1

Frie foredrag, videnskabelige posters og kasuistiske posters Frie foredrag – første session (onsdag den 24. januar kl. 11.00-12.00) F1.1 Mathilde M. Winkler Wille, Sarah J. van Riel, Zaigham Saghir, Asger Dirksen, Jesper Holst Pedersen, Colin Jacobs, Laura Hohwü Thomsen, Ernst Th. Scholten, Lene T. Skovgaard, Bram van Ginneken; Department of Radiology, Bispebjerg Hospital, Copenhagen, Denmark.

Predictive Accuracy of the PanCan Lung Cancer Risk Prediction Model; External Validation based on CT from the Danish Lung Cancer Screening Trial. F1.2 Chenxi Huang, Julie Rydberg, Cecilie Alrø Mardal, Line Toft Tengberg, Morten Bay-Nielsen, Naim Qadiri, Barbara Bonnesen; Røntgen afdeling, Bispebjerg Hospital og Gastroenheden, Hvidovre Hospital. Findings of CT in patients with acute abdomen that required acute high-risk abdominal surgery. F1.3 Carsten Lauridsen, Rikke Løvendahl Eefsen, Martin Illemann, Gunilla Høyer-Hansen, Gro L.

Willemoe ,Martin Lundsgaard Hansen, Marie B. Mogensen, Hans Christian Rolff, Ida Katrine Lund, Lars Engelholm, Eva Fallentin, Thomas Axelsen, Michael Bachmann Nielsen, Kell Østerlind; Radiologisk Klinik, Rigshospitalet. Pre-operative Dynamic Contrast Enhanced Computed Tomography of patients resected for colorectal liver metastases

F1.4 Stine Hangaard, Henrik Gudbergsen, Cecilie L. Daugaard, Henning Bliddal, Janus Damm Nybing, Miika T. Nieminen, Victor Casula, Carl-Johan Tiderius & Mikael Boesen; The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark, Department of Radiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark. Delayed gadolinium enhanced MRI of menisci and cartilage (dGEMRIM/dGEMRIC) in overweight patients with knee osteoarthritis – A cross sectional study of 86 overweight patients with intraarticular administered gadolinium contrast.

F1.5 Jon Henneberg, Alexander Hagen Kristensen, Natascha Schødts, Gerhard Tiwald; Holbæk hospital, Region of sealand. Pilot Study - BASIC – ULTRASOUND. Frie foredrag – anden session (onsdag den 24. januar kl. 13.30-14.30): F2.1 Jon Thor Asmussen; Radiologisk afdeling, Odense Universitetshospital. Helkrops MR til onkologi. F2.2 Stine Bjerrum Runge, Nicolaj Lyhne Christensen, Kim Jensen, Ib Erik Jensen; Røntgen og Scanning, Sygehus Lillebælt, Kolding. Children Centered Care: a multi-faceted concept for MRI of children aged 4-10 with the aim to reduce the need for anesthesia and increase comfort for children and parents.

2

F2.3 Janni L. B. Madsen, Louise A. Duus, Lars Lund, Tommy K. Nielsen, Michael Petersen, Ole Graumann; Department of Radiology, Odense University Hospital, Denmark, Department of Clinical Research, University of Southern Denmark, Denmark.

A systematic review regarding magnetic resonance imaging’s ability to diagnose and subdivide renal tumors among adults compared to histopathology. F2.4 Bjarke Brandt Hansen, Urszula Maria Ciochon, Charlotte Riis Trampedach, Anders Fogh Christensen, Zoreh Rastiemadabadi, Mikael Boesen; Billeddiagnostisk område, Aalborg Universitetshospital og Røntgenafdelingen, Bispebjerg og Frederiksberg Hospitaler. Grading lumbar disc degeneration — a comparison between low- and high-field MRI. F2.5 Morten Sejer Hansen, Mohammad Sohail Asghar, Jørn Wetterslev, Christian Bressen Pipper, Johan Mårtensson, Lino Beccera, Anders Christensen, Janus Damm Nybing, Inger Havsteen, Mikael Boesen, Jørgen Berg Dahl; Bispebjerg og Frederiksberg, Radiologisk afdeling. Development of secondary hyperalgesia is not correlated to pain relevant brain structures - a 3-tesla MRI study of healthy men. F2.6 Helle Precht, Karen Brage, Mia K. Andersen; University College Lillebælt, Center for Anvendt Sundhedsforskning. Forsknings delprogram: CONRAD; Diagnostik og Behandling. Posters – første session med videnskabelige posters, radiologiske posters og klin. fys. posters (torsdag den 25. januar kl. 8.30-10.00): P1.1 Stine Degn, Tommy Kjærgaard Nielsen, Janni L. B. Madsen, Ole Graumann; Department of

Radiology, Odense University Hospital, Denmark, Department of Clinical Research, University of Southern Denmark, Denmark.

Accuracy in the classification of Bosniak IIF, III and IV complex renal cysts in a daily clinical workflow. P1.2 Rosa Marie Andersen, Sten Langfelt, Hossain Mafi, Jacob Lilly, Ole Graumann; Radiologisk afdeling, Aarhus Universitetshospital. Forekomst og behandling af komplikationer til EVAR behandling - 10 års erfaring fra Aarhus Universitetshospital. P1.3 Rune Overgaard Jensen, Eskild Andreasen, Benjamin Rasmussen, Ole Graumann;

Radiologisk afdeling, Odense Universitetshospital. PoC Ultralyd møder virtual reality - Undervisning og realistisk træning. P1.4 Theresa Junker, Janni L. B. Madsen, Allan L. Pedersen, Jonas A. Bojsen, Ole Graumann;

Department of Radiology, Odense University Hospital, Denmark and Department of Urology, Odense University Hospital, Denmark.

CT Guided Cryoablation of Small Renal Masses. P1.5 Martina Kastrup Loft, Malene Roland Pedersen, Søren R Rafaelsen; Røntgenafdelingen, Sygehus Lillebælt, Vejle Sygehus. Diffusion weighted MRI in anal cancer – review.

3

P1.6 Stine Degn, Ole Graumann; Department of Radiology, Odense University Hospital,

Denmark, Department of Clinical Research, University of Southern Denmark, Denmark. Solitary kidney metastasis from lung cancer – is cryoablation a feasible treatment? P1.7 Sebastian Dirach Van; Radiologisk afd., OUH. Ændring i modtageprocedure for patienter til cerebral trombolyse/trombektomi behandling. P1.8 Jane Maestri Brittain, Eric von Benzon, Kim Francis Andersen; Klinik for Klinisk Fysiologi,

Nuklearmedicin & PET, Diagnostisk Center, Righospitalet. Concomitant polymyalgia rheumatica and large-vessel vasculitis visualized on 18F- FDG PET/CT. P1.9 Julie Rydberg, Jannick Andersen, Christian Haarmark, Bo Zerahn; Klinisk Fysiologisk og Nuklearmedicinsk Afdeling, Herlev og Gentofte Hospital, Denmark. The Influence of Anthropometric and Basic Circulatory Variables on Count Rate in Cadmium-Zinc-Telluride SPECT gamma camera gated tomographic radionuclide angiography. Posters – anden session med kasuistikker (torsdag den 25. januar kl. 15.30-17.00): P2.1 Rasmus Ahlfors, Dana Jensen; Radiologisk afdeling, Slagelse Sygehus. Arteria mesenterica superior syndrom hos ung kvinde efter større vægttab. P2.2 Ali Al-hakim, Shazia Rehman; Department of Radiology, Herlev og Gentofte Hospital. The persistent trigeminal artery and hypoglossal artery- development, anatomy and complications. P2.3 Mohammed Ali Hadi, Yousef Wirenfeldt Nielsen; Radiologisk afdeling, Herlev Hospital. Chyluria - a rare finding after partial nephrectomy. P2.4 Tina Mehajerpour, Jesper Gade; Radiologisk afdeling, Herlev sygehus.

Intracerebral hemorrhage –Dual-Energy-CT as a tool to differentiate between bleeding in an underlying tumor and a pure hemorrhage.

P2.5 Shakiba Mosadegh, Benedicte Lange; Billeddiagnostisk Afdeling, Nordsjællands Hospital, Hillerød Fibrøs dysplasi - sjælden årsag til muskuloskeletale smerter hos børn og unge. P2.6 Elaha Salik, Benedicte Lange; Department of Radiology, Hospital of North Zealand, Hilleroed. Small intestine diverticulitis as an unusual cause of acute abdominal pain. P2.7 Bolette Vilmun, Benedicte Lange; Department of Radiology, University of Hilleroed, Hospital of North Zealand, Denmark. Cervical fractures in patients with Mb. Bechterew and DISH. P2.8 Helene Mygind Wolsk, Charlotte Strandberg, Susan Nielsen; Radiologisk afdeling, Herlev og Gentofte hospital.

4

IgG4 relateret sygdom som mulig årsag til systemisk inflammation hos et barn. P2.9 Maryam Mozaffari, Gina Al-Farra; Radiologisk afdeling, Herlev og Gentofte Hospital.

Galdestensileus – set på lav dosis CT urinveje. P2.10 Zunara Butt , Martin Lundsgaard Hansen, Eva Wiinstedt Clausen, Ilse Vejborg; Radiologisk

Klinik, Rigshospitalet. Dual Energy-mammografi og brystkræft.

5

Kategori: Foredrag 1.1 Abstract til DRS Årsmøde 2018

Foredrag foretrækkes

Predictive Accuracy of the PanCan Lung Cancer Risk Prediction Model –External Validation based on CT from the Danish Lung Cancer Screening Trial

Mathilde M. Winkler Willea, Sarah J. van Rielb, Zaigham Saghirc, Asger Dirksend, Jesper Holst Pedersene, Colin Jacobsb, Laura Hohwü Thomsenf, Ernst Th. Scholtenb, Lene T. Skovgaardg, Bram van Ginnekenb. aDepartment of Radiology, Bispebjerg Hospital, Copenhagen, Denmark bDepartment of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands cDepartment of Respiratory Medicine, Herlev Hospital, Denmark dDepartment of Respiratory Medicine, Gentofte Hospital, Hellerup, Denmark eDepartment of Thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, København Ø, Denmark fDepartment of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark gDepartment of Biostatistics, University of Copenhagen, Denmark Objectives – Lung cancer risk models should be externally validated to test generalizability and clinical usefulness. The Danish Lung Cancer Screening Trial (DLCST) is a population-based prospective cohort study, which has been used to assess the discriminative performances of the PanCan models (1). Methods – From the DLCST database, 1152 nodules from 718 participants were included. Parsimonious and full PanCan risk prediction models were applied to DLCST data, and also coefficients of the model were recalculated using DLCST data. Receiver operating characteristics (ROC) curves and area under the curve (AUC) were used to evaluate risk discrimination. Results – AUCs between 0.826-0.870 were found for DLCST data based on PanCan risk prediction models. In DLCST, age and family history were significant predictors (p=0.001 and p=0.013). Female sex was not confirmed to be associated with higher risk of lung cancer, in fact opposing effects of sex were observed in the two cohorts. Thus, female sex appeared to lower the risk (p=0.047 and p=0.040) in DLCST. Conclusions – High risk discrimination was validated in the DLCST cohort, mainly determined by nodule size. Age and family history of lung cancer were significant predictors and could be included in the parsimonious model. Sex appears to be a less useful predictor. Ref: (1) McWilliams A, Tammemagi MC, Mayo JR, et al. (2013) Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med 10:910-9.

6

Kategori: Foredrag 1.2 Findings of CT in patients with acute abdomen that required acute high-risk abdominal surgery. Forfatternavne: Chenxi Huang1,3, Julie Rydberg2, Cecilie Alrø Mardal2, Line Toft Tengberg3, Morten Bay-Nielsen3, Naim Qadiri2, Barbara Bonnesen2. Navn på den der præsenterer: Chenxi Huang 1Røntgen afdeling, Bispebjerg Hospital, 2Funktions- og Billeddiagnostisk Enhed og 3Gastroenheden, Hvidovre Hospital. Introduction: Acute abdomen is the most frequent non-trauma surgical cause for emergency hospital admission (1). Some of these patients are subsequently referred to acute abdominal surgery with a high risk of morbidity and mortality (2). At our institution, a standardized, multidisciplinary consultant-led perioperative protocol was introduced in 2013, in order to improve the survival of these patients. This protocol includes an on-demand fast track CT scan yielding description / diagnosis within 2 hours of inclusion, and subsequent surgery within 6 hours. The effort of this protocol showed a significant decrease of 30-day mortality (29%) as reported in a recent publication (3). The present study reports the accuracy of the CT findings compared to the intraoperative findings in these patients. Finally, we discuss the role of fast track CT in this multidisciplinary cooperation between radiologists, surgeons and anaesthesiologists. Materials and methods: The study was a single-center intervention study in an unselected consecutive cohort. We included adult patients with the suspicion of abdominal pathology that required immediate CT diagnosis and subsequent laparotomy or laparoscopy. All patients were included from Hvidovre Hospital from July 2013 to February 2015, by senior surgeons on duty at the emergency department after initial triage. In this multidisciplinary effort the radiological contribution consisted of an on-demand abdominal CT including diagnosis description within 2 hours of inclusion. The patients underwent CT scans on a Toshiba, Phillips or Siemens scanner, 75% of the cases with I. V. contrast and 25% without. Results: A total of 371 patients were included. Fast track CT scans were able to detect a high proportion of the pathologies found at the subsequent surgery with an overall accuracy of 90%, including detection of bowel dilation at accuracy of 94% (without contrast 97%), perforated organs at accuracy of 94% (71%) and Intraperitoneal fluid 81% (61%). Conclusion: The fast and accurate diagnosis provided by CT scan enabled the clinicians to make immediate and educated decisions. The significant decrease of 30-day mortality supports the important role of CT scans and skilled radiologists in this multidisciplinary cooperation. Reference:

1. Petroze RT. Global disease burden of conditions requiring emergency surgery. Br J Surg. 2014;101(1):e23.

7

2. Tengberg LT, Cihoric M, Foss NB, Bay-Nielsen M, Gogenur I, Henriksen R, et al. Complications after emergency laparotomy beyond the immediate postoperative period - a retrospective, observational cohort study of 1139 patients. Anaesthesia. 2017;72(3):309-16.

