mse003-b the great pretender—how sarcoidosis gained its

MSE003-b

The Great PretenderHow Sarcoidosis Gained Its Reputation as the Mimic of Other Pathology Education ExhibitsLocation: MS Community, Learning Center

ParticipantsThomas Robert Semple MBBS, BSC (Presenter): Nothing to Disclose Susan Jane Buckingham MBChB : Nothing to Disclose

TEACHING POINTS

The aim of this exhibit is to

Review the pathophysiology of sarcoidosis1.Demonstrate the typical radiological features of sarcoid within the chest, abdomen and central nervous system2.Share some particularly good cases of sarcoid mimicking other conditions and the key features that suggest sarcoidcould be the underlying cause

3.

TABLE OF CONTENTS/OUTLINE

The Pathophysiology of SarcoidosisTypical Radiological Features (radiography, CT, MRI)

ChestAbdomenCentral Nervous System

Sarcoid as mimic of other pathology - illustrative cases and tell tale signs all is not what it seems(Including, amongst others, cases of sarcoid masquerading as metastatic bowel cancer (granulomatous colitis with necroticlymphadenopathy and multiple pulmonary lesions) and mimicking high grade lymphoma with extensive bone marrowinvolvement (lymphadenopathy and diffuse bone FDG avidity on PET-CT). All cases presented were subsequently biopsy provento represent sarcoidosis)

Summary

MSE004-b

Imaging of Tularemia in Various Argans: A Review Education ExhibitsLocation: MS Community, Learning Center

ParticipantsIgnacio Martin-Garcia MD (Presenter): Nothing to Disclose Rodrigo Blanco-Hernandez MD : Nothing to Disclose Roberto Tabernero : Nothing to Disclose Manuel Angel Martin Perez MD : Nothing to Disclose Piedad Arias-Rodriguez : Nothing to Disclose Jose Marin : Nothing to Disclose

TEACHING POINTS-Review the role of radiology in the battery of tests in patients with suspicion of tularemia. -Show the radiological findings in thepatient with positive serology results for Francisella Tularensis. -Present the typical spectrum of lesions in patients with aconfirmed diagnosis of tularemia.

TABLE OF CONTENTS/OUTLINEWe performed a retrospective study taking a population of 172 patients who were treated in our centre between February 2008and October 2009, with fever of unknown origin and adenopathies, and who underwent a specific serological analysis. Wepresent the spectrum of radiological findings with CT, MR an US, with different clinical forms of presentation of tularemia.According to our database, they correspond to: -Glandular tularemia: 23% (axillary, inguinal adenopathies). -Pharyngealtularemia: 28% (cervical adenopathies and abscesses). -Typhoidal tularemia: 6% (splenic and hepatic involvement).-Pneumonic tularemia: 40% (pleuropulmonary symptoms and mediastinic adenopathies) -and a rare case of spondylodiscitis:3%.

MSE008-b

Challenges of CT Imaging of Ancient Irish Bog Bodies and Diagnostic Questions to beAnswered at CT Education ExhibitsLocation: MS Community, Learning Center

ParticipantsKate Anne Harrington BMBCh, MRCPI (Presenter): Nothing to Disclose Hong Kuan Kok MBBCh, MRCPI : Nothing to Disclose

Hong Kuan Kok MBBCh, MRCPI : Nothing to Disclose Emma Phelan : Nothing to Disclose Barry Callinan : Nothing to Disclose Fintan Regan MD : Nothing to Disclose Orla Buckley MD : Nothing to Disclose

TEACHING POINTS

To learn about the Irish Bog Body, naturally preserved human remains discovered in peat bogs, which date back to the Bronzeand Iron Ages (3000-700 BC) and the use of MDCT at our institution to image, study and contribute to the archaeological workperformed on 2 such remains.The acquisition of raw data sets using MDCT and dual energy CT. Imaging parameters used to obtain good xray interaction ofdemineralised specimen.Technical challenges of of image acquisition related to the shape of the specimen and risk of specimen desiccation.Image post-processing and analysis on a dedicated medical review workstation to produce axial, multiplanar and volumetricthree-dimensional (3D) reconstructions.Key questions in evaluating the specimen by CT such as age, gender, signs of ante mortem or post mortem injury, bodypositioning at burial.

TABLE OF CONTENTS/OUTLINEIntroduction on Bog Bodies. Outline of the logistics and technical parameters used for successful CT imaging of the Bog Body.Discussion and presentation of the radiological findings of 2 Irish Bog Bodies including the unusual final postures, injuries andfractures inflicted upon them and as of yet unidentified mysterious internal spherical bodies discovered within one Bog Body.Findings provide valuable insight into anthropological, medical and forensic aspects of prehistoric human life.

MSE010-b

PaleoCT of Two Colonial Period Andean Mummies from the Muisca Culture Education ExhibitsLocation: MS Community, Learning Center

ParticipantsAnibal Jose Morillo Zarate (Presenter): Nothing to Disclose Andres Vasquez MD : Nothing to Disclose Jorge Andres Abreu MD : Nothing to Disclose Juliana Ocampo MD : Nothing to Disclose

TEACHING POINTSCT is a useful tool for the non-invasive investigation of archaeological specimens. Multidetector CT can depict pathologiespresent in ancient civilizations and can offer insight on their embalming and burial practices. Mummies can be affected bypathological entities or by taphonomic (burial) processes. CT can differentiate postmortem fractures from traumatic lesionsoccurring during the lifetime of the mummies. CT can reveal hidden offerings that can help in the understanding of extintcultural practices.

TABLE OF CONTENTS/OUTLINEDescripton of two human specimens from the Muisca Culture, one adult and one child, both from the colonial period in theandean region, that were found in two separate sites and were dated around the 17th century. Description of the burialpractices of the Muisca indians, cadaver handling and mummification processes, and wrapping and burial practices of thisAndean Culture. Depiction of anatomical and pathological features found in both specimens. Demonstration of a hidden offeringdiscovered with CT within the wrappings of the child mummy.

MSE105

Tumefactive Fibro-inflammatory Disorders of the Abdomen and Pelvis: 2014 Update Education ExhibitsLocation: MS Community, Learning Center

ParticipantsVenkata S. Katabathina MD (Presenter): Nothing to Disclose Suhare K. Khalil MD : Nothing to Disclose Venkateswar Rao Surabhi MD : Nothing to Disclose Raghunandan Vikram MBBS, FRCR : Nothing to Disclose Naoki Takahashi MD : Nothing to Disclose Srinivasa R. Prasad MD : Nothing to Disclose

TEACHING POINTSReview select fibro-inflammatory diseases presenting as masses that may masquerade as malignancies Discuss recentadvances regarding pathogenesis and clinico-pathological findings Describe MDCT/MRI/PET-CT findings and the role ofradiologist in diagnosis, management and surveillance

TABLE OF CONTENTS/OUTLINEIntroduction Taxonomy: Inflammatory pseudotumors, IgG4 sclerosing disease, auto-immune pancreatitis, sclerosingmesenteritis, retroperitoneal fibrosis and auto-immune prostatitis Recent advances in pathogenesis and molecular biologyMDCT, MRI and PET-CT findings Natural history and prognosis Conclusion Select fibro-inflammatory diseases of the abdomenand pelvis present with masses that may be mistaken for more common neoplasms. IgG4 related disease has recently beendescribed and current concepts of autoimmune pancreatitis continue to evolve. Biopsy is definitive; select masses showexquisite response to steroids or immunosuppressive drugs. Imaging findings allow initial detection, treatment follow-up andsurveillance.

MSE106

A Wolf in Sheeps Clothing: Tumor in the Abdomen Mimicking Benign Conditions Education ExhibitsLocation: MS Community, Learning Center

Location: MS Community, Learning Center

Certificate of Merit

ParticipantsSarah Kyung Oh MD (Presenter): Nothing to Disclose Zina Joan Ricci MD : Nothing to Disclose Jeffrey Harmon Roberts MD : Nothing to Disclose Victoria Chernyak MD : Nothing to Disclose Alla M. Rozenblit MD : Nothing to Disclose Fernanda Samara Mazzariol MD : Nothing to Disclose Milana Flusberg MD : Nothing to Disclose Marjorie Werner Stein MD : Nothing to Disclose Ellen Leslie Wolf MD : Nothing to Disclose

TEACHING POINTSTeaching points: Review multimodality (CT, Ultrasound, and MRI) imaging of malignant disease in the abdomen which simulatesbenign conditions, raising awareness of overlapping features and highlighting key imaging pearls for correct diagnosis. 1.Malignant disease can simulate benign conditions. 2. Superimposed infectious or inflammatory process may obscure theprimary pathology. 3. Behavior on follow up exam can be helpful in distinguishing malignant disease from benign conditions.

TABLE OF CONTENTS/OUTLINEA. Discuss differences between imaging modalities in the evaluation of tumor within the abdomen. B. Present cases wheremalignant disease simulates a benign condition. C. Present cases where a superimposed infectious or inflammatory processobscures the primary pathology. D. Highlight key features that may aid in correct diagnosis. E. Review imaging surveillancerecommendations. Cases include but are not limited to the following: - Mucinous hepatic metastases as biliary hamartomas -HCC as FNH - Scirrhous colon carcinoma as diffuse colitis with toxic megacolon - Mucinous appendiceal neoplasm as acuteappendicitis - TCC as normal renal sinus fat - Seminoma as orchitis - Psammomatous ovarian calcification as fibroids -Krukenberg tumors as tubo-ovarian abscesses - Buttock carcinoma as sacral decubitus ulcer

MSE107

Blast from the Past: Multimodality Imaging of Small Cell Carcinoma from Head to Toe Education ExhibitsLocation: MS Community, Learning Center

ParticipantsTatiana Kelil MD (Presenter): Nothing to Disclose Sreeharsha Tirumani MBBS, MD : Nothing to Disclose Michael Hayden Rosenthal MD, PhD : Nothing to Disclose Nikhil H. Ramaiya MD : Nothing to Disclose Monica J. Wood BS : Nothing to Disclose Stephanie A. Howard MD : Nothing to Disclose

TEACHING POINTS1. The revised 2010 WHO classification of neuroendocrine tumors (NET) classifies small cell carcinoma (SCC) as grade 3neuroendocrine carcinoma based on mitotic count and proliferation index. 2. SCC most commonly occurs in the lung anduncommonly in extrapulmonary sites (2-5%). 3. Extrapulmonary SCC most commonly occurs in GI (particularly esophagus) andGU (particularly cervix and bladder) tracts. 4. SCC is characterized by mutations in p53, loss of retinoblastoma gene (RB1) andtelomerase function and activation of c-KIT, MYC and PARP1. 5. SCC of the lung has striking early response to chemoradiationwith high relapse rates and unusual metastasis. 6. Relapsed SCC is extremely difficult to treat, though some respond totemozolamide, particularly in the setting of brain metastases. 7. Novel molecular targeted therapies (MTTs) in SCC includeAurora kinase (MYC) and PARP inhibitors.

