een maligniteit middels EUS met FNA bedraagt 86%. Niet diagnostische puncties variëren sterk tussen studies van 5.9-24%.[6,7] In de literatuur is slechts een casus van een post-procudurele bloeding beschreven na EUS-FNA. De procedure wordt door patiënten goed getolereerd en duurt ca. 10 minuten. EUS-FNA is een veilige en weinig belastende procedure voor het verkrijgen van een weefsel diagnose indien er bij een vergrote linkerbijnier de verdenking bestaat op een maligniteit. 74

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Educatieve abstracts Purpose: To study the short-term and long-term morphological MRI-features of rectal cancer patients with a complete tumor response undergoing a wait-and-see policy with regular MR follow-up after CRT.

E02 LONG-TERM FOLLOW-UP FEATURES ON RECTAL MRI DURING A WAIT-AND-SEE APPROACH AFTER A CLINICAL COMPLETE RESPONSE IN RECTAL CANCER PATIENTS TREATED WITH CHEMORADIOTHERAPY D.M.J. Lambregts, M. Maas, F.C.H. Bakers, V.C. Cappendijk, G. Lammering, G.L. Beets, R.G.H. Beets-Tan Maastricht Universitair Medisch Centrum, Maastricht Background: Surgical resection is the standard treatment for patients with locally advanced rectal cancer who have undergone preoperative chemoradiation (CRT). There is now, however, a trend towards a conservative wait-and-see policy for patients with a complete tumor regression. It is not clear how patients should be monitored once they are managed non-operatively and whether follow-up by MRI has any role. As part of an observational study, a series of 19 carefully selected patients with a clinical complete response was managed with a wait-and-see policy and followed regularly by rectal MRI.

MR-imaging features: Shortly (6-8 weeks) after CRT, patients with a complete tumor response showed either a normalised rectal wall (26%) or a hypointense fibrotic remnant (74%). Three patterns of fibrosis could be classified, the aspects of which were dependent on the initial tumor morphology at primary MR staging (figure 1). The aspect of the normalised wall or fibrosis remained entirely consistent during long-term follow-up (median 20, range 9-57 months). During the first months after CRT, varying degrees of postradiation edema were observed in 26% of patients, which gradually disappeared during longer follow-up (figure 2). Conclusion: The morphological MR patterns observed in these patients may be used as a reference for the follow-up of rectal cancer patients with a complete tumor response after CRT, managed with a ‘wait and see policy’.

Figure 1: Patterns of post-CRT fibrosis (d-f) and the corresponding types of primary tumors (a-c). Small polypoid tumors (a) typically resulted in a minimal fibrotic residue (d). Larger, bulky tumors (b) mostly resulted in a ’full thickness’ fibrosis (e). Spicular tumors (c) resulted in a similarly spicular fibrosis.

Figure 2: Small primary tumor (a). Six weeks after CRT there is an edematous wall thickening (b), visible as a three layered rectal wall consisting of an inner mucosa (arrowhead), a hyperintense submucosa (*) and a hypointense outer muscular wall (arrow). During long-term follow-up the edema gradually decreases untill a normalised two-layered rectal wall (d) becomes visible.

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e programma & abstracts abstracts E03 IMPLEMENTATIE VAN VIRTUELE COLONOSCOPIE IN DE DAGELIJKSE RADIOLOGISCHE PRAKTIJK M.T. de Witte1,2, P.C.G. Simons1 1 VieCuri Medisch Centrum, Venlo 2 UMC St Radboud, Nijmegen Colorectaal carcinoom is 2e kankergerelateerde doodsoorzaak in Nederland en de Westerse landen. De incidentie zal naar verwachting nog stijgen. De adenomateuze poliep wordt gezien als voorloper van het CRC, de zogenaamde “adenomacarcinoma sequence”. Het vroegtijdig opsporen en verwijderen van deze benige voorloper voorkomt het uitgroeien tot CRC(1). Virtuele colonoscopie werd voor het eerst beschreven door David Vining in 1994 (2). Initieel gestart als 2D techniek, werd al snel ook de 3D “virtuele endoscopie” ontwikkeld. De segmentatie van darmsegmenten moest aanvankelijk handmatig gebeuren, een tijdrovende en arbeidsintensieve procedure. Inmiddels is Virtuele Colonoscopie volgroeid tot een volautomatische software tool met snelle segmentatie van darmsegmenten, panoramische weergave, automatische poliepdetectie (CAD), en elektronische cleansing. Officieel geaccepteerde indicaties voor Virtuele Colonoscopie zijn onvolledige optische coloscopie voor beoordeling van het proximale colon, verhoogd complicatie risico door hoge leeftijd en / of comorbiditeit en patientenweigering (3). In onze ervaring is deze techniek echter breder toepasbaar. Uit initieel onderzoek blijkt dat bij goede patientenselectie optische coloscopie in ruim 85% van de gevallen kan worden voorkomen (4). Een recente en interessante ontwik-

E04 FUTURE CLINICAL APPLICATIONS OF HIGH RESOLUTION ANATOMICAL IMAGING OF THE BRAIN AT 7.0 TESLA MRI A.G. van der Kolk, J.J.M. Zwanenburg, F. Visser, P.R. Luijten, J. Hendrikse Universitair Medisch Centrum Utrecht, Utrecht Purpose: To show the clinical potential of anatomically highly detailed images of the brain obtained with 7.0 Tesla MRI. Background: Although not widely used clinically, an increasing number of sites worldwide have the availability of an MRI scanner with a field strength of 7.0 Tesla. There is active debate if and when it may become the field strength of choice for certain clinical applications. Specifically, high resolution anatomical brain imaging at 7.0 Tesla with sequences such as FLAIR, T1- and T2*-weighted imaging and MR angiography may be the potential area where 7.0 Tesla MRI provides additional diagnostic information not found on lower field strengths. 76