3. Tengberg LT, Bay-Nielsen M, Bisgaard T, Cihoric M, Lauritsen ML, Foss NB, et al. Multidisciplinary perioperative protocol in patients undergoing acute high-risk abdominal surgery. Br J Surg. 2017;104(4):463-71.

8

Kategori: Foredrag (videnskabelig) 1.3 Pre-operative Dynamic Contrast Enhanced Computed Tomography of patients resected for colorectal liver metastases Forfatternavne: Carsten Lauridsen, Rikke Løvendahl Eefsen, Martin Illemann , Gunilla Høyer-Hansen, Gro L. Willemoe ,Martin Lundsgaard Hansen, Marie B. Mogensen, Hans Christian Rolff, Ida Katrine Lund, Lars Engelholm, Eva Fallentin, Thomas Axelsen, Michael Bachmann Nielsen, Kell Østerlind. Navn på den der præsenterer: Carsten Lauridsen Introduktion: The purpose of the study was to investigate a possible correlation between Dynamic Contrast Enhanced Computer Tomography (DCE-CT) of colorectal liver metastases and 1) the plasma level of different forms of the urokinase plasminogen activation receptor (uPAR), and 2) the histological microvessel density (MVD). Materiale og metode: Twenty-eight patients referred to liver surgery for colorectal liver metastases were invited and 11 patients fulfilled all criteria for comparative analyses. A plasma sample for analysis of uPAR was collected and a DCE-CT was performed the day before liver surgery. Image analysis was performed at a workstation for perfusion imaging, encompassing measurements of the arterial and portal tissue perfusion (AF, PF) and Perfusion Index (PI = AF/(AF+PF)%) of the metastases. MVD was evaluated histologically in the periphery the metastases. The Spearman correlation test was used for statistical analysis. Resultater: A high PI value was significantly correlated to a high MVD (r=0.75, p=0.01). The PI and the portal flow of the metastases were significantly higher than the surrounding normal liver parenchyma. No significant correlation was found between the DCE-CT values. Konklusion: Thus, a correlation between DCE-CT characteristics and MVD in liver metastases was observed, prompting further investigations in a larger series of patients.

9

Kategori: Foredrag 1.4 Delayed gadolinium enhanced MRI of menisci and cartilage (dGEMRIM/dGEMRIC) in overweight patients with knee osteoarthritis A cross sectional study of 86 overweight patients with intraarticular administered gadolinium contrast. Stine Hangaard1,2, Henrik Gudbergsen1, Cecilie L . Daugaard1,2, Henning Bliddal1, Janus Damm Nybing2, Miika T. Nieminen3,4,5, Victor Casula3,4, Carl-Johan Tiderius6 & Mikael Boesen1,2

1The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark 2Department of Radiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.3 Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland. 4Medical Research Center, University of Oulu and Oulu University Hospital, Finland. 5Department of Diagnostic Radiology, Oulu University Hospital, Finland, 6Department of orthopedics, Clinical Sciences Lund, Lund University, Skåne University Hospital, SE-221 85 Lund, Sweden Introduction: Morphologic changes in the menisci are highly associated with development of knee osteoarthritis (KOA)(1). The aim of this study was to examine the delayed gadolinium enhanced MRI of menisci (dGEMRIM) and its relationship to Kellgren-Lawrence grade (KLG) and to articular cartilage dGEMRIC in overweight patients with KOA. Methods: 86 overweight patients (BMI>27) with KOA from the CAROT-study (Clin trial id: NCT00655941) with a mean KLG of 3 had an ultrasound guided intraarticular injection of 0.1 ml negatively charged contrast agent (4 mmol/l Multihance) in 10 mL Lidocain. Four inversion times (50, 350, 650, 1410 ms) dGEMRIC and dGEMRIM was performed in a 1.5T Philips, Intera scanner with a mean time delay of 90 minutes. T1 relaxation time-values were calculated for posterior weight bearing femoral cartilage in the lateral knee compartment, and for the posterior meniscal horn of both lateral (Fig. 1) and medial menisci. Due to advanced medial KOA and missing cartilage, dGEMRIC in the medial compartment could not be measured.

Results: For posterior femoral cartilage (N=86) the mean T1 relaxation time was 441 ms (confidence limits of the mean (CLM) 427-455 ms). The mean T1 relaxation time in the lateral menisci (N=85) was 498 ms (CLM 478-518 ms) and for the medial menisci (N=62) mean T1 relaxation time was 484 (CLM 458-510ms). A positive correlation was found between medial and lateral menisci with R=0.62 (p<0.0001) and a similar trend was observed between lateral cartilage and lateral menisci with R= 0.26 (p=0.02). Comparing meniscus T1 relaxation time-values from the most affected knee compartment to KLG showed trends toward increasing T1-values for KLG 1-3 and a decreasing T1-value for KLG 4.

Discussion/Conclusion: The positive correlation between lateral and medial menisci may indicate a parallel degradative processes occurring in both knee compartments. The correlation between menisci and cartilage T1-values suggests concomitant, but different, degeneration in the two tissues in OA. The interpretation of the numerical, and insignificantly, inverse u-shaped relation between meniscal T1-values and KLG is in accordance with previous findings comparing various

Figure 1. Sagittal view of lateral condyle with dGEMRIC and dGEMRIM.

10

degrees of meniscal degeneration with both dGEMRIM (2) and proteoglycans content from biopsies(3). Referencer (1) Englund M, Haugen IK, Guermazi A, Roemer FW, Niu J, Neogi T, et al. Osteoarthritis Cartilage

2016 (2) Sigurdsson U, Møller G, Siversson C, Lammentausta E, Svensson J, Tiderius CJ, et al. BMC

Musculoskelet Disord 2016 (3) Sun Y, Mauerhan DR, Kneisl JS, James Norton H, Zinchenko N, Ingram J, et al. Open Rheumatol J

2012

R=0.62

11

Kategori: Foredrag 1.5 Pilot Study - BASIC – ULTRASOUND Jon Henneberg, Alexander Hagen Kristensen, Natascha Schødts, Gerhard Tiwald all Holbæk hospital, Region of sealand Our hypotheses

• junior doctors (KBU-læger) will use focused ultrasound regularly after 3 hours of supervised training

• junior doctors can identify relevant pathology using focused ultrasound • junior doctors can apply ultrasound for placing PCV’s (peripheral vein catheters) • juniors doctors uses BASIC-US more often than FAST-examination

What is BASIC ultrasound? Bladder (urine retention) Aorta abdominalis (aneurism) Stones (kidney/gallbladder) Incompensation (basal pleural effusion) Cannulas (placing of difficult IVC’s) BASIC ultrasound is a concept developed by Gerhard Tiwald (GT) in collaboration with CAMES and involves ultrasound scanning of the items mentioned above. How did we test the method? Intervention group: 3 junior doctors (KBU-læger) went through a boot-camp consisting of 3 hours of training by senior hospital physician GT followed by 2 months of prospective registration of focused ultrasound exams in Akutmodtagelsen at Holbæk Sygehus. The boot camp consisted of theoretical and practical training in BASIC. The ultrasound examination performed by the junior doctors were supervised by cunning senior house physician or a CT-scan described by a radiologist. The indications we scanned by and the positive findings are mentioned in the result diagram below. Control group: 2 junior doctors who have been trained in FAST examination (at CAMES) Results Total number of BASIC-scans done in 3 months 39 Rescan with the same findings 92% Total number of FAST-scans done by control group 0 *Fig. 1 Conclusion

• BASIC ultrasound scanning when receiving acute patients is useful and often indicated • 3 hours of training in BASIC-UL has given a success rate of more then 90 percent • Positive clinical findings in 10 of 30 scans useful in diagnostics and treatment of the patient • Junior doctors trained in FAST scans did not do any FAST scans in the same period of time • Difficult placing of PVC’s were done often by junior doctors and with a high success rate (88

%)

12

*Fig. 1

0

1

2

3

4

5

Abdominal pain

in…

Central a

bdominal…

Flank p

ain

Pain in

the lo

wer…

Dyspnea

Difficu

lt PVC

NASC

ALHK

JSTH

13

Kategori: Foredrag 2.1 Helkrops MR til Onkologi Forfatternavne: Jon Thor Asmussen, Radiologisk afdeling, Odense Universitetshospital Navn på den der præsenterer: Jon Thor Asmussen Introduktion: Den tekniske udvikling i MR i de sidste 10 år har gjort det praktisk muligt at undersøge både børn og voksne fra isse til fod på rimelig tid. Der er tiltagende klinisk interesse i at vurdere respons eller screene for recidiv med denne modalitet, hos ptt som har forventet lang rest-levetid, og således undgå ioniserende bestråling. Desuden er der mere specifikke indikationer, specielt ved ”bone-only” metastasering, hvor responsevaluering eller er tæt på umulig.(1–3) Materiale og metode: Jeg vil give en oversigt over den internationale konsensus om Protokoller for Helkrops MR skanning og vise eksempler på hvad vi gør i Odense, selv om vi ikke har den optimale hardware til formålet. Konklusion: Der er stigende efterspørgsel efter Helkrops MR. Der er behov for undervisning og standardisering landet over. Referencer: 1. Morone M, Bali MA, Tunariu N, Messiou C, Blackledge M, Grazioli L, m.fl. Whole-Body MRI: Current Applications in Oncology. AJR Am J Roentgenol. december 2017;209(6):W336–49. 2. Padhani AR, Lecouvet FE, Tunariu N, Koh D-M, De Keyzer F, Collins DJ, m.fl. METastasis Reporting and Data System for Prostate Cancer: Practical Guidelines for Acquisition, Interpretation, and Reporting of Whole-body Magnetic Resonance Imaging-based Evaluations of Multiorgan Involvement in Advanced Prostate Cancer. Eur Urol. januar 2017;71(1):81–92. 3. Pawlyn C, Fowkes L, Otero S, Jones JR, Boyd KD, Davies FE, m.fl. Whole-body diffusion-weighted MRI: a new gold standard for assessing disease burden in patients with multiple myeloma? Leukemia. juni 2016;30(6):1446–8.

14

Kategori: Foredrag 2.2 Title: Children Centered Care: a multi-faceted concept for MRI of children aged 4-10 with the aim to reduce the need for anesthesia and increase comfort for children and parents Authors: Stine Bjerrum Runge, Nicolaj Lyhne Christensen, Kim Jensen, Ib Erik Jensen Presenter: Stine Bjerrum Runge. Røntgen og Scanning, Sygehus Lillebælt, Kolding. Sygehusvej 24, 6000 Kolding. stinebjerrum@hotmail.com. Introduction: MRI of younger children often requires general anesthesia (GA). Anesthesia can be unpleasant and anxiety provoking for children and parents. Rare complications include aspiration and death. For non-sedated children an MRI examination itself can be frightening. We developed and tested a multi-faceted concept with the aim to reduce the need for GA among children aged 4-6 and to increase comfort for children aged 4-10 and their parents. Materials and Method: Four main elements were included in the Children Centered Care (CCC) concept: • An interactive app for use at home in which the child is introduced to the physical environment and experience during an MRI scan, thus creating comfort and recognizability • Selection and communicative training of a dedicated pediatric team of MRI radiographers • Establishment of a children´s lounge with a toy-scanner • The use of a child-friendly environment in the MRI room with lights, graphics and in-bore solution to create positive distraction with movies and themes known from the app. For children aged 4-6, the use of anesthesia was compared before and after the establishment of the CCC concept in a prospective setup. For non-sedated children of all ages, patient-experienced quality and comfort was evaluated using a questionnaire including questions for the parents and a visual scale developed for children. Results: We included 144 and 162 children before and after establishment of the CCC concept, respectively. Of children aged 4-6, 23/40 (57%) had GA before CCC was established vs. 2/41 (5%) after (p=0.001), figure 1. Among non-sedated children aged 4-10, 89/115 (77%) reported to feel comfortable during the examination before establishment of the CCC concept vs. 142/160 (89%) after (p=0.013). The proportion of parents reporting to feel safe and assured “to a large degree” increased from 89/111 (80%) before to 145/160 (91%) after (p=0.019). Conclusion: The CCC concept markedly reduced the need for anesthesia of children aged 4-6 and improved the quality experienced by children in all age groups and their parents.

15

Figure 1:

16

Kategori: Foredrag 2.3 Titel: A systematic review regarding magnetic resonance imaging’s ability to diagnose and subdivide renal tumors among adults compared to histopathology Forfatternavne: Janni L. B. Madsen1, 2, Louise A. Duus1, 2, Lars Lund2, 3, Tommy K. Nielsen4, 5, Michael Petersen5 Ole

Graumann1, 2, 5

1Dep. of Radiology, Odense University Hospital, Denmark. 2Dep. of Clinical Research, University of

Southern Denmark, Denmark. 3Dep. of Urology, Odense University Hospital, Denmark. 4Dep. of

Urology, Aarhus University Hospital, Denmark. 5Dep. of Clinical Medicine, Aarhus University,

Denmark.