TABLE OF CONTENTS/OUTLINE1. Revised 2010 WHO classification of NET, focusing on pulmonary and extrapulmonary SCC. 2. Risk factors and epidemiology ofSCC. 3. Role of multimodality imaging (CT, MRI, PET/CT) in disease staging, focusing on prognostic implications of disease site4. Illustrate typical and atypical metastases evaluating for recurrent disease. 5. Future directions of treatment, including role oftemozolomide and novel MTTs.

MSE110

Comprehensive Update on Imaging Features and Management of Primary and MetastaticSynovial Sarcoma Education ExhibitsLocation: MS Community, Learning Center

ParticipantsAkshay Baheti MBBS, MD (Presenter): Nothing to Disclose Sreeharsha Tirumani MBBS, MD : Nothing to Disclose Rani S. Sewatkar MBBS : Nothing to Disclose Nikhil H. Ramaiya MD : Nothing to Disclose Jyothi Priya Jagannathan MD : Nothing to Disclose

TEACHING POINTS1. Synovial sarcoma (SS) occurs in the extremities and trunk in young adults and has indolent presentation mimicking benigntumor. 2. Extremity SS is best characterized on MRI as lobulated heterogeneously enhancing mass with characteristic imagingfeatures such as 'triple sign', 'bowl of grapes' appearance and fluid levels. 3. Non-extremity synovial sarcomas can occuranywhere in the trunk. Intrathoracic SS is often pleural-based at presentation, and may represent a distinct entity calledpleuroparenchymal syovial sarcoma (PPSS). 4. Pleural-based metastases are the most common sites of metastatic disease. 5.Synovial sarcomas are relatively sensitive to chemoradiotherapy in both neoadjuvant and adjuvant settings, and radiologistsplay a key role in assessing response.


1. Review the pathophysiology, classification, clinical features and management of synovial sarcomas 2. Illustrate themultimodality imaging features including CT, MRI, PET/CT of primary and recurrent extremity and non-extremity synovialsarcoma, 3. Discuss the prognostic implications of various radiologic findings and evaluation of treatment response afterneoadjuvant therapy 4. Review the metastatic pattern of synovial sarcomas with focus on their predilection for pleural-baseddisease

MSE111

CT Mapping of Patients Candidates to Cytoreductive Surgery (CRS) Combined withPerioperative Intraperitoneal Chemotherapy (PIC) and Correlation with Pathologist andSurgical Findings Education ExhibitsLocation: MS Community, Learning Center

ParticipantsMeylin Caballeros MD : Nothing to Disclose Isabel Vivas Perez MD : Nothing to Disclose Romina Zalazar MD (Presenter): Nothing to Disclose Jose Miguel Madrid MD : Nothing to Disclose Maria Paramo Alfaro MD : Nothing to Disclose Fernando Martinez-Regueira : Nothing to Disclose

TEACHING POINTS1. To discuss the utility of CT imaging for the detection and characterization of intraperitoneal disease. 2. To review theperitoneal anatomy, paying special attention to the most common sites of tumor implants. 3.To compare the locations of tumorimplants described in CT with the real locations found during surgery

TABLE OF CONTENTS/OUTLINEImaging characterization of peritoneal carcinomatosis: CT remains the standard imaging technique in identifying different sitesof carcinomatosis. Radiologist must have in mind the peritoneal anatomy paying special attention to the most common sites oftumor implants Routes of disemination: Review of imaging findings: Early stage peritoneal involment is usually subtle and easilymissed, which is why a careful assessment by radiologist is required. Imaging studies are important to identify oncologicpatients who may benefit from the combination of cytoreductive surgery and perioperative intraperitoneal chemotherapy (CRSand PIC). Correlation with surgical an pathological findings: Comparing the locations of tumor implants described in CT with thelocations found in surgery may help radiologist, clinicians and surgeons in the follow-up of this patients after recieving CRS andPIC as well as to identify the decrease or spread of carcinomatosis

MSE135

Evolutionary Branching Patterns Hidden in Anatomical Structures of Sharks, Skates andStingrays Elucidated by CT Education ExhibitsLocation: MS Community, Learning Center

ParticipantsAndrew Douglas McQuiston BS (Presenter): Nothing to Disclose U. Joseph Schoepf MD : Research Grant, Bracco Group Research Grant, Bayer AG Research Grant, General Electric CompanyResearch Grant, Siemens AG Carlo Nicola de Cecco MD : Nothing to Disclose Christian Canstein : Employee, Siemens AG Callie Crawford : Nothing to Disclose Gavin Naylor PhD : Nothing to Disclose

TEACHING POINTS1. To gain information on the structural differences between various species of closely related sharks, skates and stingrays using3rd generation dual-source CT. 2. To assess different acquisition parameters, including dual-energy CT, and reconstructionalgorithms for producing optimal images of bony and cartilaginous structures in these species. 3. To gain insights into theevolutionary branching patterns of different species of sharks, skates, and stingrays via non-destructive, comparative CTassessment of species-specific morphology.

TABLE OF CONTENTS/OUTLINEBackground information on the evolutionary branching of sharks, skates and stingrays. Description of technical parameters usedto image species of different shapes and sizes. Examples illustrating the application of various reconstruction algorithms andpost-processing techniques to sharks, skates and stingrays and the unique images produced. Synthesis of theories and methodsfor deriving patterns of evolutionary branching from CT morphology.

MSE143

Make Time for the Spine! Neuropathology Imaged on Body CT Education ExhibitsLocation: MS Community, Learning Center

ParticipantsAlexander James Kieger MD : Nothing to Disclose Elliot K. Fishman MD : Research support, Siemens AG Advisory Board, Siemens AG Research support, General ElectricCompany Advisory Board, General Electric Company Co-founder, HipGraphics, Inc Pamela Tecce Johnson MD (Presenter): Research funded, Becton, Dickinson and Company

TEACHING POINTSThe spine is imaged on all CT examinations of the chest, abdomen and pelvis. Subtle pathology involving the neural foramenand spinal canal may be the cause of the patient's symptoms or an unsuspected finding. This exhibit reviews ~ The importance

of multiplanar review to elucidate subtle findings affecting the spinal canal on CT examinations of the chest, abdomen and pelvisIllustration of range of pathology affecting the neural foramen, spinal canal and spinal cord through case review

TABLE OF CONTENTS/OUTLINECT TECHNIQUE Importance of inspecting spinal canal on axial, sagittal and coronal views Utility of IV contrast for delineating andcharacterizing pathology CASE SERIES Primary CNS tumors lower cervical spine meningioma on chest CT nerve root tumorSecondary involvement by tumor cancer invading spinal canal through neural foramen or from vertebral body metastasticdisease to the spinal canal paraspinal Ewing sarcoma Vascular pathology vertebral artery dissection on chest CT epidural AVMon abdominal CT Infection epidural abscess discitis

MSE156

Spectral Computed Tomography of Egyptian Mummies Education ExhibitsLocation: MS Community, Learning Center

ParticipantsDavid Jahangir MD : Nothing to Disclose Stephanie Maria McCann MD : Nothing to Disclose Charles William Westin MD : Nothing to Disclose Emily Teeter PhD : Nothing to Disclose Mary Greuel : Nothing to Disclose Michael Walter Vannier MD (Presenter): Nothing to Disclose

TEACHING POINTSIntact mummies are often examined with computed tomography, but many of the objects and materials found within the intactcartonnage or wrappings are unknown. We acquired CT scans of two Egyptian mummies (Third Intermediate Period, Dynasty 22and Ptolymeic era) at 4 energies (80, 100, 120 and 140 kVp). These spectral data sets were calibrated using scans of ancientEgyptian objects with known composition and other reference materials to understand the mummified contents. Wedemonstrate how multi energy CT images can characterize the contents of Egyptian Mummy CT scans. Spectral CT allowsvisualization and analysis of materials used in the mummification process.

TABLE OF CONTENTS/OUTLINEIntroduction: History of mummification processes used in ancient Egypt CT scanning of mummies Spectral CT technologySpectral CT Imaging of Egyptian mummies Differences found at 80 vs 140 kVp Pseudocolor visualization of mummy contents Multispectral material analysis method Calibration of multienergy CT using ancient Egyptian objects with known compositionResults of spectral CT scans for two Egyptian mummies Third Intermediate Period, Dynasty 22 mummy Ptolymeic eramummy Recommendations for future CT scans of Egyptian mummies

URE013-b

Dual-energy CT Characterization of Urinary Calculi: Basic Principles, Applications andLimitations Education ExhibitsLocation: NA

ParticipantsShima Aran MD (Presenter): Nothing to Disclose Khalid Walid Shaqdan MD : Nothing to Disclose Avinash Ranesh Kambadakone MD, FRCR : Nothing to Disclose Elmira Hassanzadeh MD : Nothing to Disclose Efren Jesus Flores MD : Nothing to Disclose Hani H. Abujudeh MD, MBA : Research Grant, Bracco Group Consultant, RCG HealthCare Consulting Author, Oxford UniversityPress

TEACHING POINTS

Dual-energy CT (DECT) adds many exciting new applications to single-energy MDCT as the imaging modality of choice fordetecting renal calculi. DECT allows characterization of renal stone composition which is clinically important as it allows selectionof targeted preventive approaches and stone-specific treatment options. Also using DECT, calculi are detectable onnephrographic phase imaging or in contrast-filled collecting systems using the iodine subtraction techniques. Calculation ofwater content using spectral imaging is useful to diagnose urinary obstruction. We plan to expose radiologists to a series ofchallenging cases to understand how this unique and clinically relevant modality can facilitate diagnosis and management ofrenal calculi.

TABLE OF CONTENTS/OUTLINE1. Basic principles of DECT on the basis of photoelectric and Compton interactions as well as material decomposition. 2. Availabletechniques of DE data acquisition, for example, dual source CT scanners, fast kilovoltage switching and sandwich detectortechniques. 3. Image processing and reconstruction of DECT data. 4. Clinical application of DECT for diagnosis andmanagement of renal calculi. 5. Sample cases. 6. Limitations of DECT such as the effects on image quality, and radiation dose.