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keling is korte termijn VC follow-up bij 1-2 kleine poliepen. Door de zeer accurate anatomische lokalisatie van afwijkingen middels VC blijkt deze techniek bij uitstek geschikt voor follow up van deze poliepen(5). Dit lijkt een geschikt alternatief voor de huidige richtlijnen waarbij excisie van poliepen ongeacht de grootte wordt geadviseerd (6).  Nu besloten is om in Nederland vanaf 2012 een landelijk screeningsprogramma naar CRC middels i-FOBT op te starten, zal het aantal coloscopieen en dus ook het aantal onvolledige procedures toenemen. Hierdoor zal de vraag naar VC zeker toenemen.   VC is een betrouwbare en robuuste techniek met een grote toekomst. Deze techniek dient dan ook geimplemeteerd te worden op elke radiologische afdeling. Referenties: 1. J. Stoker. CT colografie en bevolkingsonderzoek voor colorectaal carcinoom. Memorad 13 (4), 2008; 13-18.  2. DJ Vining, DW Gelfand, RE Bechtold et al. Technical feasibility of colon imaging with helical CT and virtual reality. AJR Am J Roentgenol 1994; 162:Suppl: 104 abstract. 3. EG MacFarland, JG Fletcher, PJ Pickhardt et al. ACR Colon Cancer Committee White Paper: Status of CT Colonography 2009. J Am Coll Radiol. 2009; 6: 756-772.  4. CT-colografie als eerstelijnsdiagnosticum bij patienten met darmklachten. JS Peulen. MT de Witte, P Friederich et. al. Ned Tijdschr Geneeskd 2010; 154: A1681.  5. The natural history of small polyps at CT colonography. PJ Pickhardt, DH kim et al. Annual meeting for the Soceity of Gastrointestinal Radiologsts 2008; Rancho Mirage, CA.  6. Coloncarcinoom. Landelijke richtlijn versie 2.0, 09-01-08, Landelijke Werkgroep Gastro Intestinale Tumoren.

Materials & Methods: Apart from a review of the current literature regarding anatomical brain MRI at 7.0 Tesla, the focus will be on clinical patient examples where 7.0 Tesla MRI gives additional diagnostic information or a better delineation of pathology than lower field strengths. Also, normal findings and anatomical variants not seen on 1.5 or 3.0 Tesla will be shown. When possible, comparison with 3.0 Tesla or 1.5 Tesla MR images will be given (figure 1) to further illustrate the additional information which can be gained with 7.0 Tesla scanning compared to lower field strength. Conclusion: High resolution anatomical brain imaging at 7.0 Tesla MRI can give additional information about pathology and normal anatomical variations and will be able to contribute to faster and more accurate diagnosing.

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Figuur 1: White matter lesions at 1.5T as compared to 7.0T.

E05 IS BEELDVORMING VAN ATHEROSCLEROSE KLAAR VOOR DE DAGELIJKSE PRAKTIJK? S.C. Gerretsen1, V.C. Cappendijk1, R.M. Kwee1, M.B.I. Lobbes1, M. Das1, T. Leiner2, J.M.A. van Engelshoven1, M.E. Kooi1, J.E. Wildberger1 1 Maastricht Universitair Medisch Centrum, Maastricht 2 Universitair Medisch Centrum Utrecht, Utrecht Doelstelling: Het bieden van een overzicht van de huidige mogelijkheden voor het detecteren en karakteriseren van atherosclerotische plaques.

den en hoe plaques in symptomatische en asymptomatische patiënten kunnen verschillen. Tenslotte zal uitgelegd worden welke studies er nodig zijn om het afbeelden van een atherosclerotische plaques klinisch toepasbaar te maken. Conclusie: Niet-invasieve beeldvorming is geschikt voor de detectie en karakterisatie van atherosclerotische plaques. Deze presentatie beoogt de radioloog bewust te maken van het belang van detectie en rapportage van atherosclerose. Dit is een belangrijke stap om beeldvorming van atherosclerose klinisch toepasbaar te maken.

Achtergrond: Atherosclerose is een chronische aandoening van de arteriële vaatwand die vaatvernauwingen en thrombo-emboliën kan veroorzaken hetgeen kan leiden tot een hersen- of hartinfarct. Ondanks vooruitgang in diagnostiek en behandeling blijft atherosclerose één van de belangrijkste doodsoorzaken in de westerse wereld. Geavanceerde technieken hebben aangetoond dat het mogelijk is om op niet-invasieve wijze de arteriële vaatwand af te beelden. Hierbij kunnen verschillende stadia van atherosclerose in beeld gebracht worden en zijn er verschillen waargenomen in plaques tussen symptomatische en asymptomatische personen. Echter ook op routine-onderzoeken is veel informatie over de aanwezigheid en mate van atherosclerose te verkrijgen. Gezien de mogelijke complicaties van atherosclerose is vroege detectie en rapportage van atherosclerose belangrijk. Beschrijving: In deze presentatie wordt een overzicht gegeven van de routine- en geavanceerde technieken die kunnen worden gebruikt voor beeldvorming van atherosclerose. Er wordt getoond hoe verschillende stadia van atherosclerose kunnen worden gedetecteerd, hoe stabiele atherosclerotische plaques van instabiele plaques onderscheiden kunnen wor1 6 E


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e programma & abstracts abstracts E06 LUNG PERFUSION DEFECTS ON DUALENERGY COMPUTED TOMOGRAPHY (DECT): REVIEW OF MORPHOLOGY AND DIFFERENTIAL DIAGNOSIS? A.E. Odink1, M. Rossius1, R. Booij1, C.M. Schaefer-Prokop2, I.J.C. Hartmann1 1 Erasmus Medisch Centrum, Rotterdam 2 Meander Medisch Centrum, Amersfoort Purpose: To present insight on the basic principles of DECT and provide a pictorial review of the range of morphology of lung perfusion with diagnostic clues for differentiating pulmonary embolism from other underlying diseases.

sis or pneumonia also cause perfusion defects. Location, distribution and configuration of perfusion defects together with findings in lung window settings provide the necessary information for correct differential diagnosis. Also artifacts caused by beam hardening or pulsation cause perfusion inhomogeneities that occur in typical locations and are mostly easy to dismiss. The exhibit provides an overview of the spectrum of perfusion map findings to be encountered in a group of unselected patients undergoing evaluation for suspected PE and with known or unknown concomitant lung diseases. Typical and atypical perfusion defects caused by artifacts, focal or diffuse lung parenchymal diseases will be presented together with some guidelines for correct interpretation.