Navn på den der præsenterer: Janni L. B. Madsen Introduktion: Computed tomography (CT) combined with histopathology has been standard for the diagnosis of renal tumors for decades. The contribution from magnetic resonance imaging (MRI) has been limited to cases where the CT contrast agent was considered too high a risk for the patients regarding nephrotoxicity due to low glomerular filtration rate or in cases where a second opinion was needed for example if the CT scan proved inconclusive. Recent studies have shown that Multi Planar MRI with contrast (mpMRI) are able to differ between benign and malignant renal tumors (1-5). In addition, new experimental MRI sequences, have shown promising results by providing structural information of the composition of the tumor, on a molecular level (6, 7). This offers the possibility to subgrade the renal tumors using non-invasive imaging (8, 9-12). The purpose of this systematic review was to evaluate MRI’s diagnostic accuracy regarding renal tumor classification and subdivision with histopathology as the gold standard. Materiale og metode: In a systematic review (according to PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-Analyses] statement and the QUADAS-2 [Quality Assessment of Diagnostic Accuracy Studies]) 22 publications were selected for inclusion. The publications were categorized into two groups 1) publications with emphasis on distinguishing malignant renal tumors from benign 2) publications with emphasis on the subdivision of the different malignant renal tumors. Resultater: 22 studies compromised a total of 1444 tumors in 1390 patients. Tumor distribution was 13.8% benign and 86.2% were malignant. Most frequent investigated MRI sequences were Diffusion Weighted Images (DWI) and Dynamic Contrast Enhancement (DCE). Overall, there is a tendency towards characterizing renal tumors based on the following MRI sequences: T2, T1, DCE, DWI and in- and opposed-phase. Promising results regarding MRI’s diagnostic ability to distinguish benign and malignant renal tumor, as well as subdividing the malignant subtypes, have been revealed, but due to sparse comparable studies in the field, more research is needed.

17

Konklusion: MRI has shown promising results regarding subdividing of renal tumors but generally data was inhomogeneous and therefore very challenging to compare. Therefore, more studies regarding this topic are needed before MRI can replace histopathology. Referencer: 1. Bachir Taouli, Ravi K. Thakur LM, James S. Babb, Sooah Kim, Elizabeth M. Hecht, Vivian S.

Lee, Gary M. Israel,. Renal Lesions: Characterization with Diffusion-weighted Imaging versus Contrast-enhanced MR Imaging. Radiology. 2009;251(2):398-407.

2. Sooah Kim, Monica Jain, Andrew B. Harris VSL, James S. Babb, , Eric E. Sigmund LER, Taouli B. T1 Hyperintense Renal Lesions: Characterization with Diffusion-weighted MR Imaging versus Contrast-enhanced MR Imaging. Radiology. 2009;251(3):796-807.

3. Mytsyk Y, Dutka I, Borys Y, Komnatska I, Shatynska-Mytsyk I, Farooqi AA, et al. Renal cell carcinoma: applicability of the apparent coefficient of the diffusion-weighted estimated by MRI for improving their differential diagnosis, histologic subtyping, and differentiation grade. Int Urol Nephrol. 2017;49(2):215-24.

4. Schneider G, Probst T, Kirchin MA, Stroeder J, Fries P, Buecker A. Low-dose gadobenate dimeglumine-enhanced MRI of the kidney for the differential diagnosis of localized renal lesions. La Radiologia medica. 2015;120(12):1100-11.

5. Sandrasegaran K, Sundaram CP, Ramaswamy R, Akisik FM, Rydberg MP, Lin C, et al. Usefulness of diffusion-weighted imaging in the evaluation of renal masses. AJR Am J Roentgenol. 2010;194(2):438-45.

6. Moriyama S, Yoshida S, Tanaka H, Inoue M, Ito M, Yokoyama M, et al. Mp78-03 Mri Intensity Ratio Curve Analysis: A New Objective Method for Characterizing Small Renal Masses. The Journal of Urology. 2016;195(4):e1024-e5.

7. Krabbe LM, Bagrodia A, Margulis V, Wood CG. Surgical management of renal cell carcinoma. Semin Intervent Radiol. 2014;31(1):27-32.

8. Pedrosa I, Chou MT, Ngo L, R HB, Genega EM, Galaburda L, et al. MR classification of renal masses with pathologic correlation. Eur Radiol. 2008;18(2):365-75.

9. Dodelzon K, Mussi TC, Babb JS, Taneja SS, Rosenkrantz AB. Prediction of growth rate of solid renal Masses: Utility of MR Imaging Features—Preliminary Experience. Radiology. 2012;262(3):884-93.

10. Wang H, Cheng L, Zhang X, Wang D, Guo A, Gao Y, et al. Renal Cell Carcinoma: Diffusion- weighted MR Imaging for Subtype Differentiation at 3.0 T. Radiology. 2010;257(1).

11. Sun MR, Ngo L, Genega EM, Atkins MB, Finn ME, Rofsky NM, et al. Renal cell carcinoma: dynamic contrast-enhanced MR imaging for differentiation of tumor subtypes--correlation with pathologic findings. Radiology. 2009;250(3):793-802.

12. Cornelis F, Lasserre AS, Tourdias T, Deminiere C, Ferriere JM, Le Bras Y, et al. Combined late gadolinium-enhanced and double-echo chemical-shift MRI help to differentiate renal oncocytomas with high central T2 signal intensity from renal cell carcinomas. AJR Am J Roentgenol. 2013;200(4):830-8.

18

Figur/tabel:

19

Kategori: Foredrag 2.4 Titel: Grading lumbar disc degeneration — a comparison between low- and high-field MRI Forfatternavne: Bjarke Brandt Hansen, Urszula Maria Ciochon, Charlotte Riis Trampedach, Anders Fogh Christensen, Zoreh Rastiemadabadi, Mikael Boesen Bjarke B. Hansen and Urszula M. Ciochon deler førsteforfatterskab. Navn på den der præsenterer: Urszula Maria Ciochon, Billeddiagnostisk område, Aalborg Universitetshospital og Røntgenafdelingen, Bispebjerg og Frederiksberg Hospitaler. Introduktion: Due to better image quality, high-field MRI are usually preferred by the clinicians to identify the possible source of pain in patients with low back pain. However, it would be useful to know the diagnostic capability of low-field systems compared with higher-field systems in grading disc degeneration. Thus, this study aimed to investigate differences in Pfirrmann’s disc degeneration grading on high- versus low-field magnetic resonance imaging (MRI). Materiale og metode: Low back pain patients were enrolled to undergo high-field (3 Tesla) MRI, followed by low-field (0.25 Tesla) MRI of the lumbar spine within three hours. Three radiologists graded the disc degeneration with a hiatus of three months. A subsample was re-evaluated six months later. Reproducibility between field-strength was measured by weighted Kappa statistic, absolute agreement, and the difference in the prevalence of the grading (McNemar test). Resultater: Moderate to substantial reliability (κ: 0.52 - 0.62) and absolute agreement of 43.8%-66.1% was found between field-strengths. Low-field MRI tended to have numerically higher and lower grades than high-field MRI resulting in a significant difference in the prevalence of grades (P&lt;0.001). Low-field MRI resulted in a better interreader reliability (low-field: κ = 0.63, 0.63, 0.54 versus high-field: κ = 0.55, 0.43, 0.53), whereas high-field MRI resulted in higher intrareader reliability for two readers (high-field: κ = 0.57, 0.77, 0.67 versus low-field: κ = 0.51, 0.50, 0.70). Konklusion: There was a significant difference in the prevalence of Pfirrmann’s disc degeneration grading between 0.25 Tesla and 3 Tesla MRI. Therefore, dedicated training is needed. Referencer: (1) Lotz JC, Haughton V, Boden SD, m.fl. New treatments and imaging strategies in degenerative disease of the intervertebral disks. Radiology [Internet] 2012;264:6–19.Tilgået fra: http://www.ncbi.nlm.nih.gov/pubmed/22723559 (2) Kjaer P, Leboeuf-Yde C, Korsholm L, m.fl. Magnetic resonance imaging and low back pain in adults: a diagnostic imaging study of 40-year- old men and women. Spine (Phila Pa 1976) 2005;30:1173–80. (3) Jarvik JJ, Hollingworth W, Heagerty P, m.fl. The Longitudinal Assessment of Imaging and Disability of the Back (LAIDBack) Study: baseline data. Spine (Phila Pa 1976) 2001;26:1158–66. (4) Hansen BB, Bendix T, Grindsted J, m.fl. Effect of Lumbar Disc Degeneration and Low-Back Pain on the Lumbar Lordosis in Supine and Standing. Spine (Phila Pa 1976) [Internet] 2015;40:1690–6.Tilgået fra:

20

http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&amp;an=00007632- 201511000-00011 (5) Deyo RA. Diagnostic evaluation of LBP: reaching a specific diagnosis is often impossible. Arch Intern Med [Internet] 2002;162:1444-7- 8.Tilgået fra: http://www.ncbi.nlm.nih.gov/pubmed/12090877 (6) Cheung KMC, Karppinen J, Chan D, m.fl. Prevalence and pattern of lumbar magnetic resonance imaging changes in a population study of one thousand forty-three individuals. Spine (Phila Pa 1976) 2009;34:934–40. (7) Lurie JD, Doman DM, Spratt KF, m.fl. Magnetic Resonance Imaging Interpretation in Patients With Symptomatic Lumbar Spine Disc Herniations. Spine (Phila Pa 1976) [Internet] 2009;34:701–5.Tilgået fra: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&amp;an=00007632- 200904010-00012 (8) Haefeli M, Kalberer F, Saegesser D, m.fl. The course of macroscopic degeneration in the human lumbar intervertebral disc. Eur Cells Mater 2005;10:25. (9) de Schepper EIT, Damen J, van Meurs JBJ, m.fl. The association between lumbar disc degeneration and low back pain: the influence of age, gender, and individual radiographic features. Spine (Phila Pa 1976) 2010;35:531–6. (10) Burke JG, Watson RW, McCormack D, m.fl. Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators. J Bone Jt Surg Br 2002;84:196–201. (11) Roughley PJ. Biology of intervertebral disc aging and degeneration: involvement of the extracellular matrix. Spine (Phila Pa 1976) 2004;29:2691–9. (12) Adams M a., Dolan P. Intervertebral disc degeneration: Evidence for two distinct phenotypes. J Anat 2012;221:497–506. (13) Adams MA, Lama P, Zehra U, m.fl. Why do some intervertebral discs degenerate, when others (in the same spine) do not? Clin Anat 2015;28:195–204. (14) Adams M a, Roughley PJ. What is Intervertebral Disc Degeneration, and What Causes It? Spine (Phila Pa 1976) [Internet] 2006;31:2151–61.Tilgået fra: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&amp;an=00007632- 200608150-00024 (15) Pfirrmann CW, Metzdorf a, Zanetti M, m.fl. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 2001;26:1873–8. (16) Bendix T, Kjaer P, Korsholm L. Burned-out discs stop hurting: fact or fiction? Spine (Phila Pa 1976) 2008;33:E962–7. (17) Coffey AM, Truong ML, Chekmenev EY. Low-field MRI can be more sensitive than high- field MRI. J Magn Reson [Internet] Elsevier Inc; 2013;237:169–74.Tilgået fra: http://dx.doi.org/10.1016/j.jmr.2013.10.013 (18) Lee RKL, Griffith JF, Lau YYO, m.fl. Diagnostic Capability of Low- Versus High-Field Magnetic Resonance Imaging for Lumbar Degenerative Disease. Spine (Phila Pa 1976) [Internet] 2015;40:382–91.Tilgået fra: http://www.ncbi.nlm.nih.gov/pubmed/25584942 (19) Bendix T, Sorensen JS, Henriksson GAC, m.fl. Lumbar Modic Changes—A Comparison Between Findings at Low- and High-Field Magnetic Resonance Imaging. Spine (Phila Pa 1976) [Internet] 2012;37:1756–62.Tilgået fra: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&amp;an=00007632- 201209150-00006 (20) Elm E v., Altman DG, Egger M, m.fl. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007;335:806–8. (21) Fardon DF, Milette PC. Nomenclature and classification of lumbar disc pathology.

21

Recommendations of the Combined task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine (Phila Pa 1976) 2001;26:E93–113. (22) Carrino J a, Lurie JD, Tosteson AN a, m.fl. Lumbar spine: reliability of MR imaging findings. Radiology 2009;250:161–70. (23) Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159–74. (24) Hansen BB, Hansen P, Carrino JA, m.fl. Imaging in mechanical back pain: Anything new? Best Pract Res Clin Rheumatol [Internet] Elsevier Ltd; 2016;30:766–85.Tilgået fra: http://linkinghub.elsevier.com/retrieve/pii/S1521694216300493 (25) Sorensen SJ, Kjaer P, Jensen ST, m.fl. Low-Field Magnetic Resonance Imaging of the Lumbar Spine: Reliability of Qualitative Evaluation of Disc and Muscle Parameters. Acta radiol [Internet] 2006;47:947–53.Tilgået fra: http://acr.sagepub.com/lookup/doi/10.1080/02841850600965062

22

Figur/tabel: Examples of disc degeneration grades a.m. Pfirrmann on 0.25 Tesla (A) and 3 Tesla (B) sagittal T2-weighted magnetic resonance images in the same level and patient.