URE104

Beyond Standard CT Urography Current and Novel Imaging Technologies and Strategies forReducing Radiation Exposure and Contrast Medium Load Education ExhibitsLocation: NA

ParticipantsXiaochao Guo MD (Presenter): Nothing to Disclose Juan Hu : Nothing to Disclose

Juan Hu : Nothing to Disclose Xiaoying Wang MD : Nothing to Disclose He Wang MD : Research Grant, General Electric Company Rui Wang PhD : Nothing to Disclose Kai Zhao MD : Nothing to Disclose Huihui Wang : Nothing to Disclose

TEACHING POINTS1) To review current imaging technology and its limitations in CT urography 2) To illustrate novel imaging technologies forreducing radiation exposure and contrast medium load in CT urography 3) To learn optimal strategies using these current andnovel technologies by presenting experimental data and clinical images

TABLE OF CONTENTS/OUTLINE1) Standard imaging technology and its limitations single-bolus triple phases (unenhanced, nephrographic and excretoryphase) image quality radiation exposure contrast medium (CM) 2) Current and novel imaging technologies split-bolusdouble phases (unenhanced, nephrographic- excretory phase) low kVp technique low CM dose and concentration iterativereconstruction (IR) dual-energy CT (DECT): virtrual unenhanced scan/monochromatic imaging/material density imaging 3)Optimal strategies using these technologies

URE105

CT Urography (CTU) Using New CT Technologies: Clinical Advantages of a Proposed Scan andContrast Injection Protocol Education ExhibitsLocation: NA

ParticipantsYukiko Honda MD (Presenter): Nothing to Disclose Toru Higaki PhD : Nothing to Disclose Yoko Kaichi : Nothing to Disclose Chihiro Tani MD : Nothing to Disclose Akira Taniguchi RT : Employee, Toshiba Corporation Kazuo Awai MD : Research Grant, Toshiba Corporation Research Grant, Hitachi Ltd Research Grant, Bayer AG ResearchConsultant, DAIICHI SANKYO Group Research Grant, Eisai Co, Ltd Daisuke Komoto MD : Nothing to Disclose

TEACHING POINTS

We focus on a new CTU method that uses split bolus injection and dual-energy CT (DECT) technology. It facilitates thesimultaneous acquisition of nephrographic- and excretory-phase scans and helps to reduce radiation exposure. Applying DECTtechniques to split bolus injection allows a further radiation dose reduction at CTU by generating virtual non-enhanced imagesand save actual non-enhanced scan. Virtual monochromatic CT images generated from DECT can reduce beam hardeningartifacts induced by iodinated urine and may help to identify subtle enhancements or small tumors in the ureter wall.

TABLE OF CONTENTS/OUTLINE1. Current scan- and contrast injection protocol for CTU 2. New technologies for CTU a) Dual energy CT (DECT) - Principles ofDECT - Utility and limitations of DECT for diagnosing ureter calculi and tumors b) Iterative reconstruction (IR) - Principles of IR -Improvement of CTU image quality by IR - Radiation dose reduction at CTU by IR 3. Proposed CTU protocol using newtechnologies -CTU using split bolus injection and DE technology 4. Future perspective of CTU

URE106

Thickening of the Ureter and/or Renal Pelvis: Spectrum of CT Findings Education ExhibitsLocation: NA

ParticipantsDavid Coll MD (Presenter): Nothing to Disclose C Yanguas : Nothing to Disclose Anna Soldevila MD : Nothing to Disclose M. J. Diaz : Nothing to Disclose O Valencoso : Nothing to Disclose Josep M Badal : Nothing to Disclose J Trullas : Nothing to Disclose

TEACHING POINTS

- how to perform CT of the urinary tract

- to identify false causes of ureter and renal pelvis wall thickening

- to illustrate the differences in appearaences of ureteral and/or renal pelvis thickening: mucosal or submucosal thickening

- to discuss the different etiologies of ureter and/or renal pelvis thickening correlated with clinical evolution, analytical results orpathology

TABLE OF CONTENTS/OUTLINEThe clinical presentation of the thickening of the ureter and/or the renal pelvis is highly variable. It may be asymptomatic;alternatively it may cause colicky pain or haematuria or it may present clinical and analytical signs of sepsis. Treatment optionsvary depending on the aetiology which may be A) inflammatory (pyelitis or pyeloureteriritis related or not to kidney stones), B)catheter-related or idiopathic; C) infectious (related to tuberculosis or bacterial infection); or D) neoplastic (related to urothelialcarcinoma or lymphoma). Knowledge of the different radiological manifestations of the aetiologies of thickening of the ureterand/or renal pelvis is the key to correct diagnosis and to the selection of optimal treatment.

URE107

Urinary Diversion: A MDCT Technical Challenge How to Establish the Most AccurateProcedure in Order to Assess the Main Post-surgical Complications Education ExhibitsLocation: NA

ParticipantsVioleta Gonzalez Mendez MD (Presenter): Nothing to Disclose Alicia Merina MD : Nothing to Disclose Virginia Navarro Cutillas : Nothing to Disclose Alberto Arnaiz Martinez MD : Research Consultant, Novartis AG Elena Martinez Chamorro : Nothing to Disclose

TEACHING POINTS

The main purpose of this study is to describe the best MDCT technique in order to evaluate the various complications found inearly and late follow-up of patients who previously underwent urinary diversion.

Other minor goals are to describe the main diversion procedures and to analyze the major complications.

TABLE OF CONTENTS/OUTLINEIntroduction Approach to the three most common types of urinary diversion. Overview of the MDCT technical procedure: Do weneed a phase without contrast injection? When do we need it? When is oral contrast material needed? Could and under whatcircumstances we do benefit from the split-bolus injection? How can we achieve an optimal excretory phase? Classification ofcomplications according to the time of onset, highlighting the possible peculiarities in MDCT technique depending on the type ofcomplication suspected. Early (< 30 days after surgery): Bowel: adynamic ileus, mechanical obstruction, anastomotic leak.Infectious: pyelonephritis. Postsurgical fluid collections. Urinary tract complications (anastomotic leak, obstruction, fistulas)Stomal o conduit ischemia. Wound Late Infection Calculi Ureteral stenosis Tumor recurrence Stomal / conduit : retraction,prolapse, stenosis. Herniation

VIE012-b

Dual-energy CT: Vascular Applications, Basic Physical Principles and limitations Education ExhibitsLocation: VI Community, Learning Center

ParticipantsShima Aran MD (Presenter): Nothing to Disclose Khalid Walid Shaqdan MD : Nothing to Disclose Elmira Hassanzadeh MD : Nothing to Disclose Efren Jesus Flores MD : Nothing to Disclose Hani H. Abujudeh MD, MBA : Research Grant, Bracco Group Consultant, RCG HealthCare Consulting Author, Oxford UniversityPress

TEACHING POINTS

Dual-energy CT (DECT) enhances the capability of single energy CT with several new applications for advanced imaging ofvascular pathologies. With low kVp dataset vascular attenuation is increased and therefore it is helpful in assessment of smalleror more poorly opacified vessels. This results in reduction of contrast utilization and radiation exposure. The availability of virtualnoncontrast images help in detection of vascular calcifications and endoleaks. The other key advantages of DECT for vascularimaging are the availability of advanced postprocessing application, bone subtraction and calcification removal techniques.Appropriate use of DECT techniques can save radiation dose, decrease interpretation time, or improve diagnostic accuracy.

TABLE OF CONTENTS/OUTLINE1. Physical principles of DE or spectral CT on basis of photoelectric and Compton interactions as well as material decomposition.2. Available techniques of DE data acquisition, for example, dual source CT scanners, fast kilovoltage switching and sandwichdetector techniques. 3. Image processing and reconstruction of DECT data. 4. Clinical application of DECT for diagnosis ofvascular pathologies. 5. Sample cases. 6. Limitations of DECT such as the effects on image quality, artifacts and radiation dose.

VIE013-b

CT Angiography of Spontaneous Visceral Artery Dissection: A Pictorial Review Education ExhibitsLocation: VI Community, Learning Center

ParticipantsKevin Ching MD (Presenter): Nothing to Disclose Anil Kumar Dasyam MD : Nothing to Disclose Mitchell E. Tublin MD : Nothing to Disclose Matthew Thomas Heller MD : Nothing to Disclose Biatta Sholosh MD : Nothing to Disclose Amir Borhani MD : Nothing to Disclose

TEACHING POINTS1. Spontaneous visceral artery dissection is an uncommon cause of abdominal pain that may involve the celiac trunk, superiormesenteric, renal, and inferior mesenteric arteries. Extension into more distal branches is also common. 2. Because thediagnosis is rarely suspected initially, visceral artery dissection is often suggested from subtle findings on portal venous phaseCT. Subsequent CT angiography confirms dissection and better characterizes the extent of vascular involvement. 3. Themanagement of spontaneous visceral artery dissection is determined by the organ involved and extent of distal malperfusion.


1. Overview of spontaneous visceral artery dissection a. Clinical presentation b. Etiologies of spontaneous visceral arterydissection. c. Association with inherited connective tissue diseases. 2. Discuss imaging work-up, CTA protocol, and pertinentfindings. 3. Quality images of visceral artery dissection evaluated with 64-slice CT and 3D reconstructions: examples include theceliac axis, superior mesenteric, renal, common hepatic, and splenic arteries. 4. Complications of distal malperfusion. 5.Treatment and recommendations for follow up imaging and multi-disciplinary care.

VIE142

Advanced Iterative Model Reconstruction in Improving Image Quality of CT Angiography Education ExhibitsLocation: VI Community, Learning Center

ParticipantsKenneth K. Lau (Presenter): Nothing to Disclose Nicholas David Ardley : Nothing to Disclose Kevin Buchan : Employee, Koninklijke Philips NV Theodore Lau : Nothing to Disclose

TEACHING POINTS

CT abdominal angiography (CTA) plays a vital role in diagnosing and monitoring conditions such as stenosis, occlusion,thrombo-embolism, aneurysm, dissection, endoleak and gastrointestinal bleed. Its advantages in comparison to digitalsubtraction angiography (DSA) are shorter acquisition time, non-invasive nature and less procedural complications. Vessel wallcalcification may cause beam-hardening artifact that obscures the vessel lumen. The latest Iterative model reconstruction (IMR)is a knowledge-based algorithm that improves low contrast resolution, reduces image noise and artifact. The aim of this exhibitis to assess the diagnostic utility of IMR in CTA.