Content organization: The classic presentation on a DECT perfusion map of acute pulmonary embolism (PE) is a peripheral, wedge shaped defect. However, other underlying parenchymal diseases such as emphysema, lung cysts, fibro-

Conclusion: Especially in an unselected group of patients with accompanying lung disease, knowledge of pitfalls and artifacts is important for correct interpretation of the spectrum of lung perfusion defects seen in DECT.

E07 VALUE OF COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY IN FAILED CONVENTIONAL CORONARY ANGIOGRAPHY A.S. Thijssen1, R.N. de Visser2, G.F.A.J.B van Tilborg2, A.C. Weustink1, G.P. Krestin1, N.R.A. Mollet1 1 Erasmus Medisch Centrum, Rotterdam 2 St. Elisabeth Ziekenhuis, Tilburg

Content organization: CTCA has proved its usefulness in ruling out significant coronary artery stenosis in patients with an intermediate risk of having coronary artery disease. Although CCA is superior for this purpose, the exam cannot always be successfully completed. We will present a series of cases in which CCA could not be successfully completed and where CTCA revealed the cause of the failed exam. The presentation will feature several images from CTCA studies (multiplanar reformations and 3D renderings).

Purpose/aim: If conventional X-ray coronary angiography (CCA) fails, computed tomography coronary angiography (CTCA) has the potential to provide the desired diagnostical information concerning coronary patency but may also demonstrate the cause of failing CCA exams.

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Summary: Although CTCA is primarily reserved for patients with an intermediate risk of coronary artery disease, it can be employed to image the coronary tree in cases where CCA fails. In several instances, CTCA will reveal the cause of failed CCA. CTCA data may also provide useful information for planning interventional procedures or surgery in patients with a failed CCA exam.

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Educatieve abstracts E08 PSEUDOTUMOREN BIJ METAAL OP METAAL TOTALE HEUP ARTROPLASTIEK M.F. Boomsma1, L. Sijbrandij1, B.H. Bosker2, H.B. Ettema2, C.C.C.M. Verreyen2, B.J. Kollen3, M. Maas4 1 Radiologie, Isala klieken, Zwolle 2 Orthopedie Isala klieken, Zwolle 3 Faculteit Medische wetenschappen, Universitair Medisch Centrum Groningen, Groningen 4 Radiologie, Academisch Medisch Centrum, Amsterdam

In deze presentatie zal de beeldvorming van de normale en postoperatieve heup in het kader van de THA worden besproken. Tevens wordt een overzicht gegeven van de verschillende uitingsvormen van pseudotumoren bij de MoM THA.

Na het ondergaan van een totale heupartroplastiek is bekend dat er als complicatie pseudotumoren kunnen optreden. Recente vermoedens van verhoogde incidentie van klachten, gepaard gaande met pseudotumorvorming bij metaal op metaal totale heup artroplastiek (MoM THA), hebben geleid tot veel media-aandacht. Inmiddels zijn meerdere Nederlandse ziekenhuizen overgegaan tot het oproepen van patiënten die een MoM THA hebben ondergaan.

Referenties:

Ervaringen van auteurs hebben geleid tot een “recall imaging” strategie, welke zal worden besproken. Een belangrijk item hieruit is het gebruik van CT bevindingen en de verhouding hiervan ten opzichte van een gangbare MR classificatie van pseudotumoren bij MoM THA patiënten.[2]

1. Risk assessment for pseudotumor after metal-on-metal largediameter femoral head total hip arthroplasty: a prospective cohort study. Bosker BH, Ettema HB, Boomsma MF, Kollen BJ, Wagemakers B and Verheyen CCPM. (Submitted) 2. Grading the severity of soft tissue changes associated with metalon-metal hip replacements: reliability of an MR grading system. Anderson H, Toms AP Cahir JG, Goodwin RW, Wimhurst J and Nolan JF. Skeletal Radiol (2011) 40:303–307

In een recent uitgevoerd prospectief single center cohort studie is aangetoond dat de incidentie van pseudotumoren bij deze groep patiënten 36% is. Dit heeft inmiddels geleid tot revisie tot een polyethyleen acetabulum component van de MoM THA in 28% van de patiënten met een pseudotumor.[1]

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P programma posterpresentaties & abstracts Samenvattingen Posterpresentaties P01 FOETALE POSTMORTEM RADIOLOGIE W.M. Klein, C. Marcelis, F. Vandenbussche Universitair Medisch Centrum St Radboud, Nijmegen Doel: verbetering radiologie congenitale afwijkingen bij overleden foetussen.

Discussie & conclusie: Postmortem foetale MRI en CT kunnen belangrijke bevestiging en additionele informatie. Dit is van grote waarde voor de verwerking door ouders en voor genetic counseling ten behoeve van volgende kinderen. Zeker bij een dalend aantal autopsieen is dit van groot belang. Een prospectieve studie in samenwerking met pathologie, radiologie, klinische genetica en gynaecologie zal de diagnostische waarde moeten aantonen.

Achtergrond: Met de komst van de 20-wekenecho neemt het aantal gevonden congenitale afwijkingen sterk toe, en hiermee ook het aantal zwangerschapsafbrekingen. Toch daalt het aantal autopsieen (gouden standaard). Postmortem MRI en CT kunnen, zonder het kind te beschadigen, aanvullende informatie geven. Techniek en casuistiek: Postmortem radiologische diagnostiek (<24 uur na overlijden) bestaat uit een X-babygram AP en lateraal, MRI Total body (T1 3D en T2 3D (totaal 7 minuten) met reconstructies, eventueel aangevuld met andere sequenties), en Total body CT met reconstructies. Figuur 1. Prenatale echo toonde een Siamese tweeling, waarvoor zwangerschapsafbreking. Postmortem MRI bevestigde het beeld van een thoraco-omfalopagus met gedeelde longen, hart en lever. Figuur 2. Prenatale verdenking skeletdysplasie. Postmortem babygram en CT tonen thanatofore dysplasie type 2. MRI toont uitgebreide hersenafwijkingen die niet eerder bij dit beeld werden beschreven. Figuur 3. Prenatale echo toont tumoren in hoofd en hart bij een helft van een eeneiige tweeling, terwijl het andere kind echografisch normaal is. Prenatale MRI toont ook bij het andere kind subependymale tubers. De postmortem MRI en autopsie bevestigen de diagnose tubureuze sclerose.