23

Kategori: Foredrag 2.5 Titel: Development of secondary hyperalgesia is not correlated to pain relevant brain structures - a 3-tesla MRI study of healthy men Forfatternavne: Morten Sejer Hansen, Mohammad Sohail Asghar, Jørn Wetterslev, Christian Bressen Pipper, Johan Mårtensson, Lino Beccera, Anders Christensen, Janus Damm Nybing, Inger Havsteen, Mikael Boesen, Jørgen Berg Dahl Navn på den der præsenterer: Morten Sejer Hansen Introduction: Central sensitization is a manifestation of the plasticity of the central nervous system (CNS) and represents the CNS’s ability to alter or augment pain responses. Central sensitization plays a pivotal role in the maintenance of pain, and is believed to be involved in several chronic pain conditions (1, 2). Central sensitization can readily be induced in healthy participants by applying experimental pain models (3). The development of secondary hyperalgesia, a clinical manifestation of central sensitization, presumably reflects individual levels of central sensitization. A previous study found reduced volumes of the caudate nuclei in healthy participants with small secondary hyperalgesia areas, suggesting that differences in brain anatomy may influence the propensity to develop central sensitization (4). The aim of this study was to investigate if the size of the secondary hyperalgesia area was associated with the volume of the caudate nuclei (primary analysis) or with the volume of other pain relevant brain structures (secondary analysis). Materials and methods: We recruited 121 healthy men; 118 were included in the final analysis. All participants underwent pain testing, where secondary hyperalgesia areas were elicited by the experimental heat pain model brief thermal sensitization (45°C for 3 minutes) (5). Minimum two weeks after pain testing all participants underwent whole-brain T1-weighted MRI. Anatomical images were preprocessed and analyzed using the Freesurfer imaging analysis suite (6). We extracted volumes of the following brain structures: Caudate nuclei, primary somatosensory cortex, anterior and mid cingulate cortex, putamen, nucleus accumbens, globus pallidus, insula and the cerebellum. The association between the size of the secondary hyperalgesia areas and the brain structure volumes were investigated by multiple linear regression. Results: Our findings demonstrated no significant associations between the size of the secondary hyperalgesia area and the volume of the caudate nuclei, primary somatosensory cortex, anterior and mid cingulate cortex, putamen, nucleus accumbens, globus pallidus, insula, or the cerebellum. Conclusion: We found no significant association between the secondary hyperalgesia area and the volume of any predefined brain structure relevant for pain processing. Our findings suggest that the propensity to develop central sensitization is not correlated to brain structure in healthy men. Referencer: 1. Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by

central neural plasticity. J Pain. 2009;10(9):895-926. doi: 10.1016/j.jpain.2009.06.012.

24

2. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2-15. doi: 0.1016/j.pain.2010.09.030. Epub Oct 18.

3. Werner MU, Petersen KL, Rowbotham MC, Dahl JB. Healthy volunteers can be phenotyped using cutaneous sensitization pain models. PLoS One. 2013;8(5):e62733. doi: 10.1371/journal.pone.0062733. Print 2013.

4. Asghar MS, Pereira MP, Werner MU, Martensson J, Larsson HB, Dahl JB. Secondary Hyperalgesia Phenotypes Exhibit Differences in Brain Activation during Noxious Stimulation. PLoS One. 2015;10(1):e0114840.

5. Hansen MS, Wetterslev J, Pipper CB, Ostervig R, Asghar MS, Dahl JB. The Area of Secondary Hyperalgesia following Heat Stimulation in Healthy Male Volunteers: Inter- and Intra-Individual Variance and Reproducibility. PLoS One. 2016;11(5):e0155284.

6. Fischl B, Salat DH, Busa E, Albert M, Dieterich M, Haselgrove C, et al. Whole brain segmentation: automated labeling of neuroanatomical structures in the human brain. Neuron. 2002;33(3):341-55.

25

Kategori: Foredrag (radiografi) 2.6 Forsknings delprogram: CONRAD; Diagnostik og Behandling

Forfattere: Helle Precht, Karen Brage, Mia K. Andersen Ansættelsessted: University College Lillebælt, Center for Anvendt Sundhedsforskning Baggrund Delprogrammet ”CONRAD; Diagnostik og behandling” har til formål at producere forsknings- og udviklingsbaseret viden om radiografi til gavn for borger, profession og samfund. Forskningsområderne er kendetegnet ved at være nye og under stadig udvikling og forandring, ikke mindst som følge af teknologiske landvindinger indenfor de seneste årtier. Denne udvikling revolutionerer til stadighed professionerne og deres muligheder. Der er derfor et udtalt behov for at styrke opbygningen af vidensgrundlaget. Derfor vil denne præsentation være en inspiration til at sætte gang i forskning og mulighed for at koble sig op på større netværk.

Forskningstemaer Delprogrammet har sit primære genstandsfelt indenfor radiografi og udfoldes i tre overordnede forskningstemaer, som inviterer til forskningssamarbejde med beslægtede professioner og forskningsmiljøer:

Patientologi i en højteknologisk kontekst: Udforsker hvordan man bedst muligt inddrager, rådgiver og samarbejder med patienten, pårørende og andre sundhedsprofessionelle i forbindelse med billeddiagnostiske undersøgelser, billedvejledt behandling og stråleterapi. Forskningen stiller skarpt på, hvordan kommunikation, relation, samarbejde, omsorg, instrumentel pleje og medicinering påvirkes, opleves og optimeres, når teknologien er styrende for opnåelse af diagnostiske eller behandlingsmæssige resultater.

Patientsikkerhed og strålebeskyttelse: Udforsker hvordan man bedst muligt beskytter patienter, pårørende og personale ved diagnostiske og behandlingsmæssige procedurer indenfor radiografi. Herunder, bedst mulig beskyttelse mod unødig ioniserende stråling, vævsskader samt unødige komplikationer i forbindelse med eksempelvis MR- og ultralydsskanninger. Forskningen kombinerer undersøgelse af teknologiernes muligheder og begrænsninger med eksisterende viden. Optimering af ny teknologi: Udforsker den nyeste teknologis muligheder og begrænsninger indenfor billeddiagnostik, billedvejledt behandling og stråleterapi. Teknologiens hastige udvikling betyder, at der konstant er nye muligheder for at optimere protokoller og procedurer for teknisk udførelse af undersøgelser og analyser. Målet er at forbedre billedkvalitet og behandling eller sænke stråledosis og stadig sikre den bedste diagnosticering og behandling af den individuelle patient ved optimering af hardware og software.

Implementering

26

Studerende inddrages i forskningen som sker i samarbejde med klinisk praksis og medicoindustrien. Forskningsresultater og ny viden publiceres i nationale/internationale videnskabelige tidsskrifter samt synliggøres gennem oplæg på kongresser.

27

Kategori: Poster (videnskabelig) 1.1 Accuracy in the classification of Bosniak IIF, III and IV complex renal cysts in a daily clinical workflow Stine Degn1, 2, Tommy Kjærgaard Nielsen3, 4, Janni L. B. Madsen1, 2 Ole Graumann1, 2, 3

1Dep. of Radiology, Odense University Hospital, Denmark, 2Dep. of Clinical Research, University of Southern Denmark, Denmark, 3Dep. of Clinical Medicine, Aarhus University, Denmark, 4 Dep. of Urology, Aarhus University Hospital, Denmark Presenting author: Stine Degn1 Background and Purpose: The Bosniak classification system has been shown useful in distinguishing between benign and malignant renal cystic lesions when used by experienced uroradiologists, but the classification system has never been evaluated in an everyday clinical setting among radiologists with different experience levels. The purpose was to evaluate the classification of Bosniak complex renal cysts ≥ IIF in a daily clinical workflow among radiologists with different experience level. Material and Methods: Consecutive Computed Tomography (CT)-scan reports from radiologists with different experience level from of complex renal cystic lesions ≥ category IIF in the period January 2015 - December 2016, were re-evaluated by an experienced uroradiologist to create a gold standard (GS). A weighted kappa-value was calculated between the consecutive CT-scan reports and the GS. Results: A total of 153 cystic lesions were included in the study: 134 Bosniak IIF, 15 Bosniak III and 4 Bosniak IV lesions. Approximately 60 % of the lesions changed category at re-evaluation and 8 % were found to be solid tumors. A weighted kappa value of the agreement was found to be fair with a value of 0.21 (p-value <0.0001). Conclusion: Abdominal radiologists with different experience levels have an only fair agreement when categorizing complex renal cystic lesions ≥ category IIF compared to GS. Categorisation of a complex cystic lesion should, therefore, be managed by experienced uroradiologists to avoid falsely clinical decisions.

28

Kategori: Poster (videnskabelig) 1.2 Titel: Forekomst og behandling af komplikationer til EVAR behandling - 10 års erfaring fra Aarhus Universitetshospital. Forfatternavne: Rosa Marie Andersen (præsenterer) a), Sten Langfelta), Hossain Mafia), Jacob Lillya)b) og Ole Graumannc). Arbejdssteder: a) Radiologisk afdeling, Aarhus Universitetshospital. b) Karkirurgisk afdeling, Aarhus Universitetshospital. c) Radiologisk afdeling, Odense Universitetshospital. Introduktion: Vi ønskede at undersøge forekomsten og behandlingen af komplikationer til endovascular aortic repair (EVAR) som blev diagnosticeret på postinterventions radiologiske undersøgelser. Materiale og metode: Et retrospektivt studie, hvor patienter som havde fået foretaget EVAR på Aarhus Universitetshospital (AUH) i perioden marts 2006 - marts 2016 på indikationen abdominalt aorta eller iliaca aneurisme blev inkluderet. Beskrivelser af de postinterventions radiologiske undersøgelser blev gennemset. Alle undersøgelser hvor beskrivelsen indikerede, at der kunne være en komplikation blev gennemset og kategoriseret af en radiologisk interventionsspecialist. Oplysninger om patienter og behandling blev fundet via Karbase (landsregister for karkirurgiske operationer) og patientjournaler. Resultater: 421 patienter, hvoraf 89 % var mænd, med medianalder ved intervention på 73,5 år blev inkluderet. Der var 172 komplikationer hos 147 patienter (figur 1), således fik 35% mindst en komplikation. Hovedparten af komplikationerne (n = 107) var type II endoleaks, efterfulgt af stenose (n = 19), type I endoleak (n = 16) og okklusion (n = 12). Ved 66 af komplikationerne (38 %) blev der foretaget en re-intervention (stent/PTA-behandling eller karkirurgisk operation). Disse 66 re-interventionskrævende komplikationer sås hos 55 patienter, således at 13% af samtlige patienter oplevede at få en re-interventionskrævende komplikation. De restende knap 2/3 af komplikationerne blev konservativ behandlet, primært med watchfull waiting. Konklusion: Over en periode på 10 år blev 421 patienter med abdominalt aorta eller iliaca aneurisme behandlet med EVAR på AUH. 35 % fik en komplikation, men kun 13 % fik foretaget en re-intervention.

29

Figur 1: Oversigt over komplikationer:

30

Kategori: Poster (videnskabelig) 1.3 Titel: PoC Ultralyd møder virtual reality: Undervisning og realistisk træning Forfatternavne: Rune Overgaard Jensen, Eskild Andreasen, Benjamin Rasmussen, Ole Graumann Navn på den der præsenterer: Rune Overgaard Jensen Introduktion: Virtuel undervisning med inddragelse af virtual reality (VR) vinder indpas hos mange uddannelsesinstitutioner i verden. Også i Danmark er dette blevet aktuelt, indenfor bl.a. naturvidenskabens fag (1). Flere studier har vist at simulationstræning både fremmer studerendes forståelse af f.eks. laboratoriearbejde og samtidig sparer tid og ressourcer (2-5). Point of care (PoC) Ultralyd (UL), herunder klinisk UL, er blevet et uundværligt diagnostisk værktøj i klinikken (6-8). Klinisk UL er også blevet en fast del af kandidatuddannelsen i medicin med første kursus ved Syddansk Universitet (SDU) i 2019. Sidstnævnte forventes at blive udfordrende ift. høje krav til tilgængelighed af tilstrækkeligt udstyr og undervisere. Materiale og metode: Vores mål er at udvikle et virtuelt rum med mulighed for undervisning og praktisk øvelse i PoC UL, tilgængeligt hvor som helst og når som helst. Vi har udviklet en ”proof-of-concept” udgave (se billede 1) med mulighed for betjening af et ultralydsapparat og simpel scanning. På baggrund af denne har vi modtaget et tilskud til videreudviklingen fra SDU’s e-læringspulje og opstartet et samarbejde med Radiologisk Innovationsenhed samt SDU’s e-læringskonsulenter. Perspektiver: Videreudviklingen vil resultere i en modulopbygget app til et mobilt VR sæt som initialt vil inkludere følgende: ● Intro til VR undervisning ● Kendskab til ultralydsapparatur ● Basal PoC ultralydsscanning

Senere vil komme fokuserede moduler i specifikke undersøgelser. Konklusion: App’en vil blive afprøvet på frivillige ultralydskurser for medicinstuderende og kontinuerligt udviklet mhp. at indgå i undervisningen i foråret 2019. Projektet vil køre som et samarbejde mellem Teknisk og Sundhedsvidenskabeligt fakultet ved SDU med forankring hos Radiologisk Innovationsenhed på OUH. Referencer: 1. Labster. https://wwwlabstercom/. 2017. 2. Bonde MT, Makransky G, Wandall J, Larsen MV, Morsing M, Jarmer H, et al. Improving biotech education through gamified laboratory simulations. Nat Biotechnol. 2014;32(7):694-7. 3. Makransky G, Lilleholt L, Aaby A. Development and validation of the Multimodal Presence Scale for virtual reality environments: A confirmatory factor analysis and item response theory approach. Computers in Human Behavior. 2017;72:276-85. 4. Thisgaard M, Makransky G. Virtual Learning Simulations in High School: Effects on Cognitive and Non-cognitive Outcomes and Implications on the Development of STEM Academic and Career Choice. Front Psychol. 2017;8:805.