TABLE OF CONTENTS/OUTLINEThe data sets of CTA of thoracic and abdominal aorta, pulmonary, renal, mesenteric arteries, carotid and cerebral arteries of 156patients were reconstructed using IMR and iDose IRs. 1. The vessel contours and definitions were better visualized down tosmall vessel with IMR than iDose due to image noise reduction. 2. Less beam-hardening artifacts from vessel wall calcifiedplaques allow accurate luminal assessment. 3.The presence of embolism and dissection were better depicted on IMR CTA. IMR issuperior to conventional iterative reconstruction and aids more accurate vascular pathology assessment .

VIE143

Aortic Endoprosthesis Follow-up: How, When and Why CT Angiography? Education ExhibitsLocation: VI Community, Learning Center

ParticipantsMaria Eugenia Maccarone MD : Nothing to Disclose Carlos Capunay MD : Nothing to Disclose Javier Vallejos MD, MBA (Presenter): Nothing to Disclose Patricia M. Carrascosa MD : Research Consultant, General Electric Company

TEACHING POINTSTo describe the multiphasic CT angiography protocol study To define the follow up imaging after stent graft placement Torecognize the multiphasic CT angiography as the best choice of non-invasive method to detect and classify endoleaks and othercomplications

TABLE OF CONTENTS/OUTLINEComplications after aortic endoprosthesis placement Classification of Endoleaks Imaging techniques: Digital angiography MRangiography Ultrasound CT angiography Follow up imaging after stent graft placement: When CT angiography?

VIE144

Breast Reconstruction with DIEP and SGAP Flaps Role of Pre-Operative CT Angiogram Education ExhibitsLocation: VI Community, Learning Center

Cum Laude

ParticipantsGregory Aaron Bonci MD (Presenter): Nothing to Disclose Bohdan Pomahac MD : Nothing to Disclose Dimitris Mitsouras PhD : Nothing to Disclose Stephanie A. Caterson MD : Nothing to Disclose Amir Imanzadeh MD : Nothing to Disclose Meaghan Mackesy MD : Nothing to Disclose Edward J. Caterson MD, PhD : Nothing to Disclose Frank John Rybicki MD, PhD : Research Grant, Toshiba Corporation

TEACHING POINTSPerforator flaps offer cosmetically superior results with significantly less morbidity than TRAM flaps. Choice of flap is dependenton patient anatomy and quality of vasculature. Pre-operative CTA effectively maps perforators, decreases operative time, anddecreases morbidity/complications. Post-processing may also help to determine exact tissue volume to be harvested for moretargeted reconstruction.


1. Autologous breast reconstruction basics (patient selection, aim, timing of surgery, advantages over breast implants). 2.Overview and evolution of flap options with focus on deep inferior epigastric perforator (DIEP) and superior gluteal arteryperforator (SGAP) flaps. 3. Overview of pre-operative imaging including Doppler ultrasound, CTA, and MRA. Brief review ofliterature demonstrating the advantages of CTA with regard to duration of surgery, length of hospitalization, and complicationrates. 4. Importance of angiosomes in perforator flap surgery. Alteration of imaging protocols to better determine flap vascularsupply and reduce likelihood of fat necrosis. 5. Future directions include 3D printing of perforator flaps for more customizedpre-operative planning.

VIE145

Clinical Applications of Single-source Dual-energy CT with Fast kVp Switching in CTAngiography: What the Radiologist Needs to Know Education ExhibitsLocation: VI Community, Learning Center

Selected for RadioGraphics

ParticipantsHaruhiko Machida MD (Presenter): Nothing to Disclose Isao Tanaka : Nothing to Disclose Rika Fukui : Nothing to Disclose Yun Shen PhD : Employee, General Electric Company Researcher, General Electric Company Takuya Ishikawa : Nothing to Disclose Eiko Ueno MD : Nothing to Disclose Etsuko Tate : Nothing to Disclose He Qing Wang MSc : Nothing to Disclose

TEACHING POINTSTo review limitations of conventional CT angiography (CTA) To describe basic principles and various techniques in single-sourcedual-energy CT (DECT) with fast kVp switching to overcome these limitations To illustrate various clinical applications andadvantages using these techniques by presenting clinical images

TABLE OF CONTENTS/OUTLINELimitations of conventional CTA Iodine contrast medium (CM)/radiation dose Insufficient vessel contrast enhancement (CE)Severe calcification Limited tissue characterization/perfusion assessment Metallic/beam-hardening (BH) artifacts Basic principlesand various techniques in DECT BH correction Monochromatic imaging (MI) Material density imaging (MDI) Energy level(keV)-CT value (HU) curve Effective atomic number (Z) histogram Iterative reconstruction (IR) Various clinical applications andadvantages CM dose reduction/improved vessel CE: low-keV MI/iodine (water) MDI with IR Radiation dose reduction: water(iodine) MDI replacing non-CE CT/IR Calcium reduction: iodine (calcium/hydroxyapatite) MDI Lipid-rich plaque detection: fat(water) MDI/keV-HU curve/effective Z histogram Differentiation among CM, calcification, fresh hematoma: MDI Tissueperfusion assessment: iodine (water) MDI

VIE146

Contrast Medium Delivery Strategies and Radiation Dose Parameters Affecting CTAngiography Education ExhibitsLocation: VI Community, Learning Center

ParticipantsCharbel Saade MS (Presenter): Nothing to Disclose Fadi M. El-Merhi MD : Nothing to Disclose Ali A. Haydar MD, FRCR : Nothing to Disclose Ghaleb Ghusayni : Nothing to Disclose Salam Al-Hamra : Nothing to Disclose Mukbil H. Hourani MD : Nothing to Disclose Bedros Taslakian MD : Nothing to Disclose Hussain Al-Mohiy : Nothing to Disclose

TEACHING POINTS

- Optimal opacification of the arteries is essential for CTA

- Matching timing with vessel dynamics significantly improves vessel opacification

- This leads to increased arterial opacification and reduced venous opacification

- This can also lead to a reduced volume of contrast agent.

- This can also lead to reduced radiation dose

TABLE OF CONTENTS/OUTLINEA. Vascular Anatomy B. contrast media parameters that affect bolus shaping C. scanner parameters that affect vascularopacification D. scanner and contrast parameters affect radiation dose E. stenosis and aneurysm effects on blood/contrastcirculation F. Pearls and Pitfalls G. Outcomes

VIE147

Dual Energy CT Angiography with Reduced Iodine Load: A Comprehensive and PracticalApproach Education ExhibitsLocation: VI Community, Learning Center


ParticipantsPatricia M. Carrascosa MD : Research Consultant, General Electric Company Carlos Capunay MD (Presenter): Nothing to Disclose Javier Vallejos MD, MBA : Nothing to Disclose Alejandro Deviggiano MD : Nothing to Disclose Gaston Rodriguez Granillo : Nothing to Disclose

TEACHING POINTS1- To review the indications, diagnostic imaging, potential benefits and limitations of performing a dual-energy CT angiographywith reduced iodine contrast volume. 2- To understand the advantages of dual energy CT in vascular imaging.

TABLE OF CONTENTS/OUTLINEA. Introduction to dual energy CT. Physics B. Image analysis. Spectral imaging. Material decomposition. Calcium and bonesubtraction. C. CT image acquisition. Technical parameters. Radiation issues D. Contrast injection protocol E. Diagnostic ImagingF. Potential indications. Outcomes

VIE148

Eyes Wide Open: Impending Death Signs in Cardiovascular Disease; What Every RadiologistShould Fear Education ExhibitsLocation: VI Community, Learning Center

ParticipantsAlvaro Acosta Bustillos (Presenter): Nothing to Disclose Sergio A. Criales Vera MD : Nothing to Disclose David Zamora Contreras MD : Nothing to Disclose Daniela Angulo Salazar MD : Nothing to Disclose Francisco Castillo-Castellon MD : Nothing to Disclose Luis Antonio Sosa MD : Nothing to Disclose Moises Jimenez : Nothing to Disclose

TEACHING POINTS

1. There are some MDCT findings of impending death in cardiovascular disease that the radiologist should be aware in order tocommunicate immediately to the medical and surgical team.

2. This signs are aortic rupture, collapse of the true lumen in aortic dissection, contrast-fluid levels in the vena cava, cardiactamponade, intramural haematoma more than 3 cm, and others.

3. To provide relevant information to the medical team which might be crucial for the appropriate treatment.

TABLE OF CONTENTS/OUTLINEPURPOSE/AIM Review the most common signs of impending death in cardiovascular disease. Describe imaging findings inMultidetector Computed Tomography (MDCT) of impending death in cardiovascular disease. Describe relevant information forclinicians and surgeons provided by MDCT. CONTENT ORGANIZATION (Introduction) common signs of impending death incardiovascular disease and its clinical relevance. MDCT technique requirements and special considerations. MDCT findings ofimpending death: of coronary arteries, heart chambers, pericardium, thoracic and abdominal aorta, supraaortic and mesentericvessels, and IVC. Relevant information for the clinicians and surgeons that might aid in treatment planning.

VIE149

Nitroglycerin Sprays Benefit the Vessel Depiction Performance Improvement in AbdominalCTA Education ExhibitsLocation: VI Community, Learning Center

ParticipantsRyusuke Kujirai RT (Presenter): Nothing to Disclose Susumu Sato RT : Nothing to Disclose Ryohei Horisawa RT : Nothing to Disclose Yutaka Suzuki RT : Nothing to Disclose Kenichi Ando RT : Nothing to Disclose

TEACHING POINTS

Our facility is using nitroglycerin spray in for the purpose of widening the coronary artery in coronary CTA. There is work to dilatethe blood vessels throughout the body as well as expand the coronary arteries to nitroglycerin. We have investigated whether alsouseful in abdominal CTA to use this effect. It was studied in 15 patients taken at 120kV and 80kV. without nitroglycerin(80kV/120kV) with nitroglycerin (80kV/120kV) Compared patient is 70.4 years average age. Each image was visually evaluatedaccording to the fifth rated of image quality and vascular depiction performance displays in VR. Quality and vascular depictionperformance is improved easily by using nitroglycerin. This effect is greater than the effects obtained at a low tube voltage. Therewas no significant difference 120KV and 80kV using nitroglycerin. It is possible to be used for different parts and integrated tubevoltage.


Nitroglycerin Spray is possible to enhance the depiction performance while still ensuring the quality of the CTA.