Figuur 1: Thoraco-omfalopagus, siamese tweeling. 80

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Figuur 2: Thanatofore dysplasie.

Figuur 3: Tubureuze sclerose astrocytoom.

P02 AUTOMATED BREAST VOLUME SCANNER: 3D-ULTRASOUND OF BREAST LESIONS T.A. Fassaert, M.D.F. de Jong, I.J.M. Dubelaar, M.C.J.M. Rutten Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch

Content: From a study of 200 consecutive patients, who underwent breast MRI and ABVS, we demonstrate 3D-US findings in a selection of illustrative cases with benign and malignant breast lesions. The illustrated cases are correlated with digital mammography, handheld 2D ultrasound, MRI and histopathological findings.

Purpose: Familiarize the reader with the imaging characteristics of benign and malignant findings in 3-dimensional breast ultrasound (3D-US) obtained with an automated breast volume scanner (ABVS). Emphasis is put on the added value of the new coronal plane (surgeon view) and the multiplanar correlation.

Summary: ABVS provides high-resolution 3D-US images of breast lesions. The new coronal view and multiplanar correlation facilitate the sonographic assessment of benign and malignant breast lesions.

Figuur 1: 3D-UScorrelation necrotic focus after RFA.

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Figuur 2: 3D-US correlation of lymph node & vascular bundle.

Figuur 3: 3D-US correlation of a stellate lesion. 82

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posterpresentaties P03 BRAIN PLASTICITY IN APHASIC PATIENTS AFTER MELODIC INTONATION THERAPY ASSESSED WITH FUNCTIONAL MAGNETIC RESONANCE IMAGING (FMRI) M.A.H. Bechan1, W.M.E. van de Sandt-Koenderman2, C.P. Mendez1, E.G. Visch-Brink1, M. Smits1 1 Erasmus Medisch Centrum, Rotterdam 2 Rijndam revalidatiecentrum, Rotterdam

using Statistical Parametric Mapping 8 (London, UK). After preprocessing individual statistical t-contrast maps were calculated for pre- and post-therapy datasets. Lateralization indices (LI) were calculated using the number of significantly (p<0.001) activated voxels in the left (L) and right (R) hemisphere according to (L-R)/(L+R). Results: All patients’ language improved after therapy. Pretreatment LI showed left hemispheric lateralization in the chronic patients (LI: 0.19 to 0.52) and right hemispheric lateralization in one acute patient (LI: -0.57). One acute patient showed no activation. Post-treatment, activation was more strongly left lateralized in two chronic patients (LI: -0.75 to 0.95). The acute patient became less right lateralized (LI: -0.43)

Purpose: Certain aphasic patients are treated with Melodic Intonation Therapy (MIT), which uses musical elements of speech to initiate language production. The purpose of this study is to visualize neuronal reorganizational processes in the brain in response to MIT using fMRI. Methods and materials: Four patients with chronic and two with acute aphasia (22-67 years; 4 males; 5 righthanded) were scanned at 3T before and after six weeks of MIT, which consisted of naming, repeating and spontaneous speech. To visualize language processing a block design task, consisting of listening to stories versus reverse speech, was used. Language performance was measured using the Sabadel story telling task. Imaging data were analyzed

Conclusion: Our findings support the hypothesis that the right hemisphere takes over language function from the left in the acute phase. Language recovery eventually occurs in the left hemisphere and MIT may influence this process.

Table 1: Specific in- and exclusion criteria for the MIT st.

Figure 1: Areas of activation seen in patient A1. Pre-treatm.

Figure 2: Areas of activation seen in patient C4. Pre-treatm.

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P programma posterpresentaties & abstracts P04 DESMOID-TYPE FIBROMATOSIS: A COMPREHENSIVE REVIEW OF MULTIMODALITY IMAGING FINDINGS IN PRIMARY, RECURRENT AND DEDIFFERENTIATED DISEASE WITH HISTOPATHOLOGIC CORRELATION I.J.M. Dubelaar1, U. Flucke2, J. Bonenkamp2, M. Prokop2, J.W.J. de Rooy2 1 Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch 2 Universitair Medisch Centrum St Radboud, Nijmegen Summary: Desmoid-type fibromatoses are rare, locally aggressive, non-metastazing soft tissue tumors with high tendency towards local recurrence.

P05 REPEATED PHASE-CONTRAST MAGNETIC RESONANCE ANGIOGRAPHY TO ASSESS CEREBROVASCULAR REACTIVITY IN PATIENTS WITH CAROTID ARTERY STENOSIS N.S. Hartkamp, J. Hendrikse, H.B. van der Worp, G.J. de Borst, R.P.H. Bokkers Universitair Medisch Centrum Utrecht, Utrecht Purpose: To assess the cerebrovascular reactivity in patients with internal carotid artery (ICA) stenosis and identify the optimal timing for reactivity measurements with acetazolamide as vasodilatory challenge medication. Methods: Twenty-one patients with a symptomatic ICA stenosis and 18 healthy control subjects underwent two-

Figure 1: Blood flow after acetazolamide administration.

This exhibition will review: 1. the various types and the multimodality imaging features of primary, recurrent and dedifferentiated disease with histopathological correlation 2. The role of imaging in the management of these types of soft tissue tumors 3. Current treatment options Content organization: 1. Desmoid-type fibromatosis review; - epidemiology, aetiology, localization and clinical features of different types - multimodality imaging features of primary, recurrent/ dedifferentiated disease and post- therapy changes 2. Histopathologic morphology and genetics 3. Treatment options: - local excision - radiotherapy systemic therapy

dimensional phase-contrast magnetic resonance angiography to repeatedly measure the blood flow (ml/min) in the ICAs at baseline and in 5 minute intervals for 30 minutes after intravenous administration of 12 gram acetazolamide per kilogram body weight. Results: The blood flow during the exam was significantly lower in the stenosed ICA of patients (figure 1, indicated with the star) than in the contralateral ICA (light gray) and than in the ICAs of healthy controls (white). The absolute increase of blood flow after 15 minutes was as well significantly lower in the stenosed ICA than in the contralateral ICA and than in the healthy ICAs (respectively 74.6±12, 122±18, and 137±15 ml/min), whereas the relative increase was not (respectively 46.9±6.7%, 56.0±9.4%, and 58.2±7.2%). The vasodilatory effect in the stenosed ICAs

Figure 2: Time to peak after acetazolamide administration.