31

5. Homann M. Why gamification in the classroom is such a good idea (and what Labster is doing about it). 2017;https://www.labster.com/blog/gamification-in-the-classroom/?utm_source=Labster+Science+Community+for+Teachers&utm_campaign=02b85ce1c4-EMAIL_CAMPAIGN_2017_10_30&utm_medium=email&utm_term=0_5a55abba44-02b85ce1c4-33016821. 6. Torben Lorentzen CN, Bjørn Skjoldbye. Klinisk ultralyd. 2012. 7. Christopher L. Moore JAC. Point-of-Care Ultrasonography. 2011. 8. Bjørn Skjoldbye CE, Hanne S. Grossjohann, Thomas F. Bendtsen & Lars Bolvig. Ultralyden breder sig som ringe i vandet. Ugeskrift for læger. 2014. Figur/tabel:

Billede 1: Til venstre: Syn igennem det ene øje i virtual reality headset (HTC Vive). Til højre, øverst: Kamera på virtual reality brillen der viser ”virkeligheden”. Til højre, nederst: Optagelse fra et virtuelt kamera placeret i det virtuelle rum.

32

Kategori: Poster (videnskabelig) 1.4 CT Guided Cryoablation of Small Renal Masses Theresa Junker1,2, Janni L. B. Madsen1, 3 Allan L. Pedersen1, 2, Jonas A. Bojsen1, 2, Ole Graumann1, 3

1Dep. of Radiology, Odense University Hospital, Denmark, 2Dep. of Urology, Odense University Hospital, Denmark, 3Dep. of Clinical Research, University of Southern Denmark, Denmark Presenting author: Theresa Junker Purpose: Cryoablation is a safe minimally invasive procedure in the treatment of small renal masses, with promising efficacy and low complication rates compared to a partial extirpative approach. The purpose was to evaluate the outcome of percutaneous Computed Tomography (CT) guided cryoablation of small renal masses performed at Odense University Hospital, Denmark. Material and methods: A retrospective study for technical success and complications of tumor ablation on 75 consecutive patients with initial procedures from 2012 to 2016. Data was collected and statistical analysis was performed on the variables tumor size, age, gender, histopathology, RENAL score, and various measurements for tumor localization. Results: Six patients had residual tumor present at a three months' follow-up scan. Two patients developed new visible tumor tissue in the ablation cavity at a later onset than the three months’ follow-up scan. The complication rate was 4 %, all minor complications, distributed as 2 renal abscess formations and one pseudoaneurysm. No variables were found to predict technical failure. Mean radiological follow-up for the 75 patients was 420.5 days. Conclusion: Percutaneous CT-guided cryoablation appears to have potential as a safe and effective treatment option for small renal masses with low complication rates.

33

Category: Poster (videnskabelig) 1.5 Titel: Diffusion weighted MRI in anal cancer – review Authors: Martina Kastrup Loft, Malene Roland Pedersen and Søren R Rafaelsen

Presenter: Martina Kastrup Loft Institution: Røntgenafdelingen, Sygehus Lillebælt, Vejle Sygehus

Introduction: Diffusion weighted MRI (dw-MRI) quantifies diffusion of water occurring naturally at a cellular level (Brownian movement), which is restricted in multiple neoplasms because of high cellularity. Disruption of cellular integrity secondary to therapy results in increased water diffusion across the injured membranes. Dw-MRI has shown potential to improve the accuracy of therapeutic response prediction in rectal cancer, however the literature on dw-MRI are more scarce in anal cancer. The aim of the study was conduct a systemic literature review of dw-MRI in anal cancer.

Material and methods: We searched Embase, and PubMed for full-text articles reporting results from studies of dw-MRI in anal cancer. We excluded articles published before the year 2000, articles written in a language other than English. MeSH headings and key words specifically chosen to identify published articles detailing the use of dw-MRI in anal cancer.

Results: The search resulted in the identification of six unique publications. Of these five were excluded following title and abstract screening. Two studies did not include anal cancer but adenocarcinomas, one paper was a review, one was intended on liver metastasis and one was a case study. Leaving only one study reported a combined MRI and dwi of anal cancer. The study from 2017 included 58 patients with biopsy proven anal cancer. All patients had dw-MRI and dw-MRI detected 54 of the 58 cancers. The four missed were all T1 tumors. The patients underwent neoadjuvant treatment. The tumor apparent diffusion coefficient (ADC) increased for responders from 0.830x10-6 mm2/s to 1.220x10-6 mm2/s, for non-responders showed no significant difference in ADC value between pre and post-treatment. The same was true for the lymph nodes.

Conclusion: There are few suitable studies in the literature regarding the use of dw-MRI in anal cancer. The study found that dw-MRI is useful in the TN classification. However, dw-MRI did not detect all T1 tumors. Furthermore dw-MRI is helpful in distinguishing between remaining active cancer and fibrotic tissue post-treatment.

References: Reginelli A et al. Diagnostic performance of magnetic resonance imaging and 3D endoanal ultrasound in detection, staging and assessment post treatment, in anal cancer. Oncotarget. 2017;8:22980-90.

34

Kategori: Poster (videnskabelig) 1.6 Solitary kidney metastasis from lung cancer – is cryoablation a feasible treatment? Stine Degn1, 2, Ole Graumann1, 2

1Dep. of Radiology, Odense University Hospital, Denmark, 2Dep. of Clinical Research, University of Southern Denmark, Denmark, Presenting author: Stine Degn1 Background and Purpose: Patients with solitary kidney metastasis are often treated with nephrectomy. However, in the two cases presented cryoablation has been used as an alternative treatment. Cryoablation is a minimally invasive procedure with promising results in the treatment of primary renal carcinomas – but is it cryoablation a feasible treatment for solitary kidney metastasis? Clinical cases: Case 1: A 69-year-old male debuted with pneumonia and haemoptysis and was diagnosed with Non Small Celled Lung Cancer (NSCLC) with no suspicion of disseminated disease. He was initially treated with curatively intended chemo-radiotherapy and surgery. Two and a half years later a control computed tomography (CT) scan visualised a solid tumour of his left kidney. Biopsy verified a metastasis from his NSCLC. The kidney metastasis was successfully treated with cryoablation but five months follow up CT showed a new metastasis close to the previous treated area in the kidney. A new cryoablation was performed and 3 months follow up MRI showed no residual tumor. Case 2: A 54-year-old male was diagnosed with NSCLC due to prolonged coughing. The patient received curatively intended chemo-radiotherapy. A re-evaluation of the performed CT-scan revealed a process in his left kidney, radiologically suspected as being a metastasis from his primary lung cancer. The patient received synchronously biopsy and cryoablation. Unfortunately, the biopsy came back inconclusive but no recurrence of the process was visualised at five months follow-up CT-scan. Conclusion: Cryoablation of solitary kidney metastasis show promising results. Recurrence and incomplete treatment are a concern and further research are needed before cryoablation can be implemented in a daily clinical practise.

35

Kategori: Poster (videnskabelig) 1.7 Titel: Ændring i modtageprocedure for patienter til cerebral trombolyse/trombektomi behandling. Forfatternavne: Sebastian Dirach Van, Radiologisk afd., OUH. Navn på oplægsholder: Sebastian Dirach Van. Baggrund: I maj måned blev årsrapporten fra Dansk Apopleksiregister(1) udgivet for 2016. Af tillægget til rapporten vedr. endovaskulær terapi (EVT), fremgår resultaterne fra de 3 centre for endovaskulær behandling af patienter med cerebral storkarsokklusion. Det konkluderes i rapporten, at Danmark ligger på linje med internationale resultater, og at fokus for forbedringer skal lægges på at mindske den tid, der går fra symptomdebut til EVT. Case: Resultaterne har foranlediget en ændring i modtageproceduren for disse patienter på Odense Universitets Hospital (OUH). Der er sat ind på at strømline kommunikationen og at reducere antallet af skridt, når patienten ankommer til den fælles akutmodtagelse (FAM). Af figur 1 fremgår det, at neurologisk bagvagt (trombolysevagten), modtager opkald om patienter, der enten kommer til vurdering om trombolysebehandling, eller er vurderet på et andet trombolysecenter og kommer til EVT behandling. Trombolysevagten underretter alle, der er involveret i modtagelsen af patienten. Det nyeste er, at patienten transporteres direkte til CT scanneren og at trombolysen blandes og bringes med til scanneren, så det er klart ved patientens ankomst. Man forsøger derfor, i videst muligt omfang, at planlægge andre patienter således, at scanneren er ledig ved modtagelsen af trombolysepatienten. Ved modtagelsen sker al neurologisk vurdering af patienten på scannerlejet samtidigt med, at patienten gøres klar til scanning af radiografen og modtagesygeplejersken. Findes der stadig grund til at scanne patienten, scannes patienten med det samme, og kan en blødning udelukkes på den første scanning, startes trombolysen omgående. Efter scanning køres patienten enten i venteposition eller direkte til EVT behandling. Konklusion: Ændringerne i procedure er trådt i kraft fra den 11. september i år og det fulde udbytte vil først reelt kunne måles i det nye år. Umiddelbart ses dog en positiv effekt på patientens forløb gennem FAM, hvor man har registreret patienter, der er scannet og kørt videre inden for 20 minutter efter ankomst. Der har også været tendens til, at flere får foretaget trombolysescanninger, men dette skal nok også ses i lyset af resultaterne fra det nyligt offentliggjorte DAWN studie, der fastslår, at patienter der modtages mellem 6-24 timer efter symptomdebut også kan have gavnlig effekt af EVT behandling. Referencer:

(1) Dansk Apopleksiregister Årsrapport 2016, Regionens Kliniske Kvalitetsudviklingsprogram (RKKP)

36

Figur 1. Figuren viser algoritmen for modtagelse af patienter til trombolyse/trombektomi vurdering

37

Kategori: Poster (kasuistik) 1.8 Titel: Concomitant polymyalgia rheumatica and large-vessel vasculitis visualized on 18F-FDG PET/CT Forfatternavne: Jane Maestri Brittain, Eric von Benzon & Kim Francis Andersen. Navn på den der præsenterer: Jane Maestri Brittain. Baggrund: Polymyalgia rheumatica (PMR) and large-vessel vasculitis (LVV) are related rheumatic diseases which occasionally are present concomitantly (1). PMR is characterized with synovitis and bursitis. In LVV inflammation of the blood vessel wall is seen. Both disorders can be difficult to diagnose since patients often present non-specific symptoms and results of blood tests. Exploiting that inflamed tissue has a high glycolytic metabolism 18F-FDG PET/CT can be used as a diagnostic imaging modality in PMR and LVV (2). Case: A healthy 80-year old man had during the past 6 month experienced a 5 kg non-intended weight loss and extreme fatigue. Previously he bicycled 20 – 40 km and rowed 10 – 15 km in a kayak per week but muscle tenderness in the shoulder and hip regions made exercising impossible. Blood tests showed a mild normocytic normochromic anemia, elevated C-reactive protein (100 mg/L), and erythrocyte sedimentation rate (88 mm/hour). Due to suspiciousness of malignancy, a CT scan of the thorax and abdomen was performed with normal findings. Subsequently, PMR was suspected but malignancy was still a differential diagnosis. Highly pathological 18F-FDG uptake was visualized in nine anatomical localizations characteristic of PMR: acromioclavicular joints, shoulder joints, sternoclavicular joints, hip joints, two greater trochanters, two iliopectinal bursae, two symphysis pubis enthesis, two ischial tuberosities, and interspinous ligaments, respectively (3). Additionally, generalized, highly pathological 18F-FDG uptake was seen in the wall of the aorta, the axillary, the subclavian, the common carotid, the common femoral, the superficial femoral, and the profound femoral arteries, respectively, indicative of concomitant LVV. No malignancy was visualized. Based on the clinical information and the results of the 18F-FDG PET/CT the patient was treated with 60 mg of Prednisolone resulting in normalization of blood tests and rapid remission of symptoms. He also regained the strength to exercise. Konklusion: Our case shows that 18F-FDG PET/CT can be used as a strong supportive imaging tool in the diagnosis of PMR and LVV but also its important role for differential diagnostic purposes. Referencer: 1. Buttgereit F, Dejaco C, Matteson EL, et al. Polymyalgia rheumatic and giant cell arteritis: a systematic review. JAMA. 2016;315:2442-2458. 2. Vaidyanathan S, Patel CN, Scarsbrook AF, et al. FDG PET/CT in infection and inflammation – current and emerging clinical applications. Clin Radiol. 2015;70:787-800. 3. Sondag M, Guillot X, Verhoeven F, et al. Utility of 18F-fluoro-deoxyglucose positron emission tomography for the diagnosis of polymyalgia rheumatic: a controlled study. Rheumatology. 2016;55:1452-1457.

38

Figur 1:

FIGURE 1: (A) Frontal PET MIP showed highly increased 18F-FDG uptake diffusely around shoulder (yellow arrows) and hip joints (red arrows) but also in the wall of the large arteries (green arrows) indicating synchronic LVV confirmed on sagittal (B) fused PET/CT of the aorta (green arrow).