VIE150

Novel Contrast-Injection Protocol for High Resolution Abdominal CT-Angiography: VascularVisualization Improvement with Vasodilator Education ExhibitsLocation: VI Community, Learning Center


ParticipantsMinori Hoshika (Presenter): Nothing to Disclose Norimi Nishiyama : Nothing to Disclose Yuki Kobayashi : Nothing to Disclose Yoshihiro Takeda MD : Nothing to Disclose

TEACHING POINTSTo review the advantages and limitations of CT-Angiography(CTA). To provide an explanation of the new examination methodand conventional examination methods. Review the usefulness of abdominal CTA with vasodilator (nitroglycerin).

TABLE OF CONTENTS/OUTLINE Method and characteristic of vascular visualization in CTA. Description of the high resolution in CTA method: Comparison ofGroupA (with nitroglycerin/n=23) and GroupB (without nitroglycerin/n=26) during abdominal CTA. The usefulness of CTA as anoperation tool is reported. There is a limitation to the spatial resolution in comparison with Angiography, as rendering theperipheral blood vessels is difficult. In CTA with vasodilator as an operation tool, made available in nearly all cases in Group A,visualization of the pancreaticoduodenal artery and inferior pancreatic artery. Visualization in Group B (without nitroglyceringroup) was only about 30% capability. We had same result in case we describe the inferior pancreatic artery. We conclude it isuseful to use nitroglycerin for better describing image. Vascular depiction performance is enhanced by the use of thevasodilator. In this new method, without iodine content, flow rate was also increased, and blood vessel depiction performance ispossible.

VIE151

Optimal Protocol of Scanning Mode for Reducing Contrast Medium Dose and Radiation Dose inCarotid CT Angiography: Low kVp or Low keV Scan Education ExhibitsLocation: VI Community, Learning Center

ParticipantsYunjing Xue MD (Presenter): Nothing to Disclose Qing Duan MD : Nothing to Disclose Lihong Chen : Nothing to Disclose Bin Sun : Nothing to Disclose

TEACHING POINTS1. To describe the basic principles and feasibility of low-tube-voltage carotid CT angiography and Spectral Imaging using ASiRreconstruction in combination with a lower contrast medium dose with clinical data and images. 2. Illustrate optimization of lowdose CT scan and low dose contrast medium injection protocol.

TABLE OF CONTENTS/OUTLINE1. Basic principle and clinical value of low-tube-voltage and GSI monochromatic carotid CT angiography. 2. Optimization of lowdose contrast medium injection protocol. 3. Carotid artery image quality evaluation and ASiR optimization. 100-kVp protocol hadsignificantly higher carotid enhancement and sharpness of the artery compared with the 120-kVp protocol. GSI protocol couldprovide similar image quality of carotid artery to 120-kVp protocol. 4. Both GSI and 100-kVp protocol could significantly reducethe noise of carotid and main branches of thoracic aorta images compared with that of 120-kVp protocol. 5. The GSI (60kev)scan with 50% ASiR and 3 ml/s injection velocity has lowest CM dose and can provide more information of plaque and tissuedifferentiation. 6. We can balance the image quality, useful information (vessel, plaque, stent,tumor), radiation dose andcontrast medium dose all kinds of CT scans parameters to choose the optimized CTA protocol to achieve the best clinicaleffect.

VIE152

Subtraction CT Angiography for Peripheral Arterial Occlusive Disease Using Semi-automatedPosition Matching Method Education ExhibitsLocation: VI Community, Learning Center

ParticipantsRyoichi Tanaka MD (Presenter): Nothing to Disclose Kunihiro Yoshioka MD : Nothing to Disclose Kenta Muranaka : Nothing to Disclose Akihiko Abiko : Nothing to Disclose Shigeru Ehara MD : Nothing to Disclose

TEACHING POINTSThe aims of this exhibit are to 1) understand basic concept of subtraction CT angiography. 2) get to know the differencebetween manual position matching technique and semi-automated position matching technique. 3) come to know the diagnosticaccuracy of subtraction CT angiography in comparison with invasive angiography.


A. Back ground: the limitations in current imaging procedures for peripheral arterial occlusive disease - including invasiveness inconventional angiography, radiation dose, renal dysfunction due to arteriosclerosis, and time consuming post processing andevaluation.

B. Advantage of subtraction CT angiography: its accuracy in comparison with digital subtraction angiography.

C. Position matching technique for subtraction CT angiography: the basic technique required in scanning and post-processingtechniques

D. Clinical application: Presentation in case with severe arterial calcification including cases who underwent hemodialysis

VIE153

The Application Value of Quantitative Iodine-based Substance Mappings in DiagnosingPulmonary Embolism (PE) Education ExhibitsLocation: VI Community, Learning Center

ParticipantsTingting Lin (Presenter): Nothing to Disclose Jiang Ning Dong : Nothing to Disclose

TEACHING POINTS1.To assess the value of ration-based iodine substance mappings of CT imaging in diagnosing 2.To reflect the effects of differenttypes of PE and diameters of emboli 3.To provide more morphological and functional information for the diagnosis of PE

TABLE OF CONTENTS/OUTLINERelationship of perfusion changes of ration iodine-based substance mappings with embolized locations of conventional CTPA,Perfusion changes of ration iodine-based substance mappings - different types of PE - diameters of emboli Future directions andsummary

VIE154

Upper Extremity CTA: Clinical Applications in the Subacute Setting Education ExhibitsLocation: VI Community, Learning Center

ParticipantsRadhika B. Dave MD (Presenter): Nothing to Disclose Dominik Fleischmann MD : Research support, Siemens AG

TEACHING POINTS1. Arterial phase images are crucial for the evaluation of aneurysm, stenosis, and occlusion in vasculitis. Delayed venous phaseimages are helpful to evaluate for wall enhancement. 2. Vasculitis demonstrates smoothly tapered luminal narrowing comparedto irregular luminal contour seen in stenosis secondary to atherosclerotic disease. 3. Imaging with the extremity in both theadducted and abducted positions can facilitate the diagnosis of thoracic outlet syndrome. 4. Warming of the hand prior to CTAcan be helpful to differentiate true arterial stenoses from vasospasm.

TABLE OF CONTENTS/OUTLINEUpper extremity CTA has found a niche in the assessment of acute vascular injury. However, its less well known subacuteapplications involve evaluation of vasculitis, vascular malformations, overuse syndromes, and connective tissue diseases.-Vasculitis: Aneurysms, stenosis, and wall thickening -Arteriovenous malformations: Delineation of arterial and venous supplyEvaluation of subfacial and intramuscular components Relationships to neurovascular bundles -Compression syndromes such asthoracic outlet syndrome: Variations of patient positioning to facilitate diagnosis Imaging findings -Connective tissue disorders:Vascular and extravascular imaging findings Imaging techniques to facilitate diagnosis of true arterial stenoses

SPPH01

AAPM/RSNA Physics Tutorial for Residents: Multi-spectral and Volumetric Imaging Special CoursesPH CT AMA PRA Category 1 Credits : 2.00

ARRT Category A+ Credits: 2.00

Sat, Nov 29 12:00 PM - 2:00 PM Location: E351

ParticipantsModeratorRichard J. Massoth PhD : Nothing to Disclose

LEARNING OBJECTIVES

1) Describe the underlying physics of multi-spectral volumetric imaging and advanced applications that can increase theeffectiveness of this emerging imaging technology. 2) Understand imaging artifacts resulting from hybrid imaging techniques andthe limitations of the technology. 3) Describe dual imaging techniques used in diagnostic imaging.

Sub-Events Physics Overview of Multi-spectral and Volumetric Imaging

Richard J. Massoth PhD (Presenter): Nothing to Disclose

LEARNING OBJECTIVES

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View learning objectives under main course title.

Multi-spectral CT Imaging

Mark Patrick Supanich PhD (Presenter): Research agreement, Siemens AG

LEARNING OBJECTIVES


Hybrid Imaging in Nuclear Medicine

Osama R. Mawlawi PhD (Presenter): Research Grant, Siemens AG Research Grant, General Electric Company

LEARNING OBJECTIVES


SPSP01

Nuevos Horizontes en Diagnostico por Imagen Desde el CIR: Sesin del ColegioInteramericano de Radiologa (CIR) en Espaol/New Horizons in Diagnostic Imaging fromCIR: Session of the Interamerican College of Radiology (CIR) in Spanish Special Courses

NM MR CT VA NR MK GU GI CH BR

AMA PRA Category 1 Credits : 3.75


Sat, Nov 29 1:00 PM - 5:00 PM Location: E451A

LEARNING OBJECTIVES

1) To review advances or new horizons in imaging in major subspecialties from experts from different CIR (InteramericanCollege of Radiology) countries. 2) To use a practical approach including case-based learning. 3) To seek audience participationwith presentation of unknown clinical examples related to the organ system presentations.

Sub-Events Introduccin/Opening Remarks

Gloria Soto Giordani MD (Presenter): Nothing to Disclose

LEARNING OBJECTIVES


Primera Parte/Part 1

Moderator Pablo Riera Ros MD, PhD : Medical Advisory Board, Koninklijke Philips NV Medical Advisory Board,KLAS Enterprises LLC Medical Advisory Committee, Oakstone Publishing Departmental Research Grant, SiemensAG Departmental Research Grant, Koninklijke Philips NV Departmental Research Grant, Sectra AB DepartmentalResearch Grant, Toshiba Corporation

LEARNING OBJECTIVES


Sistema Nervioso Central: Correlacin Entre Marcadores Genticos e Imgenes enAstrocitomas/Central Nervous System: Imaging-Genetic Markers Correlation in Astrocytomas

Mauricio Castillo MD (Presenter): Nothing to Disclose

LEARNING OBJECTIVES

1) To become familiar with the traditional biochemical/genetic markers of astrocytomas and how their presenceor absence correlate with imaging findings. 2) To understand the biological changes, as reflected by MRadvanced imaging techniques, that astrocytomas go through when malignant transformation occurs.