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posterpresentaties was maximal after 15 minutes (figure 2, indicated with the star) and decreased after 20 minutes (figure 1), which was significantly later than in the contralateral ICA (light gray) and healthy ICAs (white).

increase after a vasodilatory challenge with acetazolamide. The time to maximum vasodilatation was also longer in the stenosed ICA of patients. The optimal timing for single reactivity measurements using acetazolamide is between 15 to 20 minutes after administration.

Conclusion: Patients with ICA stenosis have a reduced absolute increase in blood flow with preserved relative

Results: The relative amount of ASL-signal from each VA to either hemisphere of the cerebellum and cerebrum are summarized in table 1. The posterior circulation of subject 1 was almost exclusively supplied by one VA due to a variant anatomy. The perfusion images of both the left and right VA from subject 5 shown in figure 1. Examination of the perfusion images reveals areas in the cerebellum exclusively supplied by either the left or the right VA (also shown in figure 1). The perfusion images show increasing overlap in the cerebrum. Both in the cerebellum and in the cerebrum most of the ASL-signal is observed ipsilateral from the labeled VA, although significant signal is also observed contralaterally, especially in the cerebrum.

P06 MIXED CEREBRAL PERFUSION TERRITORIES IN THE POSTERIOR CIRCULATION INVESTIGATED USING SUPER-SELECTIVE ARTERIAL SPIN LABELING MRI N.S. Hartkamp1, M. Helle2, R.P.H. Bokkers1, J. Hendrikse1, M.J.P. Van Osch3 1 Universitair Medisch Centrum Utrecht, Utrecht 2 Institute of Neuroradiology, Christian-Albrechts-Universität, Kiel, Germany 3 Leiden Universitair Medisch Centrum, Leiden Purpose: The posterior circulation is supplied with blood by the vertebral arteries (VA) that fuse into the basilar artery (BA). We aim to investigate to which extent blood mixes in the BA before it arrives in cerebral hemispheres. Methods: Five healthy volunteers were investigated on a 3T MRI scanner with super-selective pseudo-continuous arterial spin labeling (ASL) perfusion imaging, which allows separate labeling of the VAs. The contribution to the perfusion of each individual VAs was calculated for the left and right hemisphere of the cerebellum and cerebrum.

Conclusion: The results show that although most ASLsignal in the posterior flow territory originates from the ipsilateral VA, a considerable amount of ASL-signal stems from the contralateral VA, indicating mixing of blood or at least exchange of magnetization between blood streams in the BA. Mixing in the BA however does not produce a completely homogeneous blood supply to the cerebral posterior circulation in our subjects.

Figure 1: Perfusion images of the left and right VA.

Table 1: Relative contributions of the left and right VA.

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P programma posterpresentaties & abstracts P07 MALFORMATIE VAN DE VENE VAN GALENI I.J.M. Dubelaar1, F.A. Meijer2 1 Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch 2 Universitair Medisch Centrum St Radboud, Nijmegen Purpose: To inform the reader of the rare congenital aneurysmal malformation of the vein of Galen. To illustrate the appearance, therapy options and various outcome in a pictorial review.

P08 SUBSEQUENT ISCHEMIC STROKE IN VASCULAR TERRITORIES AFFECTED BY INTRACRANIAL ARTERIAL STENOSIS IN PATIENTS WITH TRANSIENT ISCHEMIC ATTACK AND ISCHEMIC STROKE P.J. Homburg, M.J. van Gils, G.J.J. Plas, H.L.J. Tanghe, D.W.J. Dippel, A. van der Lugt Erasmus Medisch Centrum, Rotterdam Background and purpose: Compared to extracranial carotid artery atherosclerosis, intracranial arterial stenosis (ICAS) has received little attention as a cause of cortical ischemic stroke. We evaluated the stroke recurrence risk of ICAS per arterial territory in a large cohort of patients with a transient ischemic attack (TIA) or ischemic stroke. Methods: Consecutive patients (n=786) were prospectively evaluated for the presence and distribution of ICAS (≥30% stenosis) using CT angiography. Multivariable Cox

P09 PROSPECTIVE QUALITATIVE COMPARISON OF 4D RADIAL ACQUISITION CONTRASTENHANCED MR ANGIOGRAPHY VERSUS DIGITAL SUBTRACTION ANGIOGRAPHY IN CHARACTERIZING INTRACRANIAL ARTERIOVENOUS MALFORMATIONS M. van der Vlies1, 2, R. van den Berg1, C.B.L.M. Majoie1 1 Academisch Medisch Centrum, Amsterdam 2 Onze Lieve Vrouwe Gasthuis, Amsterdam Introduction: Digital subtraction angiography (DSA) is the gold-standard procedure for diagnosis and follow-up of cerebral AVM because of its high temporal and spatial resolution. However, alternative time-resolved techniques such as TRICKS (GE Healthcare), TWIST (Siemens) and 4D TRAK (Philips Healthcare) are now widely available 86

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Content organization: Aneurysmal malformation of the vein of Galen is a rare congenital vascular malformation, resulting in developmental delay, congestive heart failure, hydrocephalus, brain damage and/or death in childhood. In a pictorial review, we illustrate the best outcome (spontaneous thrombosis), the worst outcome (melting brain) and therapy options (endovascular embolization). Pathophysiology, clinical presentation and therapy options will be briefly discussed. Summary: Vein of Galen malformation and resulting aneurysm is a rare, often fatal congenital disorder. Various outcome is illustrated and therapy options discussed.

proportional hazards models were used to identify risk factors associated with subsequent ischemic stroke and to analyze the stroke recurrence risk for ICAS per territory (left carotid territory, right carotid territory and posterior territory). Results: In 178/786 patients (23%), 288 ICAS were observed. Subsequent ischemic stroke occurred in 49 patients (6%), of which 15/49 (31%) occurred in a territory affected by ICAS. After adjustment for age, sex, hypertension, diabetes mellitus and extracranial artery stenosis ≥50%, ischemic stroke risks in territories affected by ICAS were HR 4.34 (95%CI 1.36-13.87) for the left carotid territory, HR 8.09 (95%CI 2.53-25.92) for the right carotid territory and HR 6.94 (95%CI 1.93-25.04) for the posterior territory. Conclusions: Ischemic stroke and TIA patients with ICAS have a particularly high risk of subsequent ischemic stroke in the affected arterial territory. This finding warrants more research in the pathophysiology of ICAS and modified treatment for patients with ICAS.