39

Kategori: Videnskabelig poster 2.9 The Influence of Anthropometric and Basic Circulatory Variables on Count Rate in Cadmium-Zinc-Telluride SPECT gamma camera gated tomographic radionuclide angiography. Julie Rydberg, Jannick Andersen, Christian Haarmark, Bo Zerahn Klinisk Fysiologisk og Nukmlearmedicinsk Afdeling, Herlev og Gentofte Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark Er dog aktuelt ansat på: Funktions- og Billeddiagnostisk Enhed, Røngtensektionen, Kettegård Allé 30, 2650 Hvidovre. Aim We aimed to determine the influence of weight, height, gender, age, heart rate and blood pressure on count rate in CZT SPECT gamma camera gated tomographic radionuclide angiography. Method A total of 1.065 eligible patients referred for routine assessment of left ventricular ejection fraction (LVEF) were registered from August 2015 to November 2016. Data was recorded on heart rate, systolic and diastolic blood pressure, age, gender, height, weight, and count rate. All radionuclide angiographies were performed on a dedicated cardiac CZT SPECT gamma camera, GE Discovery 530c. A dose of 550MBq 99mTc-labeled human serum albumin was administered intravenously to each patient. Each acquisition was analyzed twice by two experienced technologists. Results Count rate varied from 1.2 to 8.9 counts per second. All test variables were significantly associated with count rate. From the preliminary analysis, weight appeared as the main contributing factor for explaining the variations in count rate with and R2 of 0.68. A visual analysis of the relationship between count rate and weight revealed that a logarithmic transformation of count rate enhanced the linear relationship. Based on our preliminary analysis, we performed a multiple linear regression analysis of count rate (Y), with the explanatory variables: weight (XW), height (XH), gender (XG) and age (XA). The final model:

𝐿𝑜𝑔(𝑌) = 𝛽* + 𝛽, ⋅ 𝑋/ + 𝛽0 ⋅ 𝑋1 + 𝛽2 ⋅ 𝑋3 + 𝛽4 ⋅ 𝑋5

This model explains 75% of the variance (adjusted R2: 0.747) in log(count rate). Conclusion Patient height, weight, gender and age all have a significant impact on count rate when performing CZT radionuclide angiography and can subsequently be used for individualized planning of tracer dosage. Figure The relative importance of each predictor variables in the final model defined by the portion of the squared multiple correlation explained by the contribution of each possible predictor.

40

41

Kategori: Poster (Kasuistik) 2.1 Arteria mesenterica superior syndrom hos ung kvinde efter større vægttab Forfattere: Rasmus Ahlfors, Dana Jensen Fremlægger: Rasmus Ahlfors, introlæge på radiologisk afdeling, Slagelse Sygehus Baggrund: Arteria mesenterica superior syndrom (SMAS) er en sjælden tilstand (prævalens 0,5-2,4%(1) ) forårsaget af nedsat vinkel mellem aorta abdominalis og a. mes. sup. Den almindeligste årsag er tab af det viscerale fedt, der polstrer de intraabdominale kar, som følge af stort vægttab(2) eller katabole processer(1) , men også visse operationer(3) og AAA(4) kan forårsage SMAS. Til forskel fra firbenede pattedyr afgår den menneskelige a. mes. sup. ikke i en ret vinkel fra aorta, men i en vinkel på 38-56 grader og med en afstand mellem de to kar på 10-28 mm(3) . Ved f.eks. tab af fedt kan vinkel og afstand falde til et niveau (typisk 6-16 grader og 2-8 mm), hvor duodenums 3. stykke afklemmes. Afklemningen medfører duodenal udspiling og ventrikelretention - med en række yderligere komplikationer til følge(5). Typiske debutsymptomer er abdominal ubehag, kvalme og opkastninger. Symptomerne forværres ifm. fødeindtag, og afhjælpes af knæ-til-bryst positur i liggende venstreleje(6) – et kendetegn, der indgår i de kliniske kriterier for SMAS (7) . Diagnosen stilles ved CT eller UL. Syndromet kan afhjælpes konservativt med aflastning af ventrikel og proksimale duodenum ved en kombination af sonde og flydende kost, samt – på længere sigt – en reetablering af det viscerale fedt. Dog vil mange patienter have brug for operation(8) , hvis ikke tilstanden bedres efter 10-12 dage(6) . Case: En 21-årig, tidligere altid rask, kvinde henvist af egen læge med vedvarende abdominalia. Hun havde i de foregående 18 mdr. haft et tilsigtet vægttab fra 105 til 77 kg. Smerterne var primært postprandiale, men kunne også forekomme i fastetilstand. De var ledsaget af kvalme, men uden opkastninger og varede mellem 10 og 90 minutter. Der blev ikke rapporteret om lindrende faktorer.

CT af abdomen afslørede en grænsenormal vinkel mellem a. mes. sup. og aorta (16 grader) og nedsat karafstand på niveau med duodenum (6 mm). Der var ikke på scanningstidspunktet udspiling af duodenums 3. stykke eller ventrikelretention.

Konklusion: SMAS er et relativt sjældent syndrom, der kan opstå som følge af blandt andet vægttab. Det er nemt at afklare med abdominal UL og bør indgå i de diagnostiske overvejelser ved patienter med abdominalia og opkastninger.

42

Referencer

43

1. Welsch T, Büchler MW, Kienle P. Recalling superior mesenteric artery syndrome. Dig Surg [Internet]. 2007 [cited 2017 Nov 6];24(3):149–56. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17476104

2. Bhagirath Desai A, Sandeep Shah D, Jagat Bhatt C, Umesh Vaishnav K, Salvi B. Measurement of the Distance and Angle Between the Aorta and Superior Mesenteric Artery on CT Scan: Values in Indian Population in Different BMI Categories. Indian J Surg [Internet]. 2015 Dec 14 [cited 2017 Nov 6];77(Suppl 2):614–7. Available from: http://link.springer.com/10.1007/s12262-013-0941-1

3. Bernotavičius G, Saniukas K, Karmonaitė I, Zagorskis R. Superior mesenteric artery syndrome. Acta medica Litu [Internet]. 2016 Nov 26 [cited 2017 Nov 6];23(3):155–64. Available from: http://lmaleidykla.lt/ojs/index.php/actamedicalituanica/article/view/3379

4. Okuyama Y, Kawakami T, Ito H, Otsuka H, Enoki Y, Nishimura M, et al. A case of ischemic duodenitis associated with superior mesenteric artery syndrome caused by an abdominal aortic aneurysm. Case Rep Gastroenterol [Internet]. 2011 May [cited 2017 Nov 6];5(2):278–82. Available from: https://www.karger.com/Article/FullText/328442

5. Ko K-H, Tsai S-H, Yu C-Y, Huang G-S, Liu C-H, Chang W-C. Unusual complication of superior mesenteric artery syndrome: spontaneous upper gastrointestinal bleeding with hypovolemic shock. J Chin Med Assoc [Internet]. 2009 Jan [cited 2017 Nov 6];72(1):45–7. Available from: http://linkinghub.elsevier.com/retrieve/pii/S1726490109700206

6. Shah D, Naware S, Thind S, Kuber R. Superior mesenteric artery syndrome: an uncommon cause of abdominal pain mimicking gastric outlet obstruction. Ann Med Health Sci Res [Internet]. 2013 Nov [cited 2017 Nov 6];3(Suppl 1):S24-6. Available from: http://www.amhsr.org/text.asp?2013/3/5/24/121214

7. Matheos E, Vasileios K, Ioannis B, Dimitrios Z, Kostas H. Superior Mesenteric Artery Syndrome. Case Rep Gastroenterol [Internet]. 2009 May 27 [cited 2017 Nov 6];3(2):156–61. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21103268

8. Lorentziadis ML. Wilke’s syndrome. A rare cause of duodenal obstruction. Ann Gastroenterol [Internet]. 2011 [cited 2017 Nov 6];24(1):59–61. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24714262

44

Category: Poster (kasuistik/case report) 2.2 Title: The persistent trigeminal artery and hypoglossal artery- development, anatomy and complications Forfatternavne: Ali Al-hakim, Shazia Rehman Navn på den der præsenterer: Ali Al-hakim Background: The carotid-vertebrobrasilar anastomoses are four arteries that exist during the embryonic development (Fig.1). They are named after the associated anatomy. Starting from the most cephalic, they include the Primitive Trigeminal Artery(PTA), Otic Artery(OA), Hypoglossal Artery(PHA) and Proatlantal Intersegmental Artery(PIA). They regress upon development of the posterior communicating artery(PCoA)(1). In rare cases they persist beyond the normal development and are usually incidental findings. The two most common persisting fetal anastomoses are PTA and PHA with an incidence reported for PTA of 0,1-0,6%(1) and for PHA of 0.027–0.26 %(2) in different studies using Computed tomographic angiography(CTA) or Magnetic Resonance Imaging angiography(MRA)(1). Persisting PTA and PHA are commonly asymptomatic, but associations with clinical syndromes and vascular anomalies have been reported. PTA-associated cerebrovascular pathologies include trigeminal neuralgia due to vascular compression(3) and trigeminal cavernous fistula(4). Persisting PHA is most likely to cause clinical symptoms due to the posterior circulation often being strongly dependent on the blood supply from the carotid system(5). Cases: We describe 2 cases of the typical variants of persisting PTA and PHA. Case 1: A 56-year old female with bipolar disorder and alcohol addiction was admitted with symptoms of confusion. A MRI of the cerebrum revealed a subacute infarction in the right gyrus postcentralis. We performed a CTA which revealed an anomalous artery arising from the right Internal Carotid Artery after entering the cranium through the carotid foramen. It ran lateral around the sella turcica and joined the basilar artery. The finding suggested persistent PTA. Case 2: A 72-year old female was admitted with symptoms of temporary loss of nasal peripheral vision on the right eye. Non-contrast CT cerebrum was normal. We performed a CTA which revealed a second bifurcation of the right ICA giving rise to an artery entering intracranially through the right hypoglossal canal and join the basilar artery. The finding met the criteria of a persistent PHA. Conclusion: The two rare cases describe the most common variants of the persisting PTA and PHA. Acknowledgement and description of these arteries is important due to their association with the conditions described and when planning intracranial and endovascular surgery.

45

References: 1. Meckel S, Spittau B, McAuliffe W. The persistent trigeminal artery: Development, imaging anatomy, variants, and associated vascular pathologies. In: Neuroradiology. 2013. p. 5–16. 2. H. K, H. N, S. W, N. H, R.R. S, E.D. G, et al. A large aneurysm of the persistent primitive hypoglossal artery. Neurosurgery [Internet]. 1992;30(5):794–7. Available from: http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L222788 73%5Cnhttp://sfx.library.uu.nl/utrecht?sid=EMBASE&issn=0148396X&id=doi:&atitle=A+larg e+aneurysm+of+the+persistent+primitive+hypoglossal+artery&stitle=NEUROSURGERY&title =Neurosurg 3. Bondt BJ, Stokroos R, Casselman J. Persistent trigeminal artery associated with trigeminal neuralgia: Hypothesis of neurovascular compression. Neuroradiology. 2007;49(1):23–6. 4. Enomoto T, Sato A, Maki Y. Carotid-cavernous sinus fistula caused by rupture of a primitive trigeminal artery aneurysm. Case report. J Neurosurg [Internet]. 1977;46(3):373–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/839263 5. De Caro R, Parenti A, Munari PF. The persistent primitive hypoglossal artery: A rare anatomic variation with frequent clinical implications. Ann Anat. 1995;177(2):193–8.

46

Figure:

Fig. 1(1) The four persistent embryological carotid-vertebrobasilar anastomoses: Primitive trigeminal artery (short arrow) Otic Artery (asterisk) Hypoglossal artery (long arrow) Proatlantal intersegmental artery (arrowhead)

47

Kategori: Poster (kauistisk) 2.3 1. Poster (Kasuistik)

2. Titel: Chyluria - a rare finding after partial nephrectomy

3. Mohammed Ali Hadi, Yousef Wirenfeldt Nielsen

4. Præsenteres af: Mohammed Ali Hadi

5. Radiologisk afdeling, Herlev Hospital

6. Abstract:

Background:

Chyluria is defined as presence of fatty lymphatic fluid in the urinary bladder. It occurs when an abnormal connection develops between the lymphatic and urinary system (1). Causes are infections, trauma and surgery (2). Case: 62-year old male that had undergone left sided partial nephrectomy due to renal cell carcinoma. There was no metastasis and the operation was considered radical. On follow-up 18 months later, contrast-enhanced CT of the chest, abdomen and pelvis showed fat-fluid level in the bladder (figure 1), in keeping with chyluria. The patient had no symptoms and no further investigations were deemed necessary (3).

Conclusion:

Chyluria is a rare complication after renal surgery and is believed to be more common after partial than complete nephrectomy (4). It is most often asymptomatic and incidentally detected on follow-up CT.

References:

1. Diamond E, Schapira HE. A review of the literature. 1985;XXVI(5).

2. Graziani G, Verdesca S. Chyluria Associated with Nephrotic- Range Proteinuria : Pathophysiology ,. 2011;

3. Miller FH, Keppke AL, Gabriel H, Hoff F, Fh M, Al K, et al. CT Diagnosis of Chyluria After Partial Nephrectomy. 2007;(January):25–8.