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ABSTRACT

In this lecture we will use advanced MR imaging techniques, perfusion (both contrast enhanced and arterial spinlabelled), permeability, diffusion, and spectroscopy to understand the biological behavior of astrocytomas. Lowgrade astrocytomas may not show high choline on MRS but show high myoinositol which correlates with lowperfusion values. Anaplastic astrocytomas produce metalloproteases and thus VEGF and PDGF can stimulateangiogenesis resulting in high perfusion with gadolium and ASL. Lastly, hypoxia induces formation ofpermeability factors leading to edema and contrast enhancement in glioblastomas. Necrosis, seen as lipids onMRS is a marker of glioblastoma. Presence of MGMT promoter and alterations in the IDH1 gene (present in mostsecondary glioblastomas) confer a better survival pattern to glioblastoma patients and these findings are seenpredominantly in temporal and deep tumors and in those with little contrast enhancement and high signal on T2and DWI images. Thus, the intial transformation in all low grade astrocytomas is ischemia that can be seen asthe presence of lactate on MRS, while markers of higher grades such as angiogenesis, permeability, andnecrosis can be identified with perfusion, K-trans maps, and MR spectroscopy. Lack of myoinositol on MRSindicates its consumption for production of metalloproteases and thus it is also an early marker of angiogenesis.Many of these changes occur before anatomical images may suggest them.

URL

https://sites.google.com/site/castilloneuroradiology/

Active Handout

http://media.rsna.org/media/abstract/2014/14002958/SPSP01C sec.pdf

Cardiovascular: Cambios Desde el TAC y RM Hacia la Imagen Funcional y Molecular/Cardiovascular:CT and MRI Changes towards Functional and Molecular Imaging

Antonio Luna MD (Presenter): Nothing to Disclose

LEARNING OBJECTIVES

1) Revisar las indicaciones actales del TC y RM en el diagnstico cardiovascular. 2) Ensalzar las nuevasaproximaciones tcnicas en TC y RM del sistema cardiovascular. 3) Esbozar el papel potencial de la imagenfuncional y molecular en enfermedades cardiovasculares. 1) Review the current clinical indications of CT andMRI in cardiovascular diagnosis.2) Highlight the new technical approaches in CT and MRI of the cardiovascularsystem. 3) Outline the potential role of functional and molecular imaging in the management of cardiovasculardiseases.

Mama: Integracin de Medicina Nuclear en las Imgenes Diagnsticas de Mama/Breast: NuclearMedicine Integration in Breast Imaging

Maria Victoria Velasquez MD (Presenter): Nothing to Disclose

LEARNING OBJECTIVES

1) Present the current indications for Molecular Breast Imaging and Positron Emission Mammography. 2)Describe imaging protocols, radiation exposure and benefits for both techniques. 3) Outline the most commonfindings of benign and malignant breast lesion on MBI and PEM with correlation with other breast imagingstudies. 4) Navigate through the different steps of PEM guided biopsy. 5)Describe alternative management andfollow up with these techniques.

ABSTRACT

Integration of Nuclear Medicine in Breast Imaging In the last decade the introduction of Nuclear medicine asMolecular imaging of the breast had a significant development in the diagnosis of breast abnormalities. PositronEmission Mammography (PEM) and Molecular Breast Imaging (MBI) have been successful in the detection ofbenign, atypical and malignant breast conditions. PEM have been proven to represent a very helpful staging toolin patients with contraindications to breast MRI. MBI is a valuable technique for screening of high risk patientsand as for problem solving for patients with inconclusive clinical or imaging findings. This presentation willreview the main indications of these Nuclear Medicine studies and will detail the findings and the correlationwith conventional breast imaging. The breast imager will have a better understanding of the anatomic,functional and molecular breast imaging techniques.

Trax: Hallazgos de la Resonancia Magntica en Enfermedades del Parnquima/Chest: MagneticResonance Findings in Lung Parenchymal Disease

Arthur Soares Souza MD, PhD (Presenter): Nothing to Disclose

LEARNING OBJECTIVES

1) To show the value of thoracic MRI for assessment of parenchymal lung disease. 2) To demonstrate the valueof diffusion weighted MRI (DWI) for differentiating benign from malignant lung neoplasms.

ABSTRACT

In this lecture we will show the clinical ability of thoracic MRI to depict the most common patterns ofparenchymal lung diseases, and do the correlation with CT findings. MRI seems to be a valuable tool, withoutradiation exposure, for management of parenchymal lung disease. We will, also, address the importance ofdiffusion weighted MRI (DWI) for differentiating benign from malignant lung lesions.

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diffusion weighted MRI (DWI) for differentiating benign from malignant lung lesions.

URL

http://www.ultrax.com.br/chest

Conferencia del Colegio Interamericano de Radiologa/Interamerican College of Radiology Lecture

Dante R. Casale Menier MD (Presenter): Nothing to Disclose

LEARNING OBJECTIVES


Segunda Parte/Part II

Moderator Miguel E. Stoopen MD : Nothing to Disclose

LEARNING OBJECTIVES


ABSTRACT

N/a

URL

www.webcir.org

Musculoesqueletico: Imgenes Avanzadas del Cartlago Articular y "Chemichal Shift" de Mdulasea/Musculoskeletal: Advanced Imaging of the Articular Cartilage and Bone Marrow Chemical ShiftImaging

Gonzalo Javier Delgado MD (Presenter): Nothing to Disclose

LEARNING OBJECTIVES


Abdomen e Hgado: Contrastes Hepatoespecficos y Elastografia por ResonanciaMagntica/Abdomen and Liver: Liver Specific Contrast Agents and Hepatic MR Elastography

Luis Antonio Sosa MD (Presenter): Nothing to Disclose

LEARNING OBJECTIVES


Prstata: Resonancia Magntica de 3T y PET/CT con Colina/Prostate: 3T MRI and Choline PET/CT

Daniela Stoisa MD (Presenter): Nothing to Disclose

LEARNING OBJECTIVES


Handout:Daniela Stoisa

http://media.rsna.org/media/abstract/2014/14002966/cap chicago 2014.ppt

Clausura/Closing Remarks

Dante R. Casale Menier MD (Presenter): Nothing to Disclose , Pablo Riera Ros MD, PhD (Presenter): MedicalAdvisory Board, Koninklijke Philips NV Medical Advisory Board, KLAS Enterprises LLC Medical AdvisoryCommittee, Oakstone Publishing Departmental Research Grant, Siemens AG Departmental Research Grant,Koninklijke Philips NV Departmental Research Grant, Sectra AB Departmental Research Grant, ToshibaCorporation , Miguel E. Stoopen MD (Presenter): Nothing to Disclose

LEARNING OBJECTIVES

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SPPH02

AAPM/RSNA Tutorial on Equipment Selection: Multi-Spectral and Volumetric Imaging Special CoursesPH US NM CT AMA PRA Category 1 Credits : 2.00


Sat, Nov 29 2:15 PM - 4:15 PM Location: E351

ParticipantsModeratorJerry A. Thomas MS : Stockholder, General Electric Company Stockholder, Hologic, Inc Stockholder, Stryker CorporationSpeaker, Medical Technology Management Institute

LEARNING OBJECTIVES

1) Understand the advanced capabilities of multi-spectral volumetric imaging in the major modalities of Ultrasound, MRI, CT andNuclear Imaging. 2) Appreciate the clinical capabilities of multi-spectral volumetric imaging and approach to utilizing advancedimaging applications with this technology.

Sub-Events Dual Energy Imaging in Diagnostic Radiology

Jerry A. Thomas MS (Presenter): Stockholder, General Electric Company Stockholder, Hologic, IncStockholder, Stryker Corporation Speaker, Medical Technology Management Institute

LEARNING OBJECTIVES


Hybrid Imaging in Ultrasound

Evan Boote PhD (Presenter): Nothing to Disclose

LEARNING OBJECTIVES


ABSTRACT

Ultrasound imaging is a relatively inexpensive, low-risk application to patients, ubiquitously available in thehealth care setting. However, ultrasound presents a challenge to the novice user, particularly with regard torecognition of anatomic landmarks. In some situations, ultrasound imaging is not capable of resolving somestructures, either due to spatial and/or contrast resolution limitations; in certain other situations, ultrasoundoffers a superior approach to visualizing abnormalities or the depiction of blood flow in the body. Hybridultrasound may be defined in a number of ways - the most likely definition would be what might be termed'fusion' imaging, where a set of image data from a second modality is imported into the ultrasound system,anatomical landmarks are established, and a fused image is displayed in real-time. Hence the advantages ofthe other modalities would be gained during the use of the ultrasound system. Another definition of 'hybrid'may be the use of a device to depict a biopsy needle placement in real-time. A further extension of the word'hybrid' might be to include real-time simultaneous imaging with another modality, even a non-traditionalimaging modality. This presentation will review these variations of 'hybrid' ultrasound that are commerciallyavailable and in current clincal practice. However, the presentation will also cover those still in the developmentstage. The practical applications of these systems will be discussed, as will the limitations and restrictions ontheir use. Included in this will be an evaluation of cost of the system and a case-study on the use of hybridimaging in a hospital setting.

Commercially Available Multi-spectral and Volumetric Imaging Systems

Sarah Eva McKenney PhD (Presenter): Nothing to Disclose

LEARNING OBJECTIVES


ABSTRACT

The price of purchasing and maintaining the latest imaging systems is on the order of millions; tight budgets inhealth care necessitate the ability to make smart purchases. This work identifies important considerations whenpurchasing an advanced imaging system, specifically in the context of dual energy and multi-modalityvolumetric imaging. The roles of imaging stakeholders are examined including: administrators, radiologists,technologists, medical physicists, IT specialists, clinical engineers, and vendors. A general overview of the

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technologists, medical physicists, IT specialists, clinical engineers, and vendors. A general overview of thestrengths and weaknesses of volumetric commercially available imaging systems is also provided. LearningObjectives Identify the needs of the imaging cohort Evaluate prospective systems for purchase

URL

http://goo.gl/CB3Tgm

SSA03

Cardiac (Cardiovascular Disease) Scientific PapersCT CA AMA PRA Category 1 Credits : 1.50


Sun, Nov 30 10:45 AM - 12:15 PM Location: S504AB

ParticipantsModeratorLisa Diethelm MD : Nothing to Disclose ModeratorBernd J. Wintersperger MD : Speakers Bureau, Bayer AG Speakers Bureau, Siemens AG

Sub-Events Predictive Value of Coronary Artery Lumen Area Quantification for Prediction of HemodynamicallyRelevant Coronary Stenosis by Computed Tomography (CT) Angiography

Fabian Plank (Presenter): Nothing to Disclose , Tobias De Zordo MD : Nothing to Disclose , Moritz Kummann : Nothing to Disclose , Andrea Klauser MD : Nothing to Disclose , Werner R. Jaschke MD, PhD : Nothing to Disclose , Gudrun Feuchtner MD : Nothing to Disclose

PURPOSE

Coronary CTA is validated to rule out coronary artery disease (CAD), however, false positive high-grade lesionsresult in lower sensitivity. Additional mean lumen area (MLA) measurements may increase accuracy byidentifying hemodynamic relevance of a stenosis. Therefore the purpose was to evaluate the added value of MLAquantification by CTA to predict hemodynamic significance of coronary stenosis by invasive angiography (ICA)requiring coronary revascularization procedure.