to allow dynamic MR imaging for the appreciation of contrast kinetics. We hypothesized that in agreement with other studies, 4D radial acquisition contrast enhanced MRA (4D rCE-MRA) compared to DSA, approximates vascular architecture and flow dynamics of AVMs, furthermore implying a reduction in risk exposure and in procedural risks. Methods: A total of 21 consecutive patients were assessed prospectively, 7 had AVM, 7 had AV-fistula and 2 had a DVA. 4D rCE-MRA and DSA were performed. The 4D rCE-MRA images were assessed regarding vascular architecture and dynamic flow characteristics. Results: 4D rCE-MRA correctly depicted location, nidal size, venous drainage pattern and prominent arterial feeders in almost all cases of AVMs and AV-fistulas. There

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posterpresentaties was good agreement (approximately 90%) between DSA and 4D rCE-MRA images.

Conclusion: 4D rCE-MRA is a good alternative imaging modality tool approximating the imaging gold standard of DSA and furthermore proving to be a reliable minimal invasive imaging tool that avoids the risks associated with DSA.

Figure 1: 4D MRA arterial phase.

Figure 2: 4D MRA venous phase.

Figure 3: 4D MRA late venous phase, showing cerebellar AVM.

P10 RADIOFREQUENTE ABLATIE VAN OUDERE PATIENTEN MET T1 MAMMACARCINOOM DIE NIET IN AANMERKING KOMEN VOOR CHIRURGIE M.D.F. de Jong, M.J.C.M. Rutten, D. Kreb, B.G. Looij, K. Bosscha, M. Ernst, H. van der Linden, G.J. Jager Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch Doel: Radiofrequente ablatie (RFA) kan een alternatieve en effectieve behandeling vormen bij patiënten met T1 borstkanker, welke niet geschikt zijn voor chirurgisch ingrijpen. 1 6 E

Doel is te bepalen of RFA technisch haalbaar en veilig is en of lokale tumorcontrole verkregen kan worden. Daarbij wordt geëvalueerd hoe de behandeling door patiënten wordt ervaren. Methode: Patiënten >70 jaar met een oestrogeen positief mammacarcinoom < 2 cm worden gevraagd deel te nemen aan deze studie. De respons na de aanvullende RFA therapie (naast hormonale therapie) zal geëvalueerd worden, middels mammografie, echografie en MRI na 1, 6 en 12 maanden. Tevens zal een echogeleid vacuümbiopt volgen van het RFA-gebied voor histologische analyse volgen na een jaar. R A D I O L O G E N D A G E N

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P programma posterpresentaties & abstracts Ervaringen van patiënten voor, tijdens en na de behandeling worden geëvalueerd. Resultaten: In totaal hebben vijf patiënten RFA ondergaan, waarbij er geen aanwijzingen waren op lokaal recidief of residu weefsel na een jaar follow-up. De geableerde gebieden vertoonden afname van grootte en ringaankleuring gedurende follow-up. Bij één patiënte is interval follow-up niet verricht in verband met een CVA. Patiënten vonden

Figuur 1: bewezen maligne laesie linker mamma.

Figuur 2: controle na 1 maand toont ringaankleuring.

Figuur 3: na 1 jaar afname aankleuring, geen recidief. 88

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RFA-behandeling verdraagbaar en er was afname van één punt op een zeven puntsschaal ter analyse van de kwaliteit van leven. Conclusie: RFA kan technisch veilig worden uitgevoerd bij inoperabele, oudere patiënten met een solitaire borsttumor, met minimale afname op de kwaliteit van leven.

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posterpresentaties P12 PROPOSAL FOR AN ADAPTATION OF THE BERLIN ALGORITHM FOR DIAGNOSING SPA: RESULTS OF THE SPONDYLOARTHRITIS CAUGHT EARLY (SPACE)-COHORT R. van den Berg, M.H.E. Vossen, M. Reijnierse, T.W.J. Huizinga, D.M.F.M. van der Heijde Leids Universitair Medisch Centrum, Leiden

(43%) had axial SpA; 37 (75.5%) fulfilled ASAS axial SpA criteria and 47 (96%) had >80% probability. In patients (n=65) not diagnosed with axial SpA, 14 (21.5%) patients fulfilled ASAS axial SpA criteria and 7 (10.8%) had >80% probability; the majority did not have IBP. The modified Berlin algorithm, with IBP as additional SpAfeature, resulted in three entry groups; requirement of ≥4, 2-3, and 0-1 SpA-features. According to this modified algorithm, 57 patients (50%) has axial SpA; 45 (78.9%) fulfilled ASAS axial SpA criteria and 55 (96.5%) had >80% probability. Of the 57 patients not diagnosed as SpA, six (10.5%) fulfilled ASAS axial SpA criteria. 15 additional patients could now be diagnosed as axial SpA by the modified Berlin algorithm and no single patient with a probability >80% was excluded.

Background: The Berlin algorithm assists clinicians in diagnosing early axial SpA. Objectives: Validate the Berlin algorithm in the SPondyloArthritis Caught Early (SPACE)-cohort. Methods: The SPACE-cohort is set-up in our hospital to early diagnose and treat (axial) spondyloarthritis (SpA)patients. Patients with back pain (>3 months, < 2 years; onset <45 years) were included and were classified according to the Berlin algorithm and ASAS axial SpA classification criteria. The LR-product was calculated based on the present SpA-features; the cut-off 80% probability was used. Second, all patients were classified according to a modified Berlin algorithm, excluding inflammatory back pain (IBP) as entry criterion.

Conclusions: We propose a slightly modified Berlin algorithm excluding IBP as entry criterion that is better in accordance with the new ASAS axial SpA criteria.

Results: In 4/114 patients no MRI was made and were analyzed as MRI-. According to the Berlin algorithm 49 patients

Figure 1: The Berlin algorithm.

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Figure 2: The modified Berlin algorithm.