4. Kim RJ, Joudi FN. Chyluria after Partial Nephrectomy : Case Report and Review of the Literature. 2009;1–4.

48

49

Kategori: Poster (kauistisk) 2.4 Abstract

Titel: Intracerebral hemorrhage –Dual-Energy-CT as a tool to differentiate between bleeding in an underlying tumor and a pure hemorrhage. Categori: Poster (kasuistik) Authors: Tina Mehajerpour, Jesper Gade Presentation by: Tina Mehajerpour, introlæge. Afdeling og sygehus: Radiologisk afdeling, Herlev sygehus. Background: Atypical intracerebral hemorrhages (ICH) may represent bleeding in a tumor. However, detection of underlying tumor in patient with acute ICH may be difficult because hematomas can mask enhancement of tumor on post contrast CT(1), MRI has similar limitations. With conventional techniques of MRI, there is a time interval (app. 3 days – 3 months) where contrast enhancement (representing underlying tumor) and hemorrhage cannot be differentiated. Because of this limitation final diagnosis is often delayed. Dual-energy-CT (DECT) utilizes a technique that can differentiate attenuation from contrast enhancement (iodine content) from hemorrhage, regardless of the onset time of bleeding, thereby eliminating this period of time of uncertain diagnosis. DECT uses data from two different x-ray energy spectra to generate the images. X-ray attenuation as a function of photon energy is different for distinctive materials, in this example iodine, coagulated blood and water. DECT material decomposition is a mathematical method that calculates the fraction of total attenuation that can be attributed to two or three distinctive materials, in this situation enabling the separation of iodinated contrast media update in tumor from hemorrhage. These calculated data are shown as different images e.g. iodine-map and virtual non-contrast images, thereby enabling the visualization of presence or absence of enhancing tumor tissue(2,3). Case: 76-year old woman with a known intracerebral tumor is admitted and her head CT shows bleeding from the tumor. With DECT and Iodine-mapping, we demonstrate how the known underlying tumor can be isolated and separated from the hemorrhage. The tumor is vascularized and enhances with iodinated contrast media. Ioding mapping shows this enhancement, while it is not showing the high attenuation of the bleeding. Conclusion: Often patients with an ICH are admitted to hospitals after the acute phase. There has been lacking diagnostic imaging techniques in evaluating whether an ICH originates from an underlying brain tumor subacute. We show that DECT can differentiate between contrast enhancement (i.e. tumor

50

tissue) and hemorrhage, in patients with bleeding in a brain tumor. DECT is not limited to a certain period of time and this gives us the possibility to reduce an otherwise long diagnostic process. References:

(1) Kim S.J et al. Dual-Energy CT in the Evaluation of Intracerebral Hemorrhage of Unknown Origin: Differentiation between Tumor Bleeding and Pure Hemorrhage. AJNR Am J Neuroradiol 33:865 – 72; 2012.

(2) Gupta R, Phan CM, Leidecker C, et al. Evaluation of dual-energy CT for differentiating intracerebral hemorrhage from iodinated contrast material staining. Radiology 257:205–11; 2010.

(3) Reza Forghani, Bruno De et al., Dual-Energy Computed Tomography Physical Principles, Approaches to Scanning, Usage, and Implementation: Part 1. Neuroimag Clin N Am 27 371–384, 2017.

51

Kategori: Poster (kauistisk) 2.5 Fibrøs dysplasi - sjælden årsag til muskuloskeletale smerter hos børn og unge Shakiba Mosadegh, Benedicte Lange Billeddiagnostisk Afdeling, Nordsjællands Hospital, Hillerød Baggrund: Fibrøs dysplasi (FD) er karakteriseret ved fokal benign omdannelse af knoglevæv til fibrøst væv (1). FD er forårsaget af genmutationer lokaliseret på 20q13 og debuterer i barndommen (1-3). FD er ofte et tilfældigt radiologisk fund i lange rørknogler, costae, kraniet samt pelvis. Kan give symptomer i form af smerter, deformitet eller fraktur (4). Er enten monoostotisk (80-85 %) eller polyostotisk involverende flere knogler. Sidstnævnte er hos ca. 5 % ledsaget af cafe-au-lait pletter og endokrine forstyrrelser og benævnes McCune-Albrights syndrom (1,2,5). FD kan som oftest diagnosticeres ved CR, CT eller MR, men knoglebiopsi kan være nødvendigt. Behandlingen afhænger af læsionen og patientens symptomer. Kosmetisk skæmmende asymmetri og smerter kan nødvendiggøre kirurgisk intervention (6); bifosfonat behandling har været anvendt i svære tilfælde af FD (7). I meget sjældne tilfælde kan FD undergå malign transformation, hvorfor klinisk og radiologisk langtidsopfølgning anbefales (1). Case: 14-årig ellers rask dreng blev henvist til ortopædkirurgisk ambulatorium pga. intermitterende smerter i højre hofte gennem 1 år. Røntgenundersøgelse af bækken viste større radiolucent område svarende til højre ala ossis ilii, blev tolket som overlejrende luft i coecum. Nyt røntgen af bækken viste det samme; MR-scanning demonstrerede ekspansiv osteolytisk proces i højre ala ossis ilii samt en mindre ved venstre sacroiliacalled. Efterfølgende CT- vejledt biopsi viste fibrøs dysplasi. DEXA-scan viste nedsatte BMD værdier med Z-score i lumbal regionen på -1.5 std, helkrops BMD var normal. Knogleskintigrafi viste øget knoglemetabolisme i flere costae, i L4, i højre os ileum samt i venstre side af S1. Gentest for McCune-Albright sygdom på GNAS1-genet i fuldblod var normal, hvorimod mutationsudredning i GNAS1-genet på knogle-DNA viste en mutation, c.602G>A, p. Arg201His i exon 8. Denne mutation er tidligere beskrevet hos patienter med McCune-Albright syndrom. Diagnosen er således genetisk bekræftet. Konklusion: Vi vil gøre opmærksom på FD som sjælden årsag til ossøse smerter hos børn og unge. FD kan i de fleste tilfælde diagnosticeres på røntgen, CT- og MR scanning, men knoglebiopsi kan være nødvendig. Ved polyostotisk FD med eventuel endokrin dysfunktion og cafe-au-lait pletter bør patienten genetisk udredes for McCune-Albright sygdom. FD bør følges med henblik på funktionsnedsættelser, kosmetiske problemer og eventuel malign transformation.

52

Referencer:

(1) Neville B, Damm D, Bouquot C. Soft Tissue Sarcomas. In: John Dolan, editor. Oral and Maxillofacial Pathology. 3rd ed. United States of America: Saunders Elsevier; 2008. p. 553-557. (2) Shenker A, Weinstein LS, Sweet DE, Spiegel AM. An activating Gs alpha mutation is present in fibrous dysplasia of bone in the McCune-Albright syndrome. J Clin Endocrinol Metab 1994 Sep;79(3):750-755.

(3) Menon S, Venkatswamy S, Ramu V, Banu K, Ehtaih S, Kashyap VM. Craniofacial fibrous dysplasia: Surgery and literature review. Ann Maxillofac Surg 2013 Jan;3(1):66-71. (4) DiCaprio MR, Enneking WF. Fibrous dysplasia. Pathophysiology, evaluation, and treatment. J Bone Joint Surg Am 2005 Aug;87(8):1848-1864.

(5) Collins MT, Singer FR, Eugster E. McCune-Albright syndrome and the extraskeletal manifestations of fibrous dysplasia. Orphanet J Rare Dis 2012 May 24;7 Suppl 1:S4-1172-7-S1-S4. Epub 2012 May 24. (6) Kusano T, Hirabayashi S, Eguchi T, Sugawara Y. Treatment strategies for fibrous dysplasia. J Craniofac Surg 2009 May;20(3):768-770.

(7) Lane JM, Khan SN, O'Connor WJ, Nydick M, Hommen JP, Schneider R, et al. Bisphosphonate therapy in fibrous dysplasia. Clin Orthop Relat Res 2001 Jan;(382)(382):6-12.

53

Kategori: Poster (kauistisk) 2.6 Small intestine diverticulitis as an unusual cause of acute abdominal pain Elaha Salik, Benedicte Lange Department of Radiology, Hospital of North Zealand, Hilleroed Background: Non-Meckel small intestine diverticular disease is rare and has been reported in 0.3–1.3% of postmortem studies and in 0.5–1.9% of cases in small intestine contrast media studies. Duodenum is the most common site of small bowel diverticula seen in up to 6% of patients whereas diverticula in the jejunum and ileum are much less common with a reported incidence of 0.07–1.0% on imaging studies and 0.2–20 and 0.07–0.8% on autopsies, respectively (1). Diverticulitis is a rare pathology occurring in only 0,07 % to 2 % of the population with a higher incidence among elderly (2). Jejuno-ileal diverticulitis can be difficult to diagnose, partly because of the location of the disease which leads to unspecific symptoms and because of the rare occurrence. The symptoms can include acute abdominal pain (central or in the right or left lower quadrant), fever, diarrhea or bleeding (3). Based on a case, the purpose of this poster is to highlight the main symptoms and radiological findings in jejunal diverticulitis. Case: A 75 year old man was hospitalized with increasing unspecific lower abdominal pain and nausea through five days. Blood work revealed high infection parameters and CT of the abdomen showed diverticulitis in the small intestine complicated by a 4 x 1,8 cm abscess formation. He was primarily treated conservatively with antibiotics. The patient was re-hospitalized 20 days later with central abdominal pain and fever. The blood work revealed the infection parameters similar to the previous hospitalization. The repeated CT of the abdomen revealed micro-perforation, abscess formation and inflammation of the adjacent intestines and mesentery around the abscess. The patient underwent surgery and Jejunal diverticulitis with perforated abscess was identified and approximately 25 cm of the jejunum was resected. The patient was postoperatively treated with antibiotics and was released to follow-up with the GP. Conclusion: Diverticulitis in jejunum is a rare entity with a somewhat diffuse symptomatology. CT scan with intravenous contrast is the best radiological imaging for exact diagnosis. The condition can be complicated by abscesses and eventually perforation, which demands meticulous clinical observation, treatment with antibiotics and eventually surgery. References: (1) Ejaz S, Vikram R, Stroehlein JR. Non-Meckel Small Intestine Diverticulitis. Case Rep Gastroenterol 2017 May-Aug;11(2):462-472. (2) Nejmeddine A, Bassem A, Mohamed H, Hazem B, Ramez B, Issam BM. Complicated jejunal diverticulosis: A case report with literature review. N Am J Med Sci 2009 Sep;1(4):196-199. (3) Mantas D, Kykalos S, Patsouras D, Kouraklis G. Small intestine diverticula: Is there anything new? World J Gastrointest Surg 2011 Apr 27;3(4):49-53.

54

Kategori: Poster (kauistisk) 2.7 Cervical fractures in patients with Mb. Bechterew and DISH Bolette Vilmun (presenter), Benedicte Lange. Department of Radiology, University of Hilleroed, Hospital of North Zealand, Denmark. Background: The ankylosing spinal disorders (ASD) - Ankylosing Spondylitis (AS) and Diffuse Idiopathic Skeletal Hyperostosis (DISH) - share bone proliferations in the axial skeleton producing bone proliferations with high susceptibility to trauma related injuries especially in the lower cervical spine (1). AS is a seronegative spondylarthropathy characterized by fusion (ankylosis) of the spine and sacroiliac joints and eventually calcification of the intervertebral disc, which becomes the weakest point and therefore a common site of fracture (2). Several studies have reported delay in diagnosis of ASD-related cervical fractures with associated decline in neurological function, most likely due to low-impact trauma and moderate pain combined with insufficient imaging (3,4). DISH can cause the same severe fractures and the two diseases can be difficult to distinguish and can occur simultaneously (5,6) . In contrast to AS, DISH fractures are prone to occur through the ventral body. High resolution CT imaging is one of the most reliable tools for identifying the discrete fracture lines (6). Since the risk of concomitant spinal cord injury in patients with AS is 10 times higher than in the healthy population, additional MRI is recommended (7). Based on a case, the purpose of this poster is to highlight the high susceptibility to cervical spine fractures in patients with ASD and the importance of education, early detection and treatment.

Case: A 75-year old male was referred by the GP to X-ray due to minor trauma to the cervical spine 2 days earlier. X-ray showed DISH with a dislocated fracture through the C5/C6 disc. A cervical collar was applied in the emergency ward and additional MRI and CT confirmed the diagnosis and raised suspicion of additional AS. No neurological deficit was initially observed. The patient underwent 360 degree spondylodesis and was left with only minor neurological deficit. Conclusion: Suspected fractures in patients with ASD should immediately be followed by the application of a rigid cervical collar and proper imaging techniques in order to avoid neurological disorders. Early detection through education of medical staff and patients is an important factor in successful diagnosis and treatment of a suspected fracture. References:

(1) Thumbikat P, Hariharan RP, Ravichandran G, McClelland MR, Mathew KM. Spinal cord injury in patients with ankylosing spondylitis: a 10-year review. Spine (Phila Pa 1976) 2007 Dec 15;32(26):2989-2995. (2) Graham B, Van Peteghem PK. Fractures of the spine in ankylosing spondylitis. Diagnosis, treatment, and complications. Spine (Phila Pa 1976) 1989 Aug;14(8):803-807. (3) Caron T, Bransford R, Nguyen Q, Agel J, Chapman J, Bellabarba C. Spine fractures in patients with ankylosing spinal disorders. Spine (Phila Pa 1976) 2010 May 15;35(11):E458-64. (4) Schiefer TK, Milligan BD, Bracken CD, Jacob JT, Krauss WE, Pichelmann MA, et al. In-hospital neurologic deterioration following fractures of the ankylosed spine: a single-institution experience. World Neurosurg 2015 May;83(5):775-783. (5) Olivieri I, D'Angelo S, Palazzi C, Padula A, Mader R, Khan MA. Diffuse idiopathic skeletal hyperostosis: differentiation from ankylosing spondylitis. Curr Rheumatol Rep 2009 Oct;11(5):321-328. (6) Harrop JS, Sharan A, Anderson G, Hillibrand AS, Albert TJ, Flanders A, et al. Failure of standard imaging to detect a cervical fracture in a patient with ankylosing spondylitis. Spine (Phila Pa 1976) 2005 Jul 15;30(14):E417-9. (7) Sapkas G, Kateros K, Papadakis SA, Galanakos S, Brilakis E, Machairas G, et al. Surgical outcome after spinal fractures in patients with ankylosing spondylitis. BMC Musculoskelet Disord 2009 Aug 2;10:96-2474-10-96.