METHOD AND MATERIALS

45 patients (mean age 63.9) who underwent 128- or 64-slice CTA presented with at least one high-gradestenosis (> 50%) in a proximal coronary vessel (right coronary artery (RCA), left main (LM), left anteriordescending (LAD) or circumflex artery (CX)) and subsequently underwent invasive angiography (ICA). Theminimal lumen area (MLA) was quantified by CT. Results were evaluated for hemodynamic relevance in ICA(defined as fractional flow reserve 1.9mm.

CONCLUSION

A minimal lumen area cut-off of 1.9 mm or less showed highest accuracy for prediction of significantlyincreased hemodynamic relevance and may add important value to CTA.

CLINICAL RELEVANCE/APPLICATION

The added value of MLA measurements may help identify hemodynamically relevant coronary stenosis.

Increased Epicardial Fat Volume Is Independently Associated with Atrial Fibrillation, AtrialFibrillation Severity and Radiofrequency Ablation Outcome

Jadranka Stojanovska MD, MS (Presenter): Nothing to Disclose , Ella A. Kazerooni MD : Nothing to Disclose, Barry Howard Gross MD : Nothing to Disclose , Hakan Oral MD : Nothing to Disclose

PURPOSE

To determine whether intrathoracic fat volumes are independently associated with the presence of atrialfibrillation (AF), severity of AF and outcome of radiofrequency ablation (RFA) using logistic regression analysis.

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fibrillation (AF), severity of AF and outcome of radiofrequency ablation (RFA) using logistic regression analysis.


Institutional Review Board approval was obtained and patient consent was waived for this HIPPA-compliantretrospective study. A total of 231 patients, 169 with AF (75 with non-paroxysmal and 94 with paroxysmal) and62 control patients, formed the study population. AF patients underwent computed tomography (CT) of thepulmonary veins and left atrium, and control patients underwent coronary CT. Intrathoracic fat volumes(extrapericardial and epicardial) were measured for both groups. Associations between presence and severity ofAF and intrathoracic fat volumes were assessed using logistic regression analysis.

RESULTS

The epicardial fat volume remained statistically associated with the prevalence of AF [1.01 (1.003-1.03), p=0.01], AF severity [1.008 (1.001-1.02), p=0.03], and recurrence of AF after RFA [1.009 (1.001-1.01), p=0.02]after adjustment for age, gender, and body mass index. Time to recurrence after ablation was shorter inpatients who had larger epicardial fat volume than patients who did not (14 15 days versus 22 16 days,p=0.017). The epicardial fat volume was larger in the 78/169 AF patients (46%) who had AF recurrence afterRFA compared to the 91/169 or (54%) who did not have recurrence (81 47 mL versus 105 56 mL,p=0.002).

CONCLUSION

Increased epicardial fat volume is associated with the presence of AF, AF severity, and higher probability ofrecurrence of AF after radiofrequency ablation.


Extensive epicardial fat is associated with earlier recurrences of AF after radiofrequency ablation that potentiallymay reduce the transmurality of radiofrequency ablation by affecting current and impedance dynamics.Quantification of epicardial fat on pre-procedural CT scan may identify patients with AF who will benefit fromcatheter ablation as a definitive treatment for AF.

Left Atrial Appendage (LAA) Thrombosis Exclusion with Two-phase Cardiac Computed Tomography(CT) in Patients with Atrial Fibrillation (AF): A Prospective Comparison Study with TransesophagealEchocardiography (TEE)

Daniela Di Marco MD (Presenter): Nothing to Disclose , Manuela Giglio MD : Nothing to Disclose , francesca besana MD : Nothing to Disclose , Sandro Sironi MD : Nothing to Disclose , Pietro Spagnolo MD : Nothing to Disclose

PURPOSE

to evaluate the diagnostic accuracy of two-phase cardiac CT in detecting left atrial appendage (LAA) thrombosisin patients with chronic atrial fibrillation referred for radiofrequency ablation using the CARTO 3 and NavXsystem.


260 consecutive patients undergoing CARTO-guided radiofrequency ablation for atrial fibrillation wereprospectively enrolled. All patients underwent both cardiac CT and TEE within a 3-hour period or less.Diagnostic accuracy of cardiac CT for detection of LAA thrombosis was computed using TEE as referencestandard. CT scanning protocol included a standard early phase imaging to evaluate coronary arteries,pulmonary vein and LAA anatomy and a late phase imaging using prospective electrocardiographic gating 6minutes after contrast media injection. To reduce the radiation dose, late phase imaging was limited to the leftatrium and performed only when a LAA filling defect was found on early-arterial phase. Filling defects seen onadded late-phase imaging as well as on early-phase imaging were categorized as thrombus.

RESULTS

TEE demonstrated spontaneous echo contrast in 48 patients and thrombus in 6 patients. In 57 patients CTdemonstrated LAA early filling defects and a late-phase imaging was performed. All the 6 thrombi diagnosed onTEE were correctly identified on cardiac CT. The overall sensitivity and specificity were both 100%. Thecalculated radiation dose of CT examination was 3,31 mSv for early-phase imaging and 0,16 mSv for late phaseimaging.

CONCLUSION

two-phase cardiac CT is a noninvasive and accurate modality for detecting LAA thrombosis and differentiatingthrombus from circulatory stasis. Cardiac CT may obviate routine TEE before radiofrequency ablation.


two-phase cardiac-CT could be a one-stop-shop examination in patients with AF before RF-ablation allowing toobtain accurate imaging of heart, pulmonary veins and exclude LAA thrombosis, avoiding TEE

Corrected Coronary Opacification Difference Measured with Computed Tomography AngiographyPredict Coronary In-stent Restenosis

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Yang Gao (Presenter): Nothing to Disclose , Bin Lu MD : Nothing to Disclose , Zhi-Hui Hou MD : Nothingto Disclose , Fang-Fang Yu : Nothing to Disclose , Wei-Hua Yin : Nothing to Disclose , Zhi-Qiang Wang : Nothing to Disclose , Yong-jian Wu : Nothing to Disclose , Chao-wei Mu : Nothing to Disclose , Felix G. Meinel MD : Nothing to Disclose , U. Joseph Schoepf MD : Research Grant, Bracco Group Research Grant,Bayer AG Research Grant, General Electric Company Research Grant, Siemens AG , Andrew Douglas McQuiston BS : Nothing to Disclose

PURPOSE

To determine whether changes in corrected coronary opacification (CCO) across stents can identify in-stentrestenosis (ISR) severity compared with invasive coronary angiography (ICA) as a reference standard.


Between September 2009 and December 2012, patients with previous stents implantation who underwent ICAfor recurrent typical or atypical chest pain after coronary CT angiography (CTA) within three months wereenrolled. Attenuation values of coronary lumen were measured at proximal and distal of stents and normalizedto the descending aorta. Changes in CCO were calculated and CCO difference across the stent was comparedwith severity of ISR.

RESULTS

A total of 141 stents were assessed. 76 stents were normal, 18 stents had ISR < 50%, 28 stents had with ISR50% to 99%, and 19 stents were occluded. The median of CCO difference in group of no ISR, ISR < 50%, ISR50% to 99%, and ISR 100% were 0.078, 0.163, 0.346 and 0.606, respectively (all P < 0.01). For stents

AAD-PD throughout cardiac cycle is relative smaller. Thus, AAP might be the most proper parameter forestimating aortic annulus size before TAVI. Considering image quality, mid-late systole and mid-diastole weremore reliable for evaluation.


Finding out dynamic features of aortic annulus of BAS may help precisely estimate aortic annulus size, anddecrease TAVI procedure related complications.

Relationship of Breast Arterial Calcification with Coronary Calcium Score and Coronary CTAngiography

Mariana Diaz-Zamudio MD (Presenter): Nothing to Disclose , Peter Jay Julien : Nothing to Disclose , Damini Dey PhD : Research support, Siemens AG , Heidi Gransar : Nothing to Disclose , Louise J. Thomson MBCHB : Nothing to Disclose , John D. Friedman MD : Nothing to Disclose , Sean Hayes MD : Nothing toDisclose , Daniel S. Berman MD : Research Grant, Lantheus Medical Imaging, Inc Research Grant, AstellasGroup Research Grant, Siemens AG Speaker, Bristol-Myers Squibb Company Speaker, Covidien AG Speaker,Astellas Group Stockholder, Spectrum Dynamics Ltd Consultant, Bracco Group Consultant, FlouroPharma, Inc

PURPOSE

To determine whether breast arterial calcification (BAC) on mammography are predictive for high risk coronarycalcium score (CAC) and coronary artery disease (CAD) identified by coronary CTA.


Consecutive female patients age >45 undergoing coronary CTA and CAC scanning for clinical purposes andscreening mammography within 24 months from CTA were identified. Mammography studies were reviewed byan experienced reader blinded to CT results. BAC was assessed using a semi-quantitative scale(none/mild/moderate/severe). CAC was categorized as 0, 1-99, 100-399, and 400 and CTA as 0,

suppression (TE 35ms, TR 8.5s, 16 averages) and with water suppression (TE 35ms, TR 3.5s, 48 averages) withand without dielectric pads. Data were phase and DC corrected, and fitted using the AMARES algorithm injMRUI. The SNR of the TG spectra was defined as the integrated area under the (CH2)n and (CH3) peak dividedby the SD of the noise taken from the last 100 points of the FID. Statistical significance of the data was testedusing a double sided paired Student's t-test and was considered significant at p-values < 0.05.

RESULTS

In Fig. 1 spectra from two different volunteers and a summary Bland-Altman plot is shown. The mean lipid SNRfor all volunteers show an increase from 2816 (meanSD) to 4224 (p


The study group comprised 21 patients (mean age 68.77.5 years) who underwent ATP-stress dynamicmyocardial CTP scan and invasive coronary angiography (ICA) and stress myocardial perfusion imaging (MPI)(SPECT or cardiac MRI). All patients in this study had one or two vessels disease. Dynamic CTP (whole heartdatasets over 30 consecutive heart beats in systole without spatial and temporal gaps) was acquired withprospective ECG gating. Coronary stenosis >=50% was defined as positive findings in ICA, and perfusionabnormalities were defined as positive findings in MPI. In this study, the areas with ICA (-) and MPI (-) aredefined as normal, the areas with ICA (+) and MPI (+) as ischemia and the areas with ICA (+) and MPI (-) asnon-ischemia. Results of ICA and MPI are analyzed according to 3 vessel areas (LAD, LCX, RCA). 2 experiencedradiologists visually analyzed the dynamic CTP images in reference to the results of ICA and MPI and consultedtogether about the optimal scan timing for differentiation of ischemic and normal myocardium. Then, "staticimage" at the optimal scan timing was compared with "dynamic image" in the diagnostic performance fordetecting myocardial ischemia by other 2 experienced radiologists visually analyzing.