P13 DIFFERENCE IN CLINICAL PRESENTATION OF PATIENTS WITH SPONDYLOARTHRITIS WITH A POSITIVE MRI OF THE SI JOINTS AND/OR HLA-B27 POSITIVITY R. van den Berg, M.H.E. Vossen, M. Reijnierse, T.W.J. Huizinga, D.M.F.M. van der Heijde Leids Universitair Medisch Centrum, Leiden Background: The SPondyloArthritis Caught Early (SPACE)cohort is set-up in our hospital to early diagnose and treat (axial) spondyloarthritis (SpA)-patients. The new ASAS axial and peripheral SpA criteria rely on the presence of active sacroiliitis on MRI and on HLA-B27 positivity. Objective: Investigate the difference in presentation of patients with sacroiliitis vs. non-sacroiliitis on MRI and presence vs. absence of HLA-B27. Methods: Patients with back pain (>3 months, < 2 years; onset <45 years) were included in SPACE and underwent a diagnostic work-up including MRI and X-rays (SI-joints), and were classified according to ESSG, Amor, ASAS axial and peripheral SpA, and modified New York (mNY) classification criteria. Patients with sacroiliitis vs. non-sacroiliitis on MRI; and HLA-B27+ and HLA-B27- patients were compared.

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Results: 110 patients were included: 31 not fulfilling any criteria; 79 fulfilling ≥1 criteria. Male patients more frequently had sacroiliitis on MRI than female patients (p=0.01), but were not more frequently HLA-B27+ (p=0.22). Radiographic sacroiliitis was more frequent in MRI+ than in MRI-patients (p=0.00). Therefore, MRI+patients fulfilled the mNY criteria more frequently than MRI-patients (p=0.00). HLA-B27+patients more frequently had a positive family history and uveitis (p<0.001 and p=0.02 respectively) and fulfilled ESSG and Amor criteria than HLA-B27-patients (p=0.03 and p<0.001 respectively). The distribution of other SpA-features and level of disease activity among MRI+ and MRI-patients, and among HLA-B27+ and HLA-B27-patients was similar. Conclusions: Presence and distribution of SpA-features and level of disease activity in MRI+ and MRI-patients and HLA-B27+ and HLA-B27-patients is similar, except for radiographic sacroiliitis and male gender associated with MRI+, and a positive family history and uveitis associated with HLA-B27+. These findings add to the independent contribution of axial and peripheral SpA.

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Table 1: Presence and distribution of SpA-features.

P14 FEASIBILITY OF FUNCTIONAL IMAGING, INCLUDING DYNAMIC CONSTRASTENHANCED MRI AND PERFUSION CT, FOR POST-CHEMORADIOTHERAPEUTIC RESTAGING IN RECTAL CANCER PATIENTS S.J. Klieverik, E. Kluza, M. Maas, R.G.H. Beets-Tan, G. Beets, D.M.J. Lambregts Maastricht Universitair Medisch Centrum, Maastricht Aim: The aim of this study was to perform a review of the literature to determine whether 1) the current literature reports correlations between functional imaging and clinicopathological markers in rectal cancer patients and 2) if functional imaging is sensitive to chemoradiotherapy (CRT)induced changes in rectal cancer. Methods: The literature of interest was searched using Pubmed. Studies were included when correlations between functional and clinicopathological markers and differences in functional parameters between pre- and post-CRT were reported. Results: Five studies used dynamic constrast-enhanced MRI (DCE-MRI) and two studies used perfusion CT (p-CT) to 1 6 E

investigate the correlation between functional and clinicopathological markers. Two studies compared functional parameters from DCE-MRI in CRT responders vs. non-responders. Studies correlating DCE-MRI parameters with clinicopathological markers showed that higher endothelial transfer coefficient (Ktrans) and perfusion index (PI; a measure of both perfusion and cappilary permeability surface product) were significantly correlated with more advanced cancer stages (e.g. TNM stage) and that these functional parameters were significantly higher before treatment in patients with a good response to CRT than in non-responders. Two studies evaluated the correlation between p-CT parameters and clinicopathological parameters. Results showed that significantly higher blood volume, blood flow and mean transit time were found in groups with poor prognosis (e.g. high MVD, existence of lympathic metastasis). There were no studies comparing p-CT parameter in a pre vs. post-CRT setting. Conclusion: The reviewed literature shows that functional imaging parameters, especially Ktrans in DCE-MRI and BV and BF in p-CT, correlate with clinical and pathological markers. Therefore, both DCE-MRI and p-CT are of great potentional as non-invasive therapy-monitoring or therapypredicting methods in rectal cancer.


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Veel plezier op de radiologendagen 2011!

Bert-Jan de Bondt, voorzitter Vincent Cappendijk Marion Smits Bart Wiarda Henk-Jan van der Woude

Kwaliteit

Dames en heren, geachte leden van de Nederlandse Vereniging voor Radiologie,

Welkom in Maastricht op de Radiologendagen 2011! Het thema dit lustrumjaar is Kwaliteit. Kwaliteitseisen in de gezondheidszorg worden steeds meer opgelegd en zijn belangrijk voor een goede praktijkvoering. Dit geldt uiteraard ook voor de radiologie, dan bij voorkeur door ons als vereniging zelf de eisen opgesteld en in goede samenwerking met onze klinische collega’s. Voor de hand liggend is het om kwalitatief beter te worden door te leren van eigen fouten. Het programma begint donderdagochtend daarom met ‘Deze misser maak je maar 1 keer’. In de tweede plenaire sessie op donderdag ‘Setting standards in healthcare – many ways, no return’ zal het onderwerp kwaliteit belicht worden door gastsprekers Dr. M-J Vrancken Peeters (chirurg, NKI-AvL) en Prof. Dr. D. Rubin (radioloog, Stanford University, USA). Op vrijdag zal er door een drietal pro-con koppels worden gedebatteerd over het hanteren van kwaliteitsnormen: ‘Pro-con: setting standards in healthcare – which way to go?’.