55

Kategori: Poster (kasuistik) 2.8 Titel: IgG4 relateret sygdom som mulig årsag til systemisk inflammation hos et barn Forfatternavne: Wolsk, Helene Mygind; Strandberg, Charlotte; Nielsen, Susan. Navn på den der præsenterer: Helene M Wolsk, Radiologisk afdeling, Herlev og Gentofte hospital. Baggrund: IgG4 relateret sygdom (IgG4-RD) er en nyligt beskrevet, immunmedieret sygdom(1). IgG4-RD ses hyppigst hos midaldrende og med en overvægt af mænd, men der er også beskrevet tilfælde hos børn(2). IgG4-RD kan ramme alle organer, fraset hjernen. Tidligere beskrevne unifokale sygdomsenheder såsom subtyper af autoimmun pancreatitis(3), scleroserende cholangitis(4), pseudotumores i lunger og lever(5) bliver nu opfattet som en del af IgG4-RD sygdomsspektret, da der ses identiske patologiske, serologiske, radiologiske og kliniske fund. Derved kan IgG4-RD klassificeres som en systemisk sygdom med varierende fænotype. Ved radiologiske undersøgelser ses tumor-lignende læsioner, der histologisk er karakteriseret ved vævsinfiltration af IgG4-positive plasmaceller. Desuden ses forhøjet serum IgG4 i serum hos 60-70%(6). IgG4-RD responderer godt på behandling med korticoserioder, men relaps ses hyppigt ved seponering(1). Case: En tidligere rask, 12 årig dreng, debuterede med mavesmerter, vægttab, artritis symptomer fra knæ og håndled og et ukarakteristisk exanthem. Biokemisk var der påvirkede levertal, forhøjet sænknings reaktion, men normal CRP. IgG, inkl. IgG4, var normal. Ultralyd af abdomen viste en hyperekkoisk proces i leveren, tydende på vævsinvolvering. En MRCP viste kaliberveksling af de intrahepatiske galdeveje, forenelig med scleroserende cholangitis. Patienten udviklede kort efter symptomer på pneumoni; CT viste lobær pneumoni, og biopsi viste fibroserende aktiv og kronisk pleuritis. Efterfølgende fik patienten vedvarende nedsat lungefunktion. MR af muskler viste diskrete tegn på fasciitis, men en muskelbiopsi var normal. Ekkokardiografi viste let nedsat venstresidig systolisk funktion. Drengen blev sat i behandling med kortikosteroider samt mycophenolsyre, ursodeoxycholsyre og hydroxychloroquin for den scleroserende cholangitis, hvorefter symptomerne svandt og leverbiokemien normaliseredes. Efter længere tids behandling, sås desuden regression af den hyperekkoiske proces i leveren, samt normalisering af de intrahepatiske galdeveje ved MRCP. Konklusion: Vi beskriver et sygdomsforløb med en dreng som havde symptomer fra flere organsystemer og diagnostiske tegn tydende på IgG4-RD. IgG4-RD bør især mistænkes ved pancreatitis af ukendt årsag, scleroserende cholangitis, bilateral forstørrelse af spyt- og eller tårekirtler, retroperitonal fibrose samt orbitale pseudotumores eller proptose. Diagnosen kræver opfyldelse af flere diagnostiske kriterier(Tabel). Større

56

opmærksomhed på denne sygdom er vigtig da tidlig diagnostik og behandling er essentiel, for at undgå fibrosedannelse og senere organskade. Referencer: 1. Stone JH, Zen Y, Deshpande V. IgG4-Related Disease. N Engl J Med. 2012;366(6):539–51.

2. Karim F, Loeffen J, Bramer W, Westenberg L, Verdijk R, van Hagen M, et al. IgG4-related disease: a systematic review of this unrecognized disease in pediatrics. Pediatr Rheumatol Online J [Internet]. 2016 Mar 25 [cited 2016 Dec 21];14.

3. Bolia R, Chong SY, Coleman L, MacGregor D, Hardikar W, Oliver MR. Autoimmune Pancreatitis and IgG4 Related Disease in Three Children. ACG Case Rep J [Internet]. 2016 Aug 31 [cited 2016 Oct 11];3(4).

4. Mendes FD, Jorgensen R, Keach J, Katzmann JA, Smyrk T, Donlinger J, et al. Elevated Serum IgG4 Concentration in Patients with Primary Sclerosing Cholangitis. Am J Gastroenterol. 2006 Sep;101(9):2070–5.

5. Nagashima K, Sano I, Kobayashi T, Eto K, Nagai K, Ninomiya R, et al. A Case of IgG4-related Lung Pseudotumor and Pleural Inflammation with Autoimmune Hepatitis. Intern Med Tokyo Jpn. 2017 Oct 16.

6. Umehara H, Okazaki K, Masaki Y, Kawano M, Yamamoto M, Saeki T, et al. Comprehensive diagnostic criteria for IgG4-related disease (IgG4-RD), 2011. Mod Rheumatol. 2012 Jan 5;22(1):21–30.

Tabel: Diagnostiske kriterier for IgG4-RD, baseret på Umehara H et al. Comprehensive diagnostic criteria for IgG4-related disease (IgG4-RD).

(1) Kliniske og/eller radiologisk undersøgelse viser diffus/lokaliseret hævelse, eller solid masse i et eller

flere organer. (2) Hæmatologisk påvist eleveret serum IgG4 koncentration (≥135 mg/dL). (3) Histopatologisk påvist:

a) Udtalt lymfocyt og plasma-celle infitration og fibrose b) Infiltration af IgG4-postive plasmaceller: Ratio af IgG4/IgG positive celler > 40% og > 10%

positive plasmaceller. Sikker IgG4-RD = (1) + (2) + (3), Sandsynlig IgG4-D = (1) + (3), mulig IgG4-RD = (1) + (2)

57

Kategori: Poster (kasuistik) 2.9 Titel: Galdestensileus – Set på lav dosis CT urinveje Maryam Mozaffari, Gina Al-Farra. Maryam Mozaffari. Radiologisk afdeling, Herlev og Gentofte Hospital. Baggrund: Galdestenileus er en sjæland komplikation af cholecystolitiasis (1). Den skyldes en galdesten, der har migreret til tyndtarm igennem en bilioenterisk fistel. Fistlen er normalt dannet mellem galdeblæren og duodenum og obstruktionen er normalt i den terminale ileum. Det ses oftest hos ældre og er hyppigere hos kvinder (2, 3, 4). Symptomer afhænger af de forskellige kliniske typer af galdestenileus: akutte, subakutte og kroniske. Derfor kan anamnese med cholecystit, abdominalia, kvalme, opkastning, af og til hæmatemese forekomme. Uspecifikke symptomer forsinker diagnosen, og dette forøger mortaliteten. Radiologiske fund er afgørende for at stille diagnosen. Abdominal røntgen oversigt er ikke længere rutine men kan være nyttig. Ultralyd og CT-scanning med kontrast er de mest optimale modaliteter. Rigler-triaden (tarmobstruktion, pneumobili og en ektopisk galdesten, hyppigst set i højre fossa) er det klassisk radiologisk fund (5, 6,7). Behandlingen varierer mellem de forskellige kirurgiske procedurer og konservative behandlinger (5). Risikoen for residuerende galdestenileus er ca. 5% med 20% mortalitet. Den ses normalt inden for 30 dage efter den første episode og skyldes tilstedeværelsen af udiagnosticerede sten i tyndtarmen på tidspunktet for den første episode eller på grund af en ny migreret sten igennem en ubehandlet bilioenterisk fistel (8). Case: 54-årig kvinde blev indlagt på mistank om venstresidig nyresten. Lavdosis CT-skanning af urinveje viste galdestenileus. Pt. fik laparoskopisk operation og blev udskrevet uden komplikationer. En retrospektiv CT-angiografi af abdomen viste samme calculus i galdeblæren. Konklusion: Galdestenileus er en sjæland komplikation af cholecystolitiasis og Rigler-triade er den klassiske radiologisk fund. En forsinket diagnose forøger mortaliteten. Residuerende galdestenileus har en højere mortalitet og man skal altid kigge ekstra for at verificere de eventuelle flere sten for en bedre og sikkert behandlingsforløb. Referencer: 1. Raiford TS (1961) Intestinal obstruction due to gallstones. (Gallstone ileus). Ann. Surg. 153 : 830-8 2. Nuño-Guzmán CM, Marín-Contreras ME, Figueroa-Sánchez M, Corona JL. (2016) Gallstone ileus, clinical presentation, diagnostic and treatment approach. World Journal of Gastrointest Surgery 8(1): 65–76 3. Halabi WJ, Kang CY, Ketana N, Lafaro KJ, Nguyen VQ, Stamos MJ, Imagawa DK, Demirjian AN. (2014) Surgery for gallstone ileus: a nationwide comparison of trends and outcomes. Ann Surg. 259(2):329-35 4. Andersen PE et-al (2017) Basal Radiologi Textbook. FADL'S FORLAG :386

58

5. Beuran M, Ivanov I, Venter MD (2010) Gallstone Ileus–Clinical and therapeutic aspects. J Med Life 3(4): 365–371 6. Lassandro F, Gagliardi N, Scuderi M, Pinto A, Gatta G, Mazzeo R (2004) Gallstone ileus analysis of radiological findings in 27 patients. European Journal of Radiology 50(1):23-9 7. Yu CY, Lin CC, Shyu RY et-al (2005) Value of CT in the diagnosis and management of gallstone ileus. Gastroenterol 11 (14): 2142-7 8. Ulreich S and Massi J (1979) Recurrent Gallstone Ileus. American Journal of Roentgenology 133 (5): 921-923 Figur:

Figur1:Lav dosis CT- skanning af urinveje uden intravenøs kontrast viser flere dilaterede

tyndtarmslynger, overvejende i venstre side og analt for et hyperdens element, som kan repræsentere en galdesten, der ligger i den hypogastriske region.

59

Kategori: Poster (kasuistik) 2.10 Dual Energy-mammografi og brystkræft Abstract til Poster ved DRS Årsmøde 2018, Odense Zunara Butt 1), Martin Lundsgaard Hansen1), Eva Wiinstedt Clausen1), Ilse Vejborg1) 1) Radiologisk Klinik, Rigshospitalet Brystkræft er den hyppigste kræftform hos kvinder i Danmark med 4643 nye tilfælde årligt1. Ved Dual Energy (DE)-mammografi foretages mammografi med højog lav-energi røntgenstråler både før og efter intravenøs indgift af iodholdig kontrast2. Ved subtraktionsanalyse fremstilles kontrastopladende tumorsuspekte områder i brystet 3,4. DE-mammografi kan øge den diagnostiske sikkerhed i forhold til konventionel mammografi. Case 78-årig kvinde blev henvist fra egen læge til klinisk mammografi med palpabel knude i højre bryst. Den objektive undersøgelse bekræftede palpationsfund sv.t. kl. 11C. Ved bilateral mammografi i 3 projektioner suppleret med tomosyntese i MLOprojektion viste tilsvarende tumor sv.t. kl. 11C uden yderligere fund. Ultralyd påviste en stellat malignt udseende tumor målende 19 mm (BIRADS 5), der blev biopteret. Der blev foretaget supplerende DE-mammografi, hvor der blev påvist yderligere et mindre tumorsuspekt område sv.t. 11B. Efterfølgende ny fokuseret UL viste et hypoekkoisk langstrakt område på 8mm uden øget flow (BIRADS 3). Det nye fund blev ligeledes biopteret. Begge biopsier viste karcinom. Fundet af en yderligere tumor ændrede behandlingstilbuddet fra lumpektomi til mastektomi. Diskussion DE-mammografi kan være et supplement i den kliniske mammografi hos kvinder med tæt kirtelvæv, da metoden kan differentiere kontrastopladende tumorvæv i områder med tæt kirtelvæv. Studier har vist, at DE-mammografi alene har samme sensitivitet og specificitet som ved brug af kombinationen af mammografi og UL5. Endvidere har man vist, at DE-mammografi kan udføres på nogle af de samme indikationer som MR-scanning: Forud for brystbevarende operation, evaluering af respons efter neoadjuverende bestråling og som screening af højrisiko patienter. Konklusion I denne case har DE-mammografi fund haft indflydelse på selve behandlingstilbuddet for patienten, som blev ændret fra lumpektomi til mastektomi. DE-mammografi er en lovende ny modalitet, der kan være et supplement til konventionel mammografi hos kvinder med tæt brystvæv.

60

Referencer: 1) Cancer.dk, 2016, De hyppigste kræftformer, https://www.cancer.dk/hjaelpviden/ fakta-om-kraeft/kraeft-i-tal/de-hyppigste-kraeftformer/. [Besøgt D.28/11.17 kl. 19:40]. 2) David A. Scaduto, Yue-Houng Hu, Hailiang Huang, Jingxuan Liu, Kim Rinaldi, Gene Gindi, Paul R. Fisher and Wei Zhao, 2016, Dependence of Contrast- Enhanced Lesion Detection in Contrast-Enhanced Digital Breast Tomosynthesis on Imaging Chain Design, Springer international Publishing Switzerland IWDM, 2016, LNCS9699, pp. 136-144. 3) Travieso Aja MM, Rodríguez Rodríguez M, Alayón Hernández S, Vega Benítez V, Luzardo OP, 2014, Dual-energy contrast-enhanced mammography, Elsevier Doyma Radiolog’ia, 2014;56(5):390-399. 4) Thomas Knogler, Peter Homolka, Mathias Hörnig, Robert Leithner, Georg Langs, Martin Waitzbauer, Katja Pinker-Domenig, Sabine Leitner, Thomas H. Helbich, 2015, Contrast-enhanced dual energy mammography with a novel anode/filter combination and artifact reduction: a feasibility study, European Society of Radiology, 2015, DOI 10.1007/s00330-015-4007-6. 5) Badr S, Laurent N, Régis C, Boulanger L, Lemaille S, Poncelet E, 2014, Dual energy contrast enhanced digital mammography in routine clinical practice in 2013, Elsevier Doyma Radiolog’ia, 95(3):245-258.