RESULTS

Normal, ischemic and non-ischemic areas were 22/63, 29/63 and 12/63 areas. As a result of qualitativeassessment, the optimal scan timing could be 1.8-2.5 seconds after peak enhance time of the aorta (mean CTvalue (normal-ishcemia): 26.018.9 HU). 95% of all cases were included in this range. In "static CTP image" atthe optimal timing, Sensitivity, specificity, positive predict value (PPV) and negative predict value (NPV) were79.3%, 76.5%, 74.2% and 81.3%. In "dynamic CTP image", Sensitivity, specificity, PPV and NPV were 82.8%,79.4%, 77.4% and 84.4%.

CONCLUSION

In myocardial CTP imaging, the optimal timing of single-phase scan is 1.8-2.5 seconds after peak enhance timeof the aorta, which will be helpful to optimize single-phase CTP scans.


Static CTP image by scanning at the optimal timing can decrease radiation exposure with keeping the diagnosticperformance almost the same level of the dynamic CTP image.

SSA04

Chest (Lung Cancer Screening) Scientific PapersCT CH AMA PRA Category 1 Credits : 1.50


Sun, Nov 30 10:45 AM - 12:15 PM Location: S404CD

ParticipantsModeratorMark L. Schiebler MD : Shareholder, Cellectar Biosciences, Inc ModeratorCaroline Chiles MD : Nothing to Disclose

Sub-Events Lung Cancer Screening in a Predominantly Poor, Overweight, Inner-city Minority Population: InitialExperience

Alla Godelman MD : Nothing to Disclose , Hannah Milch MD (Presenter): Nothing to Disclose , Mark Kaminetzky : Nothing to Disclose , Anna Shmukler MD : Nothing to Disclose , Tova C. Koenigsberg MD : Nothing to Disclose , Linda Broyde Haramati MD, MS : Investor, OrthoSpace Ltd Investor, Kryon Systems LtdSpouse, Board Member, Bio Protect Ltd Spouse, Board Member, OrthoSpace Ltd Spouse, Board Member, KryonSystems Ltd

PURPOSE

To evaluate the applicability of the National Lung Screening Trial (NLST) results to a predominantly poor,overweight, inner-city minority population.


We examined the data for all 198 patients who underwent low dose chest CT as part of our inner-city academicmedical center's lung cancer screening program from its inception in 12/2012 till 2/2014. All met NLSTeligibility criteria. A screening coordinator worked closely with patients and tracked follow-up. CTs wereinterpreted clinically by 1 of 4 cardiothoracic radiologists. Results were reported as 5 standardized categories:1. No evidence of lung cancer, normal chest; 2. No evidence of lung cancer, benign pulmonary findings; 3.Small nonspecific pulmonary nodules; 4. Small spiculated nodule (4a) or ground glass nodule (4b); 5.Pulmonary mass (5a) or metastatic disease (5b). Routine screening in 1-year was recommended for categories1 and 2. Shorter follow up (Fleischner criteria) was advised for categories 3 and 4. Tissue correlation wasadvised for category 5. Calcium score (Shemesh et al. range 0-12) was reported. Additional data includeddemographics, smoking history, BMI, dose length product (DLP), and lung biopsy/resection pathology.

RESULTS

SSA04-01

Of 198 patients, 54% were men, 72% current smokers, 69% non-white (35% black, 31% Hispanic, 3% other).Mean age was 64 yrs, mean BMI 31 (range 20-39). Mean calcium score was 3/12 (range 0-12), mean DLP 107(range 71-223). 73% results were categories 1 and 2, 22% category 3, 2% category 4 and 3% category 5. 4of 5 category 5 patients had resections confirming the diagnosis of lung carcinoma, ranging from stage IA toIIIA. One category 5 patient awaits biopsy. One category 4 had ongoing suspicion for cancer on follow up CTbut biopsy results were benign.

CONCLUSION

Low dose CT lung cancer screening using NLST criteria is feasible in a predominantly poor, overweight,inner-city minority population. The screening coordinator plays a crucial role. In the first 15 months, lungcancer was diagnosed in 2%. Interpretation yielded a high specificity with sensitivity to be determined withongoing follow-up.


Successful initiation of a lung cancer screening program is feasible in a predominantly poor, overweight,inner-city minority population. NLST results require validation in understudied populations.

Invited Speaker: Demographic Characteristics and Results of National Comprehensive CancerNetwork High-risk Group 2 in a Clinical CT Lung Screening Program

Brady John McKee MD (Presenter): Nothing to Disclose , Jeffrey Alexander Hashim MD : Nothing to Disclose , Robert James French MD : Nothing to Disclose , Andrea Bertram McKee MD : Nothing to Disclose , Christoph Wald MD, PhD : Radiology Advisory Committee, Koninklijke Philips NV , Sebastian Flacke MD : Research Consultant, Pluromed, Inc Speaker, Nordion, Inc

PURPOSE

To compare the demographic characteristics and screening results of NCCN high-risk Group 2 (>50y, >20pack-years, 1 additional risk factor) to NCCN high-risk Group 1 (55-74y, current or former smoker quit 30pack-years) in a clinical CT lung screening program.


We retrospectively reviewed results of all CT lung screening exams performed from 1/2012 through 12/2013.Those screened had to fulfill the NCCN high-risk criteria and have an MD order for screening. All exams wereperformed on 64+ MDCT scanners at 100 kV and 30-70 mA. Image interpretation was performed bycredentialed radiologists using the structured reporting system, "LungRADS". A positive exam was defined as asolid nodule > 4mm, a groundglass nodule > 5mm, or a chest lymph node > 1 cm not stable for more than twoyears. Clinically significant incidental findings including findings suspicious for pulmonary infection wererecorded.

RESULTS

458 Group 2 and 1302 Group 1 individuals underwent prevalence CT lung screening exams during the studyinterval. Group 2 qualifying risk factors: 44% personal history of smoking related cancer, 28% chronic lungdisease, 24% carcinogen exposure, < 5% primary relative w/lung cancer. Male/female ratio, average age, andaverage pack-years was 50/50, 61, and 40 for Group 2 and 53/47, 63, and 50 for Group 1. 36% of Group 2and 50% of Group 1 were active smokers. Average duration of smoking cessation was 18.5y in Group 2, 6.7y inGroup 1. 25% in Group 2 and 28% in Group 1 had positive exams. 6.1 % in Group 2 and Group 1 had at leastone clinically significant incidental finding. 6.1% in Group 2 and 6.6 % in Group 1 had findings suspicious forpulmonary infection. 23 cases of lung cancer were diagnosed in 1328/1760 (75%) with clinical followup afterscreening: 6 in Group 2 and 17 in Group 1 with an annualized rate of malignancy of 1.6% for Group 1 and1.8% for Group 2.

CONCLUSION

Screening results for NCCN Group 2 are similar to NCCN Group 1 and those reported in the National LungScreening Trial. The prevalence rate of lung cancer in NCCN Group 2 suggests thousand of additional lives couldbe saved each year if screening eligibility is expanded to include this high-risk group.


Expanding CT lung screening eligibility to include NCCN high-risk Group 2 could increase the number of qualifiedAmericans by two to three million and offers the potential to save thousands of additional lives each year.

Trends in CT Screening for Lung Cancer at Leading Academic Medical Centers

Phillip M. Boiselle MD (Presenter): Nothing to Disclose , Caroline Chiles MD : Nothing to Disclose , James G. Ravenel MD : Nothing to Disclose , Charles S. White MD : Nothing to Disclose

PURPOSE

To determine trends in CT lung cancer screening at leading academic medical centers.


An electronic survey was emailed in March 2014 to thoracic radiologists at 21 leading academic medical centers,identified from the 2012-2013 US News and World Report listings of top hospitals, cancer centers, andpulmonary medicine centers. Radiologists who reported that they currently offer lung cancer screening wereasked additional questions which ranged from patient selection policies to the likelihood of implementing

SSA04-02

SSA04-03

forthcoming LUNG-RADS in their practice. March 2014 survey results were compared to March 2013 surveyresults for select questions that overlapped between the 2 surveys.

RESULTS

Of the 20 survey respondents (95% response rate), 19 (95%) currently have an active CT screening program,an increase from 79% in 2013. Five or fewer patients are scanned per week at most sites (14 of 19, 74%), andonly 1 site (5%) reported >20 patients per week. Regarding charges, all exams were self-pay at 9 of 19 (47%)screening sites and a majority was self-pay at the remaining sites. Similar to 2013, most programs (12 of 19,63%) require physician referral for screening. NLST entry criteria remained the most common patient selectioncriteria in 2014, but 5 sites (26%) recently expanded their age criteria in response to new USPSTFrecommendations. Regarding solid nodule size thresholds for defining a positive screen, 13 of 19 (68%) sitesuse 4 mm, 3 sites (16%) use 5mm, 2 sites (11%) use 6 mm, and 1 site (5%) does not use a sizecriterion. Less than half of the screening sites (9 of 19, 47%) definitely plan to incorporate LUNG-RADS. Almostall programs (18 of 19, 95%) routinely report coronary artery calcifications and most report this qualitatively(89%) rather than quantitatively (11%).

CONCLUSION

Most leading academic medical centers have CT screening programs, but relatively few patients are beingscreened. Only a minority of sites has modified its selection criteria in response to new USPSTF guidelines andfewer than half definitely plan to incorporate forthcoming LUNG-RADS in their practice.


Screening programs should be encouraged to standardize their lung cancer screening practices. ForthcomingACR-STR practice guidelines and LUNG-RADS can facilitate this process.

Unenhanced Chest CT at 100kV with Spectral Shaping: A Potential New Sub-millisievert Lung CancerScreening Protocol

Holger Haubenreisser (Presenter): Nothing to Disclose , Mathias Meyer : Nothing to Disclose , Sonja Sudarski MD : Nothing to Disc

mse003-b the great pretender—how sarcoidosis gained its

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