Nieuw onderwerp bij de parallelsessies is de Educatieve Voordracht. Dit is bedoeld om onderwerpen welke direct toepasbaar zijn in uw praktijk, maar (nog) niet zijn verworden tot een wetenschappelijk artikel. Bij alle wetenschappelijke abstract sessies zijn hierbij passende keynote lectures gezocht. De ‘Research Corner’ uit 2009 is gestoken in een nieuw jasje. Acht UMC’s presenteren niet alleen hun spraakmakende wetenschappelijke onderzoeken, maar steken ook de hand naar elkaar uit, om samen beter te worden. De Refresher Courses op beide dagen worden deels verzorgd door toonaangevende gastsprekers uit het buitenland. Aan de hand van de verstrekte leerdoelen kunt u beter schatten of een onderwerp uw belangstelling heeft. Wij zijn buitengewoon verheugd een aantal van u ook een workshop te kunnen aanbieden. De geluksvogels onder u gaan statistisch gezien herboren naar huis en met bouwstenen voor een robuuste teachingfile (millennium proof). Lees voor details het volledige programma.

Dit jaar is er een andere formule gekozen voor de verschillende prijzen. Naast de bekende Philipsprijs en Radiologendagen prijs zal er een toelichting op en uitreiking van de NVvR Travel Grant plaatsvinden.

Bent u dit jaar niet in de prijzen gevallen dan bent u niet minder welkom in feestelijke kleding op het Diner & Galafeest met als thema ‘Dress to impress’. Op een prachtige locatie in Maastricht wordt u op zuidelijke wijze verwend.

De radiologendagen kunnen mede mogelijk worden gemaakt door sponsoring van de industrie, u wordt dan ook van harte uitgenodigd om met de industrie in contact te komen op de expositie.

Onze dank gaat uit naar de inzet van velen, zichtbaar in het programma boekje. Namen noemen is ontoereikend, enthousiaste deelnemers is uw verdienste.

Het uitgebreide programma en de leerdoelen vindt u vooraan in dit programma- en abstractboek: Donderdag 29 september 2011: bladzijde 2 t/m 5 Vrijdag 30 september 2011: bladzijde 5 t/m 7

Expofoyer Auditorium 2 Zaal 0.1 London Zaal 0.2 Berlin Zaal 0.4 Brussels Zaal 0.5 Paris Zaal 0.8 Rome Zaal 0.9 Athens 08.30 - 09.00 Ontvangst 09.00 - 10.15 Workshop/hands-on: Workshop: Refresher course: Refresher course: Refresher course: Refresher course: To make Radlex more familiar. “Interpretatie van Buiktrauma, waar gaat Acute pijn op de borst: De knie: Niet standaard Opleiden anno 2011 Using IHE TCE for radiologisch het nou eigenlijk om Stand van zaken MRI bevindingen en export of PACS data to wetenschappelijk de postoperatieve knie an MIRC teaching file onderzoek” 10.15 - 10.45 Koffiepauze 10.45 - 12.15 Parallelsessie: Parallelsessie: Parallelsessie: Parallelsessie: Parallelsessie: De educatieve Abdominale Mammadiagnostiek 2 Kinderradiologie / MSK / Thorax / voordracht radiologie 2 Diversen Diversen 12.15 - 13.15 Lunch 12.30 - 13.00 Postersessie 13.15 - 13.30 Wetenschappelijk beleid NVvR voor academische en niet academische centra 13.30 - 14.30 Plenaire sessie: Pro-con: Setting standards in healthcare - which way to go? 14.30 - 15.15 Richtlijnen sessie 15.15 - 15.45 Theepauze 15.45 - 16.25 Prijsuitreiking: Philipsprijs, Posterprijs, Radiologendagenprijs, NVvR Travel Grant en Fellowshipdiploma’s Quiz 16.25 - 17.15 Vanaf 20.00 Diner & galafeest in Amrâth Grand Hotel De L’Empereur, Maastricht

Vrijdag 30 september 2011

Expofoyer Auditorium 2 Zaal 0.2 Berlin Zaal 0.3 Copenhagen Zaal 0.4 Brussels Zaal 0.5 Paris Zaal 0.8 Rome Zaal 0.9 Athens 10.00 - 10.45 Ontvangst 10.45 - 12.00 Plenaire sessie: Emeritus programma Deze misser maak je (start vanaf 11.20 uur) maar één keer 12.00 - 13.00 Lunch 12.15 - 12.45 Postersessie 13.00 - 14.00 Plenaire sessie: Setting standards in healthcare many ways, no return 14.05 - 15.35 Research corner Vervolg Parallelsessie: Parallelsessie: Parallelsessie: Parallelsessie: Emeritus programma Interventieradiologie / Cardiovasculaire Abdominale radiologie / Mammadiagnostiek 1 Cardiovasculaire radiologie radiologie Acute radiologie / Diversen & uitreiking Jan Hendriksprijs 15.35 - 16.00 Theepauze 16.00 - 17.15 Refresher course: Workshop: Vervolg Refresher course: Refresher course: Refresher course: Refresher course: Respons monitoring “Interpretatie van radiologisch Emeritus programma Chronische thrombo- Neuranatomie Beeldvorming bij groei- What is the best imaging made sexy wetenschappelijk onderzoek” embolische pulmonale voor dummies en puberteitsstoornissen modality for “aseptic/low hypertensie grade infection/infectious loosening of joint prostheses?” 17.15 - 17.30 Uitreiking WSS penning 17.30 - 18.45 ALV NVvR & Juniorsectie 18.15 Industrieborrel: excl. aangeboden door

Donderdag 29 september 2011

Parallelsessie: Neuro-Hoofdhals radiologie

Refresher course: Veneuze interventies

Zaal 2.1 Colorado

Parallelsessie: Abdominale radiologie 1

Zaal 2.1 Colorado

programma & abstracts voorwoord

Agfa HealthCare Alliance Medical Bard Benelux Bayer Schering Pharma Biomedic Bracco Imaging Europe Covidien Nederland Esaote Pie Medical GE Healthcare Guerbet Nederland Haga Medical Helsebemanning Medtronic Nederland Melius Pro Oldelft Benelux Radiomatix Toshiba Medical Systems Nederland Tromp Medical Vrest Medical

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sponsoren en exposanten

programma & abstracts - 16E nederlandse radiologendagen - 29 en 30 september 2011

Hoofdsponsoren radiologendagen 2011

16

29 en 30 september 2011

16

29 en 30 september logen dagen. programma & abstracts. Nederlandse Vereniging voor Radiologie. Radiological Society of the Netherlands

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